Introduction

CHAPTER 1

South Asia’s human capital challenges are among the most serious in the world. They include high levels of child malnutrition, deep deficits in early learning, an ongoing infectious disease burden, the disempowerment of women, and pervasive structural inequalities. With the onset of the COVID-19 pandemic, recent gains in human capital outcomes began to be reversed, with catastrophic consequences for the most vulnerable in the population. Environmental degradation and climate change pose even more devastating risks through their pervasive effects on health and their potential for mass displacement.

COVID-19 has significantly worsened the human capital outlook across South Asia.1 Historical precedents, expert opinion, and the experience of countries in other regions affected by this pandemic suggest that further outbreaks of the disease are likely to continue in South Asia in new waves, with viral mutations from different parts of the world and the relatively slow global vaccine rollout adding to uncertainties about the pandemic's severity and duration.

By the end of August 2020, within a few months of the start of the first wave of the pandemic, the region had reported 4.4 million infections and 75,000 deaths (officially).2 Highlighting the scale of direct and indirect impacts, preventive and curative health services were diverted to fight COVID-19, leading to poorer health outcomes for the most vulnerable. Almost 40 million children in Pakistan reportedly missed their polio vaccine drops after cancellation of the nationwide campaign in April 2020. Under-five mortality rates in all countries are likely to rise for the first time in decades. And across the region, deaths from tuberculosis, already one of the main causes of mortality, are