Children, intersectionality, and COVID-19.

Early in the COVID-19 pandemic, the broadcaster Emily Maitlis commented that COVID-19 is a “health issue with huge ramifications for social welfare and it is a welfare issue with huge ramifications for public health”. These words were prescient. It is now known that minority ethnic groups are disproportionately affected in terms of COVID-19 disease and deaths. Such disproportionality has motivated a call for an intersectional approach to COVID-19 policy. Yet there is one group of people routinely forgotten about in the turn to intersectionality: children.

The term intersectionality, first used by Kimberlé Crenshaw in the context of Black feminism, can be thought of as a framework for conceptualising an individual, group, or social problem as affected by multiple and overlapping disadvantages and discriminations. In the context of the pandemic, an intersectional approach acknowledges the effect of interdependent systems of prejudice on both direct and indirect health effects of COVID-19. For example, Berkhout and Richardson investigate the effect of COVID-19 on feminism, arguing that gender alone is inadequate to address both the risks and consequences of COVID-19, and Sasser and colleagues examine the overlapping and compounding effects of race and class.

Childism, or systematic prejudice against children, is a new concept in the context of public health. It has been invoked as a way of critiquing mass SARS-CoV-2 infections among children and the de-prioritisation of children for vaccines. What would it mean to take an intersectional approach to address childist prejudice in the pandemic?

The first step to understanding childism as part of an intersectional approach is to recognise that children are not a homogeneous group. This group includes children from minority ethnic backgrounds, girls, disabled children, children living in poverty, and so on. Yet the heterogeneousness of children as a group has been largely ignored in public health and policy decisions during COVID-19. For example, in the context of the decision to recommend vaccinating children, risks are discussed and decisions about offering vaccines are made with reference to all children, even though we know that boys are more at risk from myocarditis and pericarditis than girls. Research points to racial inequalities with respect to COVID-19 outcomes, including hospital and intensive care admissions in children.

The philosopher Karl Popper once described how he asked his students to observe: “‘Take pencil and paper; carefully observe, and write down what you have observed!’ They asked, of course, what I wanted them to observe. Clearly the instruction, ‘Observe!’ is absurd.” Popper makes the point that observation is always selective. If the right questions are not asked, data that will enable them to be answered cannot be collected.

Similarly to adults, the intersection of social, economic, and demographic characteristics, such as age, ethnicity, class, and gender, shapes children's daily experiences and outcomes. Yet, there are few data available to allow an evidence-based approach to addressing the intersectional needs of children in the context of COVID-19. Compared with adults, considerations of the effects of the pandemic on children have been deficient enough, even with lumping them all together as a homogeneous group. The dearth of data on how COVID-19 and its related interventions might differentially shape the experience of heterogeneous groups within all children is likely to compound this prejudice. An intersectional approach is key to addressing childism in public health decision making, practice, and policy.