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.

Watch the full interview here: https://youtu.be/noE5eGjERgA

Learn more at: https://kojalamedical.com/covid19theanswers/

https://www.unicef.ca/

https://www.unicef.org/

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

Kojala Medical presents COVID 19 the answers the  show that delivers the scientific evidence-based

knowledge that can safely return us all to our  pre-COVID lives. My name is Dr Funmi Okunola and

i'll be hosting the show every week you can listen  to me interview a highly respected professional

about the science that can reduce your risk  of becoming infected with this coronavirus

welcome to COVID 19 the answers i'd like  to introduce you all to Mr David Morley

President and CEO of UNICEF Canada he is a  prolific international speaker commentator human

rights advocate and mobilizer with more than 30  years of experience advancing advancing children's

rights and sustainable development on the world  stage David has occupied senior positions in some

of the world's most respected charities he has  been the Executive Director of Medicine Frontier

Canada. President and CEO Save the Children, and now  for the past 11 years President and CEO of UNICEF

Canada. Welcome! Thank you very much. For me David  can you please tell us about UNICEF and what led

you into the world of charitable organizations  and children's charities in particular?

well um i sort of i came into this this  work by accident, i think we could say

when I was doing my undergraduate, I had a  work here in in Canada, in Ottawa. I had

a particular interest in medieval Europe and um  that's what i've been i've been studying and um

which of course, does not immediately lead to  job prospects and uh, a friend of our, my family

who was a member of the Ontario human rights  commission was coming to Ottawa i was unemployed

and he my parents arranged for me to have  breakfast with him because you know maybe i could

get a job or something or he could point me in  the right direction um and i'd worked uh all the

summers during university uh uh i'd worked as a as  a camp counselor for children with special needs

and when i told this family friend what i'd done  is my summer job he said you have your whole

life ahead of you to work in an office building  in Ottawa orToronto what you should do is go

and volunteer at this organization it was  an organization set up by Costa Ricans with

Canadian support in Costa Rica for children  who've been living on the streets and uh

so i thought well okay i guess and i  went to volunteer and you know it it

i've been a you know grown up as a middle class  Canadian and i'd expected when i got to Costa Rica

to find that these kids had would have just been  crushed by the poverty that they'd had that they'd

experienced and life on the streets and life in  in pretty dickensian uh institutions and instead

i found here are these these kids with an  amazing ability to to to care for each other

creativity sparks so filled with life you know  and um so i was gonna go for three months and um

well i stayed longer and it turned into a career  because of those kids because those first kids

that i knew and i mean now it's very nice because  of Facebook those kids are you know some of them

are this is 40 years ago some of them are  grandparents now and we uh we so am i so we

sh and we share notes on grandparenting  and stuff uh it's uh it's lovely but i

that's why i'm not a medieval historian is  because of those kids and the children of

the world are glad of it what a fantastic  story i'm very fortunate i'm very fortunate

and could you please tell us about UNICEF what is  the organization about what does it do well UNICEF

began um right after world war ii when  there was famine and risk of famine

in Europe and in Asia at the end and the United  Nations one of the first things it did um was it

it realized that providing support to children  who had suffered through those two wars

was vital and that if they were going to have  if we were going to have peace and prosperity

in the world we had to be sure that that  care was taken for children and uh so we

we were started uh before the United Nations was  even one year old and as the uh as uh as the year

a few years went by and the acute phase of the  humanitarian emergency in Asia and Europe ended

and the decolonization process started  UNICEF continued to grow to to help

help situation of of health and education and  child protection in many countries and and

when the convention on the rights of the child was

finally uh passed and ratified a bit more  than 30 years ago UNICEF was named in it

where the agency named in the convention  on the rights of the child that it is our

responsibility to protect and promote the rights  of children we're the only agency named in it and

while while we know that these sort of human  rights treaties and conventions are not um

are rarely fully fulfilled this the convention  on the rights of the child is the most signed

and ratified human rights treaty in in the world  in our history um so that's what UNICEF's job is

to work with governments and community groups  uh and and the private sector and civil society

to ensure that to do our best to ensure  that children's rights are protected

and promoted that children are are they  they have adequate health qui health care

that they have adequate education and it's um  we're in this this this unique position where

we're part of the United Nations but for  us in Canada, UNICEF Canada is also a

civil society organization so we we have the  flexibility of civil society and we have the

the um authority of the United Nations and  that gives us our mandate to do what we can

for children here in Canada and also around the  world that's wonderful David thank you for that

so um moving on to our questions now part one this  involves the effects of the pandemic on children

so the effect of the COVID 19 pandemic on children  has been significant and in some ways catastrophic

a modelling study published last week  in the lances stated that globally 5.2

million children aged 17 years or under had been  orphaned due to the COVID 19 pandemic this equates

to a child becoming an orphan every 6 seconds  these figures were calculated by the researchers

up to October 2021 and they are projecting  that figures up to January 2022 once calculated

will rise to 6.7 million children orphaned the  consequences of this are devastating and enduring

resulting in institutionalization  poverty abuse mental health problems

adolescent pregnancy and chronic and infectious  disease of the 20 countries in the study low and

middle-income countries were particularly affected  though every continent has been touched by this

also this is likely to be an underestimate as  the world health organization believes mortality

estimates show that the african region for example  has under-reported death rates by a factor of 10.

