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Afghanistan: Polio Contracted by 6 More Afghan Children | TOLO News.

[4th May 2020]

Vaccination is not happening amid COVID-19.

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Faridullah Mohammadi writes:

The Afghan Ministry of Public Health (MoPH) on Monday announced the registration of 6 new polio cases, bringing the total number of polio cases among Afghan children to 11 this year.

The Health Ministry said that the main reason behind the spike in cases is that children are not vaccinated.

According to Ministry of Public Health, new cases of polio were registered in Kandahar, Badakhshan, Balkh and Herat provinces.

‘’Earlier we registered five cases of polio in Helmand, Zabul, Nimroz, Laghman and Farah provinces,” said Dr. Gula Khan Ayoub, the head of the public awareness department at the Ministry of Public Health.

“Unfortunately, one case was reported in Kunar during the current year--there are 170,000 children eligible for vaccination in Kunar,” said Gul Mohammad Bedwar, the deputy governor of Kunar province.

The Health Ministry has said that it couldn’t carry out a vaccination campaign during March and April because of the COVID-19 pandemic.

“We registered 5 cases in the south during the current year,” said Abdul Qayoum Pakhla, the head of the polio vaccination task force in the south.

“If there is no cooperation from the parents, the people and the opponents, we will witness more positive cases of polio,” said Baseer Ahmad Afzali, an official of Ministry of Health.

There are 10 million children under the age of 5 in Afghanistan who are eligible for vaccination, but the Ministry of Health says that two million of them remain deprived of polio vaccine because of war and security threats.

Afghanistan, Pakistan and Nigeria are the only countries on earth where polio still affects victims.


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Pakistan: EPI staff fighting polio, Covid-19 simultaneously | DAWN.

[May 03, 2020]

EPI technicians collecting samples for Covid-19 test in a hard area of Dasu, Upper Kohistan. — Dawn photo

EPI technicians collecting samples for Covid-19 test in a hard area of Dasu, Upper Kohistan. -- Dawn photo

Ashfaq Yusufzai writes:

PESHAWAR: As most staff members of the Emergency Operation Centre on polio stay away from workplaces due to the coronavirus pandemic, technicians of the health department’s expanded programme on immunisation (EPI) are inoculating children against 10 vaccine-preventable diseases and tracking and tracing suspected Covid-19 cases in their respective areas.

According to EPI technicians and officials, there is no break in routine immunisation as 2,876 technicians have been reaching most of the 1.1 million targeted population at 1,270 EPI centres in the province besides carrying out Covid-19-related activities.

They told Dawn that the polio staff working under the Emergency Operation Centre (EOC) stayed home and claimed credit for what was being done by the EPI staff.

The technicians said the unsung EPI heroes had been tracing the contacts of coronavirus patients, collecting samples from suspected patients with the support of medical technicians, labelling them for transportation to labs at the hardest areas, and performing duties at quarantine and isolation centres.

They added that the EPI technicians conducted immunisation sessions at the district level, where mothers were told about the significance of immunising children up to 23 months against 10 diseases, including childhood tuberculosis, polio, diphtheria, tetanus, pneumonia, pertussis (whooping cough), Hepatitis-B, meningitis, diarrhea and measles.

Insist EOC employees staying home since lockdown was enforced

The officials claimed that the highly paid EOC staff members had been staying home since the coronavirus-induced lockdown was enforced.

They said the province accounted for 92 of the countrywide 146 polio cases in 2019 and 19 of 41 cases reported in the current year until now.

The officials said KP recorded 16 of the 22 countrywide vaccine-derived polio virus (VDPV2) cases in 2019 and 38 of this year’s 42 cases.

They added that the VDPV2 had been eradicated worldwide in 2016.

A senior district health official claimed that the EOC, which was responsible for polio eradication, was presenting the work of EPI technicians as their own. “This attitude is demoralising our technicians,” he told Dawn.

