Episode 5 Part 1 – The Effect of the Pandemic on Children
Discussing The Effect of the Pandemic on Children with the President and CEO of UNICEF Canada – Mr David Morley. This week on the show, we talk about the scale of global child suffering caused by COVID-19. UNICEF has declared COVID-19 to be the worst crisis for children in the organization’s 75-year history and has called for immediate action. Today’s interview will focus on some of the major crises that UNICEF has identified as directly affecting children around the world, namely Poverty, Education, Mortality, Immunization, Nutrition, and Abuse. We also discuss the impact of the Omicron variant on children and Long Covid in children.
https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00005-0/fulltext
https://www.unicef.org/reports/unicef-75-preventing-a-lost-decade
https://tnc.news/2021/11/25/60-of-canadian-parents-worried-they-wont-be-able-to-feed-their-families/
https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html#a5
Transcript
Kojala Medical presents COVID 19 the answers the show that delivers the scientific evidence-based
Speaker:knowledge that can safely return us all to our pre-COVID lives. My name is Dr Funmi Okunola and
Speaker:i'll be hosting the show every week you can listen to me interview a highly respected professional
Speaker:about the science that can reduce your risk of becoming infected with this coronavirus
Speaker:welcome to COVID 19 the answers i'd like to introduce you all to Mr David Morley
Speaker:President and CEO of UNICEF Canada he is a prolific international speaker commentator human
Speaker:rights advocate and mobilizer with more than 30 years of experience advancing advancing children's
Speaker:rights and sustainable development on the world stage David has occupied senior positions in some
Speaker:of the world's most respected charities he has been the Executive Director of Medicine Frontier
Speaker:Canada. President and CEO Save the Children, and now for the past 11 years President and CEO of UNICEF
Speaker:Canada. Welcome! Thank you very much. For me David can you please tell us about UNICEF and what led
Speaker:you into the world of charitable organizations and children's charities in particular?
Speaker:well um i sort of i came into this this work by accident, i think we could say
Speaker:when I was doing my undergraduate, I had a work here in in Canada, in Ottawa. I had
Speaker:a particular interest in medieval Europe and um that's what i've been i've been studying and um
Speaker:which of course, does not immediately lead to job prospects and uh, a friend of our, my family
Speaker:who was a member of the Ontario human rights commission was coming to Ottawa i was unemployed
Speaker:and he my parents arranged for me to have breakfast with him because you know maybe i could
Speaker:get a job or something or he could point me in the right direction um and i'd worked uh all the
Speaker:summers during university uh uh i'd worked as a as a camp counselor for children with special needs
Speaker:and when i told this family friend what i'd done is my summer job he said you have your whole
Speaker:life ahead of you to work in an office building in Ottawa orToronto what you should do is go
Speaker:and volunteer at this organization it was an organization set up by Costa Ricans with
Speaker:Canadian support in Costa Rica for children who've been living on the streets and uh
Speaker:so i thought well okay i guess and i went to volunteer and you know it it
Speaker:i've been a you know grown up as a middle class Canadian and i'd expected when i got to Costa Rica
Speaker:to find that these kids had would have just been crushed by the poverty that they'd had that they'd
Speaker:experienced and life on the streets and life in in pretty dickensian uh institutions and instead
Speaker:i found here are these these kids with an amazing ability to to to care for each other
Speaker:creativity sparks so filled with life you know and um so i was gonna go for three months and um
Speaker:well i stayed longer and it turned into a career because of those kids because those first kids
Speaker:that i knew and i mean now it's very nice because of Facebook those kids are you know some of them
Speaker:are this is 40 years ago some of them are grandparents now and we uh we so am i so we
Speaker:sh and we share notes on grandparenting and stuff uh it's uh it's lovely but i
Speaker:that's why i'm not a medieval historian is because of those kids and the children of
Speaker:the world are glad of it what a fantastic story i'm very fortunate i'm very fortunate
Speaker:and could you please tell us about UNICEF what is the organization about what does it do well UNICEF
Speaker:began um right after world war ii when there was famine and risk of famine
Speaker:in Europe and in Asia at the end and the United Nations one of the first things it did um was it
Speaker:it realized that providing support to children who had suffered through those two wars
Speaker:was vital and that if they were going to have if we were going to have peace and prosperity
Speaker:in the world we had to be sure that that care was taken for children and uh so we
Speaker:we were started uh before the United Nations was even one year old and as the uh as uh as the year
Speaker:a few years went by and the acute phase of the humanitarian emergency in Asia and Europe ended
Speaker:and the decolonization process started UNICEF continued to grow to to help
Speaker:help situation of of health and education and child protection in many countries and and
Speaker:when the convention on the rights of the child was
Speaker:finally uh passed and ratified a bit more than 30 years ago UNICEF was named in it
Speaker:where the agency named in the convention on the rights of the child that it is our
Speaker:responsibility to protect and promote the rights of children we're the only agency named in it and
Speaker:while while we know that these sort of human rights treaties and conventions are not um
Speaker:are rarely fully fulfilled this the convention on the rights of the child is the most signed
Speaker:and ratified human rights treaty in in the world in our history um so that's what UNICEF's job is
Speaker:to work with governments and community groups uh and and the private sector and civil society
Speaker:to ensure that to do our best to ensure that children's rights are protected
Speaker:and promoted that children are are they they have adequate health qui health care
Speaker:that they have adequate education and it's um we're in this this this unique position where
Speaker:we're part of the United Nations but for us in Canada, UNICEF Canada is also a
Speaker:civil society organization so we we have the flexibility of civil society and we have the
Speaker:the um authority of the United Nations and that gives us our mandate to do what we can
Speaker:for children here in Canada and also around the world that's wonderful David thank you for that
Speaker:so um moving on to our questions now part one this involves the effects of the pandemic on children
Speaker:so the effect of the COVID 19 pandemic on children has been significant and in some ways catastrophic
Speaker:a modelling study published last week in the lances stated that globally 5.2
Speaker:million children aged 17 years or under had been orphaned due to the COVID 19 pandemic this equates
Speaker:to a child becoming an orphan every 6 seconds these figures were calculated by the researchers
Speaker:up to October 2021 and they are projecting that figures up to January 2022 once calculated
Speaker:will rise to 6.7 million children orphaned the consequences of this are devastating and enduring
Speaker:resulting in institutionalization poverty abuse mental health problems
Speaker:adolescent pregnancy and chronic and infectious disease of the 20 countries in the study low and
Speaker:middle-income countries were particularly affected though every continent has been touched by this
Speaker:also this is likely to be an underestimate as the world health organization believes mortality
Speaker:estimates show that the african region for example has under-reported death rates by a factor of 10.
