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Page 1 Page 2 A lie can travel halfway around the world while the truth is putting on its shoes. Mark Twains quote is more relevant than ever in times of online communication, where information or misinformation, bundled in bits and bytes, streams around the earth within seconds. SUMMARY DISCLAIMERUNICEF working papers aim to facilitate greater exchange of knowledge and stimulate analytical discussion on an issue. This text has not been edited to official publications standards. Extracts from this paper may be freely reproduced with due acknowledgement. For the purposes of this research, no personal data has been extracted and stored for data collection and analysis. This UNICEF working paper aims to track and analyse online anti-vaccination sentiment in social media networks by examining conversations across social media in English, Russian, Romanian and Polish. The findings support the assumption that parents actively use social networks and blogs to inform their decisions on vaccinating their children. The paper proposes a research model that detects and clusters commonly-used keywords and intensity of user interaction. The end goal is the development of targeted and efficient engagement strategies for health and communication experts in the field as well as for partner organisations. Page 3 CONTENT1. Rationale 2. Introduction 2.1 Social Media: the conversation shift 2.2 Social Media: Fertile ground for anti- vaccination sentiment 2.3 Social Media Monitoring 2.4 Influencers 3. Research Objectives 4. Methodology 4.1 Descriptive and Explorative Research Design 4.2 Data Collection 4.3 Limitations 4.4 Ethical Considerations 5. Empirical Findings 5.1 Networks: Volume and Engagement 5.2 Common Arguments 5.2.1 Religious and Ethical Beliefs 5.2.2 Side Effects 5.2.3 Development Disabilities 5.2.4 Chemicals, Toxins and Unnecessary 5.2.5 Conspiracy Theory, Western Plot and Conflict of Interest 5.3 Influencers 6. Discussion and Recommendations 6.1 Discussion 6.2 Recommendation Acknowledgements Literature Appendix 4 555 78 9 1111121313 1414191920212222 23 252527 313134 Page 4 Over the past few years, the region of Central and Eastern Europe and the Commonwealth of Independent States has been troubled by the rise of a strong anti-vaccine sentiment, particularly via the internet. Wide ranging in origin, motive, source, and specific objectives, this online sentiment has succeeded in influencing the vaccination decisions of young parents, in many instances negatively. A number of factors are at play in this online anti-vaccine sentiment. First, vaccination coverage in this region is generally high. As a result, vaccine-preventable childhood diseases like polio and measles have been absent in most countries for the past few decades. This has led to complacency toward the diseases and has unfortunately made vaccines, rather than the diseases, the focus of debate and discussion. Meanwhile, poorly-managed immunization campaigns in some countries have caused widespread mistrust of vaccines and government vaccination programs. Most countries have run sluggish, high-handed public communication campaigns while avoiding transparent dialogue with the public on possible side effects, coincidental adverse events and other safety issues. Moreover, when new vaccines have been introduced, they have often just exacerbated the publics existing doubts, hesitations or outright resistance. Into this mix, rapid penetration of the internet in the region has provided a powerful, pervasive platform for anti-vaccine messages to be disseminated. Rooted in scientific and pseudo-scientific online sources of information, messages are often manipulated and misinterpreted, undermining the confidence of parents and causing them to question the need for, and efficiency of, vaccines. The result is hesitation towards vaccination, which in large numbers poses a serious threat to the health and rights of children.This paper aims to examine this rapidly growing phenomenon and its global lessons. Depending on the nature of the problem, special strategies need to be developed to tactically address and counter, diffuse or mitigate its impact on ordinary parents. The prevailing approach of most governments in largely ignoring these forces is unlikely to address this growing phenomenon. Governments, international agencies and other partners - in particular the medical community - need to combine forces to identify the source and arguments of these online influences, map the extent to which they control negative decisions, develop more effective communication strategies and ultimately reverse this counterproductive trend. RATIONALE Page 5 The first part of this paper describes how anti-vaccination groups communicate and how social networks connect concerned parents in new ways. The second part emphasizes the role of social media monitoring in strategic communication, based on understanding audience needs. 2.1 Social media: The conversation shifts The rise of social networks has changed both the way we communicate and the way we consume information. Even within the relatively recent internet era, a major evolution has occurred: In the initial phase known as Web 1.0, users by-and-large consumed online information passively. Now, in the age of social media and Web 2.0, the internet is increasingly used for participation, interaction, conversation and community building1. At the same time, conversations or social interactions that used to occur in community centres, streets, markets and households have partly shifted to social media2. Parents, for instance, suddenly have an array of collaborative social media tools with which to create, edit, upload and share opinions with their friends, peers and the wider community. These conversations are recorded, archived and publicly available. 2.2 Social media: Fertile ground for anti-vaccination sentiment In todays information age, anyone with access to the internet can publish their thoughts and opinions. On health matters in particular, the public increasingly searches online for information to support or counter specialised, expert knowledge in medicine3. Due to the open nature of user participation, health messages, concerns and misinformation can spread across the globe in a rapid, efficient manner4. In this way, social media may influence vaccination decisions by delivering both scientific and pseudo-scientific information that alters the perceived personal risk of both vaccine-preventable diseases and vaccination side effects. INTRODUCTION 1 Constantinides et al, 2007 2 Phillips et al, 2009; Brown, 2009 3 Kata, 2012 4 Betsch et al, 2012 Page 6 In addition to this accelerated flow of information (whether accurate or not), social media messages tend to resonate particularly well among users who read or post personal stories that contain high emotional appeal. This holds true for anti-vaccination messages too. In other words, both logistically and qualitatively, social media is intensifying the reach and power of anti-vaccination messages. Negative reactions to vaccines are increasingly being shared across online platforms. All of this leads to a frustrating predicament and critical challenge: Immunizations protect people from deadly, contagious diseases such as measles, whooping cough and polio. But parents influenced by anti-vaccination sentiment often believe vaccines cause autism, brain damage, HIV and other conditions, and have begun refusing them for their children. As a consequence, health workers face misinformed, angry parents, and countries face outbreaks of out-dated diseases and preventable childhood deaths5. Why do anti-vaccination messages resonate with so many parents in the first place? Parental hesitation regarding vaccinations is thought to stem from two key emotions: fear and distrust: Vaccination is a scary act for many children and parents. A biological agent is injected into the child. The way the biological agent works in the childs body is for most people unclear, which appeals to parents fears. The high level of distrust stems from the intersection of government, medicine and pharmaceutical industry. The nature of its act and the fact that vaccinations are mostly compulsory leads to worries among citizens. (Seth Mnookin, 2011) This distrust, along with the interactive nature of social media, suggests an urgent need for health workers to become attuned to arguments and concerns of parents in different locations and of various cultural backgrounds. To achieve more synergistic relationships with an audience, organisations need to shift their communications strategy from getting attention to giving attention6. Compounding this challenge is the fact that some anti-vaccination groups are not merely sceptics or devils advocates, but operate in an organized, deliberate and even ideological manner. These anti-vaccination groups often employ heavy-handed 5 Melnick, 20116 Chaffrey et al, 2008 Page 7 communication tactics when dealing with opponents: they delete critical comments on controlled media channels, such as blogs7 ; they mobilize to complain about scientists and writers critical of their cause; sometimes they go going as far as to take legal action to prohibit the publishing of pro-vaccine material. Governments and organisations aim to keep parents accurately informed about vaccinating their children. As more of the public conversation indeed battle takes place across social media, there is an urgent need to understand this online landscape. This, in turn, requires the use of effective monitoring tools. 2.3 Social media monitoring Social media analysis plays an important strategic role in understanding new forms of user-generated content8 . Indeed, this type of monitoring has become a leading trend in Marketing, PR, political campaigns, financial markets and other sectors. As demand for this kind of data increases, more monitoring tools are becoming available. These tools search social networks for relevant content, and archive the publicly available conversation in a database. Researchers conduct their internet analysis primarily by formulating combinations of keywords that can be placed in relation and weighted for importance. There are four different types of social media monitoring: Monitoring by volume looks at the amount of mentions, views and posts a topic, organization or user receives. Monitoring by channels maps and examines the various networks that users use to exchange content. Monitoring by engagement seeks deeper insight into how many users actually respond, like, share and participate with the content. Monitoring by sentiment analysis is a qualitative approach that uses word libraries to detect positive or negative attitudes by users towards an issue9. The first phase in social media monitoring is listening to what users say, because in order, for instance, to engage effectively with parents on social networks, it is important to know what they are talking about10. 7 Kata, 2012 8 Cooke et al, 2008 9 The approach must employ qualitative analysis as machines are not able to track sarcasm or slang. 10 Kotler et al, 2007 Page 8 Social media monitoring is a young discipline that began just a few years ago, and in its initial phase the practice faced a number of challenges. Data was very complex, so first generation monitoring tools produced results that were unstructured and generally overwhelming11. Even when that data was sorted and structured, organizations struggled to generate actionable management recommendations from it12. Since that time, however, social media professionals and research communities have made steady progress in overcoming the early challenges. 