Nov 11, 2017 Volume 390 Number 10108 p2121-2214
The case for action on childhood pneumonia
Pneumonia kills almost 1 million children each year, and more than 80% of these deaths are children under 2 years of age. While not solely a disease of developing countries—it is the leading cause of child hospitalisation in the USA—it disproportionately affects children living with poverty or malnourishment who are the most vulnerable to infection. A key defence is immunisation, but over 25 million children under 2 years were not immunised with the pneumococcal conjugate vaccine in 2016. Available vaccines are produced by just two manufacturers and priced out of the reach of many countries, even with assistance from Gavi, which has immunised 109 million children against pneumococcal disease as of last year.
The core of the problem is neglect. Save the Children, in a report released on Nov 2, makes the case that pneumonia is a forgotten killer, and they are right. Despite collective support for Gavi, and WHO and UNICEF’s global plan of action for pneumonia and diarrhoea, no international initiative or campaign has yet spurred attention to the extent required. Pneumonia, despite being the leading cause of death among children, has never appeared on the agendas of the G8 or G20. As a result, the Sustainable Development Goal to eliminate preventable child deaths by 2030 will remain just an aspiration unless childhood pneumonia is vigorously addressed: the report estimates there will be 735 000 children dying from the disease in 2030 if action is not accelerated.
Save the Children’s new global campaign has the backing of former UN Secretary General Kofi Annan, who calls for pharmaceutical companies, donors, and UN agencies to come together and negotiate affordable vaccination. But vaccines are not enough, as the report concedes. Tackling pneumonia is achievable only with strong, efficient, and equitable health systems. This means action to support proper diagnosis and treatment of suspected cases, and to deliver vaccines via skilled health workers, cold storage chains, and well-governed procurement and delivery infrastructure. The case for saving children’s lives from pneumonia is clear—it will be realised only by strenghtening health systems.