Speaker:this is truly alarming these results are outpacing global COVID 19 deaths this is all happening on
Speaker:the back of a widely held misnomer that children have hardly been affected by the pandemic because
Speaker:their rates of severe disease hospitalization and death have been lower than adults
Speaker:though the severity of COVID 19 as it applies to children is beginning to change with the onset of
Speaker:the variance which we will come back to later in its 75th anniversary report entitled preventing a
Speaker:lost decade UNICEFhas stated that COVID 19 is the worst crisis for children in its 75 year history
Speaker:and has called for urgent action this interview today aims to focus on some of the main crises
Speaker:that UNICEF has highlighted directly affecting children globally today
Speaker:namely poverty education mortality immunization nutrition and abuse David at the beginning of the
Speaker:pandemic did UNICEF anticipate your children being orphaned on such a mass scale due to COVID or
Speaker:was this was this unexpected collateral damage of the pandemic that you had to account for secondly
Speaker:what measures are UNICEF taken to mitigate and support orphan children globally due to COVID
Speaker:well i think those are you know those are such shocking and sobering numbers and it's a reminder
Speaker:that for us uh at UNICEF we've we have uh been saying we quickly realized that the pandemic
Speaker:although the the mortality of children was was lower than that of adults and we don't know all
Speaker:the results of that as as you're saying yet but this was absolutely a child rights crisis
Speaker:a children's crisis we know that at the height of the pandemic more than a billion children were out
Speaker:of school and we still don't know uh we don't we don't think that all of those children are
Speaker:going to go back to school we know and we'll talk more about immunization rates for children and for
Speaker:poverty but i think none of us none of us really knew at the beginning of the pandemic
Speaker:uh how long it would go on for and how devastating it would be and this issue of of children
Speaker:losing their parents to COVID and then what does that mean for them is is one which
Speaker:which i think um
Speaker:we had not been ready for i don't think the world was ready for it you know our work because we're
Speaker:as part of the United Nations a lot of our work uh as as i mentioned earlier it's either with
Speaker:local civil society or with governments so to try and help the children who've been orphaned we work
Speaker:a lot with ministries in in countries all around the world the ministries of family the ministries
Speaker:of social affairs what what they may be called and so we are we'll be working with them to try and
Speaker:try and find models of care if there isn't care for extended family the members of extended family
Speaker:try to give some have policies that will give them support but we try to we encourage
Speaker:governments not to do institutionalization of children to find community-based responses which
Speaker:will be a way to care for those children i think in in in the vast majority of
Speaker:of cases children will be cared for by extended family and i think if we even think of here in
Speaker:canada when there are tragedies of children who are orphaned extended family is is usually the
Speaker:first to to step in um but then we have to be sure the policies are there that will give the
Speaker:support that those extended family those extended families need in a way you know the the crisis of
Speaker:of uh 20 years ago when aids was having such a destructive swath through sub-saharan africa
Speaker:we learned a lot from all those grandmothers who started caring for their grandchildren and
Speaker:we've learned about policies that can help with that and we've learned those of us who are from
Speaker:outside of those communities have learned the phenomenal strength of those communities
Speaker:and i think and i hope because we're at the early days yet that we will be able to learn
Speaker:from what happened what the way communities responded and be able to support a similar
Speaker:response that's going to be needed this time thank you for that really good answer
Speaker:the following questions are based around some of the figures stated in the UNICEF report
Speaker:and also extracted from UNICEF's website we will also briefly examine how the omicron wave has
Speaker:affected children and talk about COVID 19 and long COVID in children let's start with poverty David,
Speaker:to allow the audience some perspective what is UNICEF's definition of poverty
Speaker:according to your website 100 million more children could be living in multi-dimensional
Speaker:poverty by the end of 2021 compared to the pre-COVID era what is multi-dimensional
Speaker:poverty and what plans does UNICEF have for addressing multi-dimensional poverty
Speaker:the the multi-dimensional poverty that we that we use is uh it was first developed
Speaker:in Oxford University in the UK and the world bank has used it as well and so we have there are
Speaker:it's very detailed but i'll try to stay high level there's um there are 10 indicators there's
Speaker:three main dimensions of poverty uh when you add in the world bank it's people it's it's
Speaker:less than a dollar a night one dollar and ninety cents a day
Speaker:but but as well it's um we look at health indicators for which is um the nutrition
Speaker:and the the rate of child mortality here i'm talking about countries you know
Speaker:sorry, David could you repeat that because the screen froze, you said okay sorry, yeah
Speaker:the under the health indicators that we look at there is the nutritional status and also the
Speaker:rates of under five child mortality so we consider those then we look also at the years of schooling
Speaker:and at the country level and the level of school attendance so how many children are in of school
Speaker:age are in school and then there's a variety for living standards which um
Speaker:which go beyond just simple what's the money you you bring into the family it's what kind of
Speaker:cooking fuel do you use uh what's your sanitation is it um open defecation is it latrines is it
Speaker:plumbing um do you have access how far away is the nearest drinking water um do you have
Speaker:electricity what's your house what's your house made out of what are your assets in the house how
Speaker:much you know how much furniture and things do you have so we we look at all of those because
Speaker:in some cases people may be earning more than a dollar 90 cents a day
Speaker:but they're not in and living in an environment uh or in a region where their children are likely to
Speaker:get a chance to go to school or they may be living far away from a health clinic
Speaker:so they've got some money but they don't have access to health care for their children
Speaker:so that's why we want to look at the multi multi-dimensional poverty index because
Speaker:it's just a more accurate way to really assess what what are the levels of poverty and then
Speaker:then for us at UNICEF we that helps us decide where will we do our our programming as well um
Speaker:because we work in every country of the world uh we have a lot of choices that we must make
Speaker:and and this is one of the key drivers to where we will invest our resources
Speaker:so um so with it with multi-dimensional poverty increasing what plans do you does
Speaker:UNICEF have for addressing that well you know all the all the component
Speaker:parts of our of our work um aren't we think they will help um and and maybe we i don't know maybe