2.4 Influencers Recent studies on social media networks emphasize the central role played by influential individuals in shaping attitudes and disseminating information13. Indeed, it is argued that a group of such influencers is responsible for driving trends, influencing public opinion and recommending products14. One study found that 78% of consumers trusted social peer recommendations, while just 14% trusted advertisements15. Intensive interaction and content sharing through social media means that an audience instinctively determines its own opinion leaders. What makes opinion leaders particularly interesting and important from our perspective is that they add their personal interpretation to the media content and pass it on to their audience. Depending on whether these influencers speak responsibly or not, this can have positive or negative impact on the goal of disseminating accurate information. In his book The Panic Virus, journalist Seth Mnookin offers some examples of controversial influencers: A British gastroenterologist, Andrew Wakefield, entered into the vaccine discourse and alleged that the measles-mumps-rubella vaccine might cause autism. The medical community eventually dispelled his arguments and he lost his medical license. For a decade Wakefield - though not a public health specialist - very successfully disseminated misleading information and garnered a significant social media following. Meanwhile, actress and model Jenny McCarthy has become another self-proclaimed expert on vaccine safety. Through frequent public appearances she has positioned herself as an 11 Wiesenfeld et al, 201012 Owyang et al, 201013 Tsang et al, 2005; Kiss et al, 2008; Bodendorf et al, 201014 Keller and Berry, 200315 Qualman, 2010 Page 9 educated, internet-savvy mother set on challenging the medical establishments information about vaccinations. This, too, has helped fuel the recent growth in anti-vaccination sentiments. The public following and authority gained by Wakefield and McCarthy demonstrate how with the proliferation of online channels and the user as the centre of attention, it becomes difficult for information seekers to differentiate between professional and amateur content16. By the time the record is set straight, trust in immunization is been partly destroyed. Fostering the positive opinion of influencers in communities can have a disproportionately large impact in terms of online reputation17. Though they may not know each other in the real world, and despite ever-expanding advertisement platforms and sources, consumers around the world still place their greatest trust in other consumers18. Audiences listen to opinion leaders because they are known to be independent, credible and loyal to their peers19. Identifying and influencing the influencers of the social media conversation in the region should therefore be part of any effective strategy to reinforce positive messages in the vaccination debate. Though the internet is increasingly used to search for health information, a number of questions about social media and vaccination decisions are still unanswered: Which channels are used by anti-vaccination groups? What are the key arguments and conversation themes? What makes anti-vaccination messages appealing to parents? Who are the opinion leaders in online discussions? What are the best strategies to respond to anti-vaccination arguments? This paper seeks to understand the internal dynamics of anti-vaccination sentiment in social media networks in Eastern RESEARCHOBJECTIVES 16 Cooke et al, 200817 Ryan et al, 200918 Nielsen, 200919 Weiman, 1994 Page 10 Europe20. These insights are expected to help health workers, partners and national governments to develop appropriate response strategies in order to convince the public of the value, effectiveness and safety of vaccinations. The objectives of this research are: 1. To monitor social media networks, consolidate existing data and information from partners. 2. To categorize and analyse conversation themes, based on volume of discussion, influence, engagement and audience demographic as appropriate. 3. To identify influencers in the different language groups and platforms. 4. To contribute to a set of recommended strategies to address specific anti-vaccine sentiment around the various conversation themes. This content analysis is expected to help us understand the motivations and mind sets behind the sentiment, and offer clues that can inform the development of a strategy to effectively address the phenomenon. The research is also expected to help drawing comparisons between the anti-vaccination sentiment phenomenon and similar sentiments expressed against interventions in nutrition, child protection and other areas of UNICEF practice. This paper is supported by UNICEF Department of Communication in New York and UNICEF Regional Office for Central and Eastern Europe and the Commonwealth of Independent States. The region covers 22 countries and territories: Albania, Armenia, Azer-baijan, Belarus, Bosnia & Herzegovina, Bulgaria, Croatia, Georgia, Kazakhstan, Kosovo (UN Administered region), Kyrgyzstan, TFYR Macedonia, Moldova, Montenegro, Roma-nia, The Russian Federation, Serbia, Tajikistan, Turkey, Turkmenistan, Ukraine, Uzbekistan. UNICEF does not have a country programme in the Russia Federation but is in discussions to develop a new mode of engagement. Page 11 In order to assess the dynamics of the anti-vaccination sentiments in the four languages, a systematic mapping and content analysis via social media monitoring is proposed. For the purpose of stakeholder monitoring in social media, a combination of descriptive and exploratory methods in form of quantitative and qualitative observation is proposed. According Wiesenfeld, Bush and Skidar (2010) it is reasonable to combine both methods because social media monitoring offers the richness of qualitative research, with the sample sizes of quantitative research. It may also give the opportunity to overcome problems associated with each research method in order to understand stakeholders dynamics in social media. 4.1 Descriptive and Explorative Research Design The descriptive methodology involves recording the activities of users and events in a systematic manner. Information is recorded as events occur and archived. Descriptive research in this case involves: Figure 1: Research Process for data gathering and analysis. METHODOLOGY 12 Aggregating text from public accessible social networks in in English, Russian, Polish and Romanian language. Cleaning and categorizing the data over time. The data is categorized and analysed into reoccurring conversation themes, based on volume of posts, engagement and audience demographic as appropriate. The exploratory methodology follows the descriptive research to allow for the interpretation of patterns and to provide background understanding of sentiment and attitudes of users. The results of the structured observation will be put into context by the human judgement of the researcher through the participant observation. In this research, the researcher will be a complete observer and will not interact with the users during the participant observation (Saunders et al, 2009). 4.2 Data Collection Traditional sampling techniques such as random, convenience or judgemental sampling are difficult to apply to a fluid social media environment. On top of the social media measurement process, the selected social media channels feed into the sample set. The posts are further categorized into different issue arenas that will be associated with relevant stakeholders. Figure 1 presents the data collection process for monitoring stakeholders in social media.The process contains the following six steps: 1. Channels: The first step of the data collection process involved the selection of relevant social media channels. Social media monitoring is instead generally considered to provide a complete set of all contributors, because tools like Radian6 or Sysomos are designed to capture a wide range of social media channels, such as blogs, forums, Twitter, Tumblr, Youtube and Facebook. 2. Demographics: The software gathered relevant posts that were posted in English, Russian, Polish and Romanian language3 during the period of 1 May and 30 July 2012. Posts could be submitted from all regions worldwide. 3. Context: The quality of data collection is determined by how well the collected data is gathered with regards to formulated searches. Keyword logic and search profiles were employed to filter the data. The full list of keyword combination can be found in Appendix A. 3The approach must employ qualitative analysis as machines are not able to track sarcasm or slang. Page 13 4. Data Collection: Relevant social media mentions that contained an issue-related keyword in relation to a stakeholder-related keyword was archived in the database. The list of relevant mentions was stored chronologically and assigned an ID. The full list of exported information about each mention was stored in a separate EXCEL file. 5. Data Analysis: The empirical application and content analysis of the relevant posts can be found in Chapter 6. 4.3 Limitations There are limitations in terms of reliability and validity of the recorded data. The data collection covers a three-months period. There is a need for caution when generalizing the data because events and evolution of discussions may alter the findings in other time periods. Therefore, limitations in reliability refer to reproducibility of research results. Reliability in the extent to which measures are free from error and therefore provide consistent results, such as the consistency of data availability in social media monitoring, is the second limitations. Quantitative observation has relatively high reliability because it reduces the potential for observer bias and enhances the reliability of data (Malhorta et al, 2007). However, social media monitoring might carry the risk of monitoring bias, as the relevant posts are extracted through keyword logic that is developed by the researcher. The collected data cannot be regarded as complete. For example, the share of Russian-speaking discussions seems to be fairly low compared to the amount of users accessing social media. Governmental control and censorship might also be contributing for lower volumes.The external validity, which is defined as the extent to which the research results are applicable to other research settings (Malhotra et al, 2007), is relatively low. Because of the richness of data, the sampling needs to be based on the experience of the researcher. As a disadvantage, the lack of established sampling technique in social media limits the ability to generalize the findings to other relevant issue arenas or stakeholders in the population. However, the ability to generalize the results was enhanced by careful use of the theoretical terms and relationships in the stakeholder literature (especially Freeman, 1984; Mitchell et al, 1997; Luoma-aho et al, 2010; Owyang et al, 2010). 4.4 Ethical Considerations Monitoring social media conversations raises two important questions about a) the protection of privacy, and b) ethical concerns. The growth of interest in social media monitoring has Page 14 triggered a new debate about ethics, which centers on what is in the public domain and what is not (Poynter, 2010). Privacy is a big issue, and social networking sites are under public criticism for lax attitudes regarding the security and respect of users privacy (Wakefield, 2011). It is the responsibility of the market researcher to protect a respondents identity and not disclose it to external audiences (Malhotra et al, 2007). Social media monitoring offers a rich volume of data, however the Internet is largely unregulated. The data of users around the world is stored on servers in the US and completely available to the US authorities. What might seem legal to the researcher may not necessarily be deemed morally right by society. Public interactions in social media are available for anyone and can be assigned to a personal IP address, geographic location, language, date and even specific computer. For the purposes of this research, no personal data has been extracted. The IP addresses and geographic locations have not been stored in the excel exports as it is not necessary for the purpose of the research. A unique post ID identifies each post. The following findings start with an overview of the networks used by the anti-vaccination community. Trends in volume and engagement are outlined in 5.1. In 5.2, clusters of common belief of the anti-vaccination sentiment are categorized and explained. The importance of influence in the anti-vaccination discussion is illustrated 5.3 because it is critical to understand that communication needs require adjustment to each country or region, which itself can present a challenge. 