Statement by UNICEF Executive Director Henrietta Fore on the disruption of immunization and basic health services due to the COVID-19 pandemic
: “Around the world, the COVID-19 pandemic is overstretching health services as health workers are diverted to support the response. “Physical distancing is leading parents to make the difficult decision to defer routine immunization. “Medical goods are in short supply and supply chains are under historic strain due to transport disruptions. Flight cancellations and trade restrictions by countries have severely constrained access to essential medicines, including vaccines. “As the pandemic progresses, critical life-saving services, including immunization, will likely be disrupted, especially in Africa, Asia and the Middle East where they are sorely needed. “At the greatest risk are children from the poorest families in countries affected by conflicts and natural disasters. “We are particularly concerned about countries that are battling measles, cholera or polio outbreaks while responding to COVID-19 cases, such as Afghanistan, the Democratic Republic of Congo, Somalia, the Philippines, Syria and South Sudan. Not only would such outbreaks tax already stretched health services, they could also lead to additional loss of lives and suffering. At a time like this, these countries can ill-afford to face additional outbreaks of vaccine-preventable diseases. “The message is clear: We must not allow lifesaving health interventions to fall victim to our efforts to address COVID-19. “UNICEF is committed to supporting basic health care and immunization needs in the worst affected countries, and to doing so in a way that limits the risk of COVID-19 transmission. We are working hard to ensure adequate vaccine supplies are available in countries that need them. We are in close communication with global vaccine suppliers to ensure production is not disrupted and supply is managed in the best possible manner under these difficult circumstances. We are also providing greater support to governments to continue the supply of vaccines during this pandemic. “In the days to come, governments may have to temporarily postpone preventive mass vaccination campaigns in many places to ensure that the delivery of immunization services does not contribute to COVID-19 spread, and to follow recommendations on physical distancing. “UNICEF strongly recommends that all governments begin rigorous planning now to intensify immunization activities once the COVID -19 pandemic is under control. These vaccination activities must focus on children who will miss vaccine doses during this period of interruption and prioritize the poorest and most vulnerable children. To successfully roll-out vaccines against COVID -19 when they become available, we need to ensure that our immunization programmes remain robust and can reach those that will need these vaccines the most. “Immunization remains a life-saving health intervention. As the world's biggest buyer and supplier of vaccines, UNICEF will continue to play a pivotal role in supporting governments’ current and future immunization efforts.” Nurse Milka Babic performs immunization UNICEF/UNI218376/Pancic
More than 117 million children at risk of missing out on measles vaccines, as COVID-19 surges
“As COVID-19 continues to spread globally, over 117 million children in 37 countries may miss out on receiving life-saving measles vaccine. Measles immunization campaigns in 24 countries have already been delayed; more will be postponed. “During this challenging period, the Measles & Rubella Initiative (M&RI) expresses solidarity with families, communities, governments and emergency responders and joins our global immunization and health partners, including those within Gavi, the Vaccine Alliance and the Global Polio Eradication Initiative (GPEI) in our collective focus and fight against the threat of COVID-19. The pandemic sweeping the globe requires a coordinated effort and commitment of resources to ensure frontline health workers around the world are protected, as they face and respond to this new threat. At the same time, we must also champion efforts to protect essential immunization services, now and for the future. “The World Health Organization (WHO) has issued new guidelines endorsed by the Strategic Advisory Group of Experts on Immunization -- to help countries to sustain immunization activities during the COVID-19 pandemic. The guidelines recommend that governments temporarily pause preventive immunization campaigns where there is no active outbreak of a vaccine-preventable disease. M&RI partners, which include the American Red Cross, the U.S. Centers for Disease Control and Prevention, UNICEF, the United Nations Foundation and WHO, strongly agree with these recommendations. We also urge countries to continue routine immunization services, while ensuring the safety of communities and health workers. The recommendations also ask governments to undertake a careful risk-benefit analysis when deciding whether to delay vaccination campaigns in response to outbreaks, with the possibility of postponement where risks of COVID-19 transmission are deemed unacceptably high. “If the difficult choice to pause vaccination is made due to the spread of COVID-19, we urge leaders to intensify efforts to track unvaccinated children, so that the most vulnerable populations can be provided with measles vaccines as soon as it becomes possible to do so. While we know there will be many demands on health systems and frontline workers during and beyond the threat of COVID-19, delivering all immunization services, including measles vaccines, is essential to saving lives that would otherwise be lost to vaccine-preventable diseases. “The M&RI supports the need to protect communities and health workers from COVID-19 through a pause of mass campaigns, where risks of the disease are high. However, this should not mean that