Speaker:we can look at them more in detail but it's our investment that we try to get an education it's
Speaker:it's the investment in community health services so that uh the child mortality rate will more
Speaker:will decline um it's the investment that we will make uh we we also make in in
Speaker:where possible uh improving improving the economy so that of a place that things will be able to
Speaker:become more sustainable but education and health are so important i mean we know you know sometimes
Speaker:i feel for me that we take it for granted here because we have access to these things but
Speaker:um those are two of the areas that we work very much well that's that's much of our
Speaker:of our everyday work of of UNICEF is involved in those those two areas as well as child protection
Speaker:but those two areas particularly to address the multi-dimensional poverty thank you David
Speaker:children going to so if we move to education children going to school or not going to school
Speaker:was an incredibly polarizing topic nationally and globally during the pandemic the issue has
Speaker:multiple layers of complexity ranging from child teacher and community safety debates and issues
Speaker:around vaccine mandates for children and or teachers and so on during the pandemic over 1
Speaker:billion children were affected by school closures and at least 463 million children worldwide
Speaker:were unable to access remote learning during COVID 19 school closures and lockdowns in 2020
Speaker:worldwide during the pandemic there have been 1.3 trillion hours and counting of in-person learning
Speaker:lost with these figures in mind how do we balance the opening and closing of schools yeah that's um
Speaker:as you say it's been an issue everywhere right from every country of the world to
Speaker:to i'm sure every community where your listeners live it's been and it's an emotional topic as well
Speaker:we um at UNICEF one of the first things that we did was we said teacher once vaccines were
Speaker:available we said teachers should be considered frontline workers and they should get they
Speaker:should be right up there with the front line health workers and emergency responders to get
Speaker:vaccines when they were first out so that we could open the schools because we also felt
Speaker:uh advocated that schools should be the last to close and uh first uh first to open that if we're
Speaker:um reopening well anyhow if we're for reopening all of our uh restaurants and everything but we
Speaker:should we we should be sure to protect schools first and make sure that they get open and not
Speaker:sometimes they were lagging behind you know um because the the education loss there's there
Speaker:is no question all the results we're starting to see in Canada let alone and this is also in
Speaker:other countries that children are you know have lost a full year of education that there are um
Speaker:only speaking here in my province which is Ontario um and i know this because my spouse is involved
Speaker:in educational research uh basically children who are in grade two have lost a year's worth
Speaker:of reading grade one where you usually learn to read now what's that going to mean as we
Speaker:as they go on and we see then the social loss the social interaction loss that has happened
Speaker:as well so we know we need to be safe for children and we know that investments in
Speaker:and with the because we're not so sure what what omicron will mean but if we we've got if
Speaker:masks are going to keep help keep people healthier longer then we should keep having mass mandates
Speaker:uh we should try to encourage the ongoing vaccination of young children and go for a
Speaker:pediatric formulation as well so that preschools and day care centers can can be open as well we
Speaker:those are open safely um it it's um we have to give
Speaker:schools the a priority which is right on the heels of that of our health system i think and
Speaker:excuse me and that that's going to be the way that we'll see schools uh open and and stay open
Speaker:moving on to child mortality while the hospitalization and death rates for children are
Speaker:on the whole lower than for adults there have been significant indirect effects on children such as
Speaker:the strained health care systems preventing sick children from accessing for medical care
Speaker:access to regularly scheduled immunization has been blocked or postponed and antenatal
Speaker:care has now been affected in your opinion how are these indirect impacts of COVID 19
Speaker:going to affect children now and in the future
Speaker:you know every in 1960 so it's not 60 years ago we we is when we started
Speaker:collecting good data on the global uh under five mortality rate um
Speaker:every year that rate has got lower like fewer kids fewer children under five have died from
Speaker:preventable causes up to up to 2020 which is which is over 2019 is the last year that we've got full
Speaker:data for one of the huge reasons for that the strengthening of health systems but it's been
Speaker:the widespread access to immunization to the childhood to childhood immunization and further
Speaker:and the improvement in the development of those vaccines so it seems
Speaker:to me logical and i we don't have all the data in yet from 2020 but with all of the children
Speaker:who have missed immunization and we weren't at 100 coverage but we heard about we were very
Speaker:high global coverage for childhood immunization and it's our our statistics are that at least
Speaker:70 million children missed out last year i suspect it's more but that's what we can see right now
Speaker:it's going to mean that for the first time because of the pandemic for the first time in 60 years
Speaker:the number of children under the age of five who die from from preventable causes is going to go
Speaker:up it's that is another another huge tragedy of this of the pandemic you know because
Speaker:i have to say that that's in the context of the fact that in the last generation
Speaker:we have seen a child survival revolution there's no question you know that we used to it used to be
Speaker:um you know 30 years or so ago the under 15 million children under the age of five died
Speaker:every year from preventable causes and by 2019 it was under 5 million children a year now that's
Speaker:way too many like 5 million children like the heartache for those families and and and
Speaker:siblings and parents and grandparents is horrific but it is only one-third of the number right it's
Speaker:down from 15 million to 5 million so we've had this incredible child survival revolution um
Speaker:and it's been stopped in its tracks by the pandemic and i think it is i mean i know for us at
Speaker:UNICEF as we try to think how are we going to be able to rev up the immunization programs again um
Speaker:because those in and of themselves it's not like it's you know you in Vancouver and me and Toronto
Speaker:going as volunteers to do these things it's working with local health systems strengthening
Speaker:ministries of health community health workers who are doing all of the all of the immunization we
Speaker:provide training and in the end the vaccines but um we have to we've got to start that up again and
Speaker:and and the wonderful thing uh we see is that on very broad scale as more and more children survive
Speaker:um parents start advocating more and more and they don't have to be as afraid that their children are
Speaker:gonna die you know they then they start advocating for better education and we start seeing parents