5.1 Networks: Volume and Engagement During May to July 2012, the researchers recorded messages with anti-vaccination sentiment from 22,349 participants. The majority of participants spoke English, followed by Polish, Russian and Romanian. EMPIRICALFINDINGS Page 15 Figure 2: Participants of anti-vaccination discussions per language. Across all four researched languages, blogs are the most frequently used channel for posting anti-vaccination content in social media. Blog is short for weblog, which is a website normally maintained by an individual (or group of individuals) and updated with regular entries. Entries are typically displayed in chronological order and tagged with relevant keywords and phrases. Blog visitors usually have the opportunity comment and share the content on blogs. Blogs are by far the most important channel in terms of volume of posts in Romanian (86% of all posts) and Polish (85% of all posts). In Russian discussions, 65% of all posts are submitted on blogs and in English nearly half of the anti-vaccination content (47%) is posted on blogs. Facebook is the second largest channel in terms of volume of posts. The social network has a share of 25% in English speaking networks, 13% in Polish, 8% in Romanian, and 5% in Russian channels. Facebook allows users to build personal profiles accessible to other users for exchange of personal content and communication via the Facebook. Twitter, which allows users to send brief (<140 character-long) updates, is the second largest channel in Russian-speaking (24% of the total volume) and fourth with 5% in English-speaking anti-vaccination communities. Other channels to consider are News websites and Forums in which users post comments to engage in discussions about specific topics. Since 68% of all participants in the anti-vaccination discussions during the observed time-period speak English, the dataset is able to reveal more accurate insights into demographics compared to the other languages. Insights in all languages can be found in Appendix 4, while the following analysis focuses on the English Page 16 data set. The English dataset also reveals that blogs have generally the highest rates of mentions (61%), conversations (67%), posts (67%) and interactions (43%). Based on the volume of posts, it is a logical consequence that most engagement takes place on blogs. Engagement is defined as followed: Post: An initial message submitted to a social networking site, i.e. a blog post, Facebook status, tweet, video, etc. Interaction: Any activity created as a direct response to an initial post, i.e. comments, likes, retweets, @replies, etc. Conversation: The sum of a post and all its related interactions. Note: a post with at least one interaction is considered as conversation. Mention: An appearance of search terms in a public social media space. Figure 3: Distribution by channel for Romanian, Russian, English and Polish networks Page 17 Blogs, forums, and Facebook are the leading networks for anti-vaccination discussions in English during the observed time-period. In other words, the anti-vaccination sentiments are expressed on those platforms through posting user-generated content. However, while conversations on forums only makeup 2% of total conversations, they account for 25% of all interactions among users. This indicates a heavily engaged audience. It can Figure 4: Mentions, Conversations, Posts and Interactions per channel. Page 18 be argued that opinions are formed during interactions among users and therefore, it is vital to add pro-vaccination content to the discussions on forums. Similarly, Facebook only contains 9% of conversations, but 21% of interactions. Both channels are important to consider for interactions with the anti-vaccination sentiment even if more posts occur on blogs. Similar findings occur in Forums. Forums are designed to be interactive conversation, where topics are discussed in greater depth. The English dataset is a reflection of this distinguish feature 16% of all posts and 25% of all interaction occur on Forums. The figures show that while the volume of content on Forums is relatively low, the engagement is an important strength that shaped the opinion in the anti-vaccination community. Figure 5 indicates that the data skews towards female audiences when issues such as developmental disabilities (59%), chemicals and toxins (56%) and side effects (54%) are discussed within the anti-vaccination sentiment, whereas men focus on arguments around conspiracy theory (63%) and religious/ethical beliefs (58%). Anti-vaccination social media participants are approximately 56% female and 44% male. Figure 5: Gender comparison in English per argument. Page 19 5.2 Common Arguments The amount of argument-mentions in anti-vaccination sentiment changes significantly by language during the observed time-period. Figure 6 illustrates that conspiracy theory and religious/ethical beliefs are the main topic trends in English, while religious/ethical beliefs drive the majority of discussions in Russian speaking anti-vaccination discussions. Polish anti-vaccination discussions are driven by arguments about side effects and chemicals and toxins in vaccines. The issue of chemicals and toxins is the major driver in Romanian discussions during the observed time-period. The arguments are described in detail in the following sections. The categories are based on keyword strings that were narrowed down over time. Issues should not be regarded in a static way, they might overlap and are interconnected. 5.2.1 Religious and Ethical Beliefs Religious and ethical discussions are especially active in discussion in Russian, with 96% of all anti-vaccination discussions focused on that issue. In English discussions, 32% of all anti-vaccination discussion use religious and ethical arguments. The arguments are less relevant in Polish (5%) and Romanian (0%) speaking anti-vaccination discussions. The main train of thought derives from Figure 6: Allocation of arguments by language for the anti-vaccination sentiment. Page 20 the belief that humans are created just as they should be and external interference is not required. My body was designed by God to be self healing and self regulating and no man will be able to do better than God is a quote by a female blog commentator from the US. Another user states, anything that involves substances that should never belong in a humans body, should not be injected or consumed without that individuals consent. Anti-vaccination advocates believe in homeopathy and alternative medicine. My BodyMy Decision writes a community member from Australia. A broad sentiment that mandatory vaccination is a violation of human rights can also be detected. From an ethical standpoint, the anti-vaccination community claims that it is a basic human right to be free from unwanted medical interventions, like vaccine injections. The same kind of argumentation can be recorded in all four languages. On June 15th 2012, the Polish Parliament voted to change the existing laws on vaccinations. The Act on Preventing and Fighting Infections and Infectious Diseases in Humans and in The Act on National Sanitary Inspection has created controversy among social media users because of it makes vaccination mandatory. The anti-vaccination advocates were sending petitions to the Polish President demanding him to stop the act. The petition received support from some representatives of the Catholic Church, but not an official support from the church as whole. Radio Maryja, the most powerful independent catholic media in the country, also critiqued the act based upon: The argument that vaccines are made based on cell lines derived from the bodies of babies killed by abortion. The notion of unethical activities by campaigning teenagers and women to be vaccinated against HPV infection and it is promoting immoral, and disorderly behaviour in the area of sexuality. 5.2.2 Safety and efficacy Side effects are the most common anti-vaccination theme in Polish networks (28%), but they also play a role in English networks (9%) and Romanian (5%). The argument is mentioned in less than 1% of all anti-vaccination discussions in Russian language. Typically, parents who reach out to online communities because they are unsure about vaccines trigger the discussions about side effects. Individual stories from parents are powerful because they humanize the discussion. One user writes, My baby is 5 months old, not vaccinated and he is going through pertussis right now! Its very scary! I HATE it! I have 3 children, the other 2 were vaccinated but Im scared to vaccinate my baby! Any other mommys new at Page 21 this? This quote reflects a level of fear and uncertainty about the right thing to do, even though the mother has experienced both the effect of vaccines and vaccine-preventable diseases. Another parent writes: My brother, sister in law, and all three kids under the age 5 were vaccinated for whooping cough and they all got it! An argument in a Russian network claims that live vaccines can mutate in the organism and create deadly strains. The fear of side effects leads to discussion about vaccines causing diseases and death. A user from the UK argues, The only way you can get this virus is if it is injected into you. Besides individual stories, argumentation backed by figures without context or sources are equally powerful in fostering fear of vaccines. For example, a member in one English network posts: Vaccinated children have up to 500% more diseases than unvaccinated children. Community members in Russia postulate that vaccinated children get sick 2-5 times more often than non-vaccinated children. For example in Romania, school nurses perform the mandatory vaccination during class, which is seen as a human rights violation and a safety issue. Parents are sceptical about the skills of the school nurses and feel surpassed by authorities in its decision to have children vaccinated. A user in a Polish anti-vaccination community states: I am a mother of two disabled children. When my daughter was five months old, she had a negative reaction to the vaccine, now she has been diagnosed with autism and mental retardation. For 10 years, I did not vaccinate my children and I would not want the right to decide on this matter taken away from me. I am an educated person, and have researched the subject and do not believe in the efficacy or safety of vaccinations. 5.2.3 Developmental Disabilities Another reoccurring argument in the anti-vaccination sentiment claims that vaccines contain toxins and harmful ingredients. Injecting vaccines into the body of a child leads to brain injury and developmental disabilities. This theme is discussed in 15% of all English and Polish speaking anti-vaccination discussions. Development Disabilities was in less than 1% of anti-vaccination discussions mentioned in Russian or Romanian networks. The arguments evolve from sentiment surrounding vaccines posing challenges to the immune system and producing antibodies that may cause autoimmune diseases. Another notable argument is that vaccines are not able to fight off the mutant viruses that develop over time. Across communities, anti-vaccination advocates link vaccines to Page 22 epilepsy, autism and neurodegenerative diseases (Parkinson and Alzheimer). A member of the Polish community writes: Mercury causes developmental disorders in children (including epilepsy and autism), in adults, neurodegenerative diseases (Parkinsons and Alzheimers), and degenerative changes in the reproductive systems of men and women, impairing their ability to reproduce offspring. It is notable that figures are used based on estimates by the author without links to sources. A Russian speaking user notes that vaccinations against pandemic influenza H1N1, also known as swine, can lead to the development of Guillain-Barr syndrome, acute poliradikulita in adults, according to Canadian researchers, published in the journal JAMA. 5.2.4 Chemicals, Toxins and Unnecessary(administration of vaccines) Our doctor has advised us to avoid vaccines in absence of a direct disease risk, since the long-term side effects have not been studied writes a member of an English-speaking community. One common argument recorded in the anti-vaccination sentiment is that studies about risks and impact of vaccinations are insufficient. Vaccines have not been tested enough and have concerns regarding the lack of long-term side effects studies. Another user states that I would really want to know whether and how well vaccine manufacturers test their final vaccine products () and how much contamination they discover. A common belief is that children having a vaccine-preventable illness just need food, water, and sanitation. In Polish communities, members use the example of Scandinavian countries lobbying for a ban of questionable and potentially harmful ingredients in vaccines. The notion that Scandinavian countries banned Thimerosal a long time ago and they have a much lower percentage of children with autism was classified was an important argument for users. Drawing on that example, the most common belief in Polish communities is that mercury may cause autism. A Russian-speaking user concludes, a recent large study confirms the results of other independent observations, which compared vaccinated and unvaccinated children. They all show that vaccinated children suffer 2 to 5 times more often than non-vaccinated children. Sources or links to the recited studies are not provided. 