Prepare for a Post-Pandemic World: But, First, Feed the Children

We are now nearly a year into the outbreak of the Covid-19 virus that became a global pandemic and upended life as we knew it.

More than 60 million people have fallen ill worldwide and almost 1.5 million have died. Even so, an increasing number of public intellectuals and social sector leaders are looking to a post-pandemic world. Renowned New York Times columnist Thomas Friedman recently predicted “When we emerge from this corona crisis, we’re going to be greeted with one of the most profound eras of Schumpeterian creative destruction ever.” J-PAL’s Radhika Bhula and John Floretta, writing in the Stanford Social Innovation Review, posited that “Perhaps one positive outcome of the pandemic is that it will push us to overcome the many remaining global educational challenges sooner than any of us expect.” (I also explored implications of the pandemic on education in two previous articles)

As CEO of a foundation that seeks to make a meaningful difference in the lives of the world’s poorest people by multiplying the impact of high-performing leaders and organizations, I also look forward to the opportunities a post-Covid world will present—and encourage social sector leaders to prepare for these. But, even as we anticipate the future, we still have a crisis to get through–the true costs of which are under the radar of a fatigued public.

Top among these is the little-known fact that children may ultimately be the pandemic’s biggest victims. As UNICEF recently explained, while the direct impact of Covid-19 on child and adolescent mortality appears limited, “the indirect effects on child survival stemming from strained health systems, household income loss, and disruptions to care-seeking and preventative interventions like vaccination may be substantial and widespread.”

Consider these dismal facts, offered by UNICEF and other UN organizations (writing in The Lancet) including the World Health Organization:

– Children are dying—an additional 10,000 each month in the first year of the pandemic, as Covid-related restrictions undermine nutrition services and disrupt food and health systems worldwide.

– Wasting, meaning low-weight-for height (and essentially the technical term for life-threatening undernutrition), could strike an additional six to seven million children this year—on top of the estimated 47 million children under five affected by wasting pre-pandemic.

– The pandemic’s socioeconomic impact may increase other forms of child malnutrition, including stunting (low height-for-age) and deficiencies in vitamins and other micronutrients that are essential for physical growth and brain development.

– Covid-related disruption of immunization programs puts eighty million children under the age of one at risk of diseases like measles and polio.

To put this in context—and learn how the world can address this unacceptable situation—I spoke to two outstanding experts who devote their lives to helping children avoid, or survive, malnutrition: Dr. Víctor Aguayo, Global Chief of the UNICEF Nutrition Program, and William Moore, CEO of the Eleanor Crook Foundation, which is dedicated to fighting global malnutrition. 

To start, both told me, it is essential to understand the pre-pandemic situation. “Many people may not realize that in the first two decades of this century we have seen amazing progress on malnutrition,” said Aguayo. “We have reduced by one third the number of undernourished children, which means that today the number of undernourished children is 55 million lower than in 2000, and that is without taking into account population growth.” Moore agreed, saying, “Over a 30-year time horizon since 1990, the world has cut hunger and malnutrition in half, even in spite of major population growth. That’s an amazing accomplishment.”

But, there is still much work to be done. Indeed, in 2019, one in three children did not get the nutrition they needed, according to UNICEF’s The State of the World’s Children. They suffered, Aguayo wrote, from a triple burden: undernutrition, which is still the number one killer of children each year, and led to conditions like stunting and wasting, reflecting a profound nutritional failure in the first 1000 days of life; hidden hunger, which included deficiencies of vitamins and micronutrients like vitamin A and iron; and overweight and obesity, a problem increasingly impacting children even in poor households and countries. 

The pandemic’s onslaught threatened both progress that had occurred and that which was still needed, but the rich world, blindsided by its own problems, has hardly seemed to notice. “There just really hasn’t been much media coverage at all,” said Moore. He continued: 

For folks in the sector, we are watching as everything we’ve accomplished in the developing world over decades just falls apart at a really alarming clip. I think it’s safe to say that it is probably the worst time in decades to be a mother or a young child in the developing world. I mean, it’s never a good time, but things have gotten better for moms and kids in developing countries over the last three decades. And, suddenly, for the first time in modern history everything is really sliding backwards very quickly.

Severe Secondary Impacts

In developing countries, said Moore, the secondary impacts of Covid-19 are often more dangerous than the virus itself. “The food system disruptions and the health system shutdowns—that’s what’s probably going to have a much greater toll at the end of the day.” 

Indeed, lockdowns and other measures meant to mitigate viral spread also disrupted planting, harvest, and trade, which led to price spikes on staple foods. This, explained Aguayo, “put large numbers of children and families at risk of malnutrition and many have had to resort to poorer diets and nutrition practices that are negative to children.” While adults and children alike could suffer from malnutrition, it was children under five—and especially under two—who were most at risk. “That’s when people die from malnutrition,” explained Moore, “and that’s also the period of growth and brain development that’s most critical from a nutritional standpoint.” In addition to mitigation measures, general socioeconomic disruption could send millions of families into poverty and prevent them from feeding their children enough food to be healthy. 

Health systems disruptions due to shutdowns, social distancing requirements, and fear also had devastating consequences. “We’ve watched community health systems around the world just go dark,” said Moore. “Community health workers who move from house to house are the lifeline for the world’s bottom billion and all of a sudden most of those routine services are no longer operational.” This included immunization against childhood diseases and distribution of vitamin A to the 250 million young children worldwide who were deficient in it and thus at risk of preventable blindness, severe illness, and even death.