The last National Immunisation Day campaign was conducted on Feb 17 and the SNID in five districts on March 16, cVDP2 case response in 16 districts from March 9 and since then, no campaign has been carried out.

“We are holding vaccination session while observing social distancing rules. The federal EPI recognised the KP’s work in far flung areas, like Kohistan and Chitral,” a senior official said.

A lack of coordination between EOC and EPI has also been reported.

Recently, the EOC coordinator removed the EPI director from three official WhatsApp groups. The director, who is the EOC secretary by virtue of his designation, had formally asked the coordinator about for his video statement wherein he had given the credit for Covid-19 work to EOC staff members only.

According to EPI director Dr Mohammad Salim, the polio workers were hired only for vaccination and that it’s the EPI vaccinators, who were on ground and acted as the real frontline workers.

He said the EPI coordinators and focal persons at the district level should be recognised.

“I along with three deputy directors have visited 14 districts of KP, where we saw only EPI technicians in Covid-19 activities,” he said.

When contacted, EOC coordinator Abdul Basit said not only polio but other EOC staff members were also involved in tracing and tracking Pakistanis, who had arrived from abroad on a daily basis.

“We have been presenting reports periodically to the chief secretary, who has assigned us this duty. Our surveillance system looks after both polio and Covid-19,” he said.

Mr Basit said the centre had deployed communication staff members to scale up public awareness of Covid-19.

He said the EPI technicians were also in the field.

“When I appreciate polio programme workers, they include EPI technicians as well,” he said.

The coordinator said the door-to-door campaign was against the Covid-19 protocol as it would cause the further spread of the virus.

“Indeed, the polio workers are also on the frontline. In North Waziristan, polio teams have found 1486 foreign travellers and held sessions on social distancing in far-flung villages, where people don’t have access to social, print and electric media,” he said.


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While the west fixates on Covid-19, vulnerable countries pay the price | The Guardian.

[Sun 3 May 2020 09.03 BST]

The developed world's response to the pandemic is imperilling health systems, economies and livelihoods already on the edge.

Precautionary Measures Against COVID-19 In Yemen 2020

Spraying disinfectant to combat coronavirus in Yemen’s capital, Sana’a. About 12 million Yemenis rely on food aid, and a cholera outbreak is under way. Photograph: Mohammed Hamoud/Getty Images

Simon Tisdall writes:

People in low-income and conflict-affected countries have so far largely escaped the high levels of Covid-19 infection seen in western Europe and the US, although this may be changing.

The pandemic is killing them in different ways: lost jobs, ruined businesses, increased poverty, rising malnutrition and risk of famine, and a prospective increase in untreated, non-Covid preventable illnesses.

For many of the most vulnerable, the developed world’s cures are proving worse than the disease. At the extreme, families must choose between going hungry and getting ill.

And their plight is exacerbated by Covid-style “underlying conditions” – chronic, pre-existing political, security, economic, and climate problems that grow ever more unsustainable.

A Covid tidal wave may be about to hit sub-Saharan Africa and other less resilient regions, the International Rescue Committee warned last week. Without urgent international action, the virus could cause 1bn infections and 3.2m deaths in 34 fragile states, including Afghanistan and Syria, it said.

The World Health Organization has issued similar alerts. Yet even if these worst-case outcomes are somehow avoided, poorer countries already face enormous collateral damage.

According to UN estimates, half a billion people, or 8% of the world’s population, could be pushed into destitution by the year’s end, largely due to the pandemic. The fight against poverty would be set back 30 years.

The crisis could produce famines of “biblical proportions”, with the number of people facing hunger almost doubling to more than 250 million, the World Food Programme (WFP) said. Shortfalls in donor funding and food aid meant 30 million people could die within a matter of months, it added.

Vanishing demand, collapsed distribution chains, and disrupted export markets are pushing people to the brink, affecting groups as diverse as Ethiopian and Kenyan flower producers, Sri Lankan tea-growers, and Bangladeshi garment workers whose contracts have reportedly been cancelled by UK supermarkets.