5.2.5 Conspiracy Theory, Western Plot and Conflict of Interest In English-speaking anti-vaccination communities (24%), a strong distrust against governments and pharmaceutical industry is Page 23 recorded. The same applies for Polish (5%), Russian (1%) and Romanian (3%) at a smaller scale. However, the U.S. and western governments are viewed critically when discussing about governments and conflict of interest. In Polish networks excessive vaccinations are seen as promoted by pharmaceutical companies in order to gain profits. The role of the pharmaceutical industry is discussed mostly negatively. The sector is regarded as corrupt marketing machine. An English-speaking user states that: In the vaccine industry, scientific fraud and conflicts of interests are causing a similar cycle of deaths and injuries that is being concealed and denied by regulators and vaccine manufacturers. The industry is viewed as profit-driven and has moved from its original purpose to save lives and protect humans. Romanian discussions directly blame the U.S. for purposefully infecting people with HIV using polio vaccines. Users create a direct link between vaccines and widespread HIV in Romanian orphanages. In the same sense, users claim that vaccines are being used against the Romanian populations. According to members of the anti-vaccination sentiment, vaccines against polio and chickenpox are used in Romania, which are not used in the U.S. anymore. Polish anti-vaccination communities state the examples of swine flu and bird flu two years ago. According to the users, both cases are plots by giant pharmaceutical companies. Some countries desperately bought a huge quantity of vaccines, while Poland acted rationally and did not buy the vaccines, which saved the state budget a couple of billion. The activists are suspicious because the epidemic ended after the new vaccines were purchased by several governments. The distrust against governments is also reflected in conspiracy theories. Patterns in English-speaking communities suggest that immunization is used to control and reduce the world population. One strain of argumentation is that vaccines that are not allowed in developed countries are imported to developing countries in order to reduce population growth. 5.3 Influencers Opinion leaders in anti-vaccination sentiment show varying characteristics across countries. However, they often appear to be well educated in alternative medicine. Some have no college education; others are in the medical field (such as nurses). A high level of volume and interaction can be recorded for influencers. They often subscribe to social channels of homeopaths and Page 24 alternative medicine advocates but they can be found across platforms. The following section lists a range of influencers that are active in different channels or languages: Name Position Facebook Fans Twitter Followers Blog Language Dr. Tennpen-ny The Voice of Reason about Vaccines 36,282 1,475 Yes English The Truth About Vac-cines Answering questions from concerned parents 21,246 N/A Yes English International Medical Council on Vaccination Purpose is to counter the messages asserted by pharmaceutical com-panies, the government and medical agencies that vaccines are safe, effective and harmless 7,983 N/A Yes English The Refusers "Vaccination choice is a fundamental human right." 9,069 12,457 Yes English Mothering Magazine Mothering is the pre-mier community for naturally minded par-ents. 66,504 102,173 Yes English Oglnopo-lskie Sto-warzyszenie Wiedzy o Szczepieniach STOP NOP Protest against new laws for mandatory vaccinations in Poland and against disinforma-tion campaigns about the effectiveness and safety of vaccines. 3,203 N/A Yes Polish STOP Pr-zymusowi Szczepie Petition campaign against new new laws for mandatory vaccina-tions in Poland. 2,866 58 Yes Polish Table 1: Examples of influencers in the anti-vaccination sentiment in social media. Page 25 With respect to the above-mentioned arguments, opinion leaders in the anti-vaccination movement put an emphasis on highlighting negative stories that focus on individual cases. In some cases, they blame outbreaks on shedding vaccinated children who get unvaccinated children sick. The argumentation is based on the conviction that vaccines are unsafe and dont work. A list of common arguments by arguments by influencers per language can be obtained in Appendix B. In this section the research question will be discussed in light of the theoretical and empirical findings. It needs to be noted that the discussion only focuses on engagement with anti-vaccination advocates in the four researched languages. This does not include pro-vaccination movements, medical professionals, partners or others. The discussion will propose a model that illustrates the different drivers of anti-vaccination sentiment based on three elements. The recommendations section builds on the three elements of the model and provides practical advice for communication strategies. 6.1 Discussion In order to develop engagement and messaging strategies for anti-vaccination sentiment, it is vital to have an abstract understanding of what drives users to become suspicious about vaccinations. Based on the findings, the paper proposes a model of anti-vaccination sentiment identification and salience. We classify three main spheres that attribute to a negative sentiment towards vaccine, which help us in the identification of trends within the anti-vaccination sentiment. The classification is illustrated in the following figure: DISCUSSION &RECOMMENDATIONS Page 26 The first attribute is the individual sphere. The main motivations for users to get involved are highly personal matters driven by concern and fear. When it comes to vaccinations, some parents are not sure what the right decision is. Am I a good mother if I do not get my child vaccinated or is it my responsibility as a caring parent to ensure the best protection for my child? Personal testimonies of other parents, especially negative stories, have a huge impact on the parent and fuel the concern. The second element that characterizes the anti-vaccination sentiment is the contextual sphere. The main driver behind the contextual sphere is a distrust of governments, pharmaceutical industry, scientific bodies and international organizations. It seems to be overwhelming for parents to understand the role of the big players. An interesting observation is that users in the contextual sphere do not seem to have a general resentment against vaccines per se but most arguments focus on lack of transparency in the decision processes as well as the potential conflict of interests trigger distrust. The third attribute is labeled as transcendental sphere. Negative attitudes towards vaccinations are derived from idealistic, religious and ethical beliefs. Arguments are rooted in strong beliefs and appear dogmatic, such as God creates us in the most ideal way or a body has its natural balance. Figure 7: Model of anti-vaccination sentiment identification and salience. Page 27 Individual, contextual and transcendental sphere are the key attributes of a member of the anti-vaccination movement. We argue that the various combinations of these attributes are indicators of the salience of members. We can identify four groups that derive from Figure 3. In order to understand salience within anti-vaccination community members, we propose the following classification Core Members are users that apply to all three spheres. They are concerned about side effects, distrust the government and live according to strong religious or ethical beliefs. Intense Members are members that apply to two of the three spheres. For example, a user might have concerns about vaccinations based on an individual sphere and also carry distrust against the pharmaceutical industry. But they are not driven by any idealistic beliefs. Alert Members are users that apply only to one of the three spheres. The doubt about vaccines derives only from one sphere and has human characteristics. They seem to be less convinced of the harm of vaccinations than the other two member groups. There is a fourth group of users, the Non-Members. They simply do not apply to any of the classification. We argue that Alert Members are easier to convince of the necessity of vaccines than Intense Members. Core Members are the hardest to convince, because the arguments against vaccines are based on various foundations. The findings also show that the intensity of argumentation, the interaction and the volume varies between the spheres. Therefore, the next section outlines practical recommendation on how to draft engagement strategies for each sphere. 6.2 Recommendations The following graphic summarizes the framework for the engagement and messaging plan that enables communication officers and health workers to react to the anti-vaccination sentiments. The framework is designed to be customizable for local realities. However, it does provide an overarching guidance for communication and campaigning initiatives. Members of the individual sphere should be approached with an emotional appeal. Users in this sphere go online and search for information in order to make an informed decision. Content that encourages parents to get their children vaccinated needs to be easy to find. Hence, search engine optimization plays an important role in the outreach strategy. Search marketing is used to gain visibility on search engines when users search for terms that relate to immunization. In order to appear on top if the search Page 28 results two general approaches should be considers: Organic search (SEO): When you immunization or vaccines into a search engine like Google or Yahoo!, vthe organic results are displayed in the main space of the results-page. For example, when parents search for information about vaccinations, pro-vaccine information should rank on top of the search engine results. By optimizing websites and posts, organizations and governments can improve the ranking for important search terms and phrases (keywords). Engaging actively in discussion and providing links to pro-vaccination content also helps to increase the visibility in the ranking. Paid search (SEM) enables to buy space in the sponsored area of a search engine. There are a variety of paid search programs, but the most common is called pay-per-click (PPC), meaning the information provider only pays for a listing when a user clicks the ad. The emphasis of the content strategy is to empower parents to ask doctors the right question in order to build confidence for the decision making process. Rather than criticising parents choices not to vaccinate, the messaging should promote an individuals ability to make the world a safer place for children. The communication strategy should also highlight the individual right and responsibility to choose to vaccinate. Through emotional Figure 8: Engagement Matrix for core spheres of the anti-vaccination movement. Page 29 messaging, hesitating parents should receive key information and explain how their choices affect their own children and the ones of others. The communities in the contextual sphere source their scepticism from general distrust against the large players involved in the vaccination industry. The engagement strategy should be based on a rational appeal that focuses on the hard facts of vaccines. It is important to avoid obvious communication tactics. Transparency about vaccines, testing, ingredients, potential side effects, funding and preventable diseases is crucial to reduce distrust. The messaging should also take into account past errors in vaccine campaigns by governments and suppliers in the regions and most importantly focus on the lessons learnt and how processes have been improving since then. Transparency can be built through a multi-channel approach that features the development of vaccines with expert testimonies. Successful cases, such as the near eradication of polio as a global effort, help to reduce distrust as well. This can be backed by official statistics on how infant mortality rates have been reduced over the past 20 years. Countries that generally have a favourable public perception, such as Scandinavian countries,

