Ensuring children can continue to access life-saving vitamin A during the COVID-19 pandemic

Vitamin A dosing in Indonesia

By Alison Greig, Technical Director, Global Technical Services Unit

As the world faces the COVID-19 pandemic, the need to find ways to continue to deliver nutrition interventions safely to the most vulnerable is clear. 

We know that well-nourished people have stronger immune systems, which can help them fight infections such as common colds, influenza and other respiratory infections. On the other hand, malnourished individuals are at a higher risk of becoming ill, face the prospect of a longer recovery, and are at greater risk of death.

Malnourished children are particularly at risk. A severely undernourished child is nine times more likely to die from common infections such as malaria, measles, diarrhoea and respiratory infections than a well-nourished child 1, while good nutrition boosts immunity and helps bodies to fight disease and infections.

That’s why development organizations around the world are moving fast to change how they do things, balancing the need to deliver often life-saving nutrition interventions with the requirements to follow the necessary restrictions in movement, supply, and social interaction.

Vitamin A supplementation (VAS), a nutrition intervention that has been shown to contribute to an all-cause mortality reduction of more than 12% when provided twice yearly to children under five,2,3,4,5 is an example of this. Delivery platforms include routine health and nutrition services, as well as campaigns such as Child Health Days, large community events that bundle key health interventions.

These types of activities, which bring large groups of people together at one time, are being curtailed around the world to slow the spread of COVID-19. Yet, not being able to deliver large-scale VAS for an extended period could mean millions of children will be at an increased risk of becoming sick and even dying – not only from COVID-19, but also from measles and diarrhoea.

To avoid this, today the Global Alliance for Vitamin A (GAVA) provided some guidance as to how governments can continue to distribute vitamin A safely during the pandemic.

In a consensus statement , GAVA made the following recommendations for countries with existing VAS programs:

  1. The delivery of VAS through routine health and nutrition services should try to continue where possible, guided by local factors.
  2. Mass VAS campaigns should be temporarily suspended.
  3. No missed opportunities: VAS should be distributed along with any outbreak response vaccination campaign.
  4. Countries should start planning now for intensified, catch-up VAS distribution so that it can be implemented as soon as possible when conditions allow.

As the Chair of GAVA, Nutrition International led this initiative with its partners, and is supportive of these recommendations. We are committed to continue to advocate for the reliable distribution of vitamin A both during, and after this pandemic.

Nutrition International, with unwavering support from the Government of Canada, has been working to deliver VAS to children around the world for nearly 30 years, amounting to over 10 billion distributed capsules.

Every year, Nutrition International donates sufficient capsule supply to meet 100% of the needs of eligible countries. This represents 75% of the world’s need – and over 400 million capsules annually. We work with our GAVA partners, UNICEF and Helen Keller International, to strengthen countries’ ability to deliver two doses of vitamin A per year to children 6-59 months of age.

In order to reduce the knock-on impacts of this pandemic, it is imperative for governments to prioritize and ensure the continued or increased provision of low-cost, high-impact, proven interventions such as VAS − and concrete, evidence-based recommendations like the ones GAVA put forward will help them do so safely.

The cornerstone of any health system is the immune system strength of the people in it. Ensuring good nutrition builds the resilience of vulnerable populations to pandemics such as the one we’re living through, as well as other common diseases that kill millions every year. We must all look at how we can do things differently, change our status quo, so we can continue to strengthen the immunity of the most vulnerable populations though improved nutrition. So the world is ready to fight – now and in the future.

 

1 UNICEF. Severe acute malnutrition. https://www.unicef.org/nutrition/index_sam.html , last access 29 October 2019. 

2 Beaton et al. Effectiveness of Vitamin A Supplementation in the Control of Young Child Morbidity and Mortality in Developing Countries – Nutrition Policy Discussion Paper 13. United Nations, 1992. 

3 Villamor E., Fawzi W. Vitamin A Supplementation: Implications for Morbidity and Mortality in Children. JInfectDis. 2000. 

4 Mayo-Wilson E, Imdad A, Herzer K, Yakoob M, Bhutta Z. Vitamin A supplements for preventing mortality, illness, and blindness in children aged under 5: systematic review and meta-analysis. BMJ 2011; 343 :d5094. 

5 Imdad A, Herzer, K, Mayo-Wilson E, Yakoob MY, Bhuta ZA. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. Cochrane Database of Systematic Reviews 2010, Issue 12. 

Alison Greig

Technical Director, Global Technical Services Unit

Alison Greig, Technical Director, Global Technical Services Unit, provides program guidance, support and input to all of Nutrition International’s vitamin A supplementation, zinc and infant, young child feeding programs, at the country, regional and global levels. She has specialized expertise in vitamin A supplementation program design, implementation, and monitoring, vitamin A supply procurement, country-level forecasting and supply chain management, and in other child survival intervention programs. She has a BScH in Biology and an MSc in Public Health.  Alison joined Nutrition International in 1995.

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