this is truly alarming these results are outpacing  global COVID 19 deaths this is all happening on

the back of a widely held misnomer that children  have hardly been affected by the pandemic because

their rates of severe disease hospitalization  and death have been lower than adults

though the severity of COVID 19 as it applies to  children is beginning to change with the onset of

the variance which we will come back to later in  its 75th anniversary report entitled preventing a

lost decade UNICEFhas stated that COVID 19 is the  worst crisis for children in its 75 year history

and has called for urgent action this interview  today aims to focus on some of the main crises

that UNICEF has highlighted directly  affecting children globally today

namely poverty education mortality immunization  nutrition and abuse David at the beginning of the

pandemic did UNICEF anticipate your children being  orphaned on such a mass scale due to COVID or

was this was this unexpected collateral damage of  the pandemic that you had to account for secondly

what measures are UNICEF taken to mitigate and  support orphan children globally due to COVID

well i think those are you know those are such  shocking and sobering numbers and it's a reminder

that for us uh at UNICEF we've we have uh been  saying we quickly realized that the pandemic

although the the mortality of children was was  lower than that of adults and we don't know all

the results of that as as you're saying yet  but this was absolutely a child rights crisis

a children's crisis we know that at the height of  the pandemic more than a billion children were out

of school and we still don't know uh we don't  we don't think that all of those children are

going to go back to school we know and we'll talk  more about immunization rates for children and for

poverty but i think none of us none of us  really knew at the beginning of the pandemic

uh how long it would go on for and how devastating  it would be and this issue of of children

losing their parents to COVID and then what  does that mean for them is is one which

which i think um

we had not been ready for i don't think the world  was ready for it you know our work because we're

as part of the United Nations a lot of our work  uh as as i mentioned earlier it's either with

local civil society or with governments so to try  and help the children who've been orphaned we work

a lot with ministries in in countries all around  the world the ministries of family the ministries

of social affairs what what they may be called and  so we are we'll be working with them to try and

try and find models of care if there isn't care  for extended family the members of extended family

try to give some have policies that will  give them support but we try to we encourage

governments not to do institutionalization of  children to find community-based responses which

will be a way to care for those children  i think in in in the vast majority of

of cases children will be cared for by extended  family and i think if we even think of here in

canada when there are tragedies of children who  are orphaned extended family is is usually the

first to to step in um but then we have to be  sure the policies are there that will give the

support that those extended family those extended  families need in a way you know the the crisis of

of uh 20 years ago when aids was having such  a destructive swath through sub-saharan africa

we learned a lot from all those grandmothers  who started caring for their grandchildren and

we've learned about policies that can help with  that and we've learned those of us who are from

outside of those communities have learned  the phenomenal strength of those communities

and i think and i hope because we're at the  early days yet that we will be able to learn

from what happened what the way communities  responded and be able to support a similar

response that's going to be needed this  time thank you for that really good answer

the following questions are based around some  of the figures stated in the UNICEF report

and also extracted from UNICEF's website we will  also briefly examine how the omicron wave has

affected children and talk about COVID 19 and long  COVID in children let's start with poverty David,

to allow the audience some perspective  what is UNICEF's definition of poverty

according to your website 100 million more  children could be living in multi-dimensional

poverty by the end of 2021 compared to the  pre-COVID era what is multi-dimensional

poverty and what plans does UNICEF have  for addressing multi-dimensional poverty

the the multi-dimensional poverty that we  that we use is uh it was first developed

in Oxford University in the UK and the world  bank has used it as well and so we have there are

it's very detailed but i'll try to stay high  level there's um there are 10 indicators there's

three main dimensions of poverty uh when you  add in the world bank it's people it's it's

less than a dollar a night one  dollar and ninety cents a day

but but as well it's um we look at health  indicators for which is um the nutrition

and the the rate of child mortality here  i'm talking about countries you know

sorry, David could you repeat that because  the screen froze, you said okay sorry, yeah

the under the health indicators that we look  at there is the nutritional status and also the

rates of under five child mortality so we consider  those then we look also at the years of schooling

and at the country level and the level of school  attendance so how many children are in of school

age are in school and then there's a  variety for living standards which um

which go beyond just simple what's the money  you you bring into the family it's what kind of

cooking fuel do you use uh what's your sanitation  is it um open defecation is it latrines is it

plumbing um do you have access how far away  is the nearest drinking water um do you have

electricity what's your house what's your house  made out of what are your assets in the house how

much you know how much furniture and things do  you have so we we look at all of those because

in some cases people may be earning  more than a dollar 90 cents a day

but they're not in and living in an environment uh  or in a region where their children are likely to

get a chance to go to school or they may  be living far away from a health clinic

so they've got some money but they don't  have access to health care for their children

so that's why we want to look at the multi  multi-dimensional poverty index because

it's just a more accurate way to really assess  what what are the levels of poverty and then

then for us at UNICEF we that helps us decide  where will we do our our programming as well um

because we work in every country of the world  uh we have a lot of choices that we must make

and and this is one of the key drivers  to where we will invest our resources

so um so with it with multi-dimensional  poverty increasing what plans do you does

