Transgression of planetary boundaries and the effects on child health through an infectious diseases lens

Purpose of reviewLife on earth, as we know it, is changing. The likelihood of more frequent pandemics and disease outbreaks is something that current global healthcare infrastructure is ill equipped to navigate. Human activity is forcing our planet into a new geologic epoch, the Anthropocene, which is typified by increased uncertainty resulting from human disruption of earth's life-giving ecosystems. Plagues and pandemics have always been unfortunate partners to periods of disruption, as they will be again if the frequency and severity of climate and conflict-mediated disasters increase in coming years. If we continue to exceed and degrade the planetary boundaries that protect human health, our children and their children will reap the consequences.Recent findingsScientists have defined nine 'safe operating' planetary boundaries for life in all its glorious diversity to thrive on planet earth. Recent evidence suggests that six of these nine boundaries have already been transgressed, but the potential implications for these transgressions upon child health is not well articulated. We highlight how contravention of these boundaries will impact infectious disease risk and humans' ability to survive and thrive. We reflect specifically on how paediatricians are called upon to speak up for the most vulnerable members of our species, young children and as yet unborn future generations.SummaryPost COVID-19 initiatives to improve pandemic preparedness and response are certainly warranted, but pandemic prevention should include committed efforts not to exceed safe planetary boundaries. Willingly exceeding these boundaries has deep moral consequences that are poorly articulated by current ethical frameworks. Paediatricians are best placed to develop and champion the neglected 'third dimension' of medical ethics, recognizing the moral imperative to protect the long-term best interests of children and future generations.