Parental hesitancy against COVID-19 vaccination for children and ... BMC Public Health
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This time last year, concepts such as lockdowns, mask mandates and social distancing were unknown to most of us. Today they are part of our everyday language as the COVID-19 pandemic continues to impact all aspects of our lives. Through the following 12 charts and graphics, we try to quantify and provide an overview of our colleagues research in the face of a truly unprecedented crisis.
Over the past 12 months, the pandemic has harmed the poor and vulnerable the most, and it is threatening to push millions more into poverty. This year, after decades of steady progress in reducing the number of people living on less than $1.90/day, COVID-19 will usher in the first reversal in the fight against extreme poverty in a generation.
The latest analysis warns that COVID-19 has pushed an additional 88 million people into extreme poverty this year and that figure is just a baseline. In a worst-case scenario, the figure could be as high as 115 million. The World Bank Group forecasts that the largest share ofthe new poor will be in South Asia,with Sub-Saharan Africa close behind. According tothe latestPoverty and Shared Prosperityreport, many of the new poor are likely to be engaged in informal services, construction, and manufacturing the sectors in which economic activity is most affected by lockdowns and other mobility restrictions.
Those restrictions enacted to control the spread of the virus, and thus alleviate pressure on strained and vulnerable health systems have had an enormous impact on economic growth. The June edition of the Global Economic Prospects, put it plainly: COVID-19 has triggered a global crisis like no other a global health crisis that, in addition to an enormous human toll, is leading to the deepest global recession since the Second World War. It forecast that the global economy as well as per capita incomes would shrink this year pushing millions into extreme poverty.
This economic fallout is hampering countries ability to respond effectively to the pandemics health and economic effects. Even before the spread of COVID-19, almost half of all low-income countries were already in debt distress or at a high risk of it, leaving them with little fiscal room to help the poor and vulnerable who were hit hardest.
For this reason, in April, the World Bank and IMF called for the suspension of debt-service payments for the poorest countries to allow them to focus resources on fighting the pandemic. The Debt Service Suspension Initiative (DSSI) has enabled these countries to free-up billions of dollars for their COVID-19 response. Yet, as the graph below illustrates, debt service outlays to bilateral creditors will impose a heavy burden for years to come, and quick action to reduce debt will be needed to avoid another lost decade.
As World Bank Group President David Malpass has said, Debt service suspension is an important stopgap, but it is not enough. He added that many more steps are needed on debt relief,including an expansion of DSSI while a more permanent solution can be developed.
Without more action on debt, a sustainable recovery could be stunted in many countries along with a host of other development goals. As Global Economic Prospects noted, while many emerging markets and developing economies (EMDEs) were able to implement large-scale fiscal and monetary responses during the 2007-2008 Financial Crisis, today they are less prepared to weather a global downturn. The most vulnerable of them rely heavily on global trade, tourism, and remittances. The next edition of Global Economic Prospects, including updated forecasts, is due in early January.
Remittances the money that migrants send to their home countries are of special concern. Over previous decades, remittances have played an increasingly important role in alleviating poverty and sustaining growth. Just last year, these flows were on par with foreign direct investment and official development assistance (government-to-government aid).
But COVID-19 has spurred a dramatic reversal, with our latest forecasts finding that remittances will decline 14% by the end of 2021 a slightly improved outlook compared with the earliest estimates during the pandemic, that should not belie the fact that these are historic declines. All regions can expect a drop, with Europe and Central Asia seeing the steepest fall. Associated with these declines, the number of international migrants is likely to fall in 2020 for the first time in modern history as new migration has slowed and return migration has increased.
These drops are cutting off a lifeline for many poor families in developing countries. Migrants remittances are crucial to households around the world, and as they decline, experts fear that poverty will rise, food insecurity will worsen, and households risk losing the means to afford services like healthcare.
The pandemic slowdown has deeply impacted businesses and jobs. Around the world, companies especially micro, small, and medium enterprises (MSMEs) in the developing world are under intense strain, with more than half either in arrears or likely to fall into arrears shortly. To understand the pressure that COVID-19 is having on firms performance as well as the adjustments they are having to make, the World Bank and partners have been conducting rapid COVID-19 Business Pulse Surveys in partnership with client governments.