The Democratic Republic of the Congo, Sudan, South Sudan, Nigeria, Venezuela and Haiti are among the countries most at risk, the WFP said: “Millions can only eat if they earn a wage.”

War-torn Yemen is worse off than most. About 12 million Yemenis rely on food aid that is threatened by renewed fighting. A repeat cholera outbreak is under way. The detection last week of a Covid-19 cluster in Aden may be the least of its worries.

South Sudan is another conflict-scarred country with little or no capacity to handle a Covid-19 emergency. In 2019, 61% of the population faced food insecurity. Drought and locust infestations were contributory factors.

Yet with only 34 confirmed Covid cases so far, and no deaths, South Sudan’s main worry at present is the pandemic’s indirect impact on humanitarian aid, food supply and livelihoods.

This perspective is shared by many in South Africa, the continent’s second largest economy. The official death toll is just over 100, yet the government’s lockdown is said to be costing £570m a day. Some restrictions were eased last Friday amid fears that 1.7 million people could lose the means to make a living.

Looked at globally, the pandemic’s impact on jobs is devastating. The International Labour Organization reported last week that 1.6 billion workers in the informal economy – nearly half the world’s total workforce of 3.3 billion – “stand in immediate danger of having their livelihoods destroyed”.

Sudanese men break their fast in a street in the capital Khartoum

Sudanese men break their Ramadan fast in the capital Khartoum. The country is among those most at risk, according to the World Food Programme. Photograph: Ashraf Shazly/AFP via Getty Images

“The first month of the crisis is estimated to have resulted in a drop of 60% in the income of informal workers globally. This translates into a drop of 81% in Africa and the Americas,” it said.

If lockdowns continue or expand, this situation will only get worse. More than 436 million enterprises were at risk, the ILO’s Guy Ryder said. “For millions of workers, no income means no food, no security, and no future.”

The west’s self-absorption threatens to obscure the virus’s harmful impact on treatment of non-Covid, preventable diseases. Just as UK cancer deaths are forecast to rise due to a diversion of resources, so measles and other immunisation programmes in poorer nations are being undercut.

The WHO announced last week that polio vaccinations for up to 12 million children in Africa will be delayed as resources are switched to fighting Covid-19. It admitted the move would inevitably lead to more child polio cases.

Disrupted vaccination programmes have frequently led to “explosive” outbreaks of life-threatening diseases previously held in abeyance, warned vaccine specialist Edward Parker. “Without systematic efforts to maintain immunisation programmes, the virus’s legacy could include a disastrous surge in childhood deaths.”

The pandemic is providing cover for malign governments to pursue or accelerate policies that place lives at risk, regardless of Covid-19. A striking example is Myanmar, where the army has renewed its repression of minorities in Rakhine and Chin states.

Yanghee Lee, the UN’s human rights rapporteur, said last week she feared a repeat of the alleged genocide in 2017 when 700,000 Rohingya Muslims were forced to flee. The resulting densely populated refugee camps created in next-door Bangladesh are potentially lethal Covid-19 hotspots.

And Kashmir reveals more Covid collateral damage. The continuation of last year’s illegal Indian government lockdown is now justified by the need to contain the disease. Spiralling mental health problems, including depression, anxiety, suicide, and domestic violence, are among the results.

Not to be left out, the Trump administration is ignoring a UN call to lift sanctions on struggling, virus-hit countries such as Iran, Cuba and Venezuela while also blocking a global ceasefire.

World Bank and IMF billions offered in assistance and debt relief to poorer countries and fragile states cannot begin to repair all this hurt. Right now, western responses to the virus are imperilling more people worldwide than the virus itself.


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Pakistan's Fight Against Coronavirus Threatens Its Drive To Eradicate Polio | Radio Free Europe/Radio Liberty.