To make matters worse, the universal impact of the pandemic has meant that donor countries are also affected and many are unwilling or unable to increase contributions that would help stave off malnutrition in other countries. “We’re seeing donor dollars more at risk on issues like malnutrition than we’ve seen in recent years,” said Moore, “and we already have a $7 billion annual funding gap for what’s needed to end malnutrition.” 

Solutions

Fortunately, solutions are readily at hand—if only the world would muster the will to act. 

For starters, said Aguayo, it is essential to see that families have access to minimum diets and to reestablish nutrition services. He elaborated:

Bring essential nutrition services for children back to normal: protect breastfeeding, promote and support nutritious foods for young children and mothers; and provide therapeutic foods for children who are undernourished; make children go back to school safely so schools can become a delivery intervention for healthy meals, vouchers, micronutrient supplements, and fortified foods.

This has already started to happen, he added, as a number of countries in Africa and Asia worked to strike a better balance between “protecting everyone against the virus and protecting children against threats that might be deadlier than the virus itself.” 

It is also essential to counter fear and misinformation that is rampant the world over. Fear keeps parents from accessing primary healthcare systems and the preventive care their children need. Fake news spreads harmful lies—like the falsehood that the virus could be transmitted from mother to child through breastmilk. 

Finally, it is necessary for governments, foundations, and even individuals to contribute to the achievable goal of ending global malnutrition. Said Aguayo:

Support UNICEF… We build national systems and work with national and international NGOs delivering services to children with the highest risk, often in fragile countries and humanitarian settings; so if you are a philanthropist or even an everyday donor who feels outraged by these figures, and you’re wondering, what can we do—well, support our vision, which is help us deliver a package of essential nutrition interventions to children in the first two make-or-break years of life. These are the children that we need to protect because this is when mortality is happening… most child malnutrition deaths happen to children in the first two years of life.

The average cost of these essential interventions, added Aguayo, is strikingly low. For an average of $4.70 per child—less than it costs to buy a Starbucks latte—UNICEF and its partners can support the delivery of these essential interventions to millions of children in sub-Saharan Africa for a year. 

In July, four UN agencies issued an urgent call to action—“Child malnutrition and COVID-19: the time to act is now”—in which they estimated that at minimum US$2.4 billion is needed to protect at-risk children, prevent and treat malnutrition, and avoid human loss; they also called for four life-saving interventions and five urgent nutrition actions. Moore responded with his own plea, “It’s Time for the Global Nutrition Sector to Finally Act,” in which he praised the call to action but urged that a specific plan be created to back it. Wrote Moore:

A $2.4 billion funding appeal will not fundraise itself—we need a pledging moment and designated leadership to ensure resources materialize… All nutrition stakeholders must now push for swift development of a roadmap and fundraising framework that builds on this Call to Action. Millions of people without lifesaving services today cannot afford to wait another eight months—or worse, have these actions never materialize at all.

In our interview, Moore noted that he was optimistic that donors would soon come to the table with meaningful commitments. ECF planned to make a $50 million pledge for wasting treatment and he hoped that other private donors would step up, too; in the long run, persuading more multibillionaires to help combat malnutrition—as the Gates Foundation has done for many years—would be critical. 

Philanthropists and even small or medium-sized donors can increase their impact by joining the Coalition of Philanthropies for Global Nutrition, a collective of philanthropies advancing investments to combat malnutrition around the world. The Coalition grew out of the 2017 Nutrition for Growth Summit in Milan when several philanthropies made major commitments to nutrition and demonstrated an interest in convening with peers to take collective action on malnutrition. It serves as a vehicle through which emerging philanthropists can find ways to invest within the global nutrition landscape, find synergies between investments, and opportunities for co-investment.  It also provides a venue where emerging and in-country voices can be highlighted and receive the attention and investment they need. And, finally, the Coalition offers a forum for global philanthropies and philanthropists to enhance the efficacy of their own work, as well as drive collective impact and expand the network of funders for ending malnutrition.

Post-Pandemic Possibilities

As they look to the future, both Moore and Aguayo are cautiously hopeful. 

“All of a sudden, health ministries, for example, are willing to take risks to strengthen nutrition policies, scale up prevention programs, and simplify treatment protocols,” said Aguayo. “So we see opportunities to accelerate innovation and results.” Moore agreed, adding that innovations undertaken were often based on research and pilot projects in which ECF and other funders had been investing for years. “Countries are a lot more willing to take a risk on those right now in order to still be able to deliver care,” he said. 

One example of this is a new-found willingness to equip caregivers with MUAC (mid-upper arm circumference) measures that are a reliable, fast, and cost-effective way to identify children at risk of malnutrition rather than requiring them to go to a clinic or wait for a community healthcare provider. “We were imagining a 5 to 10-year time horizon before we really saw something like family MUACs scaled up,” said Moore. But, it is happening now—and ECF is funding UNICEF to scale its use in certain contexts. 

Optimism and determination, insisted Aguayo, provide the only path forward “I would like the world to know that it is our obligation to remain optimistic and determined and to always believe there is a way out,” he said. “The Covid-19 pandemic can be a catalyst for change, and we will not lower our ambition for children.”

Banner image courtesy of Jeremy Mines/CARE

Originally published in Forbes