Speaker:pushing for more education for these kids and um uh so it becomes it's a bedrock of a positive
Speaker:cycle and um that's why we have to that's why it's so terrible the way it's been affected
Speaker:by the pandemic and why it's so important for us to get that started again sobering
Speaker:David um so if we get moved to nutrition looking nationally in Canada in November
Speaker:2021 i read a report that sixty percent of Canadians feel worried that they are unable to
Speaker:feed their families internationally according to UNICEF an additional 67 million children
Speaker:suffered from malnutrition directly due to COVID on top of that an additional 132 million people
Speaker:in the world went hungry due to COVID 19 of which 44 million were children clearly the pandemic has
Speaker:added an additional burden globally to an already difficult problem of feeding our planet David can
Speaker:you please comment on the impact a poor diet has on the growth and development of a child
Speaker:well you know the the um the issue of stunting is stunting and wasting when children don't
Speaker:get enough food is one that can have lifelong impacts if it goes on long enough you know the
Speaker:the those early years when there's um and as a child is developing as uh as their physical
Speaker:and intellectual capacities are developing without enough food then they don't
Speaker:get the simply the fuel that they need and you know you if we ca if we um if it can be caught
Speaker:early enough and enough food and enough nutrients can can go there then you children can recover
Speaker:but if it isn't it can have a lifelong effect on on that child who and as they become an adult
Speaker:so it's one of the reasons why like you know we sometimes we separate out
Speaker:health as a medical thing and nutrition as i guess a nutritional thing one could say but
Speaker:but why we have to look at these holistically because um and it's why often in our
Speaker:you know the when you're in a a a rural clinic somewhere um off the beaten track uh that you we
Speaker:will see all of those coming together with with nutritional supplements that we that
Speaker:we try to give at the same time as we're giving the the um immunization or or uh and and and so
Speaker:we need that as an integral part of of healthcare for a child we
Speaker:because if we if we don't do that then even if there are educational opportunities
Speaker:for a child they can't take full advantage of it and that's a terrible loss and also malnourishment
Speaker:of children impairs their ability to fight disease because their immune system yes we can too
Speaker:thank you for that David um another concerning impact in society is the mounting risk of
Speaker:violence and abuse during the pandemic families in total desperation have had to make
Speaker:unthinkable decisions in order to stay alive and feed themselves and their families according to
Speaker:the UNICEF report up to 10 million more girls will be forced into child marriage before the
Speaker:end of the decade due to COVID 19. disruption in services related to violence against children
Speaker:was reported in 66 of countries globally due to COVID lockdowns resulting in school closures
Speaker:also put children at increased risk there are so many variables to come out of these statistics
Speaker:that i thought i would ask you what springs to mind with regards to these impacts on children
Speaker:one of the things
Speaker:that we forget about you know you mentioned when you mention this the combination of
Speaker:the school closures and increasing poverty because one of the things that schools do
Speaker:is their form of child protection as well because the parents
Speaker:when parents if they're having to work wherever they're working in fields and wherever schools
Speaker:are a place where they know their children are safe or should be should be safe um and when the
Speaker:schools when school is closed the parents still have to work that's where they get if they're able
Speaker:to find work but that's where the risk of child exploitation increases if the children are left
Speaker:alone if the children and and we see it we see a direct correlation between true schools closing
Speaker:and violence against children increasing and what you mentioned the early enforced child marriage
Speaker:going up when schools close so i mean that's yet another reason why why we've advocated to
Speaker:keep schools open as much as possible because not only the education but but they do become
Speaker:almost the first line uh defense against against child exploitation and abuse and you know i i
Speaker:just think of various places where i've been fortunate enough to work and and i can think
Speaker:of of teachers in in countries as desperate as as ethiopia and uganda and sierra leone all saying to
Speaker:me we know that we know that the girls are safer when they're here and when they're with us and
Speaker:so having schools as a place for child protection is really
Speaker:really key and why we think that keeping schools open or as much as possible is is so important
Speaker:right um we're now moving on to the direct impact of COVID 19 on children acutely and long COVID
Speaker:in canada the number of people 19 years and under with COVID 19 currently stands at around 60 651
Speaker:000 out of a total in canada of 3.2 million um cases equaling 20
Speaker:of the total cases so back in may 2020 this age group made up four percent of cases worldwide with
Speaker:the omicron wave of infection we've seen a much larger increase in hospitalizations and deaths in
Speaker:children particularly those under the age of five who at present in most countries are not or cannot
Speaker:be vaccinated David has UNICEF been called to provide support for increased medical services
Speaker:in lower middle income countries as a as a result of the delta and omicron wave to children
Speaker:we um the way because we work with with ministries of health um what we're finding
Speaker:actually at the moment is much more when more of our more of our efforts are still
Speaker:going into ensuring that immunization comes up and the vaccines are are distributed that's for that's
Speaker:our part of the work right is is um and those are the biggest requests that we're getting right now
Speaker:for me it's it's um uh around the issues of of vaccine equity and vaccine distribution um it's
Speaker:with all the crises you know going on in the world right now it's um just like any just like
Speaker:any emergency room we are triaging and ministries of health which are under pressure are triaging
Speaker:and getting getting COVID vaccines and getting the routine immunization vaccines
Speaker:are really the uh the immediate uh the immediate need right now and and i should
Speaker:you know just thinking of vaccines i know we're going to talk more about vaccines but um we are
Speaker:and and this may be off topic but i just don't want to be only pessimistic about vaccines um
Speaker:because talking about non-COVID vaccines there is this chance say of a of a malaria vaccine
Speaker:after all this time all this time and um we're involved in the in the trials
Speaker:with that because we're a vaccine because we distribute vaccines
Speaker:um and i think because of the impact of the the horrific toll that malaria takes
Speaker:if that works well then that will be more than good news that'll be excellent news and i think
Speaker:that may counterbalance some of the difficulties that we're facing as a global society now um
Speaker:because vaccines are key these days yes and i think the malaria vaccine is