PREVENTING A LOST DECADEUrgent action to reverse the devastating impact of COVID-19 on children and young people For 75 years, UNICEF has delivered for children. From armed conflict, natural disasters and humanitarian crises to long-term survival and development programmes, our staff and partners have been on the ground working to provide essential services for those in need. Through the decades, UNICEF has helped to develop healthier and safer environments for children and their families. Take one example vaccines. In the 1980s, UNICEF and partners embarked on a bold mission to immunize every child against preventable diseases. Together with governments, we facilitated one of the greatest logistical mobilizations in peacetime history. By the early 1990s, global childhood immunization levels reached 80 per cent. Before the pandemic, we had made great strides toward helping all children realize their right to health, education and protection. At the start of 2020, more children were living to see their first birthday than at any time in history. Child mortality had fallen by 50 per cent since 2000. Maternal mortality and child marriages were on the decline and more girls were going to and staying in school than ever before. Yet multiple crises are now threatening those hard-fought gains for children. The COVID-19 pandemic has been the biggest threat to children in our 75-year history. While the number of children who are hungry, out of school, abused, living in poverty or forced into marriage is going up, the number of children with access to health care, vaccines, sufficient food and essential services is going down. The COVID-19 pandemic, a worsening climate crisis, armed conflict, displacement and other humanitarian emergencies are depriving children of their health and well-being. These developments portend an even more challenging future a future in which the world could fall short of meeting the Sustainable Development Goals (SDGs) to end poverty, reduce inequality and build more peaceful, prosperous societies by 2030. In September, UN-Secretary General Guterres laid out the stakes to an audience of world leaders: I am here to sound the alarm. The world must wake up. We are on the edge of an abyss and moving in the wrong direction. FOREWORD The world stands at a crossroads. We have a decision to make. Do we rally and unite to protect years of progress on child rights? Or do we allow the unequal recovery from COVID-19 to further marginalize the disadvantaged and increase inequality even more? UNICEF was created at another moment of crisis. Much of the world lay in ruins following years of war. Then, as now, marginalized and vulnerable children were most affected. In this context, UNICEF was created with the mandate to uphold and defend the rights of every child. So as we commemorate UNICEFs 75th year, we must also take stock of the work yet to be done for children. Now and in the years to come, we will continue to strive to create a world where childrens rights are fully realized, and where we open opportunities for every child. This is an ambitious undertaking that depends on new and strengthened partnerships with governments, civil society, our UN sister agencies and business. But together, we can build on the foundation of 75 years of results forchildren. In the aftermath of the Second World War, the private sector was instrumental in helping to rebuild economies, services and systems for children. In the years to come, the private sector will be a pivotal partner in driving innovation and technology to help us provide better services to more children andfamilies. And of course, children and young people are the most important partners of all. They are more than voices and beneficiaries they are integral participants in creating and implementing solutions. Their strength, creativity and courage give me hope. By working with them, we can respond to and recover from the pandemic equitably and reimagine a better future for every child. Henrietta ForeUNICEF Executive Director Introduction A protracted pandemic with unequal impact A reimagined future 75 years of delivering for children 6 9 11 12 COVID-19s ongoing impact on children CONTENTS 1 Poverty Health and immunization Education Child protection Nutrition Mental health Humanitarian emergencies First in line for investment, last in line for cuts:An urgent agenda for action for children 1. Invest in social protection, human capital, and spending for an inclusive and resilient recovery. 2. End the pandemic and reverse the alarming rollback in child health and nutrition 3. Build back stronger by ensuring quality education, protection, and good mental health for every child 4. Build resilience to better prevent, respond to, and protect children from crises 15 16 19 20 21 22 24 25 Foreword Key messages 2 3 2 4 27 28 32 36 40 Preventing a lost decade: Urgent action to reverse the devastating impact of COVID-19 on children and young people4 The problem COVID-19 is the worst crisis for children in UNICEFs 75-year history. Without action, the world faces a lost decade for children, leaving the Sustainable Development Goals an impossible dream. In less than two years, 100 million more children have fallen into poverty, a 10 per cent increase since 2019. In a best-case scenario, it will take seven to eight years to recover and return to pre-COVID-19 child poverty levels. The deep disparity in recovery from the pandemic is widening the gap between richer and poorer countries. While richer countries are recovering, poorer countries are saddled with debt and development gains are falling behind. The poverty rate continues to rise in low-income countries and least developed countries. The danger For the best-case scenario to become a reality, we must take action now. Even before the pandemic, around 1 billion children worldwide, and half of all children in developing countries, suffered at least one severe deprivation, without minimum levels of access to education, health, housing, nutrition, sanitation or water. The world stands at a crossroads. We must decide to either protect and expand the gains made for child rights over years, or suffer the consequences of reversed progress and a lost decade for todays children and young people, which will be felt by all of us, everywhere. KEY MESSAGES A child drinks water from the only source in Hesbi Camp, South Lebanon, October 2021. UNICEF/UN0553717/Choufany 5 But theres hope Far from feeling powerless in the face of challenge, todays children and young people welcome change and challenges, forging ahead with resilience and courage. Rather than consigning themselves to an already determined future, they are taking action. Todays young generation are more hopeful and confident that the world is becoming a better place. Todays crises also present a unique window of opportunity for the world to reimagine itself as a fair, safe, interdependent whole in which every childs potential stands an equal chance of fulfillment. For 75 years, UNICEF has been the worlds leading architect and advocate for child rights, whose work in delivering for every child, especially in times of crisis, is as critical today as ever. This is not a moment to be cautious. This is the time to work together and build a better future. What must happen Make our collective future our children first in line for investment and last in line for cuts. This agenda for action is based on UNICEFs 75years of experience, research and practice and 75 years of listening to children and young people. To respond and recover and to reimagine the future for every child, UNICEF continues to call for: Investing in social protection, human capital and spending for an inclusive and resilient recovery Ending the pandemic and reversing the alarming rollback in child health and nutrition including through leveraging UNICEFs vital role in COVID-19 vaccine distribution Building back stronger by ensuring quality education, protection and good mental health for every child Building resilience to better prevent, respond to and protect children from crises including new approaches to end famines, protect children from climate change and reimagine disaster spending. KEY MESSAGES Rukaiya Abbas, a UNICEF Nigeria Education Officer, talks with children at Kulmsulum School in Maiduguri, Nigeria. UNICEF/UN0322355/Kokic Preventing a lost decade: Urgent action to reverse the devastating impact of COVID-19 on children and young people6 COVID-19 is the worst crisis for children in UNICEFs 75-year history. Almost two years into the pandemic, its widespread impact continues to deepen, increasing poverty and entrenching inequality. While some countries are recovering and rebuilding in a new normal, for too many, COVID-19 remains a catastrophe. The global response so far has been deeply unequal and inadequate. The world now stands at a crossroads. The actions we take now will determine the well-being and rights of children for years to come. The unequal rollout of COVID-19 vaccines is putting entire communities at risk. And as new variants continue to emerge, children and their communities continue to face health risks. Increases in poverty have set back progress toward realizing childrens rights and achieving the Sustainable Development Goals. Childrens diets have deteriorated, and families struggle to find ways to find enough food and safe water for their children. By September 2021, schoolchildren around the world have lost an estimated 1.8 trillion hours of in-person learning due to COVID-related school closures, which will have profound long-term, unequal social and economic effects. Essential nutrition and health services such as routine immunization programmes and maternal and childcare continue to be disrupted. School closures, job losses among families and increased stress and anxiety have affected the mental health of children and young people. COVID-19 remains an urgent crisis for children that requires sustained, focused action. As we commemorate UNICEFs 75th year, this report lays out the work in front of us by taking stock of the ongoing impact of COVID-19 on children and the road to respond and recover to reimagine the future for every child. INTRODUCTION 7 According to my experience studying during the pandemic, whether it was distance learning or a mix of distance and in person, it provokes a great loss of interest. There is frustration, anxiety, panic, wanting to drop out of school and well, all of this has a great impact on our mental health. I think our generation questions many things. We talk about what is taboo, but above all, we stand up and raise our voice without letting anyone silence us. We come together regardless of our differences and this is a really good thing to be able to achieve the same goal. We want to use empathy to leave behind a good planet, a good world, a good place for future generations. Sofia, Uruguay. From UNICEFs Coping with COVID, Season 2. Girls play together after school in Montevideo, Uruguay. UNICEF/UN0343234/Pazos INTRODUCTION Preventing a lost decade: Urgent action to reverse the devastating impact of COVID-19 on children and young people8 Preventing a lost decade: Urgent action to reverse the devastating impact of COVID-19 on children and young people8 AN URGENT MOMENT: THE VAST IMPACT OF MULTIPLE CRISES Children today are growing up in a world facing multiple crises. The costs are not affecting all children equally. The most marginalized and vulnerable are hurt the most and vast disparities in health, education, mental health, poverty and migrants remain: In 2020, over 23 million children missed out on essential vaccines an increase of nearly 4 million from 2019, and the highest number since 2009. At its peak, more than 1.5 billion students were out of school due to nationwide shutdowns. Millions of children are either not in school or not learning the basic skills they need to build a better future. Mental health conditions affect more than 13 per cent of adolescents aged 1019 worldwide. Globally, 426 million children nearly 1 in 5 live in conflict zones that are becoming more intense and taking heavier toll on civilians, disproportionally affecting children. Women and girls are at the highest risk of conflict-related sexual violence. Eighty per cent of all humanitarian needs are driven by conflict. 