Comment
*Trisha Greenhalgh, Jose L Jimenez, Kimberly A Prather,
Zeynep Tufekci, David Fisman, Robert Schooley
trish.greenhalgh@phc.ox.ac.uk
Department of Primary Care Health Sciences, University of Oxford,
Oxford OX2 6GG, UK (TG); Department of Chemistry and Cooperative Institute
for Research in the Environmental Sciences, University of Colorado, Boulder,
CO, USA (JLJ); Scripps Institution of Oceanography, University of California,
San Diego, La Jolla, CA, USA (KAP); School of Information and Library Science,
University of North Carolina, Chapel Hill, NC, USA (ZT); Dalla Lana School of
Public Health, University of Toronto, Toronto, ON, Canada (DF); Department of
Medicine, Division of Infectious Diseases and Global Public Health, School of
Medicine, University of California San Diego, La Jolla, CA, USA (RS)
1 Heneghan C, Spencer E, Brassey J, et al. SARS-CoV-2 and the role of airborne
transmission: a systematic review. F1000Research 2021; published online
March 24. https://doi.org/10.12688/f1000research.52091.1 (preprint).
2 Prather KA, Wang CC, Schooley RT. Reducing transmission of SARS-CoV-2.
Science 2020; 6498: 1422–24.
3 Pan M, Lednicky JA, Wu CY. Collection, particle sizing and detection of
airborne viruses. J Appl Microbiol 2019; 127: 1596–11.
4 Gelfand HM, Posch J. The recent outbreak of smallpox in Meschede,
west Germany. Am J Epidemiol 1971; 93: 234–37.
5 Morawska L, Milton DK. It is time to address airborne transmission of
coronavirus disease 2019 (COVID-19). Clinical Infect Dis 2020; 71: 2311–13.
6 Lewis D. Superspreading drives the COVID pandemic—and could help to
tame it. Nature 2021; 590: 544–46.
7 Eichler N, Thornley C, Swadi T, et al. Transmission of severe acute respiratory
syndrome coronavirus 2 during border quarantine and air travel,
New Zealand (Aotearoa). Emerging Infect Dis 2021; published online
March 18. https://doi.org/10.3201/eid2705.210514.
8 Johansson MA, Quandelacy TM, Kada S, et al. SARS-CoV-2 transmission from
people without COVID-19 symptoms. JAMA Netw Open 2021; 4: e2035057.
9 Chen W, Zhang N, Wei J, Yen H-L, Li Y. Short-range airborne route dominates
exposure of respiratory infection during close contact. Building Environ 2020;
176: 106859.
10 Bulfone TC, Malekinejad M, Rutherford GW, Razani N. Outdoor transmission
of SARS-CoV-2 and other respiratory viruses: a systematic review. J Infect Dis
2021; 223: 550–61.
Children in All Policies 2030: a new initiative to implement the
recommendations of the WHO–UNICEF–Lancet Commission
In February, 2020, we published the WHO–UNICEF–
Lancet Commission report A future for the world’s
children?1 The Commission called for a new global
movement to put the health and wellbeing of children
and adolescents at the centre of national and global
efforts to achieve sustainable development. Events
have reinforced our message, as children’s needs have
not been prioritised during the COVID-19 pandemic.
In many countries, children and adolescents have
missed out on months of education and social contact
with peers, gone hungry, missed immunisations, or
been exposed to violence or abuse, contributing to
adverse impacts on their mental health and wellbeing.2
Although the epidemiological evidence is still emerging,
negative effects on the sexual and reproductive health
and rights of adolescent girls are also a concern.3 During
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11 Klompas M, Baker MA, Rhee C, et al. A SARS-CoV-2 cluster in an acute care
hospital. Ann Intern Med 2021; published online Feb 9. https://doi.org/
10.7326/M20-567.
12 Van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface
stability of SARS-CoV-2 as compared with SARS-CoV-1. New Engl J Med 2020;
382: 1564–67.
13 Lednicky JA, Lauzard M, Fan ZH, et al. Viable SARS-CoV-2 in the air of a
hospital room with COVID-19 patients. Int J Infect Dis 2020; 100: 476–82.