children permanently miss out. Urgent efforts must be taken now at local, national, regional and global levels to prepare to close the immunity gaps that the measles virus will exploit, by ensuring that vaccines are available and that they reach children and vulnerable populations, as quickly as possible, to keep them safe. “Despite having a safe and effective vaccine for over 50 years, measles cases surged over recent years and claimed more than 140,000 lives in 2018, mostly of children and babies – all of which were preventable. Against this already dangerous backdrop, preventive and responsive measles vaccination campaigns have now been paused or postponed in 24 countries to help avert further spread of COVID-19. Campaigns expected to take place later in 2020 in an additional 13 countries may not be implemented. Together, more than 117 million children in 37 countries, many of whom live in regions with ongoing measles outbreaks, could be impacted by the suspension of scheduled immunization activities. This staggering number does not include the number of infants that may not be vaccinated because of the effect of COVID-19 on routine immunization services. Children younger than 12 months of age are more likely to die from measles complications, and if the circulation of measles virus is not stopped, their risk of exposure to measles will increase daily. “The M&RI salutes the heroism of health and emergency workers across the globe, and we recognize the vital role they play in delivering clear, trusted information, as well as preventive and supportive care within their communities. We must invest in health workers and ensure they are protected from infection and empowered as part of sustainable and functioning primary health systems. They are the first line of defense against global epidemics. We also recognize the role of parents and caregivers in ensuring their children are vaccinated by following physical distancing recommendations in line with national guidance. Finally, we call on countries and local leaders to implement effective communication strategies to engage communities, ensure supply and demand for vaccination remains strong, and help assure a healthy life for every child especially in this challenging time.” #####
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’
“COVID-19 is the first truly global crisis we have seen in our lifetimes. No matter where we live, the pandemic affects every one of us. Children have been seriously impacted. However, with more news about promising vaccines, and as we begin to imagine a day when COVID-19 is behind us, our guiding principle must be that the light at the end of the tunnel needs to shine for all. “This is why UNICEF has enthusiastically joined the Advance Market Commitment of the COVAX Facility to allow low- and lower-middle income countries access to COVID-19 vaccines. It is the best way to make sure that, as vaccines become available, no country is pushed to the back of the line. This would not only be fundamentally unfair, it would be unwise. The whole world will remain vulnerable to the virus until countries with the weakest health systems are protected from it as well. “In order for the COVAX Facility to work and guarantee equitable and affordable access to low- and lower-middle income countries, we need a global commitment to support and capitalize it, but also to finance the delivery of vaccines and associated supplies such as syringes and safety boxes. Governments must work together to ensure that COVID-19 vaccines are affordable and accessible to all countries. High-income countries should invest financially in the Advance Market Commitment and in UNICEF’s COVID-19 vaccine delivery efforts. All countries should take a strong stand against export controls on – and unnecessary stockpiling of – commodities for the COVID-19 response. “UNICEF is also leveraging our unique strengths in community engagement and vaccine supply to make sure that countries participating in the COVAX Facility have safe, fast and equitable access to the vaccine. This is an enormous undertaking and many challenges still lay ahead. As the largest vaccine buyer in the world, procuring more than 2 billion doses annually for routine immunization and outbreak response on behalf of nearly 100 countries, UNICEF is c oordinating and supporting the procurement, international freight , and in-country distribution of COVID-19 vaccines for the COVAX Facility. “Together with WHO, PAHO, GAVI and other partners at the global and regional levels, UNICEF is also working to support countries to ‘ready’ their immunization programmes for this historic roll-out. This includes assessing capacity and helping countries to strengthen their cold and supply chains so that they have adequate infrastructure to transport and store the vaccines for delivery to the frontlines. “However, the existence of a safe and effective COVID-19 vaccine alone will not end the pandemic. We need a diverse set of tools to help slow the spread of COVID-19, including diagnostics and treatments, as well as a continuance of preventive measures such as hand washing, physical distancing and mask wearing. UNICEF is providing governments with access to personal protective equipment, validated testing approaches, and proven treatments. In addition, UNICEF continues to work with multilateral partners to support governments with infection prevention control, water, sanitation and hygiene supplies, physical distancing, surveillance, contact tracing, case identification and community referral systems to stem the pandemic. “Lastly, we continue to help countries ensure the continuity of key essential services for women, children and young people – especially the most vulnerable. COVID-19 related disruptions have had a heavy impact on children: on their safety, their well-being, their future. Even as the fight against the disease enters into a hopeful new phase, we must not forget the work ahead of us to respond, recover and reimagine a better world for children.” ###
