International Development Committee Inquiry into the Secondary Impacts of COVID-19: Submission of Written Evidence by Save the Children
The COVID-19 pandemic and the lockdown measures implemented to mitigate the virus have caused vast disruptions to health and nutrition services worldwide. Of these services, routine immunisation has been most severely impacted. Prior to the pandemic, global vaccine coverage had stalled at 85%, with 20 million children unvaccinated. Due to disruptions in health delivery, this figure is projected to quadruple with 80 million children at risk of vaccine preventable diseases. An online poll issued jointly by the World Health Organisation (WHO), UNICEF and Gavi found that over 50% of the respondents indicated that their most urgent challenge was how to resume or continue routine immunization activities and implement COVID infection prevention and control (IPC) measures.
Save the Children’s recent survey of children and their caregivers unearthed the key barriers to health they have faced since the pandemic. Respondents cited closures (10%) and long queues (12%) at health centres and medicine shortages (15%) as some key barriers.
Community perceptions have also been impacted by the virus. When services are available communities are wary of accessing them due to fear of contracting the virus, reluctance to visit health clinics, transport disruptions and economic hardships caused by the impact of the virus. The provision of vaccination programmes is more difficult since the pandemic. UNICEF reports that at least 30 measles vaccination campaigns had been or were in the process of cancellations due to the pandemic leading to increased risks of measles outbreaks worldwide.
Save the Children has experienced the result of COVID-related disruptions to our programmes. In Somalia, urgent maternal complications in hospitals in Southern Somalia were left unresolved as healthcare providers fell ill with COVID-19. In Indonesia, integrated health posts were closed to mitigate the spread of the virus leaving many vulnerable children at risk of infectious disease outbreaks. 84% of health services reported disruptions in a survey carried out by UNICEF.
Economies, development and level of ODA
The world is in a deep recession, with global economic output projected to be 4.4% lower in 2020. However, whilst growth is expected to bounce back in 2021, low income countries are expected to be the only country grouping with lower economic growth in 2021 than in 2019. The recession has damaged low and lower middle-income country government revenue generation, causing increased borrowing to maintain social spending, whilst governments in higher incomes countries have been able to produce large fiscal stimulus to protect people and livelihoods. Both the borrowing during COVID-19 and before it has left 35 of the world’s poorest countries at high risk of or in debt distress, meaning that unless support is provided government spending will be constrained in the medium term. The UK has supported debt relief to 25 of the world’s poorest countries through the IMF Catastrophe Containment and Relief Trust (CCRT) and is participating in the G20 Debt Service Suspension Initiative (DSSI), although more needs to be done to avoid a debt crisis, with the UK well placed to champion a global debt restructuring mechanism, which private creditors actively participate in.
The global recession is also having a significant impact on levels of ODA in the short and medium term. The UK Government is cutting the 2020-21 aid budget by £2.9bn due to reduced economic output domestically, which is set to reduce funding in critical areas such as basic nutrition, education and agriculture. Other institutions such as the World Bank have frontloaded a significant proportion of their International Development Association (IDA) programme support for the poorest countries through 2020, leaving a large funding gap in 2021-22 and 2022-23, unless donors provide additional resources.
150 million additional children are living in poverty since the pandemic hit, to a total of 1.2 billion children, an increase of 15%.
Implications for livelihoods and food security and nutrition
Nearly half of all deaths of children under five are attributable to undernutrition. Before the pandemic 144 million children under five were stunted and 47 million children were wasted, 9 in 10 of whom lives in Africa or Asia. The pandemic is predicted to exacerbate these rates. An additional 6.7 million children could suffer from wasting in 2020, with an estimated 57.6% of them in south Asia and 21.8% in sub-Saharan Africa. Across all ages, between 14 and 80 million people may become malnourished because of economic impacts from the pandemic.
The number of people suffering from acute food insecurity, one driver of malnutrition, could double to 270 million.Save the Children’s global survey found that over 3 in 4 households reported income losses since the start of the pandemic, with 81% of respondents struggling to pay for food, 79% of which are in food insecure households., 62% of households found it difficult to provide their families with meat, dairy products, grains, fruits and vegetables. The urban poor were found to be the worst hit.
This situation is exacerbated by disruption to essential health and nutrition services. Around 90% of 105 reporting countries have had disruptions to essential health services during the pandemic, with low- and middle-income countries worst affected. Over half of countries reported disruption of essential services for the management of malnutrition. These services are vital for child survival. Many nutrition interventions are highly cost-effective, prevent disease and reduce mortality. Healthcare systems and donors must not divert away from nutritionally important functions – such as antenatal care, micronutrient supplementation, and preventing and treating acute malnutrition.
The UK’s announcement that it will lead global action to ensure the world’s poorest people are protected from coronavirus and famine is welcome. The £119m announced in September is a welcome indication that the Foreign, Commonwealth and Development Office (FCDO) recognises its value in addressing emerging hunger crises. However, the FCDO’s commitment to nutrition expires at the end of 2020. A hunger crisis is part of wider issues of malnutrition. Whilst it is vital to respond effectively in the short-term, long-term focus must be on improving the nutritional status of people.
Long term, flexible funding for nutrition is vital. The UK should commit to continue its ambitious and effective nutrition specific programming between 2021 and 2025. This means investing, at a minimum, £600 million over the same period, equivalent to a minimum of £120 million per year. This funding would go to programmes that directly target the reduction of malnutrition. It should also ensure a further £3.4 billion of nutrition relevant programming is tailored to tackle the underlying causes of malnutrition over the same period and that it will reach a further 50 million people with nutrition relevant programmes.
Current estimates show over 577 million children – approximately 33% of the total pupil population – are out of education due to school closures in response to the Covid-19 pandemic.
New analysis by Save the Children suggests that almost 10 million children are at risk of dropping out of school due to rising levels of child poverty, with the poorest and most marginalized children at greatest risk, including those from low-income households, refugees and internally displaced children, girls and children with disabilities.  Twelve countries – Afghanistan, Chad, Cote D’Ivoire, Guinea, Liberia, Mali, Mauritania, Niger, Nigeria, Pakistan, Senegal, and Yemen – are at “extreme risk” of falling behind in their progress towards Sustainable Development Goal (SDG) 4 on education.
Save the Children is already seeing the impact of school closures on children, especially girls, through our country programmes. In Uganda, teenage pregnancies have reportedly doubled, and there have been increased reports of child labour, child marriage and violence against children. Globally, an additional 2.5 million are anticipated to be at risk of child marriage over the next (?) five years, and adolescent pregnancies expected to rise by up to 1 million in 2020, because of the economic impacts of the Covid-19 crisis.
This crisis comes at a time when education budgets are under pressure as spending shifts towards the health and economic response to the pandemic. Save the Children estimates that the economic consequences of the pandemic could lead to an education financing gap in low- and middle- income countries of $77 billion over the course of the next two years. While it reduces the size of its aid budget, the UK should protect the proportion spent on education to lead by example in tackling the education crisis caused by the pandemic.
We welcome the announcement that the UK will co-host the Global Partnership for Education replenishment conference in 2021, and its commitment to leveraging the Presidency of the G7 to ensure education is at the top of the global agenda. The UK must now deliver an early and ambitious commitment to the GPE replenishment, and advocate bilaterally for other donors to do the same.
The UK has an opportunity to use its role as a global education leader to convene world leaders behind an action plan to ensure a safe return to school for every child, and secure financial support for its implementation. This plan should set out the targeted interventions that national governments should put in place in order to ensure a safe return to school for all children, especially the most marginalized, in order to reduce school dropout and improve inclusion.