14 Lednicky JA, Lauzardo M, Alam MM, et al. Isolation of SARS-CoV-2 from the air
in a car driven by a COVID patient with mild illness. medRxiv 2021; published
online Jan 15. https://doi.org/10.1101/2021.01.12.21249603 (preprint).
15 Fennelly KP. Particle sizes of infectious aerosols: implications for infection
control. Lancet Respir Med 2020; 8: 914–24.
16 Nissen K, Krambrich J, Akaberi D, et al. Long-distance airborne dispersal of
SARS-CoV-2 in COVID-19 wards. Sci Rep 2020; 10: 19589.
17 Kutter JS, de Meulder D, Bestebroer TM, et al. SARS-CoV and SARS-CoV-2 are
transmitted through the air between ferrets over more than one meter
distance. Nat Commun 2021; 12: 1–8.
18 Schijven J, Vermeulen LC, Swart A, Meijer A, Duizer E, de Roda Husman AM.
Quantitative microbial risk assessment for airborne transmission of
SARS-CoV-2 via breathing, speaking, singing, coughing, and sneezing.
Environ Health Perspect 2021; 129: 47002.
19 Sun K, Wang W, Gao L, et al. Transmission heterogeneities, kinetics, and
controllability of SARS-CoV-2. Science 2021; 371: eabe2424.
20 Laxminarayan R, Wahl B, Dudala SR, et al. Epidemiology and transmission
dynamics of COVID-19 in two Indian states. Science 2020; 370: 691–97.
21 Petersen E, Koopmans M, Go U, et al. Comparing SARS-CoV-2 with SARS-CoV
and influenza pandemics. Lancet Infect Dis 2020; 20: e238–44.
22 Guerra FM, Bolotin S, Lim G, et al. The basic reproduction number (R0) of
measles: a systematic review. Lancet Infect Dis 2017; 17: e420–28.
23 Endo A, Abbott S, Kucharski AJ, Funk S. Estimating the overdispersion in
COVID-19 transmission using outbreak sizes outside China.
Wellcome Open Res 2020; 5: 67.
24 Goldman E. Exaggerated risk of transmission of COVID-19 by fomites.
Lancet Infect Dis 2020; 20: 892–93.
25 Tang JW, Bahnfleth WP, Bluyssen PM, et al. Dismantling myths on the
airborne transmission of severe acute respiratory syndrome coronavirus
(SARS-CoV-2). J Hosp Infect 2021; 110: 89–96.
the pandemic’s first wave, only 2% of the fiscal stimulus
in high-income countries was allocated specifically to
support children.4 And despite lockdowns in countries
around the world, carbon dioxide emissions fell by
only about 6% in 2020 and have already rebounded,
revealing the lack of urgent, dedicated action on the
pixelfusion3d/Getty Images
climate crisis, which continues to jeopardise the future
of all children.5
Our Commission’s report sounded the alarm
about stalled progress on the health of children and
adolescents. The evidence is incontrovertible: successful Published Online
April 20, 2021
societies invest in their children and young people, https://doi.org/10.1016/
producing lifelong, intergenerational benefits for S0140-6736(21)00718-2
health, wellbeing, and the economy.1 We called on
governments to work across sectors to deliver children’s
entitlements, as specified by the UN Convention on the
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Rights of the Child, by leveraging high-level political
leadership and engaging communities, families, and
children themselves. We drew attention to emerging
threats to children, notably, the climate crisis and the
insidious commercial exploitation of children through
inappropriate marketing of products and services,
such as alcohol, tobacco, sugar-sweetened beverages,
breastmilk substitutes, and gambling apps, often by
exploiting children’s developmental vulner­abilities and
social media data.
Despite the lethargy of many political leaders, com­
munities understand the risks and want to take action:
a 2020 UN Development Programme survey found that
64% of 1·2 million people in 50 countries declared that
climate change was an emergency.6 Children and young
people are at the forefront of this movement, with
millions mobilised under the aegis of the School Strike
for Climate movement in at least 150 countries.
