- Tim Robertonassistant scientist in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health and lead author of a new study published in The Lancet Global Health on “Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries.”
- Dr. Beate Kampmanninfectious disease pediatrician, director of the Vaccine Centre at the London School of Hygiene & Tropical Medicine and lead vaccinology researcher at the MRC Unit The Gambia.
A new report finds 1.1 million children under 5 could die the next six months from secondary impacts of the pandemic, like disruptions to health services and access to food. Mothers are also imperiled. We speak with Tim Roberton, lead author of the study and assistant scientist in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health, and with infectious diseases pediatrician Dr. Beate Kampmann.
AMY GOODMAN: This is Democracy Now!, democracynow.org, The Quarantine Report, as we are all alone together. I’m Amy Goodman, with Nermeen Shaikh.
As more than three-quarters of the world’s children live under stay-at-home orders amidst the pandemic, a shocking new report finds the child mortality rate could increase for the first time in more than 60 years. More than a million children under 5 could die over the next six months, according to researchers at the John Hopkins Bloomberg School of Public Health, who studied the secondary impacts of the coronavirus outbreak, the disruptions to health services and access to food. More than 60,000 mothers could also die. The report was published in The Lancet Global Health and looked at 118 low- and middle-income countries.
For more, we’re joined by the lead author, Tim Roberton, assistant scientist in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health in Baltimore. Also with us, infectious disease pediatrician Dr. Beate Kampmann, who is director of the Vaccine Centre at the London School of Hygiene & Tropical Medicine, lead vaccinology researcher at the MRC Unit The Gambia.
We welcome you both to Democracy Now! Tim Roberton, let’s begin with you. Talk about the findings of this study. To say the least, deeply alarming.
DR. TIM ROBERTON: So, we know from past experience and research that in outbreak situations, people have health issues because of the virus, but also more people have health issues and complications because of the secondary effects of the outbreak. So, in the current pandemic, people are dying because of coronavirus itself. But if the pandemic and the response to the pandemic lead to the disruption of health services, then more people are going to die from other causes, as well.
So, in our study, we looked at the potential for additional deaths among pregnant women and young children. And we modeled three different scenarios, looking forward, of different severity. So, in our least severe scenario, over a period of just six months, we could see around 12,000 maternal deaths — so women dying in childbirth — and around 250,000 child deaths. These are children under the age of 5. That would represent a 39% increase in child mortality above what is currently occurring. But in our worst-case scenario, we saw that up to 60,000 maternal deaths and up to about 1 million, 1.1 million children could also die.
NERMEEN SHAIKH: So, Tim Roberton, could you explain what essential services, health services, you think — you suggest ought to be retained to diminish the possible mortality rates among women and infants? What are the procedures? What are the health services, the medicines, that should not be diverted to deal with coronavirus, or at least there should be sufficient amounts available for routine care of mothers and infants?
DR. TIM ROBERTON: So, in our study, in our modeling efforts, we look at what we call the continuum of care, so looking from antenatal care among pregnant women through to care around childbirth for moms, postnatal care, and then looking at care for newborns, for early children, so, for example, vaccinations, preventative care or curative service for children if they have pneumonia or malaria or diarrhea.
So, in general, I think we see two ways in which the secondary effects of the pandemic could impact children. So, the first way is, as I said, around health service disruption. So, ordinarily, if a family has a young child that’s sick, they may go and seek care from a health facility and get care — so, if they have malaria, might get antimalarials, or antibiotic for a cough or pneumonia. But under the pandemic, perhaps people are not able to travel to a health facility, or they might be disinclined to go. Perhaps they’re afraid of going to health services. And also, even if they were to get to a health facility, perhaps at the facility there’s now maybe fewer health workers because some health workers have been diverted to work on the COVID response, or maybe health workers themselves are sick, or perhaps at the facility there’s not the necessary treatment, drugs, medicine, because of issues to do with the supply chain, you know, health facilities just now not having the drugs that they need. So that’s the first general way in which we see this happening.
And another big general way that we see, particularly for child mortality, is an issue that was touched upon in your previous segment, which is the potential for increased undernutrition, malnutrition, because of broader macroeconomic effects — so, for example, households now not having the same income that they had, disruptions to food services, people not being able to access markets and get the necessary food for their children. And what comes from that is that we’re going to see more families living in food insecurity and potentially more children being wasted, so being undernourished. And while wasting itself doesn’t necessarily kill many kids, what it does do is it increases the likelihood that a child will die from other diseases, other infectious diseases. And in our model, that second pathway, these broader effects, increasing food insecurity, increasing undernutrition, is also a big potential way in which more children are going to die because of the pandemic.
AMY GOODMAN: I wanted to bring Dr. Beate Kampmann into the conversation, who’s speaking to us from London. If you can talk about the poorest countries in the world right now? I mean, even in the United States, the wealthiest country, it’s the lowest vaccination level, as parents are afraid to bring their kids in to the doctor. But if you can talk about countries around the world, the stopping of their immunization programs? What’s happening? And what are the places? One of your specialties is the Gambia, but talk about everywhere, from Mexico to Africa’s most populous country, Nigeria.
DR. BEATE KAMPMANN: Yeah, yeah. Thank you very much, Amy, and thank you for having me on the program. This is really an important topic, and Tim has already spoken about a whole range of services for mother and child health, so I’ll try and focus a bit on the risk of — the prevention of potentially deadly infectious diseases for which we know we have vaccines.
So, I was quite alarmed when I saw the WHO announcing at the end of March that mass campaigns should be suspended, because we know that this will potentially leave over 100 million children at risk of measles, which is a potentially lethal infection, especially in the context of malnutrition, which is also something Tim has just alluded to. So, to me, it’s really a question of what is being traded off against what, when we are looking at COVID infection prevention and spread of the pandemic versus essential services for women and children.
