Nutrition in a time of COVID-19: It's complicated

The COVID-19 crisis is likely to have complex and long-lasting impacts on our already complicated relationship with food. Whereas some high-income population groups have reported less healthy eating, more snacking and weight gain, others resorted to healthier, home-cooked meals and eating more fruit and vegetables.

Yet the pandemic also triggered significant job and income losses the world over, leading to food insecurity that could exacerbate undernutrition in children and anaemia in women.

“In the early stages of the pandemic, there was much concern that we would face something akin to famines and acute food shortages,” says paediatrician and nutritional scientist Zulfiqar Bhutta of Canada’s University of Toronto and Aga Khan University, Pakistan. “The bottom line is that this has not happened. Outside a few extremely food-insecure regions, the supply chains had the innovation to meet expectations, people came forward with philanthropy, and local support and social services kicked in. But there has been a huge impact on the informal sector and the poorest of the poor. This pandemic has affected inequities in ways that nobody could have imagined. It’s now very clear that the rich became richer and the poor became poorer.”

In a comment published in Nature Food earlier this year, Bhutta and international colleagues have projected that, without adequate responses, COVID-19 and the related economic recession could lead to millions more wasted and stunted children, and 168,000 additional child deaths in low- and middle-income countries. Also, tens of millions of adults could become undernourished and be plunged into extreme poverty.

This is illustrated by a recent Reuters survey, which found that for 75 rural families in India, household incomes had dropped nearly 75% since the start of the pandemic, with almost two-thirds of the households taking on debt.

“This has a flow-on effect, with nutritional impacts in the form of wasting and chronic undernutrition,” explains Bhutta. “This has been compounded by massive interruptions to education and health services.”

South Asia, for example, has witnessed disruptions to family planning services, nutrition counselling and the provision of food supplements and immunizations, including for breastfeeding women and children.

Supply stayed steady

At the global level, food supply chains have demonstrated exceptional resilience. Total merchandise trade showed a remarkably rapid recovery. Following a sharp contraction at the start of the pandemic, it now exceeds pre-pandemic levels and portends future growth. Trade in agricultural products was especially resilient in its response. “We never saw a trade recession in this sector,” says Josef Schmidhuber, deputy director of the trade and markets division of the UN’s Food and Agricultural Organization (FAO). “What we saw was a steady rise and even a slight acceleration of agricultural trade.”

The reasons for this are complex but have to do with our indispensable need for food and the vagaries of a competitive global import/export market.

A closer look, however, shows demand for fish and beverages declined considerably during the first six months of 2020, failing to recover to pre-crisis levels by the end of the year. These are considered luxury goods, explains Schmidhuber, that are expensive due to their high transport costs and import tariffs. Meat, fruit and vegetable trade was also affected. But cheaper goods, like cereals, rice and staples, were in higher demand.

“Where some countries had problems, other countries increased their exports, which explains why global trade remained so robust,” says Schmidhuber. For example, when European Union supply chains for citrus were disrupted at the beginning of the pandemic, Egypt stepped in to fill the gap, improving its access to the EU market.

Lessons have been learned from previous financial crises. “Governments moved away from austerity policies and understood they had an important role to play,” says Schmidhuber. “Massive stimulus packages in many G20 countries helped to reduce the period of suffering and expedite the recovery process significantly.”

But, he adds, cyclical aid tends to exacerbate price swings, contributing to the next crisis, rather than helping to avoid it. “What we need is sustainable investment and commitment to food production.”

This investment could come in the form of government support for small and medium enterprises that provide locally and regionally sourced, nutrient-rich foods. Support is also needed for shorter and more diversified food value chains. More investments are needed in national and community agriculture, and in national micronutrient premix facilities to promote local production of fortified staples. International food markets need to become more transparent and food movement needs to be monitored in real time.

Reinvigorating post-pandemic food systems also provides an opportunity to encourage healthy eating. For example, more incentives are needed to encourage food companies to make healthier products that are more affordable. The marketing of unhealthy foods by these companies could be reduced through tougher regulations. Subsidies and food vouchers should be linked to retailers providing healthy food. And food literacy and school feeding programmes leave much room for improvement.

“At a global level, we were hopelessly unprepared for this,” says Bhutta. “We were slow and made some wrong decisions. Even now, when we have clear evidence of what needs to be done for a global pandemic at a global level, we are trying very hard to control things at local levels, by closing borders, restricting travel, getting vaccines in and caring nothing about what happens to vaccines in the rest of the world.”

“How can we protect ourselves against an enemy unless we do something at the global level?” continues Bhutta. “Like with climate change, it will just come back to us in one form or another. The lessons to be learned from this are that our solutions must be global in a world that has become increasingly interconnected.”