UNICEF have for addressing that well  you know all the all the component

parts of our of our work um aren't we think they  will help um and and maybe we i don't know maybe

we can look at them more in detail but it's our  investment that we try to get an education it's

it's the investment in community health services  so that uh the child mortality rate will more

will decline um it's the investment that  we will make uh we we also make in in

where possible uh improving improving the economy  so that of a place that things will be able to

become more sustainable but education and health  are so important i mean we know you know sometimes

i feel for me that we take it for granted here  because we have access to these things but

um those are two of the areas that we work  very much well that's that's much of our

of our everyday work of of UNICEF is involved in  those those two areas as well as child protection

but those two areas particularly to address  the multi-dimensional poverty thank you David

children going to so if we move to education  children going to school or not going to school

was an incredibly polarizing topic nationally  and globally during the pandemic the issue has

multiple layers of complexity ranging from child  teacher and community safety debates and issues

around vaccine mandates for children and or  teachers and so on during the pandemic over 1

billion children were affected by school closures  and at least 463 million children worldwide

were unable to access remote learning during  COVID 19 school closures and lockdowns in 2020

worldwide during the pandemic there have been 1.3  trillion hours and counting of in-person learning

lost with these figures in mind how do we balance  the opening and closing of schools yeah that's um

as you say it's been an issue everywhere  right from every country of the world to

to i'm sure every community where your listeners  live it's been and it's an emotional topic as well

we um at UNICEF one of the first things that  we did was we said teacher once vaccines were

available we said teachers should be considered  frontline workers and they should get they

should be right up there with the front line  health workers and emergency responders to get

vaccines when they were first out so that we  could open the schools because we also felt

uh advocated that schools should be the last to  close and uh first uh first to open that if we're

um reopening well anyhow if we're for reopening  all of our uh restaurants and everything but we

should we we should be sure to protect schools  first and make sure that they get open and not

sometimes they were lagging behind you know um  because the the education loss there's there

is no question all the results we're starting  to see in Canada let alone and this is also in

other countries that children are you know have  lost a full year of education that there are um

only speaking here in my province which is Ontario  um and i know this because my spouse is involved

in educational research uh basically children  who are in grade two have lost a year's worth

of reading grade one where you usually learn  to read now what's that going to mean as we

as they go on and we see then the social loss  the social interaction loss that has happened

as well so we know we need to be safe for  children and we know that investments in

and with the because we're not so sure what  what omicron will mean but if we we've got if

masks are going to keep help keep people healthier  longer then we should keep having mass mandates

uh we should try to encourage the ongoing  vaccination of young children and go for a

pediatric formulation as well so that preschools  and day care centers can can be open as well we

those are open safely um  it it's um we have to give

schools the a priority which is right on the  heels of that of our health system i think and

excuse me and that that's going to be the way  that we'll see schools uh open and and stay open

moving on to child mortality while the  hospitalization and death rates for children are

on the whole lower than for adults there have been  significant indirect effects on children such as

the strained health care systems preventing  sick children from accessing for medical care

access to regularly scheduled immunization  has been blocked or postponed and antenatal

care has now been affected in your opinion  how are these indirect impacts of COVID 19

going to affect children now and in the future

you know every in 1960 so it's not  60 years ago we we is when we started

collecting good data on the global  uh under five mortality rate um

every year that rate has got lower like fewer  kids fewer children under five have died from

preventable causes up to up to 2020 which is which  is over 2019 is the last year that we've got full

data for one of the huge reasons for that the  strengthening of health systems but it's been

the widespread access to immunization to the  childhood to childhood immunization and further

and the improvement in the development  of those vaccines so it seems

to me logical and i we don't have all the data  in yet from 2020 but with all of the children

who have missed immunization and we weren't at  100 coverage but we heard about we were very

high global coverage for childhood immunization  and it's our our statistics are that at least

70 million children missed out last year i suspect  it's more but that's what we can see right now

it's going to mean that for the first time because  of the pandemic for the first time in 60 years

the number of children under the age of five who  die from from preventable causes is going to go

up it's that is another another huge tragedy  of this of the pandemic you know because

i have to say that that's in the context  of the fact that in the last generation

we have seen a child survival revolution there's  no question you know that we used to it used to be

um you know 30 years or so ago the under 15  million children under the age of five died

every year from preventable causes and by 2019  it was under 5 million children a year now that's

way too many like 5 million children like  the heartache for those families and and and

siblings and parents and grandparents is horrific  but it is only one-third of the number right it's

down from 15 million to 5 million so we've had  this incredible child survival revolution um

and it's been stopped in its tracks by the  pandemic and i think it is i mean i know for us at

UNICEF as we try to think how are we going to be  able to rev up the immunization programs again um

because those in and of themselves it's not like  it's you know you in Vancouver and me and Toronto

going as volunteers to do these things it's  working with local health systems strengthening

ministries of health community health workers who  are doing all of the all of the immunization we

provide training and in the end the vaccines but  um we have to we've got to start that up again and

and and the wonderful thing uh we see is that on  very broad scale as more and more children survive

um parents start advocating more and more and they  don't have to be as afraid that their children are

gonna die you know they then they start advocating  for better education and we start seeing parents

pushing for more education for these kids and  um uh so it becomes it's a bedrock of a positive

cycle and um that's why we have to that's why  it's so terrible the way it's been affected

by the pandemic and why it's so important  for us to get that started again sobering