HIV-positive… and fearless
During the first TEDxYouth event organized on 17 November in Kazakhstan, Baurzhan, age 13, and his mother Aliya spoke about living openly with HIV. This is his story. Standing before more than 100 people, Aliya asks if anyone in the audience remembers the incident in 2006 when 149 children in southern Kazakhstan were infected with the human immunodeficiency virus (HIV) at a local hospital. A few hands go up. Hesitantly. “Not too many,” sighs Aliya. “That’s 149 families facing profound pain, shock, complete lack of support and understanding.” Indeed, when the news first broke at the time, there was very little by way of public understanding and sympathy. On the contrary, the families affected have spoken about the pervasive rumors – including one suggesting that a special area would be built to quarantine the families – that they had to endure. Some families were even broken up. The sense of isolation still persists for many. “In our society,” Aliya says, “HIV is still perceived to be a ‘plague’ of the 21 st century. These families and children are hiding. They do not open up about their HIV status. These children are still invisible to society.” Then she adds, “They all live in great fear. All, but one.” A voice chimes in. “I am one of those 149 children. I am HIV-positive and today, I am the only teenager in Kazakhstan with HIV who is living openly,” says Baurzhan, age 13. Baurzhan and his mother at their home in Kazkhstan. Working towards acceptance Aliya’s son Baurzhan was just nine months old when she learned that the blood transfusion he had received for treatment was infected with HIV. When he started going to school, Baurzhan understood that there were different kinds of viruses and one of them happened to be living in him. He did not feel different, until teachers asked him not to play during recess or physical education class. “We realized that for school to be an understanding environment, we needed to organize training, raise awareness among teachers on the importance of tolerance towards children with such illnesses,” his mother says. The lanky teenager remembers crying in the school gym changing room after his classmate called him offensive names related to HIV. “I was not ready to hear it. It hurt a lot.” The incident made Aliya realize that students needed awareness training, too. She helped the school organize lessons on child rights and responsibilities explaining the universality of rights. After the first session, the boy who had offended Baurzhan apologised for what he had said. “For 11 years, I have been taking medications every day to control the amount of virus in my blood. My immunity is 900 cells. Do you know that the immunity of a healthy person is 1200 cells? So, my immunity is that of a healthy teenager,” he says. “My viral load is less than 50 copies. This means that I am just a carrier, but I cannot transmit the virus while I am taking medications.” Together with friends, Baurzhan created a self-help group called “Asian teens” where they share their experiences of living with HIV. “I want to support other kids who are living in fear because of their HIV status. I want to be a role model of living openly and without any fear.” As Baurzhan says these words, the audience erupts in standing ovation. After the TEDx talk, Baurzhan and his mother said that many people approached him and asked if they could give him a hug. “I really liked the feeling of speaking in that room – it was filled with warmth, the audience showed that they cared”, he said. “My friends who are also living with HIV cannot wait to see my video, I think they will be surprised to see the positive reaction my story received.” Baurzhan with his sibling at the family home. Baurzhan with his sibling at the family home. HIV today and steps for the future Since the outbreak in 2006, the HIV/AIDS situation has changed. By 2010, UNICEF helped decrease the rate of HIV transmission from mother to child in south Kazakhstan, which at the time had the highest number of deliveries by HIV-positive women. At country level, joint efforts of the Ministry of Health and UNICEF led to dropping the HIV transmission rate from 10.9 per cent in 2007 to 1.8 percent in 2014. Kazakhstan is now submitting a request to be certified as a country that virtually eliminated mother-to-child HIV transmission. However, more work remains, says UNICEF Health and Nutrition Officer Kanat Sukhanberdiyev. “Globally, we still see that many children are dying from HIV/AIDS. We have a long way to go until children and adolescents with HIV receive the full package of healthcare and psychosocial support.” On this World AIDS Day, UNICEF is calling on the world to increase investments in HIV prevention, testing and treatment programmes. Otherwise, by 2030, the lives of some 360,000 adolescents will be at risk of AIDS-related diseases. Find out more about UNICEF’s work on HIV in Kazakhstan.
“I’d settle for a year being sick, as long as it’s not her, not for a single day”
