Learning from Exemplars in Global Health: a road map for mitigating indirect effects of COVID-19 on maternal and child health

[...]with over 15 million confirmed cases and 618 000 confirmed deaths globally, the toll on human health has been a tragedy.1 Daily cases continue to increase as well; the 3-day rolling average of new confirmed cases was 246 597 on July 18, up from 223 597 one week prior.2 And while daily confirmed deaths have levelled off from their peak in April,3 hospital resource use is at risk of returning to levels that exceed intensive care unit capacity in 92 out of 160 countries with available projections in 2020.4 This excess resource use across health systems threatens to impact more patients than just those suffering from coronavirus disease. Financial resources have already begun diverting away from routine services and interventions, as financial channels such as the Global Fund allow the reprogramming of funds originally intended for other purposes.5 Demand to use health services is also being interrupted as physical distancing remains an effective mitigation strategy and understandable concerns about disease transmission create hesitance to seek care.6 7 Worse, the broader economic impact of the pandemic, coupled with existing healthcare inequalities and a disproportionate disease burden, is exacerbating socioeconomic disparities and the social determinants of health.8 The combination of these four forces—constrained supply, reduced resources, suppressed demand and worsening socioeconomic inequality—creates a likelihood that the indirect effects on health and nutrition will be more harmful than the direct health consequences of the disease. Under-five mortality has declined by 43% globally, with 4.3 million fewer annual deaths in 2017 than 2000.9 During the same period, the prevalence of stunted growth in children under age 5 declined from 32% to 22%, or 48.7 million fewer children.10 Progress in maternal and child health is at especially high risk during the COVID-19 response.11 The suspension of national immunisation programmes has been projected to cause 140 child deaths per COVID-19 death averted,12 putting 80 million infants at risk of contracting vaccine-preventable diseases.13 Disruptions in distribution campaigns for insecticide-treated bed nets and effective antimalarial treatments have been projected to set malaria mortality back to levels not seen in 20 years under the worst scenario, with most of those affected being children.14 The socioeconomic consequences of the pandemic could leave mothers and children especially vulnerable to health risks