David um so if we get moved to nutrition  looking nationally in Canada in November

2021 i read a report that sixty percent of  Canadians feel worried that they are unable to

feed their families internationally according  to UNICEF an additional 67 million children

suffered from malnutrition directly due to COVID  on top of that an additional 132 million people

in the world went hungry due to COVID 19 of which  44 million were children clearly the pandemic has

added an additional burden globally to an already  difficult problem of feeding our planet David can

you please comment on the impact a poor diet  has on the growth and development of a child

well you know the the um the issue of stunting  is stunting and wasting when children don't

get enough food is one that can have lifelong  impacts if it goes on long enough you know the

the those early years when there's um and as  a child is developing as uh as their physical

and intellectual capacities are developing  without enough food then they don't

get the simply the fuel that they need and you  know you if we ca if we um if it can be caught

early enough and enough food and enough nutrients  can can go there then you children can recover

but if it isn't it can have a lifelong effect  on on that child who and as they become an adult

so it's one of the reasons why like  you know we sometimes we separate out

health as a medical thing and nutrition as i  guess a nutritional thing one could say but

but why we have to look at these holistically  because um and it's why often in our

you know the when you're in a a a rural clinic  somewhere um off the beaten track uh that you we

will see all of those coming together with  with nutritional supplements that we that

we try to give at the same time as we're giving  the the um immunization or or uh and and and so

we need that as an integral part  of of healthcare for a child we

because if we if we don't do that then  even if there are educational opportunities

for a child they can't take full advantage of it  and that's a terrible loss and also malnourishment

of children impairs their ability to fight  disease because their immune system yes we can too

thank you for that David um another concerning  impact in society is the mounting risk of

violence and abuse during the pandemic  families in total desperation have had to make

unthinkable decisions in order to stay alive and  feed themselves and their families according to

the UNICEF report up to 10 million more girls  will be forced into child marriage before the

end of the decade due to COVID 19. disruption  in services related to violence against children

was reported in 66 of countries globally due  to COVID lockdowns resulting in school closures

also put children at increased risk there are so  many variables to come out of these statistics

that i thought i would ask you what springs to  mind with regards to these impacts on children

one of the things

that we forget about you know you mentioned  when you mention this the combination of

the school closures and increasing poverty  because one of the things that schools do

is their form of child protection  as well because the parents

when parents if they're having to work wherever  they're working in fields and wherever schools

are a place where they know their children are  safe or should be should be safe um and when the

schools when school is closed the parents still  have to work that's where they get if they're able

to find work but that's where the risk of child  exploitation increases if the children are left

alone if the children and and we see it we see a  direct correlation between true schools closing

and violence against children increasing and what  you mentioned the early enforced child marriage

going up when schools close so i mean that's  yet another reason why why we've advocated to

keep schools open as much as possible because  not only the education but but they do become

almost the first line uh defense against against  child exploitation and abuse and you know i i

just think of various places where i've been  fortunate enough to work and and i can think

of of teachers in in countries as desperate as as  ethiopia and uganda and sierra leone all saying to

me we know that we know that the girls are safer  when they're here and when they're with us and

so having schools as a place  for child protection is really

really key and why we think that keeping schools  open or as much as possible is is so important

right um we're now moving on to the direct impact  of COVID 19 on children acutely and long COVID

in canada the number of people 19 years and under  with COVID 19 currently stands at around 60 651

000 out of a total in canada of  3.2 million um cases equaling 20

of the total cases so back in may 2020 this age  group made up four percent of cases worldwide with

the omicron wave of infection we've seen a much  larger increase in hospitalizations and deaths in

children particularly those under the age of five  who at present in most countries are not or cannot

be vaccinated David has UNICEF been called to  provide support for increased medical services

in lower middle income countries as a as a  result of the delta and omicron wave to children

we um the way because we work with with  ministries of health um what we're finding

actually at the moment is much more when  more of our more of our efforts are still

going into ensuring that immunization comes up and  the vaccines are are distributed that's for that's

our part of the work right is is um and those are  the biggest requests that we're getting right now

for me it's it's um uh around the issues of of  vaccine equity and vaccine distribution um it's

with all the crises you know going on in the  world right now it's um just like any just like

any emergency room we are triaging and ministries  of health which are under pressure are triaging

and getting getting COVID vaccines and  getting the routine immunization vaccines

are really the uh the immediate uh the  immediate need right now and and i should

you know just thinking of vaccines i know we're  going to talk more about vaccines but um we are

and and this may be off topic but i just don't  want to be only pessimistic about vaccines um

because talking about non-COVID vaccines there  is this chance say of a of a malaria vaccine

after all this time all this time and  um we're involved in the in the trials

with that because we're a vaccine  because we distribute vaccines

um and i think because of the impact of  the the horrific toll that malaria takes

if that works well then that will be more than  good news that'll be excellent news and i think

that may counterbalance some of the difficulties  that we're facing as a global society now um

because vaccines are key these days  yes and i think the malaria vaccine is

particularly good i think it has a 75 percent  efficacy so that's yeah that's fantastic

it's incredible it's incredible and  and yeah and the way malaria can

dodge things i mean that you know it's but anyhow  it's very good yeah i know that is very good

um david um with such a large jump in the  proportion of pediatric COVID cases long

