The world continues to face global health crises. The COVID-19 pandemic, recent monkeypox outbreaks and the rapid spread of vector-borne diseases exacerbated by the climate crisis have created an increasingly complex global public health landscape. Rising cases of Ebola are emerging in new geographical areas, and 29 countries had reported cholera outbreaks as of October 2022. While there has been significant progress in mitigating the effects of disease outbreaks, there have been acute disparities in countries’ abilities to cope with and recover from public health emergencies, particularly in those countries where people are caught in humanitarian crises.
More than 6 million lives have already been lost across the globe due to the pandemic, and more than 19 million cases have been reported across the 27 countries with an HRP as of July 2022. Actual COVID-19 cases are likely higher than reported, as many HRP countries continue to struggle with weak testing and sequencing infrastructure. The pandemic’s medium- and long-term impacts are far reaching and have the greatest impact on the most vulnerable people. Pandemic-related disruptions to caregiving, schooling and social services risk sending women and children into a spiral of harm and violence, with heightened risks of child marriage and child labour.
Highly unequal and unevenly administrations of COVID-19 vaccines (2021 - October 2022)
The availability and roll-out of vaccinations have been highly unequal and unevenly distributed. To date, only 2.3 per cent of the 13 billion COVID-19 vaccines administered worldwide took place in the 29 countries with an HRP.
COVID-19 exacerbates pre-existing inequalities linked to age, gender, disability and other factors. Fewer women and girls have received vaccinations than men and boys, despite often being on the front lines of the pandemic as health-care workers and therefore more exposed to the virus. In South Sudan, research reveals that women represent more than 70 per cent of people who test positive for the virus, yet they comprise just 26 per cent of people vaccinated. The pandemic’s secondary effects continue to worsen gender inequalities. Gender-based violence (GBV) is increasing, as is the number of girls being forced to drop out of school and women taking up unpaid caretaking in the home. The pandemic continues to disrupt access to sexual and reproductive health care, including family planning services, further increasing the risk of health complications and school dropouts. Persistent vaccine inequity will continue to cost lives, prolong the pandemic, and increase the risk of new and potentially more dangerous variants of the virus emerging.
The air we breathe – a global threat
Clearer blue skies emerged in many parts of the world in 2020, caused by reduced air pollution during pandemic-related lockdowns, and a jarring halt in economic and social activities. Just the year before, air pollution contributed to 6.4 million deaths around the world — more in one year alone than official records of COVID-19-related deaths since 2020. Yet unlike COVID-19, the health effects of air pollution can take years to manifest.
Almost the entire global population breathes air that exceeds WHO’s air quality limits, which threatens health. People living in vulnerable conditions are often more exposed to polluted environments and are at even greater risk of illness and death: 95 per cent of all air pollution-related deaths in 2019 occurred in low- and middle-income countries. The elderly, young people and people with underlying health conditions are disproportionately affected: Air pollution causes 1 in 10 of all deaths of children under age 5, a figure that is set to rise.
Most deaths related to air pollution are caused by human exposure to fine inhalable particles or particulate matter. Concentrations are many times higher in developing countries, affecting billions of people. This type of air pollution penetrates deep into the lungs and enters the bloodstream, causing cardiovascular, stroke and respiratory impacts. Air pollution is also associated with respiratory diseases, particularly asthma, leading to coughing, wheezing or difficulty breathing – and increasing hospital admissions. Research also points to air pollution as a factor in increased COVID-19 incidence and death rates.
In 2019, the economic cost of the health impact of air pollution amounted to $8.1 trillion, 6.1 per cent of global GDP. The associated illnesses, premature deaths, lost earnings and increased health-care expenditures resulting from air pollution place a heavy economic toll on lower- and middle-income countries. Polluted air affects crop yields and ecosystems, resulting in acidification and altered water systems, and it leads to a loss of biodiversity and negative impacts on plant growth. To date, 64 vertebrates are specifically threatened by airborne pollutants. In the same way that the world responded to the COVID-19 pandemic, air pollution calls for speedy, coordinated, cross-border political leadership, with robust governance and enforced air-quality standards.
Increased disease outbreaks continue to disrupt essential health services and immunizations. Global vaccination coverage is in decline, with 25 million infants missing out on vaccines in 2021. This is the largest recorded reduction in 30 years, caused by factors including the increased number of children living in conflict and fragile settings, and the pandemic. Across GHO countries, 14 routine immunization campaigns were postponed due to the pandemic in the second quarter of 2022. These disruptions drive increased cases of vaccine-preventable diseases, such as measles or polio. The percentage of children receiving vaccines against diphtheria, tetanus and pertussis (or whooping cough) fell 5 percentage points between 2019 and 2021. The historic backsliding in immunization rates is happening against a backdrop of interruptions in critical testing, treatment and prevention activities for other infectious diseases, including HIV, tuberculosis and malaria. For example, the number of people reached with HIV-prevention services decreased by 11 per cent in 2022.
