In February, 2020, the WHO–UNICEF–Lancet Commission's report A Future for the World's Children? examined threats facing children—from climate change and related crises of poverty, migration, and malnutrition; commercial marketing of harmful substances; and across all sectors, from unsafe roads and hazardous housing to inadequate education and social protection.1 The COVID-19 pandemic is exacerbating many of these threats, jeopardising child welfare gains, and causing a global economic crisis in which children will be prime casualties.2 Yet recovery and adaptation to COVID-19 can be used to build a better world for children and future generations.

Children are less affected clinically by COVID-19 than adults.3 Nonetheless, children are impacted by the pandemic's indirect effects, not least from separation or loss in their own families. Projections suggest that over a million preventable child deaths might occur due to decreased access to food and disruption of essential health services.4 Children risk missing out on growth monitoring, preventive care, and timely management of acute disease and injuries. Some children are experiencing reduced access to social service referrals while suffering from increased rates of domestic violence.

Even as the COVID-19 response creates short-term benefits such as reductions in air pollution and road traffic injuries, the impacts of the pandemic led the World Food Programme to warn of a coming “hunger pandemic”,6 and tens of millions of children worldwide could face extreme poverty.2 Malnutrition and poverty in pregnancy and early childhood can negatively influence children's physical health and cognitive trajectories throughout the life course.7 COVID-19 has also prevented continuous education for over 1·5 billion children and young people.8 School closures worsen the learning gap since children from wealthier families continue schooling with digital tools, whereas poorer children fall further behind, in all countries.9 In some settings, girls might be less likely to resume schooling due to increased rates of early pregnancy, as occurred in Sierra Leone after the outbreak of Ebola virus disease.10 Meanwhile, hundreds of millions of children who rely on school meals globally are deprived.2
In this pandemic children constantly hear about disease and death, which prompted Norway's Prime Minister, Erna Solberg, to say, “It's OK to be scared” in a children-only press conference.11 Many children have been or continue to be unable to play or socialise outside the home. Adolescents especially can suffer when deprived of social stimuli, since peer interaction is key to their development.12 Many children and adolescents are spending more time online, allowing social interaction for some but also increasing the risk of exploitation, bullying, and intensified commercial marketing.1, 13

The most vulnerable children are those who have been separated from caregivers; in past health-related disasters up to 30% of such children met the criteria for post-traumatic stress disorder.14 Parents may also struggle to provide the responsive parenting needed to help children thrive during the COVID-19 pandemic.15
Children's futures are at risk, especially those who are poor, female, disabled, Indigenous, from racial, ethnic, and sexual minorities, or are otherwise vulnerable in unequal societies. Among the children who make up more than half of the world's refugees, the shocks engendered by COVID-19 are especially dire.16 The UN Committee on the Rights of the Child warned that COVID-19 poses grave threats to children's rights,17 and the pandemic has been used as a pretext to circumvent laws and treaties designed to protect children—eg, the US order in March, 2020, that allows expulsion of unaccompanied children who are “from a country where a communicable disease exists”.18

Our Commission showed that what is good for children is good for societies: investment in children's wellbeing provides benefits that are immediate, long term, and intergenerational.1 While the pandemic will strain public finances, there must be no return to the austerity policies that followed the 2008 financial crash, which escalated health and social crises in Europe19 and elsewhere. So far, countries' responses have focused on short-term business relief and social protection and not on the long-term recovery needed to create healthier and more equal societies.