From Peril to Promise: Our Debt to Children

by , | Apr 14, 2020

UPDATE: Since we wrote this piece, the UN has quantified the number of children at risk from missing routine measles vaccinations. They’ve identified a horrifying 117 million spread across 37 countries, 24 of which have already suspended their routine immunization coverage.

As our colleague Alex Evans explored here recently, the tail end of the decade with no name featured an increasingly heated intergenerational debate about resources and fairness. While Gen Z’s beef with Boomers may now seem as distant as, say, Brexit or the 10 Year Challenge, it provides us with important lessons we need to take on board as we deal with the long shadow the COVID-19 pandemic will cast.

The Director General of WHO has already described COVID-19 as “the defining public health crisis of our time”. Elsewhere, comparisons with World War II abound. Among the most important features of the global post-war settlement was a strong focus on children, their needs and rights. UNICEF was founded in late 1946, initially to meet emergency needs in nutrition and health but quickly moving into advocating and providing for long range benefits. Organising immunisation was among its first priorities.

A week ago, we touched on the risk the pandemic poses to routine immunisation work, particularly in low and middle income countries. It is already likely that hundreds of thousands of children will not receive the vaccines they need to protect them against a raft of communicable diseases. The poorest and most vulnerable are inevitably most at risk. And yet for these children, a virus like measles may pose a much greater threat than COVID-19.

Overstretched public health systems in many low and middle income countries are already finding it difficult, or impossible, to maintain routine immunisation work as they move to take on the pandemic. Meanwhile, development partners, including UNICEF, have reluctantly taken the decision to suspend work in this area for fear of spreading COVID-19 further. 

Nor is it clear that routine immunisation work will resume smoothly once the acute phase of the crisis has passed. Once a vaccine becomes available, health systems worldwide will begin to grapple with the administrative and logistical complexities of immunising large proportions of their populations against COVID-19. Resources will flow into this area, further increasing the risk that children will die from preventable diseases.

And immunisation is far from being the only essential service children are foregoing as the world tries to slow the spread of COVID-19.

More than 1.5 billion children and young people who were learning at the start of the year are now out of school or university. With unanswered questions about how much this will slow the spread of the epidemic, this is another area where children are sacrificing something deeply important to their future to help protect older people.

We must do more to minimise the health and education burdens being borne by children. Wherever possible, we should maintain preventive health services, while planning for rapid catch-up in affected areas once the immediate shock has receded. We need to continue protecting vaccine supply chains to ensure routine immunisation can continue during a COVID-19 vaccine rollout. 

In education, meanwhile, we need to remove as many barriers to online and other alternative learning content as we can. And we should harness the power of parents the world over to use their own passions and interests as a focus to keep their children learning.

But in the longer run, the world must commit to paying back the debt to children that is mounting up during this global emergency, just as it did after World War II. 

We see three distinct phases to deliver promise from peril:

First, listen to what children are doing for us. We need to quantify the price they are paying in missed immunisations and days at school.

Next, it is time to think. We know what young people worry about when they think of their futures, but before the pandemic we refused to act on their fears. The climate emergency, rising inequality, the chance to do meaningful, properly paid work. This is the currency with which we can pay children back.

Finally, we must act. Listen, think, and then invest in children and in their futures through policies and programmes that are tailored to tomorrow’s realities, not the world before COVID-19. We must be ready to take action as swiftly and decisively as the world did to benefit those other children in 1946.


  • specialises in working with governments to help them strengthen delivery of public services, particularly education, in fragile and conflict affected states. She has acted as an adviser to senior officials and politicians in a range of countries, including Pakistan, Nigeria and Lebanon. Victoria is Managing Director of River Path Associates, and collaborates regularly with other consulting firms. She is also a Director of the Acasus Foundation. Since 2015 she has served on the board of the Eden Academy Trust, a multi-academy trust of schools for children with complex educational and health needs in London and the North East of England.

  • Emma Hannay is a public health doctor with a focus on global health strategy and delivery. She works at a global level on organizational strategy across a range of disciplines in global health, and at a country level in implementing health systems reforms in complex operating environments. In her previous role as Head of Health at Acasus, she was part of the team leading the Pakistan Health Reforms Roadmaps, which improved primary care for more than 150 million people, and the DRC’s Mashako Plan to increase immunization coverage for children.

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