Alongside compounding crises, the pandemic is expected to have pushed an additional 95 million people into extreme poverty by the end of 2022. It is critical that Governments, humanitarian organizations and their partners focus on expanding all health services and social safety net programmes, as well as vaccine equity and access, to get ahead of the next global public health emergency.
Vaccination coverage (2000 - 2021)
Mental health in emergencies: Underrecognized and underresourced
Nearly one in every five people living in conflict-affected settings is estimated to be living with a mental health condition. One in 11 has a moderate or severe mental disorder. Despite the scale of the problem, many affected populations, specifically women and young children, do not receive any mental health and psychological support services (MHPSS) due to such services being inadequate or non-existent.
Mental health and psychosocial conditions take a huge toll on families and communities in conflict-affected settings. Research consistently shows that caregivers’ poor mental health is linked to adverse childhood outcomes, such as low birth weight, prematurity, developmental delays and various health problems later in life. Caregiver mental health can also serve as a direct risk or protective factor for child mental health.
According to a recent analysis of global MHPSS activities in development and humanitarian assistance, only 0.31 per cent of official development assistance and 1 per cent of private sector funding went to funding for child, youth and family MHPSS in 2019.
References
- WHO, WHO Director-General's opening remarks at Member State Information Session on COVID-19 and other issues, 27 October 2022.
- The reported number of cases is likely a gross underestimate of actual infections due to many being unreported, with increasing at-home testing.
- According to data from the WHO Coronavirus (COVID-19) Dashboard.
- According to data from the World Health Organization’s Coronavirus (COVID-19) Dashboard, and OCHA’s Financial Tracking Service Appeals and Response Plans 2022, using figures as of October 2022 and the list of GHO 2023 countries.
- CARE International, Gender Gaps in COVID-19 Vaccines.
- World Health Organization, Expanding Reach: Addressing Gender Barriers in COVID-19 Vaccine Rollout.
- World Bank, The Global Health Cost of PM2.5 Air Pollution: a case for action beyond 2021, 2022.
- According to data from the World Health Organization’s Coronavirus (COVID-19) Dashboard.
- WHOBillions of people still breathe unhealthy air: new WHO data, 4 April 2022.
- WHO, More than 90% of the world’s children breathe toxic air every day, 29 October 2018.
- World Bank, The Global Health Cost of PM2.5 Air Pollution: a case for action beyond 2021, 2022.
- WHO, Billions of people still breathe unhealthy air: new WHO data, 4 April 2022.
- State of Global Air, State of Global Air. Accessed November 2022.
- World Bank, The Global Health Cost of PM2.5 Air Pollution: a case for action beyond 2021, 2022.
- UNEP, Statement by Chief Scientist for the 2022 International Day of Clean Air for blue skies, 7 September 2022.
- World Health Organization, COVID-19 Pandemic Fuels Largest Continued Backslide in Vaccinations in Three Decades.
- HRP countries are those countries that have an HR. GHO countries are those countries that are covered by the GHO due to their inclusion in a regional plan, flash appeal or other type of plan, e.g. the 17 countries included in the Regional Refugee and Migrant Response Plan for Venezuela.
- World Health Organization, COVID-19 Pandemic Fuels Largest Continued Backslide in Vaccinations in Three Decades.
- The Global Fund, Results Report 2021.
- World Bank, Pandemic, prices, and poverty.
- Charlson, F., et al. (2019). New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. Lancet, 394, pp. 240-248. https://doi.org/10.1016/S0140-6736(19)30934-1.
- Zhang S, Dang R, Yang N, Bai Y, Wang L, Abbey C, Rozelle S. ‘Effect of Caregiver's Mental Health on Early Childhood Development across Different Rural Communities in China’. Int J Environ Res Public Health. 2018 Oct 23;15(11):2341. doi: 10.3390/ijerph15112341. PMID: 30360569; PMCID: PMC6265717.
- Izett, E. (2021). Prevention of Mental Health Difficulties for Children Aged 0–3 Years: A Review. Frontiers. Retrieved September 20, 2022, from https://www.frontiersin.org/articles/10.3389/fpsyg.2020.500361/full.