The COVID-19 pandemic—and the resulting economic crisis and disrupted food and health systems—will likely severely worsen all forms of malnutrition globally. In the short to medium term, micronutrient deficiencies, child wasting and stunting, and overweight and obesity are all expected to surge, stemming the tide of recent progress toward achieving the World Health Assembly’s 2025 Global Nutrition Targets.
What impacts can we anticipate, particularly for maternal and child nutrition, nutrition interventions, and mortality? What adaptations can help rebuild stronger health, economic, and food systems, protecting nutrition and healthy diets moving forward? A May 28 virtual policy seminar cohosted by IFPRI and the CGIAR Research Program on Agriculture for Nutrition and Health (A4NH) explored these questions.
The global community now faces a “perfect storm for nutrition,” with impacts on every form of malnutrition, said Marie Ruel, Director of IFPRI’s Poverty, Health, and Nutrition Division. “The current crisis is affecting all of the systems we are relying on for improving nutrition,” Ruel said, including health, social protection, water, sanitation, and food systems.
As health care workers are reassigned to focus on COVID-19, there are fewer available to focus on essential nutrition actions, Ruel said, including antenatal care, childbirth, immunization, and micronutrient supplementation, as well as preventing and treating malaria and other diseases that have impacts on nutrition. In addition, many people are afraid to go to health centers because they fear being exposed to the coronavirus, leading to drops in demand for basic health and nutrition-related services.
Current economic challenges also threaten to make nutrition matters worse. Ruel cited IFPRI research that projects an additional 140 million people worldwide could fall into poverty this year alone, alongside projected declines in consumption of nutritious yet more costly items such as fruits, vegetables, and animal source foods as people try to maintain their caloric intake on reduced budgets.
Information beginning to come in from phone surveys echoes this, with Bangladesh reporting declines in food expenditures accompanying declines in income, and disruptions in food supply chains from changing demand and supply impacting Ethiopia. The pandemic has also disrupted social protection programs around the world, with implications for nutrition. For example, school feeding programs struggle to come up with alternate strategies that still provide nutritious food in light of widespread school closures.
Ruel recommended a number of actions to protect nutrition: Keeping food systems functioning, including the informal sector; facilitating innovations to improve access to nutrient rich foods, including stimulating demand and addressing misinformation; protecting basic health services and social safety nets; and focusing on vulnerable groups and inequalities. “The crisis is exacerbating all of the inequalities in age, gender, for refugees, the poor,” and other vulnerable groups, she said.
Robert Black, Director of the Institute for International Programs at the Johns Hopkins University (JHU) Bloomberg School of Public Health, zeroed in on the pandemic’s indirect effects on children in low- and middle-income countries (LMICs). While COVID-19 child mortality rates appear to be quite low, he said, children will be disproportionately affected by disrupted routine health services and rising food insecurity.
Black cited new research from JHU’s Lives Saved Tool published in The Lancet Global Health journal looking at hypothetical COVID-19 outbreak and response scenarios in 118 LMICs. While the projections vary depending on circumstances and time, one scenario projected a 10%-45% relative increase in child deaths in these countries over the next six months. In one scenario, increased wasting accounted for 20% of additional child deaths. Expanded modeling in collaboration with IFPRI is under way, looking at impacts on income, food systems, nutritional status, and health systems, he noted. The broader collaboration will help researchers consider relationships between these things and their effects, as well as to assess the priorities of various nutritional interventions and their costs in coming phases of the pandemic.
India carries a third of the global stunting burden, IFPRI Research Fellow Rasmi Avula said, but thanks to key nutrition interventions, it has made progress on the issue in recent years. Now the pandemic is challenging that progress. As in other countries, a lockdown and resulting economic stresses have had negative impacts on diets. However, the policy environment has been dynamic and changing, Avula noted, with guidance issued on how to continue to deliver essential nutrition services.
Nutrition programs are adapting, as well. While many frontline workers have been diverted to pandemic-related tasks and access to some areas has been restricted, many programs are delivering services at facilities or to homes instead of centers. There are a number of encouraging anecdotal examples, including using mobile phones to contact beneficiaries and deliver services such as counseling, and beneficiaries reaching out with questions. Going forward, researchers should study these developments in a more systematic way, she said.
While there are indications that diets are being impacted by the pandemic, we don’t yet know what the precise impacts are, said Corinna Hawkes, Director of the Centre for Food Policy at City, University of London. Evidence thus far suggests these have fallen mainly on nutritious foods such as fruit, vegetables, milk, fish, legumes, and eggs.
“What has been very clear is that every dimension of the food system has been affected” by the pandemic, Hawkes said, including economic, political, social, and environmental aspects. She expressed concern that the initial health and economic shock will ripple out to have a second impact that includes diet and nutrition. That’s going to happen over the short term, she added, but we need to think about what the implications are for the long term as well.
Hawkes detailed three kinds of pandemic impacts on food systems: First, most directly, people who work in food systems are getting sick. Beyond this are impacts from lockdowns and other policies to contain the spread of the virus. Finally, responses from governments, programs, industry, and businesses to manage those impacts themselves affect food systems. Together, all these will change food systems, the food environment, and ultimately nutrition.
Innovations will be key to managing these impacts and their effects on nutritious diets, Hawkes said, including at the policy level for social protection, at the community level for food access, and at the producer level for ensuring the sale of nutritious foods.
“’No backsliding’ is a great ambition,” said A4NH Director John McDermott, referencing the session title in his closing remarks, “but as we’ve heard today, it’s inevitable that there will be some.” He noted that a great deal of work and a real global effort has gone in to making progress during ordinary times, but now, in “extra-ordinary” times, problems are arising. He stressed the need to align food, nutrition, health, and other sectors to work together toward a response to these challenges, and to empower people at the national and local levels to do what they are doing well.
Janet Hodur is a Communications Specialist with the IFPRI-led CGIAR Research Program on Agriculture for Nutrition and Health (A4NH).