Little Varya was 3 years old when Alexei and Nastya Naumov adopted her from an orphanage. They had long dreamed of children, when they found this girl who looked so much like Alexei Naumov. Nothing could stop them: neither difficulties, nor Varyusha's diagnosis – HIV, which the orphanage told them about right away. Varya Varya at the New Year celebration Nastya and Alexei decided that they wouldn’t conceal their now 9 year old daughter’s diagnosis. It is better to put all the cards on the table, than constantly have to look over their shoulder, they say. The parents always emphasize: they have never regretted their decision. In November 2018, when Varya was in the first grade, she fell ill with scarlet fever. The family had just moved to Almaty from Atyrau. Nastya Naumova brought her daughter to two pediatricians, but they did not suspect anything. And then their infectious disease specialist at the AIDS center confirmed the diagnosis. ‘Guys, you have scarlet fever,’ she said. “It seemed to me that this was a forgotten disease, that it is simply impossible. Varya has recovered, but I was still afraid. And as it turned out, not in vain,” says Nastya. The Naumovs were warned that live vaccines are contraindicated for a child with HIV. “I was afraid that Varya would get infected,” Anastasia says. “I didn’t know how the virus would work with her diagnosis, how it would affect the body. And, thank God, for a long time she was able to avoid infection. But, as it turned out, not measles.” In Kazakhstan all children diagnosed with HIV usually receive a medical contraindication for vaccination, which applies to the so-called live vaccines against measles, mumps and rubella. Although in accordance with the WHO clinical protocol, a vaccine against measles, mumps, and rubella (MMR) and other measles-containing vaccines (MCV) should be considered for HIV-infected patients who are asymptomatic or mildly immunosuppressed, as per the routine national schedule. For infants with high risk of exposure to the measles virus, an additional dose of single-antigen measles vaccine administered at 6–11 months of age is recommended, followed by a first dose of routine MMR or another MCV at age 12 months or older (with a minimum interval of 1 month between doses).1 Parents can learn more about each vaccine, included into the National Vaccination Calendar, at a special website dedicated to children routine vaccination: EGU.kz In February 2019, when Varya was preparing to go to school, she noticed red dots on her legs: hemorrhagic vasculitis. Nastya and Varya were immediately taken to the hospital; they thought it was an allergy. For 3 weeks the child was not diagnosed, doctors had not realised that it was measles. Anastasia Naumova shares her story Anastasia Naumova shares her story Later, it turned out that hemorrhagic vasculitis was Varya’s body's reaction to measles. The incubation period was already in progress. But the doctors the Naumovs visited did not understand this. Their infectious disease specialist arrived at the hospital only after Varya's temperature rose to 40 degrees, and diagnosed her with measles. Varya and her mother were taken to the infectious diseases hospital. Varya at the hospital with measles Varya at the hospital with measles “I will never forget the following 10 days…,” Nastya says. Varya fell seriously ill. She was burning with a fever, crying from pain at night. There was nothing Nastya could do to help her child. “I have hardly slept these ten days. I would lean on the table, doze off, the timer would go off - I set Varya's temperature to be measured every hour. And you can't do anything - the treatment is symptomatic,” Nastya says. The complications were the worst. Varya had right-sided pneumonia, so severe that she could not swallow saliva. How would Nastya give her pills? Water? Food? “I was almost shoving this pill into her mouth, and Varya cried and shouted: ‘Mom, it hurts! Mom, don't!’ Almost two years have passed since that moment, and I am still shaking. I’d settle for a year being sick, as long as it’s not her, not for a single day. When you see that your child suffers so much simply because someone did not give her the vaccine, how would you feel about it? I have no words,” Nastya says. In total, they spent about 6.5 weeks in the hospital. During their stay the hospital was full. Children and many adults - all with measles. Fortunately, Varya pulled through. Emaciated, she weighed 17 or 18 kilograms, weak, but alive. Varya does not mention her illness. Nastya noticed that after the illness Varya started having problems studying. Apparently, this ten day long fever affected her cognitive abilities. “I believe if opponents of vaccination ever saw how people bear measles, they would think about it. It's a shame that children who have medical contraindication are at risk,” Nastya says. The Naumovs then vaccinated their daughter (with those vaccines that are not contraindicated for her) in an ordinary district hospital. “The child has HIV infection, an incurable disease, but even she did not have a reaction to the vaccine,” Nastya says. In 2019, there was an outbreak of measles in Kazakhstan with 16,871 cases, of which 13,326 (78.9%) were laboratory confirmed.2 19 children and two adults dies from the disease. Among the victims of measles, 8 children were not vaccinated due to medical contraindications. In 2020, 3,270 cases of measles were registered, of which 2,265 were children under 14 years of age. False contraindications and medical exemptions have been identified as one of the main causes of missed opportunities to vaccinate against measles during the root cause analysis conducted by UNICEF Kazakhstan. The analysis was the part of the UNICEF Kazakhstan Measles Outbreak Prevention Program funded by the US Agency for International Development (USAID). “We sincerely thank USAID for partnering in such an important program for children's lives to prevent a measles outbreak in the future and strengthen the immunization programme in Kazakhstan. We believe that this project will help save and preserve the lives and health of Kazakhstani children and families," said the UNICEF Representative in Kazakhstan Arthur van Diesen. The Program provided technical support to analyze the causes of the measles outbreak, study parents' views on vaccination and awareness campaigns, as well as recommendations for improving the supply of vaccines and building the capacity of healthcare workers for immunization. For example, UNICEF is providing a series of trainings to address false contraindications in cooperation with the Association of Family Doctors of Kazakhstan in Aktobe, Atyrau, Eastern-Kazakhstan, Kyzylorda, Turkestan, Karaganda oblasts, Almaty and Shymkent.