COVID in children is now a concern similar  to adults a previous guest of the podcast

Dr Jason Morley discussed a multi-disciplinary  approach to the care of adults with long COVID

involving a range of physician specialists  and other health care professionals such as

physiotherapists psychologists ots for example  working as a team clearly the multi-disciplinary

approach described requires skilled medics  and support as well as significant financial

backing low and middle-income countries will have  higher SARS-CoV-2 infection rates due to a lack of

access to vaccines so how do you envisage these  countries funding long-COVID care for children

really i don't know now how it's going to

how it will be possible because as i say  the the triaging ministries of health and

departments of finance in in low and middle  income countries are going to have to deal with

with what they are facing um uh i think they're  going to be dealing with other matters first

and it's not out of any callousness or anything  it's just where can they make the biggest impact

uh positive positive steps forward for their  country so the kind of um looking into those those

very real and very important issues of long COVID  i think are going to be how those will be funded

are still a bit down the road and  exactly how those are going to be working

i know you're not a medic david but  do you have any perspective of how

COVID 19 the disease will show itself  in children as the pandemic progresses

um i i fear you would have  to have a medic on this one

yeah no that's okay yeah i'll cut that  children of med a child of medics but no don't

that's not good no that's fine i'll cut that  question out so do you want to take a break

because we've been going for nearly an hour before  we go into vaccine equity or do you want to um

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

okay too no i'm fine okay okay so now moving on  to part two of our program global vaccine equity

the world health organization has a strategy  to achieve global COVID 19 vaccination of 40

percent of the population in every country by  the end of 2022 and 70 by the middle of 2023.

David could you please tell the audience about  COVID 19 vaccines global access facility or COVAX

and unisex role and whether you think this the  world health organization strategy is achievable

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

to get the funding i think we have the elements  in place to be able to to hit those targets

i am an optimist though um but the way  it the way COVAX has worked is that um

the w the world health organization um gavi the  the global alliance uh for vaccines initiative

and sapi which is uh also involved  in vaccines have come together to um

they were putting out a lot of the  tenders a lot of the ways to try and get

vaccines developed right and it was this came  together right at the as a as a coalition right

at the beginning of the pandemic um before there  were any vaccines yet still for against COVID and

they turned those three organizations  right away turn to UNICEF

we because because UNICEF has developed  over over the existence of our organization

the infrastructure that the world needs to be  able to deliver vaccines in a in in before up

to before the pandemic we procured and uh  delivered almost half of the vaccines that

vaccinated almost half of the world's children  so in an average year uh we would be shipping

sending out um at least a billion vaccines  for the routine childhood immunization

uh in fact until about maybe eight years ago we  actually were vaccinating more than half of the

world's children but then uh the government of  india took out started doing it themselves and

there's a lot of that's a lot of children's  you know so uh but still it's about 45 of the

world's children that we would vaccinate every  year so we had the infrastructure we know the

capabilities of ministries of health we know where  um where the bottlenecks are in a system we know

uh who's got a good cold chain to keep the  vaccines called um and uh our colleagues

know how do you get vaccines through um through  customs uh with a minimum of uh problems our and

and our colleagues know know the components  you know how how to get because you got the

the vial with the vaccine in it but then there's  the syringes and the safety boxes and everything

else you need to pull together so that's a huge  part uh for routine childhood immunization that

that UNICEF does so um as the world health  organization was starting to think about this well

we were the natural uh natural implementing  agency for this so we we're working together uh

to make that to make that happen um we um we  haven't how i am optimistic is that the issue

we we've come so far when you think two years ago  we didn't even know what COVID was a year ago we

did we delivered the first um the first vaccines  uh through COVAX reached Ghana it was the first

country in the world to get some uh they got them  in uh February of last year um and now they're

the many of the bottlenecks have been overcome  not all of them not all of them but many um

and so i think that if the money is there um  we have the system that can make it work and

uh it's an extremely one of the bigger one of  the biggest things we had to do in working with

ministries of health and in training with with  community health workers um was vaccine hesitancy

and the difference of giving the vaccines to  adults as opposed to children um and i think we've

seen that in canada you know that distribution  for uh the the organization that we had to do here

to be able to vaccinate adults as opposed  to the routine immunization for children

it's different and adults are well sometimes they  don't want to get vaccinated in a certain way or

they're babies too they don't want to get this  type babies can take their vaccines better than

house too often so there's there's training  that that we have to do in many countries

um so we put a lot of those building blocks in  place and um now it's ramping it up further great

David UNICEF did, oh sorry i jumped there,  drawing from a commentary titled vaccine

apartheid global cooperation and equity  published in the lancet in February 2022

i quote an open letter to G20 leaders in October  2021 highlighted how 133 doses per 100 people

have been given in high income countries compared  with four doses per 100 people in low income

countries the world health organization director  general has called the divide a vaccine apartheid

speaking beyond the phrase vaccine inequity to  emphasize the scope of this moral failure and

make explicit comparisons to the south african  system of institutionalized racial segregation

