WRITTEN EVIDENCE BY RESULTS UK TO THE INTERNATIONAL DEVELOPMENT COMMITTEE INQUIRY ON HUMANITARIAN CRISES MONITORING: CORONAVIRUS IN DEVELOPING COUNTRIES - SECONDARY IMPACTS

About RESULTS UK

RESULTS UK seeks to mobilise the public and political will to end extreme poverty. We undertake strategic policy, parliamentary and grassroots advocacy on three key determinants of poverty: economic opportunities, health and education, with a particular focus on child vaccinations, tuberculosis (TB), education and nutrition.

This submission will explore the following points, as outlined in the inquiry’s Terms of Reference:

●        Non-coronavirus health care; communities trust and engagement in healthcare provision

●        Food security

●        Level of ODA (implications for food security and nutrition)

●        Treatment of women and children.
 

This submission will highlight the secondary impacts of COVID-19 on: 1) immunisation; 2) nutrition; 3) tuberculosis; 4) global education and girls. This evidence builds upon RESULTS UK’s previous two submissions to the IDC’s Humanitarian Crises Monitoring inquiry earlier this year. As a member of both Bond and AFGH, RESULTS UK endorses their submissions to this inquiry.

What are the secondary impacts of the COVID-19 pandemic on routine immunisation?

The COVID-19 pandemic has been highly disruptive for routine immunisation services threatening to reverse years of progress made on ensuring equitable access to vaccination, and therefore, putting millions of lives at risk. The diversion of resources to fight COVID-19, and the change to health-seeking behaviour because of enforced lockdowns, as well as the threat of COVID-19 spreading through community immunisation programmes has impacted efforts to reduce the rates of vaccine preventable diseases. The impact of this disruption has been so severe that the WHO, UNICEF and Gavi are predicting that at least 80 million children under the age of one are at risk of missing out on routine vaccines[1]. The logistical challenges brought about by the pandemic has also disrupted vaccine supply chains. UNICEF (responsible for shipping 30-40% of global produced vaccines) reported a 70-80% reduction in planned vaccine shipments[2].

The profound shift in health systems across the world to tackle COVID-19 has been highly disruptive to efforts to immunise children against polio. Polio campaigns were halted in countries supported by the Global Polio Eradication Initiative (GPEI) due to the risk of health workers spreading COVID-19 within communities. As a result, up to 50 million children in Pakistan and Afghanistan missed polio vaccines. This has been highly disruptive, leading to an increase in wild polio cases in the two endemic countries (Pakistan and Afghanistan - over 100 reported cases between them in 2020[3]).  The introduction of routine immunisation services has also been impacted: out of 68 Gavi supported vaccinations programmes, 44 have been impacted, and 39 have been delayed[4].

Research has suggested that that for every one COVID-19 death attributable to COVID-19 infections acquired during routine vaccination clinic visits, as many as 84 deaths in children could be prevented by sustaining routine childhood immunisation[5].

RECOMMENDATIONS:

1)      The Foreign, Commonwealth and Development Office (FCDO) should ensure that routine immunisation services are maintained, and even intensified in regions in where there has been disruption to these services.
 

2)      The FCDO should ensure that pledges made to Gavi and GPEI are disbursed in full and to their original timelines.
 

3)      The FCDO should ensure that Gavi and GPEI continue to focus their core objectives on providing equitable early childhood vaccines and polio eradication respectively despite disruption and diverted resources to COVID-19.
 

4)      Use the UK presidency of the G7 to leverage support for routine immunisation services and equitable immunisation coverage among bilateral partners.

What are the secondary impacts of the COVID-19 pandemic on nutrition?

Due to COVID-19, it is estimated that in 2020:

●                433 more children per day could die of undernutrition[6].

●                The number of people facing acute food insecurity will double from 135 million to 260 million[7].

●                Wasting (too thin for height) will increase from 47 million to 54 million[8].

●                Stunting (impaired growth) and anaemia are predicted to increase but are more difficult to model.

There are various reasons for recent increases in malnutrition. Firstly, people have had less money to spend on food as unemployment has risen and economies have contracted[9].  Simultaneously the production, storage, distribution, marketing and transport of food has been disrupted, reducing the availability of nutritious food and pushing prices up. Food prices have risen on average by 6.4% – with significant disparities between countries and food types. The worst effects were recorded in Rwanda where average food prices have risen by almost 25%[10]. High food prices contribute to an over-reliance on cheap non-nutritious staples.

As health systems have pivoted to focus on COVID-19, non-emergency health services have been disrupted. UNICEF report a 30% reduction in the coverage of essential nutrition services in low- and middle-income countries, with declines of 75–100% under lockdown contexts[11]. 63% of countries have had disruptions in antenatal care and 59% in postnatal care, which increases risks of childhood malnutrition[12].

Breaches of the International Code of Marketing of Breastmilk Substitutes have increased with some companies donating formula, contacting mothers directly to market products and spreading misinformation about the risk of transmitting COVID-19 via breastfeeding – as Danone India did with its VoiceOfExperts Youtube series[13].

