Multilaterals brace for pandemic’s indirect effects

As the world raced throughout the month to respond to COVID-19, several multilaterals sounded the alarm over indirect global health effects of the disease, including increased morbidity and mortality from other causes. UNICEF cited the experience of past epidemics, like the 2014 West Africa Ebola outbreak and SARS in 2003, in noting that supply chain disruptions, declining use and availability of health services, and resource and personnel reallocation can continue affecting mortality “for an extended period following the pandemic.”

Immunization remained a primary concern. UNICEF, WHO, and Gavi reported on May 22 that 80 million children under 1 year are at risk of vaccine-preventable diseases due to vaccine disruptions from the pandemic. In a statement drawing attention to the Global Vaccine Summit—coming up on June 4—the organizations noted that immunization is already “substantially hindered” in at least 68 countries, the result of fear of the coronavirus and impaired mobility among families, reallocation of health resources, and a massive backlog in vaccine shipments. Both WHO and the Global Polio Eradication Initiative updated their vaccination guidance in late May, with an eye toward resuming services where the risk of doing so is warranted.

Meanwhile, the UNICEF-led UN Inter-agency Group for Child Mortality Estimation began assessing the indirect effects of COVID-19 on children and adolescents, and The Lancet published a modeling study on maternal and under-5 child deaths, which estimated that coronavirus-related reductions in essential care and decreased access to food would result in 253,500 additional child deaths and 12,200 additional maternal deaths under the least severe scenario in just a six-month period—and more than 1.1 million additional child deaths in the same period under the most severe scenario. Separately, a Guttmacher Institute report estimated that a 10 percent decline in contraceptive use in LMICs due to reduced access during the pandemic would result in an additional 15 million unintended pregnancies over one year.

COVID-19 also threatens a sharp increase in deaths from HIV. A WHO- and UNAIDS-led modeling group predicted that a six-month disruption in antiretroviral therapy availability could lead to more than 500,000 extra deaths from AIDS-related illnesses in sub-Saharan Africa in 2020–2021—perhaps doubling the number of such deaths in the region. Excess mortality would continue for another five years.

Mental health consequences are likely, too. A UN policy brief warned that the pandemic “has the seeds of a major mental health crisis,” with frontline health workers, older adults, and children and adolescents at particular risk.

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