Speaker:particularly good i think it has a 75 percent efficacy so that's yeah that's fantastic
Speaker:it's incredible it's incredible and and yeah and the way malaria can
Speaker:dodge things i mean that you know it's but anyhow it's very good yeah i know that is very good
Speaker:um david um with such a large jump in the proportion of pediatric COVID cases long
Speaker:COVID in children is now a concern similar to adults a previous guest of the podcast
Speaker:Dr Jason Morley discussed a multi-disciplinary approach to the care of adults with long COVID
Speaker:involving a range of physician specialists and other health care professionals such as
Speaker:physiotherapists psychologists ots for example working as a team clearly the multi-disciplinary
Speaker:approach described requires skilled medics and support as well as significant financial
Speaker:backing low and middle-income countries will have higher SARS-CoV-2 infection rates due to a lack of
Speaker:access to vaccines so how do you envisage these countries funding long-COVID care for children
Speaker:really i don't know now how it's going to
Speaker:how it will be possible because as i say the the triaging ministries of health and
Speaker:departments of finance in in low and middle income countries are going to have to deal with
Speaker:with what they are facing um uh i think they're going to be dealing with other matters first
Speaker:and it's not out of any callousness or anything it's just where can they make the biggest impact
Speaker:uh positive positive steps forward for their country so the kind of um looking into those those
Speaker:very real and very important issues of long COVID i think are going to be how those will be funded
Speaker:are still a bit down the road and exactly how those are going to be working
Speaker:i know you're not a medic david but do you have any perspective of how
Speaker:COVID 19 the disease will show itself in children as the pandemic progresses
Speaker:um i i fear you would have to have a medic on this one
Speaker:yeah no that's okay yeah i'll cut that children of med a child of medics but no don't
Speaker:that's not good no that's fine i'll cut that question out so do you want to take a break
Speaker:because we've been going for nearly an hour before we go into vaccine equity or do you want to um
Speaker:yeah i'm just yeah we can just um you know move on i mean if i mean if you want to sure but i'm
Speaker:okay too no i'm fine okay okay so now moving on to part two of our program global vaccine equity
Speaker:the world health organization has a strategy to achieve global COVID 19 vaccination of 40
Speaker:percent of the population in every country by the end of 2022 and 70 by the middle of 2023.
Speaker:David could you please tell the audience about COVID 19 vaccines global access facility or COVAX
Speaker:and unisex role and whether you think this the world health organization strategy is achievable
Speaker:um i'm an optimist so um if before i i'll explain a bit about how it works but but um if we're able
Speaker:to get the funding i think we have the elements in place to be able to to hit those targets
Speaker:i am an optimist though um but the way it the way COVAX has worked is that um
Speaker:the w the world health organization um gavi the the global alliance uh for vaccines initiative
Speaker:and sapi which is uh also involved in vaccines have come together to um
Speaker:they were putting out a lot of the tenders a lot of the ways to try and get
Speaker:vaccines developed right and it was this came together right at the as a as a coalition right
Speaker:at the beginning of the pandemic um before there were any vaccines yet still for against COVID and
Speaker:they turned those three organizations right away turn to UNICEF
Speaker:we because because UNICEF has developed over over the existence of our organization
Speaker:the infrastructure that the world needs to be able to deliver vaccines in a in in before up
Speaker:to before the pandemic we procured and uh delivered almost half of the vaccines that
Speaker:vaccinated almost half of the world's children so in an average year uh we would be shipping
Speaker:sending out um at least a billion vaccines for the routine childhood immunization
Speaker:uh in fact until about maybe eight years ago we actually were vaccinating more than half of the
Speaker:world's children but then uh the government of india took out started doing it themselves and
Speaker:there's a lot of that's a lot of children's you know so uh but still it's about 45 of the
Speaker:world's children that we would vaccinate every year so we had the infrastructure we know the
Speaker:capabilities of ministries of health we know where um where the bottlenecks are in a system we know
Speaker:uh who's got a good cold chain to keep the vaccines called um and uh our colleagues
Speaker:know how do you get vaccines through um through customs uh with a minimum of uh problems our and
Speaker:and our colleagues know know the components you know how how to get because you got the
Speaker:the vial with the vaccine in it but then there's the syringes and the safety boxes and everything
Speaker:else you need to pull together so that's a huge part uh for routine childhood immunization that
Speaker:that UNICEF does so um as the world health organization was starting to think about this well
Speaker:we were the natural uh natural implementing agency for this so we we're working together uh
Speaker:to make that to make that happen um we um we haven't how i am optimistic is that the issue
Speaker:we we've come so far when you think two years ago we didn't even know what COVID was a year ago we
Speaker:did we delivered the first um the first vaccines uh through COVAX reached Ghana it was the first
Speaker:country in the world to get some uh they got them in uh February of last year um and now they're
Speaker:the many of the bottlenecks have been overcome not all of them not all of them but many um
Speaker:and so i think that if the money is there um we have the system that can make it work and
Speaker:uh it's an extremely one of the bigger one of the biggest things we had to do in working with
Speaker:ministries of health and in training with with community health workers um was vaccine hesitancy
Speaker:and the difference of giving the vaccines to adults as opposed to children um and i think we've
Speaker:seen that in canada you know that distribution for uh the the organization that we had to do here
Speaker:to be able to vaccinate adults as opposed to the routine immunization for children
Speaker:it's different and adults are well sometimes they don't want to get vaccinated in a certain way or
Speaker:they're babies too they don't want to get this type babies can take their vaccines better than
Speaker:house too often so there's there's training that that we have to do in many countries
Speaker:um so we put a lot of those building blocks in place and um now it's ramping it up further great
Speaker:David UNICEF did, oh sorry i jumped there, drawing from a commentary titled vaccine
Speaker:apartheid global cooperation and equity published in the lancet in February 2022
Speaker:i quote an open letter to G20 leaders in October 2021 highlighted how 133 doses per 100 people
Speaker:have been given in high income countries compared with four doses per 100 people in low income
Speaker:countries the world health organization director general has called the divide a vaccine apartheid
Speaker:speaking beyond the phrase vaccine inequity to emphasize the scope of this moral failure and
Speaker:make explicit comparisons to the south african system of institutionalized racial segregation