These offer a glimmer of good news. Responses collected between May and August showed that many of these firms were retaining staff, hoping to keep them on board as they ride out the downturn. More than a third of companies have increased the use of digital technology to adapt to the crisis. The same data warned, however, that the firms sales have dropped by half amid the crisis, forcing companies to reduce hours and wages, and most businesses especially micro and small firms in low-income countries are struggling to access public support.
Reduced family incomes whether due to job loss, a stop in remittance payments, or a multitude of other COVID-19-related factors will continue to put human capital at risk. With less money, families will be forced to make trade-offs and sacrifices that could harm health and learning outcomes for a generation.
The pandemic has highlighted the need for effective, accessible and affordable health care. Even before the crisis began, people in developing countries paid over half-a-trillion dollars out-of-pocket for health care. This costly spending causes financial hardship for more than 900 million people and pushes nearly 90 million people into extreme poverty every year a dynamic almost certainly exacerbated by the pandemic.
And health care is just one way that COVID-19 is affecting countries human capital. Even before the pandemic, the world faced a learning crisis, with 53% of children in low- and middle-income countries unable to read a basic text on completing primary school. Pandemic-led school closures intensify these risks.
At the height of the COVID lockdown, more than 160 countries had mandated some form of school closures for at least 1.5 billion children and youth. Regular updates on global closures can be found here.
COVID-19s effects on education could be felt for decades to come, not just causing a loss of learning in the short term, but also diminishing economic opportunities for this generation of students over the long term. Due to learning losses and increases in dropout rates, this generation of students stand to lose an estimated $10 trillion in earnings, or almost 10 percent of global GDP, and countries will be driven even further off-track to achieving their Learning Poverty goals potentially increasing its levels substantially to 63 percent, equivalent to an additional 72 million primary school aged children.
As economic conditions force families to make difficult decisions on household spending, concerns about student dropout rates have grown. Speaking on our Expert Answers video series, World Bank Global Director for Education Jaime Saavedra said he is particularly worried for students in secondary school and tertiary education. Many in those demographics will not come back to the system because this is going to be a huge economic shock, so families might not have resources or some [students] will have to resort to work, he explained. Others who were previously on the brink of dropping out will be more likely to do so due to the pandemic, Saavedra said.
To mitigate these losses and try to sustain learning amid the crisis, countries are exploring options for remote learning with mixed results. In many places, a key obstacle is a lack of high-quality, affordable broadband.
On the Development Podcast, we spoke to two Colombian mothers who live on opposite sides of the digital divide. We heard about their radically different experience of home-based education.
Their experience is not unique: around the world, the pandemic and associated lockdowns are underscoring that digital connectivity is now a necessity. The internet is the gateway to many essential services, such as e-health platforms, digital cash transfers, and e-payment systems.
Unfortunately, access to digital infrastructure and connectivity remains severely limited in the worlds poorest countries, which are eligible for grants and concessional lending from the World Banks International Development Association (IDA). While mobile coverage has expanded rapidly on a global level, IDA countries still lag far behind, with mobile internet penetration rates of 20.4 percent at the end of 2019, compared to 62.5 percent for other countries.
And while the pandemic demonstrates the need for greater connectivity, it could actually widen the digital divide, as private investments become constrained and public financing is diverted to urgent policy priorities like health and social protection.5
AndCOVID-19also posesa serious threat toother development divides. Notably,gender gaps could widenduring and after the pandemic.Thiscould reversewomens and girlsdecades-longgains in human capital, economic empowerment,andvoice and agency.
At the beginning of the year the Women, Business and the Law report noted considerable progress in womens economic opportunity over the past 50 years. For example, in 1970, just two countries had laws mandating equal renumeration for work of equal value. As the chart below shows, that situation has significantly changed in 50 years. But even today more than two thirds of economies could still improve legislation affecting womens pay.
Of course, equal pay is just one aspect of gender equality. Across multiple indicators, the pandemic is exacerbating risks for women and threatening hard-fought-for gains. As this crises has unfolded, women have lost their jobs at a faster rate than men, due to the fact that they are more likely to be employed in sectors hardest hit by lockdowns, such as tourism and retail. Additionally, women in low- and middle-income countries are more likely to be predominantly employed in informal jobs, which often means they lack access to social protection and other safety nets.