For CAP-2030 see https://cap- On April 21, 2021, we launched Children in All Policies
2030.org/
2030 (CAP-2030), with the support of our founding
partners WHO, UNICEF, and The Lancet. Our ambition
is to join our voices to those of children and young
people, activists, civil society institutions, religious
groups, UN organisations, politicians, governments,
private sector leaders, academics, and others working
to centre children’s health and wellbeing in the urgent
work of sustainable development. We encourage people
to join the movement to preserve children’s future and
contribute to CAP-2030 by getting in touch via our
website.
CAP-2030 has three objectives. First, we build
coalitions for children across sectors, beginning in
Argentina, France, Ghana, India, Nepal, Pacific Island
countries, Senegal, Sweden, and South Africa, with
further countries planned. Country leadership is key
and activities will vary given different country contexts,
ranging from intersectoral approaches to promote
children’s rights to health and wellbeing (Argentina),
joined up action by diverse stakeholders to promote
early childhood development (Ghana), and innovative
governance approaches for reform of alcohol policy
(South Africa) to working with children to mitigate
the climate crisis in high-income countries (France). A
learning agenda across countries will promote a shared
sense of mission and engage national political leaders.
Second, we seek to advance action on the global
climate crisis by centring children’s perspectives and
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harnessing their voices to drive action by national and
global policy makers. Specifically, we aim to amplify
the activism of children and young people, notably,
Indigenous youths and others at the forefront of the
environmental justice movement. We will also support
policy makers by providing evidence and data on the
impact of the climate emergency on children’s health—
eg, by using dynamic causal modelling to illustrate
the dire effects on future generations, and possible
solutions.
Our third objective is to address the problems
associated with commercial marketing and advance
understanding of this key area for improving children’s
health and wellbeing. We will strengthen a binding
international treaty, the UN Convention on the Rights
of the Child, to protect children from exploitative
marketing of harmful products and services. To do so,
we will seek leadership from countries that already
defend children using innovative legal instruments—
eg, Chile’s limit on marketing of unhealthy foods to
children younger than 14 years in schools and other
settings.
Scientists, citizens, and activists know what
must be done. Powerful forces, however, are allied
against foundational work towards democratisa­
tion, decolonisa­ tion, gender equality, and the fight
against corporate capture and wealth inequities.
Scientific evidence is not enough: knowledge must be
transformed into strategic political and social action.
We propose a model based on science, advocacy, and
coalition building, taking inspiration from approaches
such as the “triangle that moves the mountain”,
which advocates in Thailand have used to drive far-
reaching health reforms.7 Our empirically grounded
recommendations about what enables children to be
healthy and well will be disseminated using impactful
communication strategies, to ensure our messages
reach key decision makers and communities. Critically,
we will build coalitions of champions in the political
sphere and civil society, linked with the voices of children
and young people.
We will learn from the evidence on what makes
transnational advocacy networks effective,8 engage
with young people as advocates,9 select global policy
forums that will catalyse positive outcomes,10 and
leverage non-governmental organisations and advocates
across countries.11 Crucially, we must avoid reinforcing
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existing power imbalances, such as those between low-
income countries and high-income countries.12 National
coalitions will drive our work, not only in terms of
executing strategy but also in agenda setting and decision
making.13 Additionally, as our movement grows, we will
work with community collectives to harness people’s
problem-solving skills over the challenges that affect
them.14
We have long-term, ambitious goals. But our call to
action—to put children in all policies to build a healthier
and more equitable world for future generations—
rests on unassailable science and powerful emotional
logic. Together with the global health community,
governments, communities, and young people them­
selves, we can usher in this brighter future.
We declare no competing interests. The CAP-2030 initiative is supported by the
Children’s Investment Fund Foundation. Feedback on our theory of change was
provided by members of the Health Policy Analysis Working group at the
Johns Hopkins School of Public Health.
*Sarah L Dalglish, Anthony Costello, Helen Clark, Awa Coll-Seck
s.dalglish@ucl.ac.uk
University College London, London WC1H 9BT, UK (SLD, AC); The Helen Clark
Foundation, Auckland, New Zealand (HC); Partnership for Maternal, Newborn &
Child Health, Geneva, Switzerland (HC); Senegal Presidency, Dakar, Senegal (AC-S)
1 Clark H, Coll-Seck AM, Banerjee A, et al. A future for the world’s children?
A WHO–UNICEF–Lancet Commission. Lancet 2020; 395: 605–58.