[May 03, 2020 07:03 GMT]

A health worker marks the finger of a child who just received the polio vaccine in Lahore on February 18, shortly before the nation shifted gears to fight the coronavirus pandemic.

A health worker marks the finger of a child who just received the polio vaccine in Lahore on February 18, shortly before the nation shifted gears to fight the coronavirus pandemic.

Daud Khattak and Frud Bezhan فرود بيژن write:

Pakistan’s long battle to eradicate the crippling polio virus has been thwarted by militant attacks, radical Islamic clerics, and anti-vaccination propaganda.

But the South Asian nation of 220 million people is facing a new hurdle: the coronavirus pandemic.

Pakistani authorities have halted a nationwide door-to-door polio vaccination drive to stop the spread of the coronavirus -- with polio workers and resources being redeployed to tackle the pandemic.

Pakistan has registered more than 19,100 coronavirus cases and 440 deaths as of May 3, according to official numbers.

But the real number of infections is believed to be much higher, as little testing has been completed.

The government originally imposed restrictions on the movement of people and enforced social-distancing measures but have since eased them.

Pakistani health officials warn that the suspension of the polio-eradication campaign will prevent tens of millions of children from being vaccinated and fuel a resurgence of the disease.

With the disappearance of wild polio cases in Nigeria in recent years, Pakistan and neighboring Afghanistan are currently the only countries in the world where new polio cases are discovered.

Polio Cases Will 'Definitely Increase'.

The coronavirus crisis led Pakistani authorities to stop a nationwide immunization drive scheduled for April that was intended to vaccinate some 40 million children.

The campaign was seen as crucial after Pakistan recorded 147 polio cases in 2019, a sharp rise from a record low figure of 22 cases in 2017. So far this year, authorities have recorded 41 cases.

The majority of the cases of polio -- a childhood virus that leads to deformed limbs, paralysis, and even death -- were recorded in the northwestern province of Khyber Pakhtunkhwa.

A man performs wudu (ablution) before Friday Prayers in Peshawar during the Muslim holy month of Ramadan amid the coronavirus lockdown in Khyber Pakhtunkhwa Province.

A man performs wudu (ablution) before Friday Prayers in Peshawar during the Muslim holy month of Ramadan amid the coronavirus lockdown in Khyber Pakhtunkhwa Province.

“The number of polio cases will definitely increase because we were in the middle of an anti-polio campaign when the coronavirus outbreak halted everything,” said Abdul Basit, the provincial coordinator for the National Emergency Operation Center in Khyber Pakhtunkhwa.

“It happened in the past and it will happen again that when children are not getting immunization, the number of cases goes up,” he said, adding that he expected it would be months before the campaign could resume.

“But right now our whole setup is engaged in efforts against the coronavirus outbreak,” he said.

Nadeem Jan, a public health specialist with Khyber Pakhtunkhwa's government, said the polio campaign must restart as soon as it is safe to do so.

“The current number of cases we have is much more compared to previous years,” he said. “We fear that this number will go up as the polio drive is halted due to the coronavirus situation.”

Jan said all polio-eradication programs have been suspended until May 31.

“We don't see a chance for an effective countrywide anti-polio campaign until June,” he said. “A wide-ranging campaign is urgently needed.”

Change Of Duties.

Pakistan employed tens of thousands of health workers who went door-to-door to administer anti-polio drops and educate communities that were reluctant to immunize their children.

Now, those same workers are helping a national effort to stem the spread of the coronavirus.

“My duty has now been changed to tracking coronavirus cases,” said Shakeel Khan, 33, a polio worker in the northwestern Khyber tribal district.

“We are monitoring people to see if they show symptoms of the coronavirus,” he said. “We monitor who comes into the district. We are meeting local mullahs and tribal elders to advise them about physical distancing and how they can reduce the chances of being infected.”

But Pakistan’s redeployment of health workers to fight the coronavirus could come at a cost.

Ten polio cases have been recorded since the coronavirus outbreak in March, said Khan.