Speaker:David UNICEF did a fantastic job with many obstacles by delivering 1 billion COVID vaccine
Speaker:doses to 144 countries by the end ofDecember 2021 truly amazing the original target was 2 billion
Speaker:doses so what were the factors in your opinion that impacted the shortfall of the original target
Speaker:what additional assistance would UNICEF need to deliver a larger volume of doses
Speaker:well i think um you know that that what you quoted from the landsat um is the reason we didn't hit
Speaker:our target at first you know the um but there are elements within that first of all it was um
Speaker:ramping up production you know there were um and i remember there was
Speaker:for one of the one of the dos one of the uh brands ran into difficulty with their
Speaker:with a factory i think it was in baltimore and so suddenly the u.s which was going to be
Speaker:oh they had to scramble to do that so there was in after after the vaccines had been
Speaker:invented it was rampant is getting getting production high enough and that and then yeah
Speaker:absolutely wealthy countries outbid others to get to get those uh vaccines and um but we now
Speaker:uh what i have heard from some of our colleagues who are close to this is that the issue um
Speaker:is not there will be a sufficient supply maybe there already is so it's no longer
Speaker:supply that's that's an issue uh it's um and to reach some of the low-income countries that
Speaker:that this is too much of a blanket statement but it's relatively true have have uh less robust
Speaker:health systems middle-income countries have tend to have slightly more robust
Speaker:health systems uh so it's making sure that that things like the cold chain and that
Speaker:there's a sufficient um all the supplies that we need to to uh go out because you know the
Speaker:landsat was saying in that in october of last year was four doses per hundred
Speaker:uh the most recent i've heard is now it's ten doses per hundred in in low-income countries so
Speaker:it's not good enough please no i'm not saying that it's good enough but i do think that the numbers
Speaker:keep moving and i think we'll be able to to keep the uh keep the speed uh on its way i think
Speaker:but but you know what i'll tell you there are two things that really concern me um about how we will
Speaker:keep that speed up um one is when when people in the wealthiest countries the high income countries
Speaker:like ours here in canada or in the uk when our when we have many of our leaders saying okay
Speaker:the pandemic's over um well maybe it feels that it's over for those of us
Speaker:who are middle class canadians um but it's not over but because we're if we think it's over
Speaker:then maybe we'll forget and the political support for sending for helping other countries
Speaker:will decline and so that will be less likely and my other fear is that as a species it seems
Speaker:we can only keep one thing in our mind at a time and with the war in ukraine that is um
Speaker:which is horrific and i i mean it's horrific but it it may be that combination of the war
Speaker:in ukraine and that things are opening up in the oecd countries we're going to forget
Speaker:about the rest of the world and and of course that's horrible for the people who are suffering
Speaker:the countries and economies which are still shaking but also it's foolish because
Speaker:we know that low vaccination rates are going to mean more opportunities for for more variants and
Speaker:you know in our own self-interest
Speaker:it's foolish let alone um let alone for the fact that it's morally repugnant
Speaker:well said and um politicians can go on and on about the pandemic being over but the evidence
Speaker:is all pointing to the fact that it isn't this is what we may well be done with this
Speaker:virus but this virus has is not done with us yet and i think that attitude will poke us
Speaker:in the eye in the in the very um short distance future frankly yeah, vaccines in low and middle
Speaker:income countries are in short supply and adults are being prioritized for COVID vaccination
Speaker:bearing in mind that children in low and middle income countries have had more severe cases and
Speaker:deaths from COVID 19 due to poverty poor nutrition higher rates of pre-existent illness can we
Speaker:reshape this narrative to allow more children to be vaccinated in lower and middle-income countries
Speaker:yet balanced COVID vaccinating adults to avoid children being orphaned
Speaker:you you mentioned earlier about the impact of poor nutrition on on health and on opportunities
Speaker:for child survival and i suggest this is a good example of of that that when when children are
Speaker:weaker diseases have are more are worse for those for those children i think that we need
Speaker:we still need to be sure that frontline workers are all getting vaccinated and being you know
Speaker:the health particularly health workers and as i mentioned earlier teachers um and that's where
Speaker:we've been um we've been putting a lot of our emphasis in so that's still those are adult and
Speaker:those those are adults but they're they're key adults in in bringing the pandemic and and then
Speaker:and then once they're fully vaccinated schools can be can be open and if then frontline workers
Speaker:health workers can be community health workers you know can be delivering vaccines
Speaker:then they're going to be able to that i mean the routine immunization vaccines that is going to be
Speaker:that is going to be very helpful i think um within the uh when you talk about about the narrative
Speaker:i think we have to um again it's almost a matter of triage you know i think what are
Speaker:the vaccines that we are going to be able to get into countries first so if it's going to be um
Speaker:adult or or adolescent or pediatric formulations if it's if it's for adults um that will uh
Speaker:i think that still needs to be the the priority is figuring out and it will be it will be
Speaker:physicians like you and your counterparts in countries around the world who will decide
Speaker:uh in those ministries who are the most vulnerable and and starting with the most vulnerable and
Speaker:working our way that way sort of um as we have as we have here it's it's imperfect but i think it's
Speaker:the best way for us to approach how to how to move forward on this okay thank you and another
Speaker:question in that topic um COVID vaccination of children has not been a global success story
Speaker:regardless of perceived economic status even in high income countries COVID vaccination is not
Speaker:universal for example the UKhas been very slow to vaccinate children in North America there is
Speaker:a relatively poor uptake of COVID vaccination particularly in the 5 to 11 year age group what
Speaker:plan is COVAX developing for the COVID vaccination of children in low and middle-income countries
Speaker:it's um it's important important to remember that that or to be to be clear because i
Speaker:realize i haven't been clear much of what we do at uh our colleagues in COVAX is
Speaker:responsive to what ministries of health are within a given country are going to want
Speaker:so we're not at UNICEF we're not the ones who are saying um you should vaccinate in such and
Speaker:such a region or do it in such and such a way what we're doing is is providing the support
Speaker:and then the ministry of health and together with the world health organization but the ministries
Speaker:are the ones who are making the decisions about who will get priority and who will be saying