David UNICEF did a fantastic job with many  obstacles by delivering 1 billion COVID vaccine

doses to 144 countries by the end ofDecember 2021  truly amazing the original target was 2 billion

doses so what were the factors in your opinion  that impacted the shortfall of the original target

what additional assistance would UNICEF  need to deliver a larger volume of doses

well i think um you know that that what you quoted  from the landsat um is the reason we didn't hit

our target at first you know the um but there  are elements within that first of all it was um

ramping up production you know there  were um and i remember there was

for one of the one of the dos one of the  uh brands ran into difficulty with their

with a factory i think it was in baltimore  and so suddenly the u.s which was going to be

oh they had to scramble to do that so there  was in after after the vaccines had been

invented it was rampant is getting getting  production high enough and that and then yeah

absolutely wealthy countries outbid others to  get to get those uh vaccines and um but we now

uh what i have heard from some of our colleagues  who are close to this is that the issue um

is not there will be a sufficient supply  maybe there already is so it's no longer

supply that's that's an issue uh it's um and  to reach some of the low-income countries that

that this is too much of a blanket statement but  it's relatively true have have uh less robust

health systems middle-income countries  have tend to have slightly more robust

health systems uh so it's making sure that  that things like the cold chain and that

there's a sufficient um all the supplies that  we need to to uh go out because you know the

landsat was saying in that in october  of last year was four doses per hundred

uh the most recent i've heard is now it's ten  doses per hundred in in low-income countries so

it's not good enough please no i'm not saying that  it's good enough but i do think that the numbers

keep moving and i think we'll be able to to  keep the uh keep the speed uh on its way i think

but but you know what i'll tell you there are two  things that really concern me um about how we will

keep that speed up um one is when when people in  the wealthiest countries the high income countries

like ours here in canada or in the uk when our  when we have many of our leaders saying okay

the pandemic's over um well maybe it  feels that it's over for those of us

who are middle class canadians um but it's not  over but because we're if we think it's over

then maybe we'll forget and the political  support for sending for helping other countries

will decline and so that will be less likely  and my other fear is that as a species it seems

we can only keep one thing in our mind at a  time and with the war in ukraine that is um

which is horrific and i i mean it's horrific  but it it may be that combination of the war

in ukraine and that things are opening up  in the oecd countries we're going to forget

about the rest of the world and and of course  that's horrible for the people who are suffering

the countries and economies which are  still shaking but also it's foolish because

we know that low vaccination rates are going to  mean more opportunities for for more variants and

you know in our own self-interest

it's foolish let alone um let alone for  the fact that it's morally repugnant

well said and um politicians can go on and on  about the pandemic being over but the evidence

is all pointing to the fact that it isn't  this is what we may well be done with this

virus but this virus has is not done with us  yet and i think that attitude will poke us

in the eye in the in the very um short distance  future frankly yeah, vaccines in low and middle

income countries are in short supply and adults  are being prioritized for COVID vaccination

bearing in mind that children in low and middle  income countries have had more severe cases and

deaths from COVID 19 due to poverty poor nutrition  higher rates of pre-existent illness can we

reshape this narrative to allow more children to  be vaccinated in lower and middle-income countries

yet balanced COVID vaccinating adults  to avoid children being orphaned

you you mentioned earlier about the impact of  poor nutrition on on health and on opportunities

for child survival and i suggest this is a good  example of of that that when when children are

weaker diseases have are more are worse for  those for those children i think that we need

we still need to be sure that frontline workers  are all getting vaccinated and being you know

the health particularly health workers and as i  mentioned earlier teachers um and that's where

we've been um we've been putting a lot of our  emphasis in so that's still those are adult and

those those are adults but they're they're key  adults in in bringing the pandemic and and then

and then once they're fully vaccinated schools  can be can be open and if then frontline workers

health workers can be community health  workers you know can be delivering vaccines

then they're going to be able to that i mean the  routine immunization vaccines that is going to be

that is going to be very helpful i think um within  the uh when you talk about about the narrative

i think we have to um again it's almost a  matter of triage you know i think what are

the vaccines that we are going to be able to get  into countries first so if it's going to be um

adult or or adolescent or pediatric formulations  if it's if it's for adults um that will uh

i think that still needs to be the the priority  is figuring out and it will be it will be

physicians like you and your counterparts in  countries around the world who will decide

uh in those ministries who are the most vulnerable  and and starting with the most vulnerable and

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

the best way for us to approach how to how to  move forward on this okay thank you and another

question in that topic um COVID vaccination of  children has not been a global success story

regardless of perceived economic status even in  high income countries COVID vaccination is not

universal for example the UKhas been very slow  to vaccinate children in North America there is

a relatively poor uptake of COVID vaccination  particularly in the 5 to 11 year age group what

plan is COVAX developing for the COVID vaccination  of children in low and middle-income countries

it's um it's important important to remember  that that or to be to be clear because i

realize i haven't been clear much of what  we do at uh our colleagues in COVAX is

responsive to what ministries of health are  within a given country are going to want

so we're not at UNICEF we're not the ones who  are saying um you should vaccinate in such and

such a region or do it in such and such a way  what we're doing is is providing the support

and then the ministry of health and together with  the world health organization but the ministries

are the ones who are making the decisions about  who will get priority and who will be saying

um here's how we think you should do it and  there's i think there's a general agreement about

the frontline health workers but it's um we are  still globally outside of high income countries

the issue of pediatric pediatric vaccination  against COVID is is again this is probably