Through pandemics and epidemics, hope stays alive
For more than 70 years, we have been working to improve the lives of children and their families. Our mission is made possible by a strong network of talented and dedicated staff that includes physicians, clinicians, logistics experts and communication specialists. As the global COVID-19 pandemic unfolds, we look back at UNICEF's history of responding to health crises the world over, and look ahead to recovering from this one. Филиппины UNICEF/UN03784 Индия, 1961 год. Медицинский работник делает девочке прививку против оспы. UNICEF/UNI41906 Disease prevention Since its beginnings, UNICEF has been at the forefront of disease prevention and revolutionizing children’s health. Working closely with partners like the World Health Organization (WHO), we have seen the eradication of smallpox and the near eradication of polio. Since 1988, the number of children affected by polio has reduced by 99 per cent. Today, some of the same lessons we’ve learned in contact tracing in communities are being applied to reach vulnerable children and their families in some of the remotest parts of the world. Бангладеш, 1989 год. Посол доброй воли ЮНИСЕФ Одри Хепбёрн делает прививку от полиомиелита ребёнку в клинике. In the 1980s UNICEF led the child survival revolution — a shift from treating health issues to preventing them — helping to reduce child deaths by up to nearly 80 per cent in some countries. Our worldwide distribution of oral rehydration solution has helped reduce the number of deaths from diarrhoea — a leading killer of young children — by 60 per cent between 2000 and 2007. Mass immunization campaigns have also played a huge role in protecting children against preventable diseases. For measles alone, about 20 million young people’s lives were saved between 2000 and 2015 thanks to such efforts by UNICEF and partners. HIV and AIDS In 1987, AIDS became the first disease to be debated on the floor of the UN General Assembly. As Member States convened, UNICEF and WHO were already monitoring possible interactions between the disease and immunization and breastfeeding. As infections spread, UNICEF geared its research, policy, planning and fundraising to better understand how to prevent mother-to-child transmission. To equip the public with facts, we supported health education around the world, particularly in sub-Saharan Africa, working tirelessly to inform, educate and protect against stigma and discrimination around HIV and AIDS. Медицинский работник берёт кровь для исследования на ВИЧ Since 2010, 1.4 million HIV infections among children have been averted. The reduction in mother-to-child transmission is viewed as a public health success story. Jointly with partners, UNICEF has set ambitious targets for ending AIDS by 2030. Малыши обнимаются в приюте Swine flu In 2009, the swine flu pandemic swept across the world primarily affecting children and young adults who were otherwise in good health. UNICEF put measures in place to prepare for possible local outbreaks in 90 countries. These measures remained in place after the pandemic with an eye on future outbreaks. Mедицинские работники посещают дома Ebola Within two and a half years of the 2014 outbreak of Ebola in West Africa, more than 28,616 cases and 11,310 deaths had been recorded. During the crisis, UNICEF helped in providing care for ostracized children suspected of being infected, children who lost parents and guardians to Ebola, and the millions who were out of school. Since 2018, with the start of the second-biggest Ebola epidemic ever recorded, we have been working with partners across the region to prevent transmission and protect affected children. Within a year, UNICEF and partners had trained more than 32,400 teachers on how to teach children about Ebola prevention and how to make schools a protective environment. Медицинский работник измеряет температуру Coronavirus (COVID-19) The ongoing COVID-19 pandemic has upended family life around the world. Economic shutdowns, school closures and confinement measures are all having a heavy impact on children now and the longer-term repercussions risk their safety, their well-being and their future. UNICEF is calling for swift global action without which, this health crisis risks becoming a child-rights crisis. ЮНИСЕФ Южный Судан, 2020 год. ЮНИСЕФ располагает сетью, состоящей из 2500 социальных активистов, работающих в течение года для повышения осведомлённости людей о важности соблюдения правил гигиены, иммунизации, питания, защиты детей и образования. UNICEF is on the ground in more than 190 countries, partnering with governments, health workers and other front-line responders to keep children healthy, safe and learning, no matter who they are or where they live. COVID-19 is one of the biggest fights in our history, yet, it is a fight that together we can win. Are you with us?
COVID-19 could reverse decades of progress toward eliminating preventable child deaths, agencies warn
– The number of global under-five deaths dropped to its lowest point on record in 2019 – down to 5.2 million from 12.5 million in 1990, according to new mortality estimates released by UNICEF, the World Health Organization (WHO), the Population Division of the United Nations Department of Economic and Social Affairs and the World Bank Group. Since then, however, surveys by UNICEF and WHO reveal that the COVID-19 pandemic has resulted in major disruptions to health services that threaten to undo decades of hard-won progress. “The global community has come too far towards eliminating preventable child deaths to allow the COVID-19 pandemic to stop us in our tracks,” said Henrietta Fore, UNICEF Executive Director. “When children are denied access to health services because the system is overrun, and when women are afraid to give birth at the hospital for fear of infection, they, too, may become casualties of COVID-19. Without urgent investments to re-start disrupted health systems and services, millions of children under five, especially newborns, could die.” Over the past 30 years, health services to prevent or treat causes of child death such as preterm, low birthweight, complications during birth, neonatal sepsis, pneumonia, diarrhea and malaria, as well as vaccination, have played a large role in saving millions of lives. Now countries worldwide are experiencing disruptions in child and maternal health