2 Clark H, Coll-Seck AM, Banerjee A, et al. After COVID-19, a future for the
world’s children? Lancet 2020; 396: 298–300.
UK Public Health Science 2021: a call for abstracts
We invite abstract submissions for Public Health Science:
A National Conference Dedicated to New Research in UK
Public Health, which is to be held as a virtual conference
on Nov 26, 2021. This annual conference aims to
showcase the diversity, quality, and impact of public
health research in the UK and Ireland. The conference
provides a platform for researchers, practitioners, and
policy makers, including those early in their careers,
to discuss important public health issues and the
implications of the latest public health perspectives and
science for public health practice, policy, health services,
and research.
One of the greatest challenges of our time is the
climate crisis and its impacts on environments,
livelihoods, health, and wellbeing.1 Climate change
has been called the biggest threat to global health
in the 21st century and especially affects the most
vulnerable populations in society. The COVID-19
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Comment
3 Eaton L. School closures and teenage pregnancy. Bull World Health Organ
2021; 99: 6–7.
4 Richardson D, Carraro A, Cebotari V, Gromada A. Supporting families and
children beyond COVID-19: social protection in high-income countries.
Florence, Italy: UNICEF Office of Research-Innocenti, 2020.
5 International Energy Agency. After steep drop in early 2020, global
carbon dioxide emissions have rebounded strongly. March 2, 2021.
https://www.iea.org/news/after-steep-drop-in-early-2020-global-
carbon-dioxide-emissions-have-rebounded-strongly (accessed
March 26, 2021).
6 UN Development Programme, University of Oxford. People’s climate vote:
results. 2021. https://www.undp.org/content/undp/en/home/librarypage/
climate-and-disaster-resilience-/The-Peoples-Climate-Vote-Results.html
(accessed March 26, 2021).
7 Wasi P. “Triangle that moves the mountain” and health systems reform
movement in Thailand. Human Res Health Develop J 2000; 4: 106–10.
8 Shiffman J. Networks and global health governance: introductory editorial
for health policy and planning supplement on the emergence and
effectiveness of global health networks. Health Policy Plan 2016;
31 (suppl 1): i1–2.
9 Shiffman J, Quissell K, Schmitz HP, et al. A framework on the emergence and
effectiveness of global health networks. Health Policy Plan 2016;
31 (suppl 1): i3–16.
10 Deitelhoff N, Wallbott L. Beyond soft balancing: small states and coalition-
building in the ICC and climate negotiations. Cambridge Rev Int Aff 2012;
25: 345–66.
11 Keck ME, Sikkink K. Activists beyond borders: advocacy networks in
international politics. Ithaca, NY: Cornell University Press, 1998.
12 Daphi P, Anderl F, Deitelhoff N. Bridges or divides? Conflicts and synergies
of coalition building across countries and sectors in the global justice
movement. Soc Mov Stud 2019; published online Oct 25. https://doi.org/
10.1080/14742837.2019.1676223.
13 Crutchfield LR. How change happens: why some social movements succeed
while others don’t. Hoboken, NJ: Wiley, 2018.
14 Gram L, Desai S, Prost A. Classroom, club or collective? Three types of
community-based group intervention and why they matter for health.
BMJ Global Health 2020; 5: e003302.
pandemic, and the social and health inequalities that Published Online
April 21, 2021
it has laid bare, highlights converging climate and https://doi.org/10.1016/
health crises. S0140-6736(21)00942-9
Although submissions can be related to any area of
public health, for this year’s conference we welcome
interdisciplinary submissions from researchers, charities,
local authorities, National Health Service workers, and
policy makers at the intersection between environment,
sustainability, and public health, including the COVID-19
pandemic.
The conference will consist of oral paper presenta­
tions, chaired poster sessions, and keynote speeches.
Submissions are now open for oral and poster
presentations. Abstracts can be submitted under any
of the three core themes: creativity in public health
science; new methodological approaches to public
health science; or impact and implementation of public
health science in policy and practice. Research described
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