And the next generation? Girls in many countries may face increased expectations to take on care-related tasks that could affect their ability to stay engaged in education over the long term. Our partners at UNESCO have projected that 11 million girls might never return to their studies following the pandemic.
Beyond education, children male and female are also vulnerable to the global rise in food insecurity, affecting people in both urban and rural settings. Our World Development Indicators show that even before COVID-19 emerged, the number of people who were undernourished an indicator that tracks how many people fail to access sufficient calories was increasing, after decades of decline.
Like with so many other aspects of global development, COVID-19 stands to exacerbate this already worrying trend. The pandemic may add between 83 and 132 million people to the total number of undernourished in the world in 2020, according to a preliminary assessment by our partners at the UN Food and Agriculture Organization (FAO). FAOs data helps underpin the World Bank Groups World Development Indicators.
In many places, food insecurity and COVID have compounded the impact of fragility, conflict, and violence (FCV), which threatens a reversal of progress on development. In 2000, one out of five of the worlds extremely poor people lived in fragile and conflict-affected situations (FCS). Since then, poverty has fallen steadily in other economies, but the number of poor people living in FCS continues to grow.
Today, around half the worlds poor reside in fragile and conflict-affected situations. In fact, poverty is becoming more concentrated in these places, which will be home to up to two-thirds of the worlds extremely poor people by 2030. COVID-19 is likely to further exacerbate this trend.
For FCV, food insecurity, and a number of other challenges, climate change is a threat multiplier. Even as the world focuses on the pandemic, climate shocks, natural disasters and ecosystem loss have not stopped. But how we respond to COVID-19 can help strengthen how we are able to handle future risks and shocks. As governments take urgent action and lay the foundations for their financial, economic, and social recovery, they have a unique opportunity to create economies that are more sustainable, inclusive, and resilient.
To support a resilient recovery, the World Bank Group will continue to make major investments that help countries integrate climate action into their development agendas.
The Group has steadily increased our climate financing: having committed $83 billion to climate-related investments over the last five years and exceeding our targets for each of the last three years. We will further boost support for countries to accelerate climate action and boost resilience to its mounting impacts. Amid COVID-19, this means looking at ways to align short-term objectives like job creation and economic growth with long-term goals like decarbonization, adaptation, and resilience to help our client countries shape a sustainable recovery.
Conclusion
The impact of COVID-19 has drawn numerous comparisons some to the Global Financial crisis of 20072008, others to World War II, and more still to crises we know only from history books. While these may seem dramatic, the pandemic has had wide-ranging impact on nearly every aspect of development, like few crises before it.
The full scale of the pandemic will only be known in years to come, as we collect and analyze the data, adapt and evolve our financing to meet countries needs, and continue our work to end extreme poverty and promote shared prosperity. To pursue this mission effectively, we will remain a long-term partner to our client countries, providing the data, technical assistance, and financing that will be needed to navigate the global community out of this truly global crisis.
Sara Haddad, Paul McClure, Jasmin Buttar, Bassam Sebti, Srimathi Sridhar and Christine Montgomery contributed to this project.
The World Bank Groups Response to the COVID-19 (coronavirus) Pandemic
In the wake of COVID-19, there have been calls for the world to be better prepared for the next pandemic. These calls are driven by a sense that the outbreak could have been foreseen and prevented, or that the spread could have been more effectively contained causing less social and economic disruption and averting deaths.
Such calls have been made in the past and have resulted in meaningful action. Yet, the world tends to move on quickly, with new crises taking center stage, resulting in the now familiar cycle of panic and neglect. This is a concern: although the timing and nature of the next pandemic spark is unknowable, it is certain to happen.
Perhaps things will be different this time. COVID-19 has brought into sharp focus the limitations of past efforts and the need for a more ambitious and sustained approach to preparedness. It is encouraging to see widespread calls for more financing, a reform of global governance for health-related crises, and fresh thinking around global public goods.
But lets first take a look at what pandemic preparedness is and what types of investments it requires.
Preparedness starts at country level and comprises many elements. First and foremost, it requires strong and resilient health systems, in particular primary care, to facilitate detection of disease outbreaks, provide essential care, and support deployment of vaccines and other medical countermeasures. Second, it requires surveillance systems and laboratory capacity to detect both human and zoonotic disease outbreaks. Third, mechanisms are needed for coordination across sectors for prevention and preparedness. Fourth, preparedness requires legal frameworks and regulatory instruments to support both outbreak prevention and the deployment of countermeasures. Fifth, there is a need for well-functioning supply-chains as well as adequate stockpiles of essential goods and equipment.