“Polio cases have already increased since the coronavirus outbreak,” he said. “It will keep increasing in the next two to three months if the polio campaign does not restart.”

Long Struggle.

The coronavirus is only the latest obstacle keeping Pakistan from eliminating polio.

Khyber Pakhtunkhwa is a poor and religiously conservative region that was once a stronghold of militant groups like Al-Qaeda and the Pakistani Taliban.

Many residents of the province, which lies along the porous border with Afghanistan, have been suspicious of the polio vaccine, with conservative Islamic clerics and militants claiming it is a Western conspiracy to harm or sterilize children.

In April 2019, a vaccination drive in the province was thwarted after a mass panic was created by rumors of children fainting or vomiting after they were immunized.

As the rumors spread, thousands of panicked parents rushed their children to hospitals in the provincial capital, Peshawar, forcing the health facilities to declare emergencies. The rumors turned out to be wildly exaggerated.

Public-health studies in Pakistan have shown that maternal illiteracy and low parental knowledge about vaccines -- together with poverty and rural residency -- are the factors that most commonly influence whether parents vaccinate their children against the polio virus.

Anti-vaccination propaganda has also been fueled by a distrust of Western governments who fund vaccine programs, including after the CIA reportedly staged a fake hepatitis-vaccination campaign in 2011 to confirm the location of Al-Qaeda leader Osama bin Laden -- living in the Pakistani garrison town of Abbottabad -- where he was killed by U.S. SEALs.

Since then, some clerics have even issued fatwas saying that children who become paralyzed or die from polio are "martyrs" because they refused to be tricked by a "Western conspiracy."

Pakistani militants have also propagandized that Western-made vaccines contain pig fat or alcohol, which are both forbidden in Islam.

Militants in Pakistan have kidnapped, beaten, and assassinated dozens of vaccinators or their armed police escorts in recent years in a bid to stop local anti-polio campaigns.


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Despite Covid-19 pandemic, routine vaccination of children continues across the Middle East and North Africa | ReliefWeb.

[Source: UNICEF] [Posted: 3 May 2020] [Originally Published: 3 May 2020] [Origin: View original]

UNICEF delivered more than 17.5 million doses of vaccines amid heavy movement restrictions.

Link to the multimedia products here.

AMMAN, 3 May 2020 --Despite the COVID-19 outbreak, most countries in the Middle East and North Africa continue with routine immunization for children while applying strict precautionary health measures. However, in some countries, special vaccination campaigns have had to come to a halt as health workers were diverted to the response of COVID-19. As a result, one in five children or 10 million children under the age of five risk missing their polio vaccination while nearly 4.5 million children under the age of 15 risk missing their measles vaccination.

"Immunization for children is possible even in the time of COVID, using protective measures to protect the child, the mother and the vaccinator. It is absolutely critical that every child gets immunized against deadly diseases including polio, measles, diphtheria and hepatitis" said Ted Chaiban, UNICEF Regional Director for the Middle East and North Africa.

Precautionary measures during immunization campaigns include abiding to a disinfection process, using personal protective equipment including gloves, face masks and robes as well as avoiding overcrowding and adhering to social spacing in health care centres.

"Last year, UNICEF with partners reached nearly 34 million children with lifesaving vaccines including measles and polio across the region. This year, COVID-19 pandemic is overstretching health systems, as frontline workers are supporting the outbreak response. Despite that, nearly 1.5 million children on average are getting their vaccines every month" added Chaiban.