50 million children suffer from wasting, the most life-threatening form of malnutrition, and this figure could increase by 9 million by 2022 due to the pandemics impact on childrens diets, nutrition services and feeding practices. Approximately 1 billion children nearly half of the worlds children live in countries that are at an extremely high risk from the impacts of climate change. More children are displaced than ever before. Last year, more than 82 million people worldwide were forcibly displaced. Health workers carry vaccines for COVID-19 vaccination session in Ramgarh, Banswada, India. UNICEF/UN0499236/ Bhardwaj 9 A PROTRACTED PANDEMIC WITH UNEQUAL IMPACT Around the world, the pandemic continues to wreak havoc on young lives. COVID-19 has affected essentially every child in the world. But it has not affected all children equally. Governments are scrambling to accelerate vaccination programmes while prolonging or even reintroducing public health measures. A survey of UNICEF Country Offices from March and April 2021 report that all countries not only those with ongoing humanitarian response or that are off-track towards reducing child mortality rates continue to face some severe service disruptions due to the COVID-19 pandemic and response. Countries with Humanitarian Action for Children (HAC) appeals are more affected. Lockdown measures that restrict mobility, access and transportation are a leading reason for service disruptions. The economic recovery has been deeply unequal. While richer countries are expected to regain all pandemic losses before the end of 2022, low-income countries face a fiscal and economic crisis that could last for years. And while richer countries are spending trillions on stimulus programmes and rolling out COVID-19 vaccines, low-income countries face slower economic growth, vaccine shortages, food insecurity and deepening poverty. With many lower-income countries in debt distress, the pandemic is widening the gap between rich and poor countries. Nowhere is this clearer than the roll-out of COVID-19 vaccines. The triumph of science and human inventiveness led to the creation of life-saving vaccines in record time. Yet as those in richer countries have access, many in poorer countries still wait for their first dose. As of 1 November 2021, over 80 per cent of administered COVID-19 vaccine doses have been in high- and upper-middle-income countries. Just 1.5 per cent have been given in low-income countries. At the Global COVID-19 Summit in September, world leaders set a target that every country should vaccinate 70 per cent of its population by mid-2022. Yet according to one estimate, the more than 85 low-income countries will not reach a vaccination rate of 60 per cent until 2023, or even later. This unjust rollout not only affects those who lack access to vaccines but it also affects the entire world. As the virus continues to spread, the more it continues to mutate, potentially into more dangerous variants. The pandemic will not be over for anyone until it is over for everyone. A PROTRACTED PANDEMIC WITH UNEQUAL IMPACT Preventing a lost decade: Urgent action to reverse the devastating impact of COVID-19 on children and young people10 COVID-19 changed how I look at the world. We have had to learn to adapt quickly to unpredictable conditions. COVID-19 changed me personally to take better care of my health and cleanliness and to take care of each other I still want to be an agent of change and give more contributions to the children in Indonesia, in particular, the children in Kabupaten Bone My hope for Indonesian girls is that they can pursue as high an education as possible without obstacles, such as child marriage, arranged marriage and other things. I wish that people realized that education is the most significant thing. Zulfa, Indonesia. From UNICEFs Coping with COVID, Season 2. Endah puts a mask on her daughter Fatima, 3, before leaving their home in Bekasi, West Java province, Indonesia. UNICEF/UNI346202/Wilander 11 A year ago, we urged the world to take action to avert a lost COVID generation. One year later, it is clear that far from being powerless in the face of challenge, todays children and young people are the welcome generation welcoming change and challenges, forging ahead with resilience and courage. Rather than consigning themselves to an already determined future, they are taking action and opening new opportunities. Todays young generation is more hopeful and confident that the world is becoming a better place. UNICEFs Changing Childhood project surveyed over 20,000 people across 21 countries and found that instead of despairing in the face of inequality and the climate crisis, the young are instead more confident that the world is becoming a better place compared to those aged 40 and older. The survey also found that todays young people are more likely than the older generation to recognize the progress made as living standards have risen and access to services has expanded. The expectations of children and young people are changing. They want to be more than voices speaking out and beneficiaries of services. They are rights-holders and act as agents of change and participants in creating and implementing solutions. From addressing the climate crisis, mental health, education, xenophobia, racism and discrimination they are calling for adults to reimagine a better future. As adults, we need to listen to and learn from their perspective. We cannot afford to fail them. As UNICEF commemorates its 75th anniversary, we are recommitting ourselves with a new spirit of urgency to work with partners, supporters and children and young people all over the world to ensure children survive and thrive into healthy, productive adulthood and protect the most marginalized and vulnerable. A REIMAGINED FUTURE Children should be first in line for investment and last in line for cuts. We are starting our 76th year by calling for urgent action to respond to and recover from COVID-19. An equitable recovery will not only reverse the effects of the pandemic, but also build a foundation for responding to future crises and reverse the deep inequalities that affect children: 1. Invest in social protection human capital and spending for an inclusive and resilient recovery: Ensure an inclusive recovery for every child Invest in the untapped potential of young migrants, refugees, and internally displaced people. 2. End the pandemic and reverse the alarming rollback in child health and nutrition, including through leveraging UNICEFs vital role in COVID-19 vaccine distribution: Ensure fair and equitable access to COVID-19 vaccines Protect children from deadly but treatable diseases Reverse the child nutrition crisis. 3. Build back stronger by ensuring quality education, protection and good mental health for every child: Resume in-person learning and improve quality education for every child. Invest in the mental health and well-being of children and young people. 4. Build resilience to better prevent, respond to and protect children from crises, including new approaches to end famines, protect children from climate change, and reimagine disaster spending: Consign famine and food insecurity to history Take urgent action to protect children from climate change and slow the devastating rise in global temperatures Reimagine disaster spending. Redouble efforts to protect children in war A REIMAGINED FUTURE OF DELIVERING FOR CHILDREN 75 YEARS Following the 1989 adoption of the Convention on the Rights of the Child the most comprehensive international legal framework on childrens rights UNICEF brought nations together under the banner of childrens rights and adopted a human rights-based approach to programming, placing human rights principles at the centre of its work. Inthe 1990s, UNICEF also developed School-in-a-Box, which continues to keep children learning in emergency settings. On a global scale, childrens health and well-being have improved significantly since 1946. Together with partners, UNICEF has developed life-changing innovations for children: the India MarkII family of water handpumps developed in the 1970s is still the worlds most widely used human-powered pump. 1946 1970s 1980s 1990s When UNICEF was founded in 1946 during the aftermath of World War II, the world faced unprecedented devastation. The worlds children needed the support, services and advocacy that UNICEF could provide. Photographs: top left UNICEF/UNI43138/Unknown, top right UNICEF/UN0300443/Bannon, bottom left UNICEF/UNI43280/Wolff, bottom right UNICEF/ UN0339499/Frank Dejongh In the early 1980s, UNICEF launched the Child Survival and Development Revolution, a drive to save the lives of millions of children each year, focusing on four low-cost measures: growth monitoring, oral rehydration therapy, promotion of breastfeeding and immunization. A decade later, UNICEF took a leading role in challenging systemic inequity around the world. In 2015, the world began working toward a new global development agenda, seeking to achieve, by 2030, new targets set out in the Sustainable Development Goals (SDGs). But there is still much to do. Deeply ingrained discrimination, poverty and inequality are leaving too many children and young people behind. UNICEF is dedicated to continuing to reach children from the poorest, most disadvantaged households, communities and countries. 2000s 2010s 2020s Photographs: top left UNICEF/UN0519450/Upadhayay, top right UNICEF/UN0528415/Sujan, bottom left UNICEF/UNI187128/Noorani, bottom right UNICEF/UN0546107/Contreras In the 2000s, UNICEF brought to scale a ready-to-use therapeutic food, which has become the global standard to treat children suffering from malnutrition. From 2000 to 2019, scaling up of coverage of malaria prevention and treatment, such as insecticide-treated nets, malaria rapid testing and drugs, reduced global malaria mortality by 60 per cent. And in 2020, as the world grappled with the COVID-19 pandemic, UNICEF played a key role in the UN-wide response and led efforts to procure and supply COVID-19 vaccines so that all countries have fair and equitable access to the vaccine as part of the COVID-19 Vaccine Global Access Facility (COVAX). Preventing a lost decade: Urgent action to reverse the devastating impact of COVID-19 on children and young people14 Hamsatou, 13, washes her hands at the Socoura displacement camp in Mopti, Mali. UNICEF/ UN0488966/ Keta 15 COVID-19S ONGOING IMPACT ON CHILDREN Conflicts are increasingly affecting civilians, disproportionately affecting children, with women and girls at increased risk of conflict-related sexual violence. In 2020, over 23 million children missed out on essential vaccines, the highest number since 2009. The percentage of children living in multidimensional poverty is projected to have increased from 4648per cent pre-COVID-19 to around 52 per cent in 2021, an increase of 100 million additional children. The percentage of children in monetary poor households is projected to have increased from 32 per cent in 2019 to 35 per cent in 2021, more than 60 million more children compared to before the pandemic. At the peak of the pandemic, 1.8 billion children lived in the 104 countries where violence prevention and response services were seriously disrupted. By October 2020, the pandemic had disrupted or halted critical mental health services in 93percent of countries worldwide Schools were closed worldwide for almost 80 per cent of the in-person instruction time during the first year of the pandemic. At its peak in March 2020, 1.6 billion learners (90percent of total learners worldwide) were facing school closure. 