services, such as health checkups, vaccinations and prenatal and post-natal care, due to resource constraints and a general uneasiness with using health services due to a fear of getting COVID-19. A UNICEF survey conducted over the summer across 77 countries found that almost 68 per cent of countries reported at least some disruption in health checks for children and immunization services. In addition, 63 per cent of countries reported disruptions in antenatal checkups and 59 per cent in post-natal care. A recent WHO survey based on responses from 105 countries revealed that 52 per cent of countries reported disruptions in health services for sick children and 51 per cent in services for management of malnutrition. Health interventions such as these are critical for stopping preventable newborn and child deaths. For example, women who receive care by professional midwives trained according to internationals standards are 16 per cent less likely to lose their baby and 24 per cent less likely to experience pre-term birth, according to WHO . "The fact that today more children live to see their first birthday than any time in history is a true mark of what can be achieved when the world puts health and well-being at the centre of our response,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “Now, we must not let the COVID-19 pandemic turn back remarkable progress for our children and future generations. Rather, it’s time to use what we know works to save lives, and keep investing in stronger, resilient health systems.” Based on the responses from countries that participated in the UNICEF and WHO surveys, the most commonly cited reasons for health service disruptions included parents avoiding health centers for fear of infection; transport restrictions; suspension or closure of services and facilities; fewer healthcare workers due to diversions or fear of infection due to shortages in personal protective equipment such as masks and gloves; and greater financial difficulties. Afghanistan, Bolivia, Cameroon, the Central African Republic, Libya, Madagascar, Pakistan, Sudan and Yemen are among the hardest hit countries. Seven of the nine countries had high child mortality rates of more than 50 deaths per 1000 live births among children under five in 2019. In Afghanistan, where 1 in 17 children died before reaching age 5 in 2019, the Ministry of Health reported a significant reduction in visits to health facilities. Out of fear of contracting the COVID-19 virus, families are de-prioritizing pre- and post-natal care, adding to the risk faced by pregnant women and newborn babies. Even before COVID-19, newborns were at highest risk of death. In 2019, a newborn baby died every 13 seconds. Moreover, 47 per cent of all under-five deaths occurred in the neonatal period, up from 40 per cent in 1990. With severe disruptions in essential health services, newborn babies could be at much higher risk of dying. For example, in Cameroon, where 1 out of every 38 newborns died in 2019, the UNICEF survey reported an estimated 75 per cent disruptions in services for essential newborn care, antenatal check-ups, obstetric care and post-natal care. In May, initial modelling by Johns Hopkins University showed that almost 6,000 additional children could die per day due to disruptions due to COVID-19. These reports and surveys highlight the need for urgent action to restore and improve childbirth services and antenatal and postnatal care for mothers and babies, including having skilled health workers to care for them at birth. Working with parents to assuage their fears and reassure them is also important. “The COVID-19 pandemic has put years of global progress to end preventable child deaths in serious jeopardy,” said Muhammad Ali Pate, Global Director for Health, Nutrition and Population at the World Bank. “It is essential to protect life-saving services which have been key to reducing child mortality. We will continue to work with governments and partners to reinforce healthcare systems to ensure mothers and children get the services they need.” "The new report demonstrates the ongoing progress worldwide in reducing child mortality,” said John Wilmoth, Director of the Population Division of the United Nations Department of Economic and Social Affairs. “While the report highlights the negative effects of the COVID-19 pandemic on interventions that are critical for children’s health, it also draws attention to the need to redress the vast inequities in a child's prospects for survival and good health.” ###### A child and his mother while waiting to receive medical care UNICEF/UNI347480/Poveda
World's richest countries grappling with children’s reading and math skills, mental well-being and obesity
On average 40 per cent of children across all OECD and EU countries do not have basic reading and mathematics skills by age 15. Children in Bulgaria, Romania and Chile are the least proficient in these skills. Estonia, Ireland and Finland the most proficient. In most countries, at least 1 in 5 children lack confidence in their social skills to make new friends. Children in Chile, Japan and Iceland are the least confident in this area. The report also contains data on clear areas of progress in child well-being. On average, 95 per cent of pre-school aged children are now enrolled in organized learning programmes, and the number of young people aged 15-19 not in education, employment or training has declined in 30 out of 37 countries. Yet, these important gains are at risk of falling back due to the impact of COVID-19. Countries are also ranked based on their policies that support child well-being and other factors including the economy, society and environment. Norway, Iceland and Finland have the highest-ranking policies and context to support child well-being. On average, countries spend less than 3 per cent of their GDP on family and child policies. “In times of crisis and calm, families need supportive governments and workplaces in order to raise the next generation of happy and healthy citizens,” said Fayaz King, Deputy Executive Director at UNICEF. “An investment in children is a direct investment in our future.” Due to the COVID-19 outbreak, in the first half of 2020 most of the countries covered in the report kept schools closed for more than 100 days while strict stay-at-home policies were also implemented. The report notes that loss