These and other elements of preparedness are established and reflected in the approach to the Joint External Evaluation Tool that emerged from the 2005 International Health Regulations.
As pathogens do not respect borders, there are also important cross-country dimensions of preparedness, with regional, and sub-regional institutions playing key roles in areas such as regulatory harmonization, standards for reporting and information sharing on disease outbreaks, sharing of key public health assets such as high complexity laboratories, and pooled procurement.
Many countries, especially low- and middle-income countries, have long-standing weaknesses in these preparedness domains, which translate into weaknesses at the regional level as well. Even countries with stronger preparedness were profoundly challenged by the COVID-19 pandemic, highlighting vulnerabilities associated with the breakdown of global supply chains, and the role that a lack of trust, cohesion, and mechanisms for intra-government coordination have played in undermining response.
The World Bank, though IDA and IBRD, has a strong track record in providing the long-term, predictable, sustained financing that countries need to prepare for pandemics, often requiring multi-sectoral interventions. For example, using a One Health approach, that recognizes the linkages between human and animal health, and the environment, the Regional Disease Surveillance Systems Enhancement (REDISSE) program, developed in the wake of the Ebola crisis, has helped strengthen national and regional capacity for disease surveillance and epidemic preparedness across 16 countries in West and Central Africa. We have also supported the Africa CDC through IDA financing. As we help countries to address the current pandemic with our $157 billion COVID support package, the largest in our history, we continue to help build capacity to prepare for future pandemics. Whats more, both IDA and IBRD leverage significant resources in the capital markets: IDA now provides more than $3 in concessional finance for every dollar of donor contribution; for IBRD, one dollar of additional capital can enable additional $10 in financing to clients.
Looking ahead, the World Banks suite of financing mechanisms and instruments, global footprint, strong in-country presence, multisectoral expertise, and broad reach to policymakers positions us well to expand support for country and regional preparedness. Preparedness will be an important focus of IDA20, and it is set to feature more prominently in our country engagements.
The COVID-19 pandemic has also highlighted the need for action at the global level and a large share of proposed increases in international finance for preparedness is focused on addressing perceived gaps in the global domain.
Financing needs at the global level are diverse and complex. One key priority is to step up the financing of R&D on therapeutics and vaccines. This area is receiving significant public, private, and philanthropic financing, including in support of the Coalition for Epidemic Preparedness Innovations (CEPI), which is set up as a World Bank-supported FIF and seeks to positively disrupt financing models for vaccines against epidemic diseases.
Equally important is the financing for medical countermeasures to ensure timely and equitable access for all countries. On the demand side, this will require building on our collective experience with pooled procurement mechanisms like COVAX and the African Vaccine Acquisition Trust (AVAT). On the supply side, there is a need to boost distributed manufacturing capacity to ensure equitable access to low-cost vaccines. Not every country needs its own vaccine manufacturing capacity, but we need to ensure that there is sufficient production capacity in developing countries that can be quickly scaled up. Pharmaceutical companies are unlikely to invest without some degree of demand and price certainty, which is where advanced market commitments backed by donor financing can help.
The ambitious preparedness agenda has generated calls for scaling up financing. The G20 HLIP estimated that US$34 billion of public financing per year is needed over the next five years, with nearly half coming from donors. More recently, the US government has called for a US$10 billion global health fund to prepare for future pandemics and announced a US$250 million contribution to jumpstart the effort. It has been proposed that the fund be established at the World Bank.
Additional financing for preparedness could help expand the support that the World Bank and others provide to countries and regional institutions and help address gaps at the global level.
A key next step is to unpack the needs assessment and costing exercise prepared by the G20 HLIP and deepen the analysis of gaps. Financing is key for better preparedness, but strong preparedness also requires sustained political will. This would seem to require a set of globally agreed norms and standards on pandemic preparednessbuilding on the Joint External Evaluation Tool-and regular monitoring and assessment of performance against those standards. Perhaps it is time to consider a new global compact on pandemic preparedness, similar to the one for climate, to ensure shared commitment and collective accountability around pandemic preparedness.