To facilitate vaccination campaigns for children across the region, UNICEF will continue to support health authorities and health workers across the region:

  • Close monitoring of in-country vaccine stocks to avoid expiry of vaccines, especially in countries where routine vaccination or campaigns activities have been suspended.
  • The procurement and shipment of vaccines especially to countries where borders have been closed or flights have been suspended.
  • Despite challenges, movement restrictions and closures of borders and air space in most countries of the region, UNICEF was able to bring in 17.5 million doses of vaccines to the Middle East and North Africa since the beginning of the year. More shipments of vaccines and other lifesaving supplies are in the pipeline.
  • Continue to support health authorities and health workers on the frontlines with the delivery of critical medical, health and hygiene supplies, including personal protective equipment like surgical masks, gowns, gloves and goggles, COVID-19 testing kits, disinfectants, hand sanitizers, thermometers and the training of health workers on infection prevention.

Since 2017, UNICEF procured and shipped nearly half a billion doses of different types of vaccines including against measles, mumps, rubella and polio to the Middle East and North Africa.

Notes to editors.

Efforts to reach every child under the age of five with lifesaving vaccines are under serious jeopardy.

The region has been polio free for more than two years. Due to the suspension of vaccination campaigns, nearly 10.5 million children under the age of five in Iraq, Sudan, Syria and Yemen have not been reached with polio vaccination putting their lives at risk.

Nearly 4.5 million children under the age of 15 in Iraq, Lebanon, Yemen and Djibouti have not been reached with vaccination against measles.

Media Contacts.

Juliette Touma Regional Chief of Communications UNICEF Middle East and North Africa Regional Office Tel: 00962798674628

Email:

jtouma@unicef.org Lina Elkurd Communication Officer UNICEF Middle East and North Africa Regional Office Tel: 00962791096644

Email:

lelkurd@unicef.org


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The changing face of COVID-19: a live tracker of its impact on children | ReliefWeb.

[Source: Save the Children] [Posted: 3 May 2020] [Originally Published: 3 May 2020] [Origin: View original]

FRIDAY 1 MAY 2020.

By Oliver Fiala and Chiara Orlassino.

There is real and present danger that the 2020s will become a 'lost decade' with unprecedented reversals in development progress. The pandemic has already caused devastating human suffering across the world, including well over 200,000 deaths. And while children seem to be less susceptible to the direct consequences of the coronavirus, they are becoming the biggest victims of its social and economic impacts.

New research and estimates on the potential socio-economic impact of COVID-19 are released daily and it can be challenging to stay on top of the most relevant insights. We've summarised what we believe to be the pandemic's most severe consequences on children living in low- and middle-income countries. This builds partly on earlier evidence laid out in an UN brief, but incorporates many new findings and estimates as well as some learning from previous pandemics.

We plan to update this blog post every two weeks as new evidence emerges. But despite our best efforts to cover a wide range of impacts on children, we'll need your help. Please let us know of any research or estimates you'd like to see included by adding a comment below.

Children will be affected by COVID-19 and its consequences in many ways, and while it is sometimes difficult to clearly distinguish some impacts, we've sorted our insights in four categories:

  1. Child poverty: COVID-19 likely pushes children into poverty or increases the depth for children already living in poverty -- both if measured monetarily or multidimensionally.

  2. Survive: Disruptions in health services could lead to hundreds of thousands of additional child deaths and leaves millions of children unvaccinated against infectious diseases.

  3. Learn: With schools closed for the vast majority of children in the world, many will lose out on essential learning and there is a real risk that some children will not come back to school afterwards.

  4. Be Protected: The disruption of prevention services and the economic consequences of the pandemic will lead to increases in domestic violence, child marriages and other harmful practices, especially for girls and women.

CHILD POVERTY.

Various forecasts and projections in the last few weeks are showing the devastating effects the new coronavirus is likely to have on the world's poorest countries, especially in Sub-Saharan Africa. Our own estimate for Sub-Saharan Africa suggests more than 30 million children in this region alone might be pushed into extreme poverty, reversing much of the progress made in the last decade.

Globally, early estimates vary between 40-60 million by the World Bank to 84-132 million by the UN (based on the IFPRI poverty model). We are currently working with UNICEF to better understand and measure the consequences of COVID-19 on children living in poverty, both if measured in monetary terms as well as for multidimensional child poverty.