too sweeping a statement but it is we're still  trying to get enough adult vaccination all of

the vulnerable adults uh vaccinated and that  that's led by the local ministries of health

and and it also and it depends  when we get donations of actual

doses what kind of doses do we get  as well because we get both doses

themselves donated as well as money for us  to buy the dose by the kind of vaccines so um

so we're we we really want to help ministries  of ensure that ministries of health that local

ownership is really what's driving this  within a given country right thank you

so kovacs depends on the philanthropy of  high-income countries donating vaccines

surplus vaccine is donated once the  donating country is sufficiently supplied

this does not appear to address  the root causes of vaccine inequity

i've heard of various ideas to overcome this  inequity such as addressing patent rights for

mrna technology so that poorer countries  can manufacture the vaccines themselves

alternatively alternatively i've heard of an  idea of COVID vaccines that should be made

in a number of smaller advanced countries with  smaller populations as there will always be a

bias to vaccinate your own country first so the  population is smaller then they could quickly

distribute to everyone else after vaccinating  their own most manufacturing is happening in

countries with large populations such as the usa  india uk which is possibly stalling distribution

to learning lower middle income countries  david what are your thoughts do you have

what thoughts do you have on increasing vaccine  production and equitable distribution globally

well i think that you know we're seeing  um for instance in in south africa not a

small country but um i do think having um  having the manufacturing of of the vaccines uh

in a variety of countries and regions is extremely  important and will be extremely helpful um

if things really um get further bogged down um

then there's you know we there are  mechanisms in the world trade organization

which might become necessary like compulsory  licensing like waving patent rights

and or else you know and i think some places are  looking to some companies who have the patents um

to to uh to share the patents at a at a minimal  or nominal fee seem might be what they want to do

to avoid anything compulsory coming uh  that but but that would help but it's um

it's also um other uh it's it's  it's not we have to remember

that it's not only the the vaccine itself it's not  only the vial that we always see a picture of on

television it's how do we get we got to be sure  that we don't start having a shortage of syringes

because we need all those syringes right there's  a there's a special um special syringe one dose

a set amount so that you can't uh syringe  there has been some of our my colleagues

have just expressed concern that all of the supply  chain stuff that goes into making those syringes

um there's a risk we're not they're still being  produced now but that could be a concern down down

the road or later on this year as well as the the  the safety boxes and and still the ppe right the

the that the frontline workers need  who are administering the vaccine so um

making a i do think dispersing the  the manufacturing of the vaccines

but also ensuring the supply chain  of the other less less high-tech uh

side of of making vaccination uh making me to the  everything you need as i say to turn the turn that

those what's in what's the vaccine to turn it  into a vaccination that goes into somebody's arm

we've got to i think a decentralized  manufacturing is going to will be helpful

and and will allow for faster and more  equitable distribution thank you for that

um

with respect i think you've partially answered  this already so forgive me if i'm repeating myself

but with respect to vaccine distribution in areas  where people can least afford it former CEO of

merck ken fraser has a great quote the  last mile challenge is the greatest

David how is UNICEF working to overcome that  last mile challenge what else do you need

you think needs to be done for equitable vaccine  distribution so we're talking about actually

um needles in arms yeah no, i love this question  because that last mile challenge is what is

UNICEF and and our partners our uh you know civil  society groups ngos ministries of health we're

thinking about that all the time how do you get  all and what we what we know is that if you say

i'm going to reach this village that's beyond  the end not only of the paved road but even

of the dirt road that just has paths to get to  it if that's the village we're going to reach

that it's going to make all the way along  the chain from the from the capital city and

the airport where things landed it's going to  make it all stronger and it's absolutely it's

a challenge i don't want to belittle it but  goodness me the community health workers that

it's been my privilege to meet in a few different  countries and their their commitment their

uh enthusiasm like those folks are the  heroes i think it's the it's the the

i was just talking with a friend the  other day about about a guy named

edward that's why i remember because i was talking  about the other day i met him a few years ago in

in uh he's a community health worker in uganda  and he just inspired me because they were that

uganda was setting up a system where you  could do uh report stockouts uh of medicine

by text medicine by text by sms and uh and he  would say yeah and we have to climb up a tree

to hot to be able to get the signal right to  send the message to to into kampala and um

uh so yeah it's a challenge there's no i mean and  i don't want to belittle it by that challenge but

anyway i don't want to romanticize it although  i can assure you i feel pretty romantic about

it when i think of those people who are  doing so much and making such a remarkable

difference so i'm not sure that i would agree that  the last mile challenge is the greatest um it's a

huge challenge but there are challenges all the  way along the way and what we'd have at the end

at that in that last mile is people who are hungry  to help and the community health workers who give

them the tools and they're going to do the job so  sometimes the challenge is um is maybe us in the

high income countries opening our hearts enough to  be able to to make sure that there's to to to the

need for vaccine equity and justice that might be  a greater challenge than that last mile well said

despite a great desire for the pandemic to be over

there is a worldwide push by governments and  public health agencies to declare we have to

live with the coronavirus and claiming that  we're in an endemic phase according to the

evidence-based information we are still in the  middle of a pandemic and it is far from over

as you've correctly stated earlier  there will be more variants emerging

given 50 percent of the world's population are  effectively unvaccinated particularly if COVID

