"Biblical". That was the word that the world’s press needed to (finally) run stories about the impacts of the COVID-19 crisis on food and nutrition. Thank you to the Executive Director of the World Food Programme, David Beasley, for the turn of phrase, because these headlines finally roused world leaders from their slumber on the potential scale of the coming food and nutrition disaster.
Behind the headlines, what do the numbers say about the potential size of the looming food and nutrition crisis? Estimates are far and few between.
The reporting around the release of the 2020 Global Report on Food Crises suggested that the impact of COVID-19 on the number of people in acute hunger could be to increase current estimates of 135m (already a record) by a further 130 million to 265m (although I could not find this number in the actual report which was prepared before the COVID-19 crisis). Nevertheless, these suggested increases are in line with recent analysis from the UN WIDER group that projects the impact of potential GDP losses on the number of people living on less than USD1.90 a day. For a 10% decline in global GDP the WIDER report projects an extra 180 million people living in extreme poverty, with 150 million living in Africa and South Asia. Nearly all of those people will be hungry.
And if you think a 10% GDP decline is hype, remember that the Fitch ratings currently suggest 4% drop in global GDP - twice the 2009 global financial crisis - and they have been rapidly worsening the forecast over the past few weeks. European economies are projected to suffer GDP losses of 6-10 %. I cannot imagine that the declines in Africa and South Asia will be much lower than this given that a much higher proportion of their workforce cannot "work from home" since physical labour is their key asset. In addition, the kind of income support available to people in high income countries is simply not available in low- and middle-income countries.
Hunger is a terrible thing. It demolishes the body; it extinguishes hope; and it strains the bonds of solidarity. But it is just one part of the food and nutrition story. The number of people who are not getting enough vitamins and minerals in their diet to prevent mortality and sickness – those with hidden hunger - is twice the number who are hungry. And it is the foods that are rich in vitamins and minerals that are most at risk of scarcity and food price spikes at the moment because they are perishable and most affected by supply chain distributions. And they were more expensive pre-crisis. So, we might have an additional 300 million people with micronutrient deficiencies. This is "biblical" on steroids.
But it gets worse. For the very youngest, those in the first 1000 days after conception, disruptions to their very own supply chains - in the womb and in the first 2 years of life - is a disruption to their lifelines. If they don’t get the right "just in time" food, care, health care and water and sanitation, their bodies will, literally, be shaped by the crisis. Forever. Their immune systems will be compromised, their brain development impaired and their bone and muscle development undermined. They will be "the COVID-19 generation", marked for life. Their own kids will be more likely to be born stunted too: the children of the COVID-19 generation.
What kind of numbers are we talking about? Well, again we have to use rather crude methods to get a sense of the magnitude. Luckily there are credible estimates of the relationship between GDP and stunting rates of children under 5. Stunted children are short for their age, with their shortness being a marker of their unfulfilled potential and their vulnerability to an early death. The estimates suggest that a 10% decline in GDP per capita will lead to an increase of 5% in stunting rates. The 2020 UN Joint Malnutrition Assessment gives the global stunting rate as 21.3%. In other words, one fifth of under 5 children are stunted: 144 million of 676 million under 5’s already have had their lives and life chances damaged by malnutrition. If stunting rates increase by 5% (not 5 percentage points) that means an extra 7 million stunted children. For some perspective, the UK - where I live - has 4 million kids in this age group, in total.
This is "biblical" throughout the life course and across generations.
So, what to do about it?
First, act now, act now, act now. Just like dealing with the virus, early action is vital. Stop malnutrition from gaining a malevolent hold of children’s lives before irreversible damage is done. It is a true no-regrets act because the benefit-cost ratio of scaling up nutrition programmes is 16:1. There aren’t many better economic investments, COVID-19 or not, so the opportunity costs of this choice are unlikely to be higher.
Second, maintain coverage rates of essential nutrition programmes - and increase them. Coverage rates of essential programmes that we know are cost effective are shockingly low: 20-30% of the children, girls and women who need them get them. The programmes represent the leading edge of support in shoring up immunity rates at the population level. They are, so to speak, the "personal protective equipment" (PPE) of infants - the front line of the next generation. Let’s spend as much time getting these essential nutrition programmes to infants as we do to the equally essential job of getting PPE to front line health workers.
Third, keep the supply of nutritious food moving - and expand the flow. Unlike the 2008-9 food price crisis this coming crisis is not one of drought, oil prices and biofuels. This is one a car crash of supply chain logistics. Farmers can’t get inputs to grow food, workers cannot get to fields to harvest, storage facilities can’t move food stocks, small and medium businesses can’t get foods to process, wet and dry markets can’t open, retailers cannot get food to sell in markets, and consumers cannot get the food they want at the price they can afford. The supply chains that are moving are doing so because food workers are putting their bodies on the line, braving possible infection to put food on the table for their families and for the rest of us. The fragility of these food supply chains is being cruelly exposed by the lockdown. We have to find ways now to keep them moving - support food system workers, keep SMEs from going under, and keep markets open--and work hard to make them more resilient: greater diversity to spread risk, shorter chains to reduce risk, and risk planning rewarded via lower insurance and credit premiums. GAIN is doing its bit with a USD50m emergency multidonor fund called Keeping Food Markets Working.
Fourth, do whatever possible to shore up incomes and food demand - the driver of food systems. High income countries are spending trillions to do this, via support to furloughed workers, mortgage and rent "holidays", small (and large) business support, unemployment benefits, and lunch vouchers for millions of school children. Emerging economies cannot do this from domestic resources. They need help from the IMF and other development finance institutions, and the HPIC (heavily indebted poor countries) need sustained and significant debt relief.
Some policymakers reading this will think, "this is all very well, but there is no money for hunger, hidden hunger and malnutrition - it is all going to the COIVD-19 response". But addressing hunger, hidden hunger and child undernutrition IS a part of the COVID-19 response. A big part. In fact it is the only part that really protects the youngest generation. Remember, malnutrition kills over 2 million infants every year. At the moment global COVID-19 deaths are a tenth of that, at 200,000.
As various editions of the Global Nutrition Report note, governments and donors spend only 1% of their budgets on nutrition, despite the fact that child undernutrition is linked to 45% of all child deaths under 5. That equation looked grossly unbalanced in normal times but now, frankly, it looks negligent and irresponsible. We need to help champions in donor agencies to make the case for nutrition in their agencies, agencies that are wrapped up in dealing with the COVID-19 response.
So, in the end, I would argue that my friend David Beasley is only one third right. If we don’t act now, the coming food and nutrition crisis will not only be biblical. It will be biblical, on steroids, and across generations.
We know what to do, we know how to do it, and we know we can find the funds for it. How can we even think about writing off the most vulnerable generation - our babies and infants? Let’s act now and deny COVID-19 this terrible long-term legacy. That can be our legacy.