SURVIVE.

FOOD SECURITY AND NUTRITION.

The economic shock which families are facing, coupled with mitigation measures which risk disrupting food supply chains, pose a significant risk of food insecurity. The World Food Programme (WFP) has issued a warning that unless swift action is taken the number of people suffering from acute food insecurity could double, jumping from 135 to 265 million. The situation is particularly dire for children as school closures mean that 368.5 million children globally who rely on school meals might have lost access to a reliable source of food. Sub-Saharan Africa is particularly affected, with 50% of the global food insecure population located on the continent even before the pandemic started. More than 50 million would suffer from hunger in West Africa alone, and the number of food insecure people could more than double in East Africa, jumping to 43 million. Early estimates suggest that the number of children under age five who are stunted may increase by 5% or an extra 7 million children.

CHILD SURVIVAL.

While children seem to make up less than 2% of diagnosed COVID-19 cases, we have reasons to be particularly concerned by the secondary effects of the crisis on children. There is evidence for increasing child mortality either due to weakened or disrupted health services or due to reduced utilisations of routine services. A new paper by Johns Hopkins modelled various reductions of coverage of life-saving interventions and for different time periods for 118 low- and middle-income countries. Reductions in coverage of around 15% for 6 months would result in 253,500 additional child deaths (an increase of 10%), while reductions of around 45% for 6 months would result in 1,157,000 additional child deaths (45% increase). Similarly, the WHO models that suspension in campaigns and loss of access to treatment for malaria could increase malaria deaths by 50% (with scenarios ranging from 7% to 99%), which children being disproportionally affected. A parallel picture emerges in other epidemics, for instance during Ebola in Sierra Leone, where deaths tolls rose significantly during and after the crisis, almost exclusively due to causes of deaths other than Ebola. This was accompanied by significant drops in health seeking behaviour (for instance for diarrhoea, acute respiratory, malaria etc.) in GuineaLiberia and Sierra Leone.

IMMUNISATION.

As a direct consequence of COVID-19, immunisation campaigns -- such as those for measles targeting 78 million children in at least 23 largely high-burden countries or those focussed on polio -- have been suspended. Data from March across most of India's health facilities shows significant drops in child immunisations relative to the same time last year, ranging from 16% for PCV and BCG to 69% for MMR. Those numbers are deeply troublesome as they suggest negative long-term effects on children who are losing out on life-saving vaccines, and are in line with similar observations during the Ebola outbreak.

MENTAL HEALTH.

Despite a lack of recent data on the effects of covid-19-related quarantine on children's mental health, there are fears that quarantined children "might be more susceptible to mental health problems because of their higher risk of infection, and the grief and fear caused by parental loss or separation." Previous research on the effect of health-related disasters on children's psychological wellbeing finds that 30% of isolated or quarantined children met criteria for PTSD, a percentage four times higher than in non-quarantined peers.

MATERNAL HEALTH.

Disruptions to health services also has significant impacts on the utilisation of maternal health services, which have seen drops by as much as 33% in India in March, which echoes similar findings in previous epidemicsJohns Hopkins estimates increases in maternal mortality ranging from 8% to 39% depending on the severity and duration of disruptions to routine health care.

LEARN.

Almost 1.3 billion children are currently out of school across the world, with impacts of prolonged school closures on remote learning, learning outcomes and school enrolment.

REMOTE LEARNING.

Remote learning will likely deepen education inequalities and learning gaps because of the digital divide and different loss of learning by socio-economic group. Worldwide, 50% of the students out of the classroom do not have access to a computer, and 40% lack internet access at home; with those figures as high as 90% and 82% in Sub-Saharan Africa, respectively, Additionally, online education might disadvantage girls: globally, 25% fewer women have access to the internet than men, and in Sub-Saharan Africa women are 50% less likely to use the internet than men.

LEARNING OUTCOMES.

