In this joint statement from RCPCH Global and the International Child Health Group, published in August 2020, we call on governments, donors and agencies to monitor and report the effects of the pandemic response on families and children, and to prioritise a new era of investment in robust, family-centred health systems.
- Mothers, newborns and children – especially in the poorest countries – are suffering significant indirect impacts on health and care as a result of COVID-19, with potentially long-term adverse effects.
- Governments, donors, international agencies and civil society organisations engaged in confronting COVID-19 must collaboratively and transparently monitor, and publicly report, the effects of pandemic response on families and children.
- Global investments in COVID-19 recovery must prioritise a new era of investment in robust health systems supporting a family-centred model of healthcare and child health programmes.
Despite direct effects on children from the COVID-19 virus being rare so far, the indirect effects of the COVID-19 pandemic worldwide could be catastrophic for children, with considerable excess death and suffering.1 2
Many major causes of mortality in children are expected to make a comeback this year as a result of the pandemic and response. At the same time, the capacity of governments, health systems, development and humanitarian organisations to respond to child health is decreased.
Vaccine supplies globally are already being compromised due to COVID-19 response and transport restrictions, with great impact in low-income country settings.3 Vaccination activities have been delayed or suspended in at least 27 countries to prevent the spread of COVID-19, despite several having ongoing measles epidemics.4 More than 100 million children may go without measles vaccination this year,5 and other preventable outbreaks may follow. Modelling suggests that for every COVID-19 death prevented by suspension of routine vaccination in order to reduce transmission, more than 100 children could die as a result.6 Childhood malaria deaths are also predicted to double this year,7 due to downscaling of prevention and treatment. The World Food Programme predicts a doubling of malnutrition, disproportionately affecting children.8
Maternal and child health services, many of which already suffered from a background of underinvestment, limited resilience and fragile demand, are now severely compromised in many low-resource settings, due to closures, fear of attending health facilities and lack of personal protective equipment.9 Over a million excess child deaths could occur in the next 6 months as a result.10
Children’s mental health and safety are also at risk due to disruption of socio-economic and environmental conditions needed for healthy childhoods, and the exacerbation of family and gender based violence and abuse.11 Hardships for children living in poverty are amplified, a consequence of unemployment and income insecurity.12 13 Girls in particular may drop out of education as families re-enter poverty, and the position of migrant and refugee children has become more precarious.14
The burden of the indirect consequences of the pandemic will fall disproportionately on children, but we are alarmed at how little attention their needs are receiving.
Child health professionals must advocate for children’s needs to become more visible, and for the rights of all children to protection, survival, participation and development to be upheld within global and national actions. We must ensure the impact of the pandemic on children’s health and experiences is visible in data and in decision making by strengthening surveillance of the indirect effects, and communicating this to the wider public. Whilst attention shifts towards interventions directed towards COVID-19 with a focus on global health security, governments, international organisations and the private sector must also prioritise the continuation and support of child health programmes throughout this pandemic. We must not leave children behind.
- Dr Sunil Bhopal, Convenor, International Child Health Group
- Dr Susan Broster, Global Officer, Royal College of Paediatrics and Child Health
- Professor Russell Viner, President, Royal College of Paediatrics and Child Health
Published 12 August 2020
This statement was slightly amended on 25 August 2020.
- 1Sochas, L., Channon, A. A. & Nam, S. Counting indirect crisis-related deaths in the context of a low-resilience health system: the case of maternal and neonatal health during the Ebola epidemic in Sierra Leone. Health Policy Plan. 32, iii32–iii39 (2017).
- 2Parpia, A. S., Ndeffo-Mbah, M. L., Wenzel, N. S. & Galvani, A. P. Effects of response to 2014-2015 ebola outbreak on deaths from malaria, HIV/AIDS, and tuberculosis, West Africa. Emerg. Infect. Dis. 22, 433–441 (2016).
- 3Geneva Palais briefing note on the impact of COVID-19 mitigation measures on vaccine supply and logistics. Available at: www.unicef.org/press-releases/geneva-palais-briefing-note-impact-covid-19-mitigation-measures-vaccine-supply-and. (Accessed: 10 May 2020)
- 4Roberts, L. Why measles deaths are surging — and coronavirus could make it worse. Nature 580, 446–447 (2020).
- 5More than 117 million children at risk of missing out on measles vaccines, as COVID-19 surges - Measles & Rubella Initiative. Available at: measlesrubellainitiative.org/measles-news/more-than-117-million-children-at-risk-of-missing-out-on-measles-vaccines-as-covid-19-surges/. (Accessed: 11 May 2020)
- 6Benefit-risk analysis of health benefits of routine childhood immunisation against the excess risk of SARS-CoV-2 infections during the Covid-19 pandemic in Africa | CMMID Repository. Available at: cmmid.github.io/topics/covid19/EPI-suspension.html. (Accessed: 10 May 2020)
- 7WHO urges countries to move quickly to save lives from malaria in sub-Saharan Africa. Available at: www.who.int/news-room/detail/23-04-2020-who-urges-countries-to-move-quickly-to-save-lives-from-malaria-in-sub-saharan-africa. (Accessed: 10 May 2020)
- 8 WFP Chief warns of hunger pandemic as COVID-19 spreads (Statement to UN Security Council) | World Food Programme. Available at: www.wfp.org/news/wfp-chief-warns-hunger-pandemic-covid-19-spreads-statement-un-security-council. (Accessed: 11 May 2020)
- 9WTO | 2020 News items - WTO report finds growing number of export restrictions in response to COVID-19 crisis. Available at: www.wto.org/english/news_e/news20_e/rese_23apr20_e.htm. (Accessed: 16 May 2020)
- 10Roberton, T. et al. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. Lancet Glob. Heal. 0, (2020).
- 11Home Office preparedness for Covid-19 (Coronavirus): domestic abuse and risks of harm within the home - Home Affairs Committee - House of Commons. Available at: publications.parliament.uk/pa/cm5801/cmselect/cmhaff/321/32105.htm. (Accessed: 28 May 2020)
- 12Coronavirus lockdown: India jobless numbers cross 120 million in April - BBC News. Available at: www.bbc.co.uk/news/world-asia-india-52559324. (Accessed: 28 May 2020)
- 13Children In Lockdown: What Coronavirus means for UK children - Unicef UK. Available at: www.unicef.org.uk/coronavirus-children-in-lockdown/. (Accessed: 28 May 2020)
- 14Protecting the most vulnerable children from the impact of coronavirus: An agenda for action | UNICEF. Available at: www.unicef.org/coronavirus/agenda-for-action. (Accessed: 28 May 2020)