50 million children suffer from wasting, the most life-threatening form of malnutrition. This figure could increase by 9million by 2022 because of the impact of the pandemic. COVID-19S ONGOING IMPACT ON CHILDREN Preventing a lost decade: Urgent action to reverse the devastating impact of COVID-19 on children and young people16 The COVID-19 pandemic is reversing progress in the fight against child poverty. Although in much of the world, child poverty levels in late 2021 are not as high as in the early months of the pandemic in 2020, it will take at least seven to eight years to recover and return to pre-COVID-19 child poverty levels. Simply put, the recovery is not fast enough. UNICEF calculates child poverty by two distinct but complementary measures: children living in monetary poor households and multidimensional poverty (deprivations in at least one of the following: education, health, housing, nutrition, sanitation and water). The percentage of children living in monetary poor households is projected to have increased dramatically in 2020 compared to 2019. While globally, 2021 is expected to see a modest decrease from 2020, there is a stark inequality. While richer countries seem to be improving, the poverty rate is expected to increase in low-income countries and least developed countries compared to 2020. In developing countries, the percentage of children living in multidimensional poverty is projected to have increased from 4648 per cent pre-COVID-19 (around 1 billion children) to around 52 per cent in 2021. This is equivalent to a projected increase of 100 million additional children living in poverty compared to 2019. In the least developed countries, the increase in poverty is projected to be even more dramatic, rising from 48 per cent in 2019 to around 56 per cent in 2021 (an increase of over 40 million children). In addition, lower-income countries are recovering at a slower pace and continue to have higher levels of POVERTY Sebabatso Nchephe, 18, stands on the roof of the home she shares with her mother and two sisters in Ivory Park, an informal settlement on the outskirts of Johannesburg, South Africa. UNICEF/UNI363394/Schermbrucker 17 The share of children living in monetary poor households is projected to continue rising in low-income countries FIGURE 1 unemployment, prolonging the suffering of families and children. The unequal distribution of the COVID-19 shock will likely deepen inequality between countries and particularly impact children living in low-income regions. Children already living in monetary poverty are more likely to suffer a greater depth of poverty, while a new pool of children is more likely to increase the prevalence of poverty due to the unemployment rate increase. Even before the pandemic, almost half of all children in developing countries suffered at least one severe deprivation such as education, health, housing, nutrition, or water and sanitation. In 2020, multidimensional poverty increased 1518 per cent due to immediate impacts of COVID-19 such as school closures and health services disruption. Some of this increase is projected to be reversed in 2021 as schools reopen and health services recover. However, as the pandemic continues, lagging and cumulative effects of the economic disruption on nutrition are becoming evident, leading to a change in the composition of child poverty. These changes include both a different set of children and different problems. Underlying many of these challenges are significant gaps in social protection. For example, only 1 in 4 children have access to any form of child or family benefit.1 1 Note: For more on the assumptions, analysis, and methods used to expand and update the projections of the impact of COVID-19 on child poverty and children living in monetary poor households carried out last year by Save the Children and UNICEF, please see Impact of COVID-19 on children living in poverty: A Technical Note . COVID-19S ONGOING IMPACT ON CHILDREN The rise in multidimensional poverty since before the pandemic is expected to be more dramatic for the least-developed countries FIGURE 2 0 10 20 30 40 60 50 2019 2020 2021 Low-income countries Least developedcountries Lower-middle-income Non-least-developedcountries Developing countries Upper-middle-income 0 10 20 30 40 60 50 Developing countries Least-developedcountries Non-least-developedcountries 2019 2020 2021 Children living in monetary poor households (%) Children living in multidimensional poverty (%) Preventing a lost decade: Urgent action to reverse the devastating impact of COVID-19 on children and young people18 According to data from the first quarter of 2021, more than half of respondent countries reported some level of reduction in routine vaccination services compared to the same time in 2020 and more than one third of respondent countries reported disruptions to both routine facility-based and outreach immunization services. Years of progress in childhood immunization were eroded in less than two years of the pandemic: In 2020, over 23 million children missed out on essential vaccines an increase of nearly 4 million from 2019, and the highest number since 2009. HEALTH AND IMMUNIZATION Of those 23 million more than 60 per cent live in just ten countries (Angola, Brazil, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Mexico, Nigeria, Pakistan and the Philippines) and 17 million of them did not receive any vaccines (zero-dose children). Most of these children live in communities affected by conflict, under-served remote areas, or informal urban settings where they experience multiple deprivations, including poor access to basic health and social services. Rocham Dear holds her disabled child at a UNICEF-supported vaccination and screening centre in Ratanakiri province, Cambodia. UNICEF/UN0403524/Raab 19 The impact of school closures during the first year of the pandemic was truly a worldwide phenomenon, affecting all countries and regions. In all, schools were either fully or partially closed worldwide for almost 80 per cent of the in-person instruction time during the first year of the pandemic. Globally during the first year of the pandemic, schools were fully closed 43 per cent of the time intended for in-person classroom instruction. Schools were partially closed 35 per cent of the time. Latin America and the Caribbean has been the most affected region with 80 per cent of instruction time disrupted due to full school closures. South Asia, the most populous region where the loss of instruction time due to full school closures accounted for 57 per cent, and Middle East and North Africa accounted for 51 per cent. In some countries, schools have been closed throughout the entire pandemic from early 2020. According to data from UNESCO, as of 31 October, 2021, an estimated more than 55 million students are affected by school closures in 14 countries, without any in-person learning. Low-income and lower-middle income countries have been more affected by full school closures than upper-middle income and high-income countries. Richer schoolchildren have access to digital technology that allows them to learn remotely, whereas children from poorer households are at risk of falling further behind in their education. The combination of prolonged school closures and inadequate remote learning could translate into substantial learning loss, further exacerbating the learning crisis. Stark inequalities in internet access remain across and within countries. Globally, 2.2 billion children and young people aged 25 years or less two thirds of children and young people worldwide do not have an internet connection at home. EDUCATION Disparities in access to the internet are even starker between rich and poor countries. Only 6 per cent of children and young people aged 25 years or younger in low-income countries have internet access at home, compared to 87 per cent in high-income countries. Globally, among the richest 20 per cent of families, 58per cent of children and young people aged 25 years or younger have internet access at home compared to only 16 per cent of children and young people from the poorest 20 per cent of households. COVID-19S ONGOING IMPACT ON CHILDREN Children in school No. 78 in Yerevan, Armenia wear masks at school to protect themselves and others from COVID-19. UNICEF/UN0415007/Galstyan Preventing a lost decade: Urgent action to reverse the devastating impact of COVID-19 on children and young people20 A higher percentage of in-person instruction time was disrupted by full school closures in low- and lower-middle-income countries FIGURE 3 Percentage of in-person instruction time disrupted by school closures over the first year of the pandemic (11 March 2020 11 March 2021) Note: Schools are considered fully closed if the closures institutionalized by the governments affect at least 70 per cent of the students (in pre-primary through upper secondary education) in a country; subnational school closures affecting a smaller share of students are considered as partial. 46 42 41 33 32 24 0 3 3 22 36 13 27 29 25 21 26 39 24 25 97 18 40 35 22 34 33 51 29 38 32 29 44 51 3 79 57 43 42 53 40 21 Western Europe West andCentral Africa Eastern Europeand Central Asia East Asiaand Pacific Eastern andSouthern Africa Middle East andNorth Africa North America Latin Americaand Caribbean South Asia World Low income Lower middleincome Upper-middleincome High income BY RE GIO NB Y IN CO ME GR OU P Schools that are fully closedSchools that are fully open Schools that are partially closed 21 CHILD PROTECTION Even before COVID-19, violence was all-too common in the lives of children, affecting at least 1 billion children every year. All indications suggest that the disruptions and public health measures associated with the pandemic may have increased the frequency and intensity of this violence. At the same time, children have been cut off from many of the positive and supportive relationships they rely on when in distress, including at school, in the extended family or the community. At the peak of the pandemic, 1.8 billion children lived in the 104 countries where violence prevention and response services were seriously disrupted. While the immediate health crisis will eventually wane, the impact of violence and trauma in childhood can last a lifetime including serious social and economic costs. Child marriage is closely associated with lower educational attainment, early pregnancies, intimate partner violence, maternal and child mortality, increased rates of sexually transmitted infections, intergenerational poverty, and the disempowerment of married girls. The pandemic is undoing years of progress in the fight against this practice. Up to 10million additional child marriages can occur before the end of the decade as a result of the COVID-19 pandemic. Poverty reduction along with access to education and jobs are key to ending child marriage. Global progress to end child labour has stalled for the first time in 20 years. The latest global estimates indicate that the number of children in child labour has risen to 160 million worldwide an increase of 8.4million children in the last four years. At the beginning of 2020, 63 million girls and 97 million boys were in child labour globally, accounting for almost 1 in 10 of all children worldwide. An additional 9 million children are at risk of being pushed into child labour by the end of 2022 as a result of the increase in poverty triggered by the pandemic. COVID-19S ONGOING IMPACT ON CHILDREN Meimouna, 12 years old, has everything to succeed. A brilliant student, she gets good marks and dreams of becoming a teacher. However, in the Mberra refugee camp, Mauritania, where she lives, a threat hangs over her future: early marriage. UNICEF/UN0479231/Pouget Preventing a lost decade: Urgent action to reverse the devastating impact of COVID-19 on children and young people22 NUTRITION The pandemic has harmed the nutrition, diets and food security of children and adolescents, especially for those living in poverty with multiple vulnerabilities. Childrens diets have long been inadequate only 29 per cent of children aged 623 months receive a minimally diverse diet and only 52 per cent receive a minimum meal frequency, with no notable change in the last 10 years. The pandemic has made childrens diets even worse. Quarantine measures, deteriorating economic conditions of families, and school closures have led to dramatically increased food insecurity. In the Philippines, households classified as moderately or severely food insecure jumped to 65 per cent, compared to 40 per cent before the pandemic. Fifty-six per cent of Filipino households report problems accessing food because of job loss, lack of money or limited public transportation. Economic situations have forced families to resort to difficult food-based coping strategies to manage limited food resources. These included limiting portion sizes during meals and relying on less preferred or less expensive food. In Cambodia, households that adopted these strategies increased from 62 per cent in August 2020 to 71 per cent in July 2021. Lower dietary diversity. The pandemic has also affected the quality of childrens diets, dramatically increasing their risk for micronutrient deficiencies. In Sri Lanka, there was a reduction in the consumption of flesh foods, dairy, pulses, and vitamin A rich foods among children 623 months old compared to data from November 2019. Children have consumed more processed foods. With more time spent at home due to social distancing and mobility restrictions, children and their families have shifted their food consumption patterns, often eating more unhealthy foods. For example, consumption of fruits declined by 30 per cent in Kenya and Uganda compared to pre-COVID-19. In Zimbabwe, 36percent reported an increase of sugary and junk food consumption since the beginning of lockdown in May 2020. Children have witnessed more ads for unhealthy products in the media during the pandemic. A review of social media posts from Uruguay corroborates the digital marketing practices of food companies. More than a third (35 per cent) of their Facebook posts on ultra-processed products made reference to the COVID-19 pandemic as an excuse to stay home and consume