Prolonged school closures could worsen learning outcomes in the long-term and widening existing inequalities, with an increasing number of children falling below minimum proficiency standards. Summer loss literature could give an indication in terms of potential effects and equity impacts: when schools are closed during the summer breaks, learning for children from more disadvantaged socio-economic backgrounds flattens, while children from privileged socio-economic backgrounds continue to gain new skills.

SCHOOL ENROLMENT.

The third step is getting children back into school once they open and help them to catch up on lost learnings, especially for more disadvantaged children. The experience from the Ebola crisis illustrates this challenge: various evidence finds that an aggravated financial situation made it more difficult for families to send their children back to school. In a heavily affected village in Sierra Leone, school enrolment rates for adolescent girls dropped by as much as one third.

BE PROTECTED.

CHILD MARRIAGE & TEENAGE PREGNANCIES.

The mitigation policies for, and economic repercussions of, COVID-19 are likely to have devastating effects for many children's right to be protected from harmful practices and violence, especially for adolescent girls. The pandemic could cause 13 million additional child marriages by 2030 due to a combination of prevention programmes being paused and potential effects of increasing poverty on the prevalence of early marriage. This mirrors previous evidence from the Ebola outbreak in Liberia, however the impact of such shocks on child marriage may vary depending on the cultural context.

Disruptions to health services could lead to loss of access to contraception for 47 million women (of all age groups), which may result in 7 million unintended pregnancies. Many of those pregnancies may happen to adolescent girls, with previous assessments for Ebola indicating increases of teenage pregnancies in Sierra Leone by up to 65%.

FGM & GENDER-BASED VIOLENCE.

UNFPA and partners project 2 million additional cases of FGM and 200 million cases of gender-based violence as the consequence of the pandemic. While coherent data is still lacking, many countries do experience stark increases in the reports of domestic violence (for instance in KosovoItalyJingzhou/China and France).

CHILD LABOUR & BIRTH REGISTRATION.

There are concerns that COVID-19 will increase the prevalence of child labour, as families' economic hardships put pressure on children to substitute labour for learning. Research by the World BankUNECA and Save the Children found similar patterns emerged during the Ebola outbreak.

Lessons learnt from Ebola suggest that there is a risk that COVID-19 will result in an 'invisible generation', with evidence by UNICEF showing that in Liberia birth registrations suffered a 39% decline between 2013 and 2014.

VULNERABLE CHILDREN.

Children are generally a vulnerable group for a variety of reasons (e.g. higher likelihood of being poor, disruption to schooling, dependency and risk of separation from guardians). However, some children are even more vulnerable than others. First and foremost, evidence consistently points to poverty as leading determinant of the severity of the impact of a disaster on a child and their household -- a concern mirrored by the estimated increases in child poverty above.

Refugee children are also likely to bear a disproportionate burden of the adverse consequences of the pandemic. Data on refugee children is lacking even in the best of times, and to our knowledge there is currently no evidence on the specific impact of COVID-19 on children on the move. However, as refugee settlements are often packed, inadequate spaces lacking basic sanitary amenities effective mitigation strategies may be much more difficult to introduce.

Young women and girls are likely to suffer disproportionately from the crisis. First, they experience structural vulnerabilities, such as weaker safety nets to protect them from economic shocks. Second, the crisis might exacerbate existing inequalities, jeopardising or reversing hard-won gains towards gender equality. On a final sombre note, women and girls face specific challenges -- such as gender-based violence (GBV), child marriage, and teenage pregnancy. As we laid out above, all of these are proven to rise during and in the aftermath of pandemics, with devastating effects for women and especially for adolescent girls.

PROTECTING A GENERATION.

Save the Children has laid out a global call for Protecting a Generation with specific opportunities for the UK Government. These calls are underpinned by our programmatic work, policy positions and evidence of the impact of past health and humanitarian disasters We invite you to collaborate with us as this research continues, and suggest insights, evidence and pieces that we have not yet considered. Thank you.


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