Speaker:um here's how we think you should do it and there's i think there's a general agreement about
Speaker:the frontline health workers but it's um we are still globally outside of high income countries
Speaker:the issue of pediatric pediatric vaccination against COVID is is again this is probably
Speaker:too sweeping a statement but it is we're still trying to get enough adult vaccination all of
Speaker:the vulnerable adults uh vaccinated and that that's led by the local ministries of health
Speaker:and and it also and it depends when we get donations of actual
Speaker:doses what kind of doses do we get as well because we get both doses
Speaker:themselves donated as well as money for us to buy the dose by the kind of vaccines so um
Speaker:so we're we we really want to help ministries of ensure that ministries of health that local
Speaker:ownership is really what's driving this within a given country right thank you
Speaker:so kovacs depends on the philanthropy of high-income countries donating vaccines
Speaker:surplus vaccine is donated once the donating country is sufficiently supplied
Speaker:this does not appear to address the root causes of vaccine inequity
Speaker:i've heard of various ideas to overcome this inequity such as addressing patent rights for
Speaker:mrna technology so that poorer countries can manufacture the vaccines themselves
Speaker:alternatively alternatively i've heard of an idea of COVID vaccines that should be made
Speaker:in a number of smaller advanced countries with smaller populations as there will always be a
Speaker:bias to vaccinate your own country first so the population is smaller then they could quickly
Speaker:distribute to everyone else after vaccinating their own most manufacturing is happening in
Speaker:countries with large populations such as the usa india uk which is possibly stalling distribution
Speaker:to learning lower middle income countries david what are your thoughts do you have
Speaker:what thoughts do you have on increasing vaccine production and equitable distribution globally
Speaker:well i think that you know we're seeing um for instance in in south africa not a
Speaker:small country but um i do think having um having the manufacturing of of the vaccines uh
Speaker:in a variety of countries and regions is extremely important and will be extremely helpful um
Speaker:if things really um get further bogged down um
Speaker:then there's you know we there are mechanisms in the world trade organization
Speaker:which might become necessary like compulsory licensing like waving patent rights
Speaker:and or else you know and i think some places are looking to some companies who have the patents um
Speaker:to to uh to share the patents at a at a minimal or nominal fee seem might be what they want to do
Speaker:to avoid anything compulsory coming uh that but but that would help but it's um
Speaker:it's also um other uh it's it's it's not we have to remember
Speaker:that it's not only the the vaccine itself it's not only the vial that we always see a picture of on
Speaker:television it's how do we get we got to be sure that we don't start having a shortage of syringes
Speaker:because we need all those syringes right there's a there's a special um special syringe one dose
Speaker:a set amount so that you can't uh syringe there has been some of our my colleagues
Speaker:have just expressed concern that all of the supply chain stuff that goes into making those syringes
Speaker:um there's a risk we're not they're still being produced now but that could be a concern down down
Speaker:the road or later on this year as well as the the the safety boxes and and still the ppe right the
Speaker:the that the frontline workers need who are administering the vaccine so um
Speaker:making a i do think dispersing the the manufacturing of the vaccines
Speaker:but also ensuring the supply chain of the other less less high-tech uh
Speaker:side of of making vaccination uh making me to the everything you need as i say to turn the turn that
Speaker:those what's in what's the vaccine to turn it into a vaccination that goes into somebody's arm
Speaker:we've got to i think a decentralized manufacturing is going to will be helpful
Speaker:and and will allow for faster and more equitable distribution thank you for that
Speaker:um
Speaker:with respect i think you've partially answered this already so forgive me if i'm repeating myself
Speaker:but with respect to vaccine distribution in areas where people can least afford it former CEO of
Speaker:merck ken fraser has a great quote the last mile challenge is the greatest
Speaker:David how is UNICEF working to overcome that last mile challenge what else do you need
Speaker:you think needs to be done for equitable vaccine distribution so we're talking about actually
Speaker:um needles in arms yeah no, i love this question because that last mile challenge is what is
Speaker:UNICEF and and our partners our uh you know civil society groups ngos ministries of health we're
Speaker:thinking about that all the time how do you get all and what we what we know is that if you say
Speaker:i'm going to reach this village that's beyond the end not only of the paved road but even
Speaker:of the dirt road that just has paths to get to it if that's the village we're going to reach
Speaker:that it's going to make all the way along the chain from the from the capital city and
Speaker:the airport where things landed it's going to make it all stronger and it's absolutely it's
Speaker:a challenge i don't want to belittle it but goodness me the community health workers that
Speaker:it's been my privilege to meet in a few different countries and their their commitment their
Speaker:uh enthusiasm like those folks are the heroes i think it's the it's the the
Speaker:i was just talking with a friend the other day about about a guy named
Speaker:edward that's why i remember because i was talking about the other day i met him a few years ago in
Speaker:in uh he's a community health worker in uganda and he just inspired me because they were that
Speaker:uganda was setting up a system where you could do uh report stockouts uh of medicine
Speaker:by text medicine by text by sms and uh and he would say yeah and we have to climb up a tree
Speaker:to hot to be able to get the signal right to send the message to to into kampala and um
Speaker:uh so yeah it's a challenge there's no i mean and i don't want to belittle it by that challenge but
Speaker:anyway i don't want to romanticize it although i can assure you i feel pretty romantic about
Speaker:it when i think of those people who are doing so much and making such a remarkable
Speaker:difference so i'm not sure that i would agree that the last mile challenge is the greatest um it's a
Speaker:huge challenge but there are challenges all the way along the way and what we'd have at the end
Speaker:at that in that last mile is people who are hungry to help and the community health workers who give
Speaker:them the tools and they're going to do the job so sometimes the challenge is um is maybe us in the
Speaker:high income countries opening our hearts enough to be able to to make sure that there's to to to the
Speaker:need for vaccine equity and justice that might be a greater challenge than that last mile well said
Speaker:despite a great desire for the pandemic to be over
Speaker:there is a worldwide push by governments and public health agencies to declare we have to
Speaker:live with the coronavirus and claiming that we're in an endemic phase according to the
Speaker:evidence-based information we are still in the middle of a pandemic and it is far from over