The global pandemic led to the postponement of the Nutrition for Growth summit, where the FCDO was expected to renew its commitments to nutrition. Existing commitments expire at the end of 2020 with no commitments from 2021 onwards.

RECOMMENDATIONS:

The FCDO should:

1. Renew its commitments to nutrition before the end of the year and continue to invest at least £120 million per year on nutrition specific programmes and £680 million per year on nutrition sensitive programmes between 2021-2025[14].

2. Renew its commitment to reach 50 million women of childbearing age, adolescent girls and children with nutrition interventions over 2021-2025.
    
3. Sustain and adapt existing services for the early detection and treatment of malnutrition, including enabling families to screen their own children for malnutrition.
    
4. Ensure a nutrition-sensitive COVID-19 response by, including integrating services to treat and screen for COVID-19 with services that treat and screen for malnutrition.
    
5. Ensure nutrition data is being collected in a way that is both accurate and efficient and includes the training of community health workers to collect data using no-touch assessments or web-based surveys.

What are the secondary impacts of the COVID-19 pandemic on healthcare provision for TB

Tuberculosis kills 1.4 million people each year, more than HIV and malaria combined[15].In 2019, one third of all people with TB were never formally diagnosed or treated. With every untreated person going on to infect approximately 10-15 people a year, this diagnostic gap, combined with the spread of drug-resistant TB, has been the main barrier to reaching SDG target 3.3 to end TB by 2030. A new report suggests that a 15-year delay to reaching this target would lead to an economic and human cost of US $3 trillion[16].The costs of the TB epidemic are this high because the majority of affected people are of working age and live in emerging economies, including India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa[17].

COVID-19 has had an enormous impact on TB. Almost all countries report core TB infrastructure and human resources being diverted to bolster the COVID-19 response, with tests run on the same platforms, and staff trained as respiratory infectious disease specialists[18]. As global trade is compromised and ministries of health prioritise COVID-19, there are concerns about stock-outs of critical commodities[19]. In its recently released Global TB Report, the WHO estimates that the number of TB deaths could increase by 0.2-0.4 million in 2020 alone if the number of people with TB detected and treated were to fall by 25-50% over a period of 3 months[20]. Case notifications have dropped beyond this range in a number of high-burden countries, with limited access, diverted resources, fear of visiting health centres and stigma surrounding TB and COVID-19 playing a major role[21].

Importantly, TB programmes do not appear to be recovering at the same rate as other disease programmes[22]. Communities affected by TB report being too scared to visit healthcare providers, of contracting COVID-19 or being stigmatised because of the similar symptoms between TB and COVID-19.[23] A further concern is that, as the broader effects of COVID-19 push more people into poverty, their likelihood of catching and developing TB and drug-resistant TB increase drastically. A widening case-notification gap, sustained lockdowns, combined with increased rates of poverty in many high burden countries, creates a potential perfect storm for TB.

RECOMMENDATIONS:

The FCDO should:

1. should prioritise health systems strengthening as integral to tackling COVID-19 and strengthening pandemic preparedness.
    
2. Invest in the Global Fund to Fight AIDS, TB and Malaria’s COVID-19 Response Mechanism, and utilise the UK’s forthcoming G7 presidency to leverage other donors.
    
3. Enable plans in place so that all investments in the COVID-19 response are TB sensitive and TB sustainable, with tools, infrastructures and workforces sustained and for strategic TB ‘catch up’ initiatives as COVID-19 needs subside.
    
4. Ensure existing commitments to health systems strengthening, and TB programmes specifically, are disbursed on time.

What are the secondary impacts of the COVID-19 pandemic on global education and girls?

At the peak of pandemic-enforced school closures, 91% of the world’s children were out of school. By August 2020 one billion children still faced this predicament. The poorest and most marginalised children have been affected first and foremost globally.

Girls are particularly vulnerable. In crises, they are often the last in line to access quality schooling and the first to be pulled out. With predictions of an additional 20 million girls not returning to secondary school after the pandemic[24], many now face added the risks of early pregnancy, child marriage, child labour, sexual abuse and exploitation. With girls being kept at home, they are increasingly vulnerable while facing increased domestic burdens.  Girls are often expected to conduct care work and household chores to support the supervision of younger siblings, and where family members fall ill with the virus. Time for them to participate in distance learning is taken away, reducing their connection to school and increasing the likelihood of them never returning.

RECOMMENDATIONS:

1. In its education Official Development Assistance (ODA) programming, the UK should prioritise gender sensitive, inclusive and flexible learning in the emergency response when schools remain closed. Part of this support should be targeted at the most marginalised, including girls, those with disabilities, internally displaced and refugees.
    
2. The UK must scale up support for non-formal learning, investing in tech, low-tech and no tech (not-for-profit) solutions that reach every child.
    
3. As part of an integrated human development response, funding for education should be ring-fenced from potential cuts to UK ODA, with the UK increasing the proportion of ODA that goes to education to 15%.
    
4. The UK is a world leader with clear goals for supporting access to quality education for the most marginalised children. At next year’s Global Partnership for Education replenishment, the UK has an opportunity to solidify this reputation by making an ambitious pledge, and leveraging its position as co-host to encourage other donor countries to do the same.