So, I work primarily in West Africa. And our own group has, for example, mapped out the consequences of vaccination services not being delivered, even without the presence of a pandemic. And we already showed that there’s a plateau of about 80% of vaccination, and that is not enough for herd immunity for diseases, for example, like measles, that need to have a cover of up to 95% in the community to prevent outbreaks. And just to give a recent example, during the Ebola outbreak in the DRC, about three times as many people died from measles as did end up dying from Ebola. So the consequences of not vaccinating and providing the essential services in the immunization programs are really, really rather devastating.
NERMEEN SHAIKH: And, Dr. Kampmann, if you could also talk about the fact that you’ve said that the effects of diminishing or entirely preventing people from getting vaccinations — that the effects will only be known in a year or two, not immediately, and what you think needs to be done or can be done to ensure that vaccinations continue despite this pandemic?
DR. BEATE KAMPMANN: Yeah. So, it depends slightly on the level of vaccine coverage that the individual countries have. And it also depends on the diseases that we’re trying to prevent. So, measles is a highly infectious disease that needs 95% of the community to be immune to protect the individual but also to stop transmission in the community. There’s meningitis. There’s pneumonia. There’s diarrhea. All of those are vaccine-preventable and are amongst the most common causes for childhood morbidity and mortality, especially in children under the age of 5.
So, the solutions to consider in a situation where healthcare workers might feel exposed if they run vaccination campaigns, or parents might feel reluctant to go to immunization clinics — and we’re seeing this in the U.K., as well — we need to really, first and foremost, have a commitment that the delivery of vaccines to populations remains a high priority for health services. Then we can possibly break down the interventions that could be done into — some of them being purely logistical. For example, flights are suspended all across the globe, and flights bring vaccine supplies to countries. Maybe extra flights need to be chartered to bring vaccines to countries. And, for example, in the Gambia, we have already run out of oral polio vaccine for one reason or another, and that’s already shown a bottleneck.
When it comes to healthcare workers and the public, obviously, the personal protective equipment needs to be available to healthcare workers. People need to respect good hand hygiene. And we need to probably run the clinics in a slightly different way — stagger appointments so not everybody turns up at the same time, and maybe more frequent clinics in different smaller places.
The third intervention, I think it’s crucial that we have data collection tools that will allow us to capture what is going on in the immunization system, who has received vaccines and who hasn’t, because it’s not just now that the children and anyone in the community will suffer from preventable infectious diseases, it’s in a little while, when the herd immunity or the community immunity has either dropped or there are new birth cohorts of children who then, because of suspension of immunization programs, would have never seen a vaccine. And the health systems need to put in place records for that to be feasible, and the data collection systems really need to be fit for purpose.
And we really probably need to think about new models of delivering vaccines and to have more platforms, and maybe not just restricting them to the usual EPI clinics. For example, antenatal services play a big role in maternal immunization.
AMY GOODMAN: And, Dr. Tim Roberton, the response of governments to your report? I mean, it is a deeply alarming report, the number of children who will die in the next six months around the world, not to mention mothers.
DR. TIM ROBERTON: Since we published the report, we’ve had a lot of countries reaching out to us, country offices of NGOs working in different countries around the world, and even ministries of health themselves, contacting us and saying, “You know, we really appreciate this study, because we are actually starting to see this play out in our country, and we’re worried about it.”
And over the next few months, our goal is to do more of our own kind of modeling and analysis, working with countries themselves, to use their own assumptions around what they think is happening in their country, based on available data, as Dr. Kampmann said, and also then model different potential scenarios that they could put in place, different policy options that they can, so that they can mitigate the spread and transmission of COVID —
AMY GOODMAN: Dr. Roberton, let me ask you a quick question.
DR. TIM ROBERTON: — and also continue to maintain care. Yeah.
AMY GOODMAN: The significance of President Trump saying that the U.S. is going to pull out of the World Health Organization, and the overall stopping of funding to it? The role the WHO plays in children and maternal mortality and health?
DR. TIM ROBERTON: Absolutely. I mean, the WHO plays a crucial role for maternal and child health around the world. It’s a vital mechanism for coordinating work in the global health space. Also, I think what people don’t realize is the technical assistance that WHO provides to different governments and ministries of health around the world.
And right now countries are looking for guidance about how they can — how they can do this, what sort of policy options they should be considering, what sort of action they can take. And WHO has been putting out guidance now, operational guidance, on how countries can maintain these maternal and child health services while also addressing COVID. So, I think to undermine WHO now or to defund it, I think, would be highly counterproductive.
NERMEEN SHAIKH: And, Tim, could you also, very quickly, before we conclude, talk about some of the concerns you have raised about disruptions both in food supplies as well as the disruptions to pharmaceuticals and medicine supplies in the areas in which you’re most concerned?
AMY GOODMAN: And we have 20 seconds.
DR. TIM ROBERTON: Yeah. So, this is, I think, perhaps often overlooked, but is an absolutely kind of vital thing to be considered. I mean, health systems are complex, and so we’re not really sure how these secondary effects play out. But I think governments can make sure that they have social safety nets for people who are suffering food insecurity, and kind of bolster and perhaps may need to expand some of these social protection programs to make sure that children aren’t at risk.
AMY GOODMAN: We want to thank you both so much for joining us, Drs. Tim Roberton of the Johns Hopkins Bloomberg School of Public Health — we’ll link your report — and Dr. Beate Kampmann, infectious disease pediatrician and director of the Vaccine Centre at London School of Hygiene & Tropical Medicine.
That does it for our show. Very Happy Birthday to Tey-Marie Astudillo. I’m Amy Goodman, with Nermeen Shaikh. Thanks for joining us.