Speaker:as you've correctly stated earlier there will be more variants emerging
Speaker:given 50 percent of the world's population are effectively unvaccinated particularly if COVID
Speaker:vaccination is defined as a three dose vaccine program what are your opinions with regards to
Speaker:live with the coronavirus and ending public health measures such as masking and vaccine
Speaker:mandates particularly since the majority of the world's children are unvaccinated from COVID
Speaker:you know
Speaker:i'm not a policy maker and i think um sometimes as we talk about the need to live with the live
Speaker:with the pandemic live with coronavirus um is is because societies and high income countries
Speaker:are exhausted uh by everything that we i don't think that's necessarily a so it may just be
Speaker:a reality i'm talking here with the high income countries um you know the and
Speaker:in that huge global pandemic of the spanish flu the last the the in that in the third year which
Speaker:we don't talk much about the third year of the spanish flu we just talked about the first two
Speaker:because people were tired of the measures they had to take and they just figured why
Speaker:i was gonna have to live with it so i think it's i think that
Speaker:living with the pandemic may be
Speaker:maybe something that we do have to do because our societies are fed up with it you know it's um
Speaker:i'm not by any means saying it's the right thing i'm not saying you know but i just
Speaker:think there's a there's a um there's a collective exhaustion with this and and and if that means
Speaker:that that variants spring up because so because as you were saying so few people are vaccinated
Speaker:well i mean right globally um
Speaker:then we'll be back where we were before uh but i think that is um living with the coronavirus
Speaker:statement is more a political statement than a health analysis statement yeah well said again
Speaker:if we look to the future david we will successfully emerge from this pandemic
Speaker:if we manage to achieve global cooperation leading to adequate sharing and distribution
Speaker:of COVID vaccines resulting in actual needle in arms with regards to COVID vaccination
Speaker:presuming we achieve this what new landscape of worldwide healthcare access do you see for
Speaker:our planet do you think this can materialize into better resources and access to healthcare
Speaker:in low and middle income countries benefiting from infrastructure created from the pandemic
Speaker:well well despite what i've often been saying here as i said i'm i'm optimistic i'm optimistic for
Speaker:two reasons one is um you know in in your question just now you talked about uh global cooperation
Speaker:and one thing that has been exciting for me i must say is is the response of
Speaker:many many many tens of thousands of canadians who've said who've said
Speaker:we need global solidarity to fix this it's not we need to uh um it's not just my neighborhood
Speaker:or my province or even my country we re there's a recognition that that that the world right now
Speaker:it's the only place we have to live and so when we say charity begins at home well home can be
Speaker:south africa home can be bangladesh home you know our home can be toronto or vancouver but but that
Speaker:i've at a grassroots level in so many times it's been a wonderful sense of global solidarity as
Speaker:people have have have risen to the occasion i believe and i also think you know what i mean
Speaker:one example is um around the ultra cold chain in order to to to do the vaccination campaigns that
Speaker:need to happen absolutely we're we're we're UNICEF is working with those local ministries
Speaker:of health to make sure that it's not a bunch of outsiders coming in or it's not a bunch of
Speaker:uh um you know changing all these news having to create new imposed new systems or anything no
Speaker:it's strengthening ministries of health and it's strengthening the training of community health
Speaker:workers it's strengthening um those those supply chains that are reaching out to that last mile
Speaker:um we've so for example we have delivered hundreds of um
Speaker:of new uh ultra cold uh fridges to keep uh and and we're not taking them back afterwards
Speaker:i mean they're there they've gone to countries along with the the system in order to keep them
Speaker:ultra cold and we've also upgraded the cold train i'm just picking the cold chain because
Speaker:since i'm not medical it's one i can understand the uh uh the importance of of that um
Speaker:and we've been upgrading um the physical infrastructure of clinics and all so that uh
Speaker:um to be the sub-centers which from which often the the the the vaccines are go out to the more
Speaker:rural areas and we're doing more training so so i do think that the result from this
Speaker:is going to be our stronger health systems in many countries it it will be a byproduct and
Speaker:byproduct that we're trying to do on purpose i mean we have to address the pandemic now and then
Speaker:and then the stronger health systems will be a way to to address the issues now but it will
Speaker:it really will leave a legacy that can be used once things are back for a new
Speaker:normal whatever we want to call it and that'll have stronger systems that can do a better job
Speaker:of the routine immunization for children that can do a better job of delivering nutrition that um
Speaker:and that that's going to make things better so i i it's going to take you know i talked
Speaker:about the child this child survival revolution that's been stopped by the pandemic it's not
Speaker:gonna be today but i do think that we'll be able to come out of that maybe it's gonna be
Speaker:might take a couple of years but it'll will come out a couple more years we'll come out stronger
Speaker:and we'll be able to do more as a global society to to
Speaker:to ensure that global health is is higher on the agenda and that most importantly
Speaker:from our perspective as that children lead healthier lives i think that will
Speaker:come that was a fantastic statement to end this interview David um thank you for your contribution
Speaker:UNICEF is an amazing organization one of those who i would say are holding up the world at the moment
Speaker:we are all thankful that you continue to be a great advocate and champion of children's rights
Speaker:thank you very much and i'd like to really um appeal to the audience to please donate
Speaker:to UNICEF you've seen and heard today of the amazing work and things that they do nationally
Speaker:and internationally not just for children but for adults so um they people can donate by going to
Speaker:the website is that right David yes that's right yeah and and here in here in Canada it's UNICEF.ca
Speaker:is where people can go to make donations and be part of our global movement to improve to improve
Speaker:child health excellent and yes and i think it's UNICEF.org if you're it's the global one
Speaker:and i know that you go around the world so um yeah UNICEF.org is is also the way so
Speaker:wonderful and um obviously those links will be provided on the show notes so people can uh click
Speaker:on and and go to those directly so please join us for next week's episode called uh vaccination of
Speaker:the indigenous people of Canada and the effects of COVID 19 on the indigenous people of Canada
Speaker:thanks for listening to this week's episode of COVID 19 the answers if you enjoyed the episode
Speaker:please subscribe rate and review and do visit our website kojalamedical.com/covid19theanswers