of family members and friends, anxiety, stay-at-home restrictions, lack of support, school closures, the balancing of work and family life, poor access to healthcare, combined with the economic loss caused by the pandemic are catastrophic for children’s wellbeing, affecting their mental and physical health, and their development. Before the COVID-19 outbreak the average relative child poverty rate across the 41 countries was 20 per cent. With GDP expected to fall over a two-year period in almost all of these countries, unless governments take immediate remedial actions child poverty will rise. “As the economic, educational and social fallout of the pandemic continues to take hold, without concerted effort, there will be a worsening, devastating impact on the well-being of today’s children, their families and the societies they live in,” said Olsson. “But these risks do not have to become the reality, if governments take decisive action now to protect children’s well-being.” On the basis of the report and these recent developments UNICEF is calling for the following steps to protect and improve child wellbeing: Take decisive action to reduce income inequality and poverty and ensure that all children have access to the resources they need. Rapidly address the serious gap in mental health services for children and adolescents. Expand family-friendly policies to improve work-family balance, especially access to high-quality, flexible and affordable early-years childcare. Strengthen efforts to protect children from preventable diseases, including reversing recent falls in measles immunization. Improve COVID-19 policies that support families with children and ensure budgets that support child well-being are protected entirely from austerity measures. ###
As COVID-19 devastates already fragile health systems, over 6,000 additional children under five could die a day, without urgent action
– An additional 6,000 children could die every day from preventable causes over the next six months as the COVID-19 pandemic continues to weaken health systems and disrupt routine services, UNICEF said today. The estimate is based on an analysis by researchers from the Johns Hopkins Bloomberg School of Public Health, newly published in The Lancet Global Health journal . Based on the worst of three scenarios in 118 low- and middle-income countries, the analysis estimates that an additional 1.2 million under-five deaths could occur in just six months, due to reductions in routine health service coverage levels and an increase in child wasting. These potential child deaths will be in addition to the 2.5 million children who already die before their 5 th birthday every six months in the 118 countries included in the study, threatening to reverse nearly a decade of progress on ending preventable under-five mortality. Some 56,700 more maternal deaths could also occur in just six months, in addition to the 144,000 deaths that already take place in the same countries over a six-month period. “Under a worst-case scenario, the global number of children dying before their fifth birthdays could increase for the first time in decades,” said UNICEF Executive Director Henrietta Fore. “We must not let mothers and children become collateral damage in the fight against the virus. And we must not let decades of progress on reducing preventable child and maternal deaths be lost.” In countries with already weak health systems, COVID-19 is causing disruptions in medical supply chains and straining financial and human resources. Visits to health care centres are declining due to lockdowns, curfews and transport disruptions, and as communities remain fearful of infection. In a commentary to the Lancet report, UNICEF warns these disruptions could result in potentially devastating increases in maternal and child deaths. The paper analyzes three scenarios for the impact of reductions in lifesaving interventions due to the crisis on child and maternal deaths. It warns that in the least severe scenario, where coverage is reduced around 15 per cent, there would be a 9.8 per cent increase in under-five child deaths, or an estimated 1,400 a day, and an 8.3 per cent increase in maternal deaths. In the worst-case scenario, where health interventions are reduced by around 45 per cent, there could be as much as a 44.7 per cent increase in under-five child deaths and 38.6 per cent increase in maternal deaths per month. These interventions range from family planning, antenatal and postnatal care, child delivery, vaccinations and preventive and curative services. The estimates show that if, for whatever reason, routine health care is disrupted and access to food is decreased, the increase in child and maternal deaths will be devastating. The greatest number of additional child deaths will be due to an increase in wasting prevalence among children, which includes the potential impact beyond the health system, and reduction in treatment of neonatal sepsis and pneumonia. According to the modeling, and assuming reductions in coverage in the worst-case scenario, the 10 countries that could potentially have the largest number of additional child deaths are: Bangladesh, Brazil, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, Uganda and United Republic of Tanzania. The 10 countries that are most likely to witness the highest excess child mortality rates under the worst-case scenario are: Djibouti, Eswatini, Lesotho, Liberia, Mali, Malawi, Nigeria, Pakistan, Sierra Leone and Somalia. Continued provision of life-saving services is critical in these countries. In addition to the estimated potential rise in under-five and maternal deaths described in the Lancet Global Health Journal analysis, UNICEF is deeply alarmed by the other knock-on effects of the pandemic on children: An estimated 77 per cent of children under the age of 18 worldwide – 1.80 billion out of 2.35 billion – were living in one of the 132 countries with stay-at-home policies, as of early May. Nearly 1.3 billion students – over 72 per cent – are out of school as a result of nationwide school closures in 177 countries. 40 per cent of the world’s population are not able to wash their hands with soap and water at home. Nearly 370 million children across 143 countries who normally rely on school meals for a reliable source of daily nutrition must now look to other sources as schools are shuttered. As of 14 April, over 117 million children in 37 countries may miss out on their measles vaccination as the pandemic causes immunization campaigns to stop to reduce the risk of spreading the virus. This week, UNICEF is launching