The global economy is beginning to bounce back from the economic ravages of the coronavirus pandemic, with growth of 5.6 percent expected for 2021. But this recovery is not being experienced equally. Poorer countries are contending with a deeper, longer-lasting crisis that has increased global poverty and is reversing recent trends of shrinking inequality.
The result is that the impact of the COVID-19 pandemic is largest for the worlds poorest. In 2021, the average incomes of people in the bottom 40 percent of the global income distribution are 6.7 percent lower than pre-pandemic projections, while those of people in the top 40 percent are down 2.8 percent. The reason for this large difference: The poorest 40 percent have not started to recover their income losses, while the top 40 percent has recovered more than 45 percent of their initial income losses. Between 2019 and 2021, the average income of the bottom 40 percent fell by 2.2 percent, while the average income of the top 40 percent fell by 0.5 percent.
The decline in income has translated into a sharp increase in global poverty. About 97 million more people are living on less than $1.90 a day because of the pandemic, increasing the global poverty rate from 7.8 to 9.1 percent; 163 million more are living on less than $5.50 a day. Globally, three to four years of progress toward ending extreme poverty are estimated to have been lost.
The number of poor people has increased across all regions, and particularly in Sub-Saharan Africa and Latin America and the Caribbean. For example, high-frequency phone surveys conducted by the World Bank found that 81 percent of households in Peru and 85 percent of households in Senegal reported income losses in the first months of the pandemic. Extreme poverty in low-income countries has rapidly increased, setting back progress by eight to nine years, while progress in upper-middle-income countries has been set back by five to six years.
The poorest arent the only ones affected as households in the bottom 60 percent of the global income distribution have lost ground due to the pandemic. Pre-COVID-19 projections estimated that the daily per capita incomes of households in the middle of the global income distribution would grow from $7.15 in 2019 to $7.44 in 2021. Income for these households is now projected to be $7.05 in 2021, down 5 percent from the pre-pandemic estimates.
The diverging economic recovery means the COVID-19 crisis has directly offset declining inequality between countries. Now, between-country inequality is estimated to increase for the first time in a generation.
Emerging evidence shows that within countries, inequality may also have worsened. The World Banks phone surveys in developing economies showed that poorer households lost incomes and jobs at slightly higher rates than richer households, a trend that contributes to the worsening of global poverty and inequality. Thats because vulnerable groups women, those with low education, and those informally employed in urban areas were hit particularly hard.
It is not possible to quantify the effect on global inequality yet, but simulations suggest that an increase of just 1% in within-country inequality would result in 32 million people living on less than $1.90 a day in 2021 and increase the gap between the income growth of the bottom and top 40 percent to 4 percent from 2.7 percent with no change in within-country inequality.
The ravages of COVID-19 will also affect inequality and social mobility in the long run. Those who lost income due to the pandemic have been almost twice as likely to spend down assets or savings, leaving them less able to cope with continued or recurrent income losses. They have also been 57 percent more likely to go a full day without eating, which carries serious long-term consequences for cognitive and physical development when experienced among children. It is also estimated that COVID-19 could lead to an aggregate loss of between 0.3 and 0.9 years of schooling, with poorer families the most impacted.
Job losses among the most vulnerable workers, including women, youth, and those without college education, can affect their productivity and income growth even as economies revive. In addition, the severe impacts seen for small and micro enterprises can lead to the erosion of entrepreneurial capital and jobs that can be hard to reverse. Thats perhaps why, in economies where policies were becoming less restrictive and jobs were coming back between July 2020 and January 2021, the employment gaps between groups produced by the initial impacts of the pandemic did not narrow significantly.
Tackling increases in inequality and global poverty needs to start by accelerating the economic recovery in low- and lower-middle income countries. That means increasing the supply of COVID-19 vaccines to these countries, as their current low vaccination rates are an obstacle to growth. Additionally, increasing fiscal space, such as through the IDA20 replenishment, and fair and efficient domestic resource mobilization will be needed to support investments required for inclusive growth.
To ensure that the recovery is equitable and benefits all groups within countries, spending and policies that target women, low-skilled workers and urban informal sector workers are necessary. This includes providing equal access to financial services and technology and investing in safety nets and social insurance. In addition, children and parents need to be supported through policies as schools reopen.
Making our societies resilient to future crises requires taking on structural inequalities today.
