Why We Must Prioritize the Rights of Children in Pandemic Preparedness and Response

Judith Kose, Former Director of Pediatric and Adolescent Services, Elizabeth Glaser Pediatric AIDS Foundation?

Mary Atieno Ojoo, Technical Manager, Medicines and Nutrition, UNICEF?

According to the United Nations Convention on the Rights of the Child (CRC), children must receive well-informed and preventative health care services regardless of their economic or geographic situation. This includes access to basic medical assistance, mental health services, and nutrition counseling. It also includes access to sexual and reproductive health education, screenings, and services. The CRC also states that all children have the right to receive the highest attainable standard of health, free from discrimination. HIV and TB epidemics have a severe impact on children, as they are particularly vulnerable to infection due to their immature immune system. In addition, children are often more exposed to the risk factors associated with these diseases, such as poverty, inadequate nutrition, and overcrowded, unsanitary living conditions. In response to this threat, many public health initiatives have been established to combat HIV and TB in children. These initiatives include improved diagnosis and treatment, education, and prevention programs.??

Innovating for Inequalities??

The fight for an AIDS-free generation and a TB-free future are fused together – particularly as it pertains to implementing effective case finding initiatives. According to the Joint United Nations Program on HIV/AIDS (UNAIDS), in 2021, approximately 160,000 children were newly diagnosed with HIV, with almost half infections were due to HIV positive women didn’t receive ARV treatment during pregnancy and breastfeeding. Data from the World Health Organization (WHO) also shows that children younger than 15 accounted for 11% of the total burden of TB in 2021, and only 40% of all childhood TB cases were reported, leaving the majority of children and adolescents impacted by TB undiagnosed and untreated. The plight of children co-infected with HIV and TB is further worsened given that TB is the leading cause of death among HIV-positive people and accounts for nearly one-third of all AIDS-related deaths globally – 10% of which were children.?

All of these deaths are preventable. Without HIV diagnosis and treatment, one-third of infected infants will die before the age of one, and almost one-half before their second birthday. Simultaneously, in most cases, TB is treatable and curable. However, per UNICEF, infants and young children are more likely than older adolescents and adults to develop life-threatening forms of TB disease due to “massive under-diagnosis.”??

In a statement released from UNAIDS in 2021, “one of the most glaring disparities [to end HIV] is our failure to meet the needs of children living with HIV.” As of 2021, 800,000 children living with HIV are not accessing treatment, and only 41% of them have viral suppression. Without identifying those children most impacted by HIV and TB — or those co-infected with both HIV and TB — the global health community cannot effectively gauge those most in need of treatment. By integrating TB screening and diagnosing in the HIV service delivery platform and vice versa, the global health community can better find children impacted with either or both diseases.?? ?

The Importance of Pediatric Formulations?

?Identifying children at risk of contracting TB and/or HIV and those living with TB and/or HIV is just one step to ending childhood TB and pediatric HIV. Effective pediatric formulations must be made accessible to all children, regardless of geography, in order to succeed in this fight. Currently, many of the drugs designed for children impacted by TB and HIV prioritize those living in countries with high GDP (large market countries), thereby leaving children living in countries with low GDP (small market countries) unfairly behind. As a result of these unreasonable expectations, many small market countries are not only unable to identify children living with either illness but are also limited in their capacity to provide pediatric-friendly medical therapies.?

?Breakthroughs in pediatric drug formulations for both HIV and TB offer promising results when offered at the early stage of disease progression. For those children in countries in which childhood TB and pediatric HIV are not prioritized, many are unable to access the requisite child-friendly formulations that will curb disease progression. Drug regimens that have been proven to be effective in adults are often not tailored for the unique developmental needs of children. Some of the issues making treatment of either disease for children to tolerate include the high number of pills, pill size, and pill taste. Furthermore, because of these complex treatment regimens – and lack of readily available child-friendly formulations – adherence is often unsustainable and difficult to manage, leading many children to be hospitalized.?

?While some medical facilities are able to both diagnose and treat TB and HIV, not all are able to offer the requisite expert regimens needed to treat the diseases – especially in their advanced stages. These facilities are often far removed from the communities in which children and families impacted by HIV and TB reside. Furthermore, these extended hospital stays often present families with difficult financial decisions as many caregivers are often forced to take time away from work in order to visit their children receiving treatment in medical facilities far away from their homes.??

Alliances for the Health of All Children and Adolescents??

States must uphold the rights of children to health and dignity, regardless of their geographic or economic status. By improving measures to identify children in need of care, developing more suitable pediatric therapies, and decentralizing treatment centers, the global health community can expand the ability of countries to access treatments more equitably and bridge the gaps facing children who are impacted by TB and HIV, as well as other diseases, such as malaria, cholera, measles, neglected tropical diseases, and childhood cancer. Recently released guidance from the WHO emphasizes the need for countries to prioritize the quick rollout of treatments that are easily tolerated by children in order to more efficiently treat TB, HIV, and other diseases. For example, one solution is the WHO Global Accelerator for Paediatric Formulations Network (GAP-f), a network that offers a sustainable model that prioritizes, aligns, and accelerates access to better pediatric formulations. Furthermore, GAP-f provides a collaborative framework to deliver appropriate, affordable, and effective pediatric drug formulations for children impacted by diseases irrespective of where they live.?

The important work of GAP-f and the fight to end childhood TB and to achieve an AIDS-free generation are underscored by a simple inalienable fact: children and adolescents are human beings. As such, they are entitled to fair treatment that both recognizes and values their dignity and social well-being. Ignoring or de-prioritizing the health care needs of children and adolescents simply because of the challenging complications based upon their ages or location is an abject failure that must be meaningfully addressed.??