Pregnant mothers and babies born during COVID-19 pandemic threatened by strained health systems and disruptions in services
– An estimated 116 million babies will be born under the shadow of the COVID-19 pandemic, UNICEF said today ahead of Mother’s Day. These babies are projected to be born up to 40 weeks after COVID-19 – currently straining health systems and medical supply chains all over the world – was recognized as a pandemic on March 11. New mothers and newborns will be greeted by harsh realities, UNICEF said, including global containment measures such as lockdowns and curfews; health centres overwhelmed with response efforts; supply and equipment shortages; and a lack of sufficient skilled birth attendants as health workers, including midwives, are redeployed to treat COVID-19 patients. “Millions of mothers all over the world embarked on a journey of parenthood in the world as it was. They now must prepare to bring a life into the world as it has become – a world where expecting mothers are afraid to go to health centres for fear of getting infected, or missing out on emergency care due to strained health services and lockdowns,” said Henrietta Fore, UNICEF Executive Director. “It is hard to imagine how much the coronavirus pandemic has recast motherhood.” Ahead of Mother’s Day, recognized in May in over 128 countries, UNICEF is warning that COVID-19 containment measures can disrupt life-saving health services such as childbirth care, putting millions of pregnant mothers and their babies at great risk. Countries with the expected highest numbers of births in the 9 months since the pandemic declaration are: India (20.1 million), China (13.5 million), Nigeria (6.4 million), Pakistan (5 million) and Indonesia (4 million). Most of these countries had high neonatal mortality rates even before the pandemic and may see these levels increase with COVID-19 conditions. Even wealthier countries are affected by this crisis. In the US, the sixth highest country in terms of expected number of births, over 3.3 million babies are projected to be born between March 11 and December 16. In New York, authorities are looking into alternative birthing centers as many pregnant women are worried about giving birth in hospitals. UNICEF warns that although evidence suggests that pregnant mothers are not more affected by COVID-19 than others, countries need to ensure they still have access to antenatal, delivery and postnatal services. Likewise, sick newborns need emergency services as they are at high risk of death. New families require support to start breastfeeding, and to get medicines, vaccines and nutrition to keep their babies healthy. On behalf of mothers worldwide, UNICEF is issuing an urgent appeal to governments and health care providers to save lives in the coming months by: Helping pregnant women to receive antenatal checkups, skilled delivery care, postnatal care services, and care related to COVID-19 as needed; Ensuring health workers are provided with the necessary personal protective equipment and get priority testing and vaccination once a COVID-19 vaccine becomes available so that they can deliver high quality care to all pregnant women and newborn babies during the pandemic; Guaranteeing that all infection prevention and control measures are in place in health facilities during childbirth and immediately after; Allowing health care workers to reach pregnant women and new mothers through home visits, encouraging women living in remote areas to use maternal waiting homes, and by using mobile health strategies for teleconsultations; Training, protecting and equipping health workers with clean birth kits to attend home births where health facilities are closed; Allocating resources to lifesaving services and supplies for maternal and child health. While it is not yet known whether the virus is transmitted from a mother to her baby during pregnancy and delivery, UNICEF recommends that all pregnant women: Follow precautions to protect themselves from exposure to the virus, closely monitor themselves for symptoms of COVID-19 and seek advice from the nearest designated facility if they have concerns or experience symptoms; Take the same precautions to avoid COVID -19 infection as other people: practice physical distancing, avoid physical gatherings and use online health services; Seek medical care early in if they live in affected or at-risk areas and have fever, cough or difficulty breathing; Continue breastfeeding their baby even if they are infected or suspect being infected as the virus has not been found in samples of breastmilk. Mothers with COVID-19 should wear a mask when feeding their baby; wash hands before and after touching the baby; and routinely clean and disinfect surfaces; Continue to hold the newborn and perform skin-to-skin care; Ask their midwife or doctor where they feel is the safest place to give birth and have a birth plan in place to reduce anxiety and to ensure they get to the place on time; Continue medical support, including routine immunizations, after the baby is born. Even before the COVID-19 pandemic, an estimated 2.8 million pregnant women and newborns died every year, or 1 every 11 seconds, mostly of preventable causes. UNICEF calls for immediate investment in health workers with the right training, who are equipped with the right medicines to ensure every mother and newborn is cared for by a safe pair of hands to prevent and treat complications during pregnancy, delivery and birth. “This is a particularly poignant Mother’s Day, as many families have been forced apart during the coronavirus pandemic,” Fore said. “But it is also a time for unity, a time to bring everyone together in solidarity. We can help save lives by making sure that every pregnant mother receives the support she needs to give birth safely in the months to come.” ######
Заявление Исполнительного директора ЮНИСЕФ Генриетты Фор относительно сбоев в предоставлении услуг по иммунизации и базовых медицинских услуг в связи с пандемией COVID-19
Загрузить мультимедийный контент о вспышке COVID-19, мытье рук и вакцинах можно здесь: https://uni.cf/2WydpEk . Nurse Milka Babic performs immunization UNICEF/UNI218376/Pancic