Wherever COVID-19 strikes, it magnifies unfairness and inequality. In every nation and every community touched by the virus, hard-won progress for women, newborns and young people is being reversed.
This is not the work of the disease itself, but of our reaction to it: resources for essential health care shrink, people fear using health services, and poverty and hunger grow. The problems are compounded by fragile health systems and lack of preparation. A recent study in the Lancet indicates that, in low- and middle-income countries, all these factors could kill more than a million children and thousands of mothers in the next six months.
In the past twenty years, keeping mothers and children alive has been one of the great public-health success stories. Child death rates have almost halved, and maternal death rates are down by over a third. Those gains are now being eroded as inequalities spread, running like fractures along the lines of age and sex, further fragmented by geography, income, disability and ethnicity.
This time must be different
We can choose a better future, guided by our knowledge of past pandemics. In those other outbreaks, women – along with children, adolescents and the most vulnerable – often haven’t received their fair share of resources and services. They’ve been excluded from decision-making. Globally, seventy per cent of health workers are female, yet women’s basic needs have often gone unmet and their voices unheard. Resources to deal with the pandemic are often diverted from women’s health services, with lasting effects on their children, their families, and their economies.
These “secondary effects” often dwarf a virus’s direct impact. For example, during the 2014-15 outbreak in Sierra Leone, more than 3,500 people died of Ebola. But at the same time, an estimated 3,600 mothers and babies died because of disruption to essential health services. In some West African countries, twenty-five years of progress on maternal mortality was wiped out.
We see similar patterns now. The Guttmacher Institute warns that COVID-19 could have a catastrophic effect on sexual and reproductive health in poorer countries. Even a ten per cent reduction in care could kill 168,000 babies and 28,000 mothers, and lead to three million unsafe abortions.
Children are heavily affected too. Many will suffer the lifelong effects of not being immunised against other serious diseases, as parents shun health facilities for fear of contagion – or of breaking curfews, or because they simply can’t get there without public transport. And the economic effects are already worsening inequality and hunger. The UN estimates that between 42 and 66 million children will fall into extreme poverty this year because of the virus’s economic impact.
In all these ways, COVID-19 is not the great leveller, but rather the great amplifier of inequality. That gives us a clear duty to protect the most vulnerable and disadvantaged, and to address the root causes of inequality. We must act now – while the storm is raging – or be ashamed by the number of lives swept away on our watch.
How to protect the most vulnerable
We, the authors of this article, come from four continents, but speak with one voice on what we – as a global community – must do differently this time.
One, we need national policies and budgets to protect human rights and promote inclusivity, equity and fairness – during this pandemic and in its aftermath. That should include strategies for preventing gender-based violence, child abuse, and the mistreatment of health workers. Because these crimes are often hidden, we should encourage people to share their experiences – as Femnet has done with its #inclusivelockdown hashtag on Twitter. Women’s voices and leadership must be at the core of our response, along with a recognition of children’s needs.
Two, we need to focus on strengthening health systems, including immunisation and basic primary health care, to ensure universal health coverage. We need to expand health infrastructure to rural and underserved areas, and gradually expand universal health coverage. Women and families, especially in disadvantaged communities, need support to keep using essential health services, including those for sexual and reproductive health. That means doing things differently – like temporarily moving maternity care elsewhere, perhaps to now-empty hotels.
Three, we need to put our money into solutions that focus on partnership. To beat this pandemic without disastrously increasing inequality, we need many different stakeholders to work together: civil society, business, health professionals, donors, and engaged citizens. We call for multi-stakeholder partnerships that allow women, children and adolescents to take part in decisions that profoundly affect their health and wellbeing.
That’s why we wholeheartedly support the Access to Covid-19 Tools (ACT) Accelerator – an unprecedented commitment by global leaders to work together, to develop and manufacture vaccines, tests and treatments for Covid-19, and to make them available and affordable for everyone, everywhere. It was launched by the WHO on 24 April, and an EU-led fundraising initiative met its initial target of €7.5 billion in just two days. The Accelerator came after an open letter to G20 governments – signed by 214 world leaders, economists, and health experts – called urgently for co-ordinated global leadership and solidarity.
A hopeful precedent: global co-operation in peacetime
As the open letter says, if COVID-19 remains in any country, it will re-emerge and prolong this economic and health crisis. And so, although the pandemic magnifies inequality, it also pushes us towards solidarity, giving us an opportunity to restructure our health systems and leave no one behind. We have the tools for effective co-operation on global problems: a whole-of-government approach, involving multi-stakeholder partnerships. They’ve been sharpened in our work on the Sustainable Development Goals. Let’s use them now.
Already, we’re seeing people and nations working together in peacetime in a way we’ve only achieved before in war. Our response now could set a precedent for tackling other long-standing issues, such as poverty, gender inequality and climate change. Let’s prove we can work together to overcome unfairness and inequality, for the good of everyone.
Where the figures come from
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Para 2, ‘A recent study in the Lancet…’ – Roberton T, Carter ED, Chou VB, Stegmuller AR, Jackson BD, Tam Y, Sawadogo-Lewis T, Walker N. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. The Lancet Global Health. 2020 May 12.
Para 3, ‘Child death rates have almost halved…’ – https://www.who.int/news-room/detail/19-09-2019-more-women-and-children-survive-today-than-ever-before-un-report
Para 4, ‘Resources to deal with the pandemic are diverted from women’s health services…’ – https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2930526-2
Para 5, ‘…in Sierra Leone, more than 3,500 people died of Ebola…’ –
https://www.afro.who.int/news/statement-end-ebola-outbreak-sierra-leone
Para 5, ‘…an estimated 3,600 mothers and babies died…’ –
https://academic.oup.com/heapol/article/32/suppl_3/iii32/4621472
Para 6, ‘…the Guttmacher Institute warns…’ –
Para 7, ‘… between 42 and 66 million children will fall into extreme poverty …’ – ‘Impact of COVID on Children’ – https://unsdg.un.org/sites/default/files/2020-04/160420_Covid_Children_Policy_Brief.pdf