more of their products. Maria Mndez, 26, is feeding crushed bananas to her two-year-old daughter Mariela in Colotenango, Guatemala. UNICEF/UN0515109/Volpe 23 In Lusikisiki Ngobozana, Eastern Cape, South Africa, a caregiver monitors Marlons recovery from acute malnutrition, while his mother, Nomakhosazana, holds him. COVID-19-related lockdowns made those living in marginalized communities even more vulnerable. In South Africa, moderate and severe acute malnutrition remain a significant underlying causes of child mortality. Many families say the frequency of caregivers home visits have decreased and clinics havent been consistently open. Pandemic-necessitated travel restrictions further exposed a sharp divide between those who can afford adequate diets and services and those who cannot. From UNICEF and Magnum Photos Generation COVID photo project. UNICEF/UN0488697/Sobekwa/Magnum Photos Preventing a lost decade: Urgent action to reverse the devastating impact of COVID-19 on children and young people24 MENTAL HEALTH Even before the pandemic, in almost every country, mental health remains stigmatized and underfunded and poor mental health is limiting the life chances of children and adolescents around the world. More than 13 per cent of adolescents aged 1019 live with a diagnosed mental disorder. Suicide is the fourth leading cause of death for young people aged 15-19. Half of all mental health conditions start by 14 years of age. COVID-19 has exposed the extent and severity of the mental health crisis. The disruption to routines, education, recreation, as well as concern for family income, health and increase in stress and anxiety, is leaving many children and young people feeling afraid, angry and concerned for their future. By October 2020, the pandemic had disrupted or halted critical mental health services in 93 per cent of countries worldwide, while the demand for mental health support increased. National lockdowns have piled pressure on vulnerable children, as well as parents and caregivers ability to protect and nurture them. According to UNICEFs Changing Childhood project across 21 countries in the first half of 2021, 1 in 5 young people reported often feeling depressed or having little interest in doing things. In fact, we wont know the true impact of COVID-19 on childrens mental health for years. Children in Chattisgarh, India participate in games and activities to build emotional awareness as part of a Manas Foundation mental health and pschyo-socio-support programme facilitated by UNICEF. UNICEF/UN0517425/Panjwani 25 HUMANITARIAN EMERGENCIES Current humanitarian trends are deeply concerning. A steep rise in the number of countries and people affected humanitarian crises, including natural disasters, armed conflict and infectious disease outbreak continues. United Nations inter-agency appeals reflects the growing scale of humanitarian assistance and protection needs. In 2011, 14consolidated appeals aimed to reach 112 million people. By 2021, this number has grown to nearly 160million people across 27 consolidated appeals. Conflicts are increasingly affecting civilian populations, disproportionately affecting children. Women and girls are at increased risk of conflict-related sexual violence. As the intensity of conflict has increased, the number of people internally displaced by conflict reached its highest level. Entering 2021, there were an estimated 48 million internally displaced persons globally, and the number of refugees had reached 20 million. On top of this, the worsening climate crisis is also a deepening child rights crisis. Increasingly severe and frequent weather events and natural disasters are exacerbating chronic vulnerabilities. Globally, approximately 1 billion children nearly half of the worlds children live in countries that are at an extremely high-risk from the impacts of climate change. A humanitarian shipment which arrived at Beirut international airport through a UNICEF charter flight. The shipment included essential drugs, oral rehydration salts and antibiotics, medical and surgical supplies, and nutritional commodities. UNICEF/UN0551291/Choufany COVID-19S ONGOING IMPACT ON CHILDREN Preventing a lost decade: Urgent action to reverse the devastating impact of COVID-19 on children and young people26 A boy smiles at a learning centre in Barranquilla, Colombia, which provides education to children aged 615 who have been displaced by violence and are not enrolled in school. UNICEF/ UN0488971/Romero 27 As when UNICEF was founded 75 years ago, the world needed solutions to heal divisions, harness global progress, and protect and uphold universal human rights. We believe just as firmly now as we did 75 years ago that this starts with guaranteeing the next generation a better life than the last. We know what this world looks like. It is a world where we realize the Convention on the Rights of the Child and the Sustainable Development Goals in their entirety. Where we work together to end the pandemic and reverse the potentially devastating backslide in progress on child health and nutrition. Where we build back stronger by ensuring quality education and mental health for every child. Where we end poverty and invest in human capital for an inclusive recovery. Where we reverse climate change. And where we secure a new deal for children living through conflict, disaster, and displacement. The solutions below provide a clear roadmap towards this world. But this is only the beginning. We will only emerge stronger by working together governments, businesses, civil society, the public and most of all children and young people, to build a better future for every child. 1.Invest in social protection,human capital and spending for an inclusive and resilient recovery. 2.End the pandemic and reverse the alarming rollback in child health and nutrition including through leveraging UNICEFs vital role in COVID-19 vaccine distribution. 3.Build back stronger by ensuring quality education, protection, and good mental health for every child. 4.Build resilience to better prevent, respond to, and protect children from crises including new approaches to end famines, protect children from climate change, and reimagine disaster spending. First in line for investment, last in line for cuts: AN URGENT AGENDA FOR ACTION FOR CHILDREN AN URGENT AGENDA FOR ACTION FOR CHILDREN Preventing a lost decade: Urgent action to reverse the devastating impact of COVID-19 on children and young people28 INVEST IN SOCIAL PROTECTION, HUMAN CAPITAL, AND SPENDING FOR AN INCLUSIVE AND RESILIENT RECOVERY 1 Ranvir laughs heartily as he plays with his friends at an Anganwadi centre in Nayakheda, Rajasthan, India. Similar to day care centres, Anganwadi Centres provide meals, basic health services, immunization and a happy and safe place to play and learn for children in villages and rural areas throughout India. UNICEF/ UNI333247 29 ENSURE AN INCLUSIVE RECOVERY FOR EVERY CHILD Economic crises are often followed by cuts to government spending, including on programmes for children. If the world repeats this pattern in the wake of COVID-19, poverty and deprivation among children will persist long after the immediate crisis has waned. To prevent a lost decade, it is essential that countries invest in children to achieve sustained, inclusive economic growth and ensure they are prepared for the global economy of the future. We urgently need an inclusive recovery plan to reinstate the hard-won development gains of the past and avert the consequences of poverty for millions more children and their families. The COVID-19 pandemic risks devastating long-term economic consequences for children, communities and countries around the world. Children who were already marginalized are the most affected, as they suffer the impact of living in poverty, lost education, poorer nutrition and disrupted mental health. An inclusive recovery requires: 1. Governments safeguarding critical social spending to ensure that social systems and interventions are protected from spending cuts and expanded where inadequate. All governments should identify and ring-fence spending on programmes for children, adopting the principle of children being first in line for investment and last in line for cuts. Expand resilient social protection programmes for the most vulnerable children, no matter their migration status, as well as families with children, including working towards universal child benefits and child-friendly services like affordable, quality childcare. 2. Governments ensuring the best, most equitable, effective, and efficient use of financial resources across social sectors for human capital development. This includes ensuring that the recovery from the COVID-19 pandemic is green, low-carbon and inclusive, so that the capacity of future generations to address and respond to the climate crisis is not compromised. 3. International donors directing finance towards an inclusive recovery that protects children, especially the poorest and most marginalized. Maintain or increase overseas aid commitments, identifying context-specific new financing options, and direct funding to those countries most affected and least able to take on new lending. Act on debt relief, including extending current debt service suspension beyond December 2021 and to middle-income countries. Ensure coordinated action covering all creditors to restructure and, where necessary, reduce debt. AN URGENT AGENDA FOR ACTION FOR CHILDREN A Rohingya refugee girl jumps across a bridge in a large puddle caused by recent rains in Balukhali camp for Rohingya refugees in Coxs Bazaar District, Bangladesh. UNICEF/UN0205640/Sokol Preventing a lost decade: Urgent action to reverse the devastating impact of COVID-19 on children and young people30 INVEST IN THE UNTAPPED POTENTIAL OF YOUNG MIGRANTS, REFUGEES AND INTERNALLY DISPLACED PEOPLE One way to grow human capital following COVID-19 is to invest in talent on the move, a unique, yet largely untapped pool of talent, ideas, and entrepreneurship. Often resilient, highly motivated and with experience overcoming adversity, migrant and displaced youth have the potential to help solve some of our greatest challenges. McKinsey calculated that migrants made up just 3.4 per cent of the worlds population in 2015 but contributed nearly 10 per cent of global gross domestic product (GDP). Our own lives are touched every day by inventions and products developed by migrants or refugees. In 2017, nearly half of all Fortune 500 companies were founded by American immigrants or children of immigrants. While talent is universal, for many, opportunities are hard to come by. Governments and donors around the world must do more to break down the barriers standing in the way of this enormous potential to build back stronger. Unlocking the untapped potential of talent on the move requires: Governments removing barriers that prevent children and young people on the move accessing education, health and social protection. This includes opening national schools to all children independent of migration status, abolishing school fees, establishing scholarship programmes and paid traineeships, and providing financial assistance for school supplies. Governments recognizing prior learning and qualifications of migrant and displaced children and young people. Innovative digital solutions can be leveraged to achieve this. Governments stepping up their efforts to close the digital divide and create more opportunities for refugee and migrant children and youth to transition from learning to earning. Governments, caregivers and social services providing young people with more relevant and targeted information on available education and employment

In Focus: Immunization

Statement by UNICEF Executive Director Henrietta Fore on the disruption of immunization and basic health services due to the COVID-19 pandemic

Governments must invest in immunizing the most vulnerable children and addressing vaccine hesitancy

Celebrating the past, present and future benefits of vaccines

Tracking anti-vaccination sentiment in Eastern European social media networks

In the COVID-19 vaccine race, we either win together or lose together

Teachers should be prioritized for vaccination against COVID-19

Preventing a lost decade

As the COVID-19 pandemic begins to enter a new phase, UNICEF reminds the world that ‘the light at the end of the tunnel needs to shine for all’

UNICEF’s social protection response to COVID-19

The State of the Global Education Crisis

Debt relief for the poorest countries critical in fight against COVID-19

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