Can evidence drive health equity in the COVID-19 pandemic and beyond?

An Imperative to Include Children's Voices in Policy Development: Part of the Solution to Understanding the Impact of Policy on Children's Mental Health

The recent JAACAP editorial by Pumariega1 uses evidence of the unintended consequences of US immigration policy to offer a broader lesson about the direct and indirect consequences of policy on the mental health of children and youth (herein children). Pumariega calls for data standards and transparency for state-level databases on policies affecting the status of children to "move us toward evidence-based vs ideologically based policy development that is sensitive to mental health needs of children."1 The International Network for Epidemiology in Policy (INEP) represents 24 epidemiology societies across the globe and works to address policies that have global public health impacts. We would take Pumariega's argument further and suggest that there is a global imperative not only to consider the needs of children but also to include their voices about their physical and mental health and right to a healthy future in policy development. Prioritizing the well-being of children in policy development in this way will have an impact over their life course. Including children in decision making also guards against teleological perspectives of child development that view adulthood as the purpose of childhood, which undermines the dignity and equality of children and their experiences.2 Soon after adoption of the 17 Sustainable Development Goals (SDGs), the Lancet Commission placed the health and well-being of children at the center of the SDGs. This work continues as Children in All Policies 2030 (CAP-2030; https://cap-2030.org) to ensure that children reach their potential. The CAP-2030 initiative partners with child activists and coalitions, with the participation of an advisory board of 21 young people from 16 different countries, to amplify and center children's voices in national and global policymaking.

COVID-19 Vaccination and Public Health: Addressing Global, Regional, and Within-Country Inequalities

The COVID-19 pandemic, with over 775 million cases and 7 million deaths by May 2024, has drastically impacted global public health and exacerbated existing healthcare inequalities. The swift development and distribution of COVID-19 vaccines have been critical in combating the virus, yet disparities in access to and administration of the vaccine have highlighted deep-seated inequities at global, regional, and national levels. Wealthier nations have benefited from early access to vaccines, while low- and middle-income countries (LMICs) have faced persistent shortages. Initiatives such as COVAX aimed to address these disparities, but challenges persist. Socioeconomic factors, education, ethnic identity, and the healthcare infrastructure play crucial roles in vaccine equity. For example, lower-income individuals often face barriers such as poor access to healthcare, misinformation, and logistical challenges, particularly in rural areas. Addressing these inequities requires a multifaceted approach, integrating national policies with local strategies to enhance vaccines' accessibility, counter misinformation, and ensure equitable distribution. Collaborative efforts at all levels are essential to promote vaccine equity and effectively control the pandemic, ensuring that all populations have fair access to life-saving vaccines. This review explores these complex issues, offering insights into the barriers and facilitators of vaccine equity and providing recommendations to promote more equitable and effective vaccination programs. With a focus on the different levels at which vaccination policies are planned and implemented, the text provides guidelines to steer vaccination strategies, emphasizing the role of international cooperation and local policy frameworks as keys to achieving equitable vaccination coverage.