Food insecurity will be the sting in the tail of COVID-19.

On April 29, UNICEF published a discussion paper comparing the probable downstream effects of COVID-19 in developed and developing countries. High-income and upper-middle-income countries have borne the brunt of deaths associated with COVID-19 so far, and they are now seeing diminishing mortality rates. Countries across the world are easing lockdown restrictions. But, as this UNICEF paper outlines, for populations least affected by the disease itself, but for whom food insecurity, hunger, and malnutrition are already prevalent and critical problems, the worst might be yet to come.

The Global Nutrition Report launched this month, with the bleak headline finding that one in nine people is hungry or malnourished. In 2018, almost a quarter of the world's children younger than 5 years, 149·0 million children, were stunted and 7·3% (49·5 million children) were wasted. Progress over the past few years has been minimal and remains far from the 2025 global nutrition targets: to reduce childhood stunting to fewer than 100 million children and childhood wasting to 5% or less.

Now, in light of current global events, tackling malnutrition is expected to become harder still. On April 20, the 2020 Global Report on Food Crises was published, describing the factors that have led to a perfect storm for a food crisis in sub-Saharan Africa. According to the report, armed conflict remains a key driver of food insecurity in the region, disrupting agriculture and trade, blocking supply chains, and prompting mass population displacement. Exacerbating the situation since last June, unusually heavy rains have facilitated the development of locust swarms, devastating crops across east Africa. Movement restrictions in response to the COVID-19 crisis are delaying delivery of pesticides and stationing of staff to address the problem. Moreover, reports indicate that, where farmers can grow crops, lockdown restrictions are regularly preventing them from transporting produce and livestock to markets, and that rice imports to sub-Saharan Africa that were intended to compensate for the shortfall have been disrupted or stopped, driving up prices of this staple food. Finally, wage losses resulting from government-imposed shelter-in-place orders are further restricting the purchasing power of many families who were already on the borderline of poverty: an African Union study has projected that up to 20 million jobs could be lost in the region due to the COVID-19 crisis.

The Global Report on Food Crises estimates that 135 million people were food insecure in 2019, but more recent World Food Programme (WFP) projections indicate that, because of the economic effects of and supply chain disruptions associated with COVID-19, this number could double in 2020, to 265 million people. In announcing these projections, WFP Executive Director David Beasley warned: “if we don't prepare and act now—to secure access, avoid funding shortfalls and disruptions to trade—we could be facing multiple famines of biblical proportions within a short few months.”

Women and, particularly, children could bear the brunt of the effects of food insecurity, as well as COVID-19-associated health system disruptions. In their Article in The Lancet Global Health, Timothy Roberton and colleagues estimate the effects of these disruptions on maternal and under-5 child deaths in 118 low-income and middle-income countries. They find that even a small reduction in coverage and use of maternal and child health services could lead to 42 240 additional child deaths and 2030 additional maternal deaths per month, with worst-case scenario disruptions potentially resulting in an excess 1 157 000 child deaths and 56 700 maternal deaths over 6 months. These indirect effects will reach far beyond the disease itself, with long-term social and economic consequences for individuals and society.

How can we prepare for this impending humanitarian disaster? In March, the UN set up the US$2 billion COVID-19 Global Humanitarian Response Plan, to enable agencies such as WHO, UNICEF, and the WFP to provide food, water and sanitation, and vaccinations, as well as COVID-19 testing materials and medical equipment, to the most vulnerable communities. At the time of writing, it had only received 46% of the required amount. Fully funding this appeal should be an urgent priority for donors, even as they struggle with economic shocks of their own. Additionally, restrictions on transport and trade should be considered in the wider context of their potentially devastating effects on food supply chains. To paraphrase David Beasley, leaders should be acutely alert to the potential for an infectious disease pandemic to be compounded by a pandemic of undernutrition.