vaccination is defined as a three dose vaccine  program what are your opinions with regards to

live with the coronavirus and ending public  health measures such as masking and vaccine

mandates particularly since the majority of the  world's children are unvaccinated from COVID

you know

i'm not a policy maker and i think um sometimes  as we talk about the need to live with the live

with the pandemic live with coronavirus um is  is because societies and high income countries

are exhausted uh by everything that we i don't  think that's necessarily a so it may just be

a reality i'm talking here with the high  income countries um you know the and

in that huge global pandemic of the spanish flu  the last the the in that in the third year which

we don't talk much about the third year of the  spanish flu we just talked about the first two

because people were tired of the measures  they had to take and they just figured why

i was gonna have to live with  it so i think it's i think that

living with the pandemic may be

maybe something that we do have to do because  our societies are fed up with it you know it's um

i'm not by any means saying it's the right  thing i'm not saying you know but i just

think there's a there's a um there's a collective  exhaustion with this and and and if that means

that that variants spring up because so because  as you were saying so few people are vaccinated

well i mean right globally um

then we'll be back where we were before uh but  i think that is um living with the coronavirus

statement is more a political statement than a  health analysis statement yeah well said again

if we look to the future david we will  successfully emerge from this pandemic

if we manage to achieve global cooperation  leading to adequate sharing and distribution

of COVID vaccines resulting in actual needle  in arms with regards to COVID vaccination

presuming we achieve this what new landscape  of worldwide healthcare access do you see for

our planet do you think this can materialize  into better resources and access to healthcare

in low and middle income countries benefiting  from infrastructure created from the pandemic

well well despite what i've often been saying here  as i said i'm i'm optimistic i'm optimistic for

two reasons one is um you know in in your question  just now you talked about uh global cooperation

and one thing that has been exciting  for me i must say is is the response of

many many many tens of thousands of  canadians who've said who've said

we need global solidarity to fix this it's not  we need to uh um it's not just my neighborhood

or my province or even my country we re there's  a recognition that that that the world right now

it's the only place we have to live and so when  we say charity begins at home well home can be

south africa home can be bangladesh home you know  our home can be toronto or vancouver but but that

i've at a grassroots level in so many times it's  been a wonderful sense of global solidarity as

people have have have risen to the occasion i  believe and i also think you know what i mean

one example is um around the ultra cold chain in  order to to to do the vaccination campaigns that

need to happen absolutely we're we're we're  UNICEF is working with those local ministries

of health to make sure that it's not a bunch  of outsiders coming in or it's not a bunch of

uh um you know changing all these news having  to create new imposed new systems or anything no

it's strengthening ministries of health and it's  strengthening the training of community health

workers it's strengthening um those those supply  chains that are reaching out to that last mile

um we've so for example we  have delivered hundreds of um

of new uh ultra cold uh fridges to keep uh  and and we're not taking them back afterwards

i mean they're there they've gone to countries  along with the the system in order to keep them

ultra cold and we've also upgraded the cold  train i'm just picking the cold chain because

since i'm not medical it's one i can understand  the uh uh the importance of of that um

and we've been upgrading um the physical  infrastructure of clinics and all so that uh

um to be the sub-centers which from which often  the the the the vaccines are go out to the more

rural areas and we're doing more training  so so i do think that the result from this

is going to be our stronger health systems in  many countries it it will be a byproduct and

byproduct that we're trying to do on purpose i  mean we have to address the pandemic now and then

and then the stronger health systems will be  a way to to address the issues now but it will

it really will leave a legacy that can  be used once things are back for a new

normal whatever we want to call it and that'll  have stronger systems that can do a better job

of the routine immunization for children that can  do a better job of delivering nutrition that um

and that that's going to make things better  so i i it's going to take you know i talked

about the child this child survival revolution  that's been stopped by the pandemic it's not

gonna be today but i do think that we'll be  able to come out of that maybe it's gonna be

might take a couple of years but it'll will come  out a couple more years we'll come out stronger

and we'll be able to do more  as a global society to to

to ensure that global health is is higher  on the agenda and that most importantly

from our perspective as that children  lead healthier lives i think that will

come that was a fantastic statement to end this  interview David um thank you for your contribution

UNICEF is an amazing organization one of those who  i would say are holding up the world at the moment

we are all thankful that you continue to be a  great advocate and champion of children's rights

thank you very much and i'd like to really  um appeal to the audience to please donate

to UNICEF you've seen and heard today of the  amazing work and things that they do nationally

and internationally not just for children but for  adults so um they people can donate by going to

the website is that right David yes that's right  yeah and and here in here in Canada it's UNICEF.ca

is where people can go to make donations and be  part of our global movement to improve to improve

child health excellent and yes and i think  it's UNICEF.org if you're it's the global one

and i know that you go around the world so  um yeah UNICEF.org is is also the way so

wonderful and um obviously those links will be  provided on the show notes so people can uh click

on and and go to those directly so please join us  for next week's episode called uh vaccination of

the indigenous people of Canada and the effects  of COVID 19 on the indigenous people of Canada

thanks for listening to this week's episode of  COVID 19 the answers if you enjoyed the episode

please subscribe rate and review and do visit  our website kojalamedical.com/covid19theanswers