Pneumonia Report Card shows prevention, treatment tools not widely adopted in countries where disease kills most children

Nov 14 2010

In advance of World Pneumonia Day, the International Vaccine Access Center (IVAC) on Thursday released a report card (.pdf) showing that pneumonia prevention and intervention targets are not being met in the 15 countries where three-quarters of deaths in children under age 5 from the disease occur each year, IRIN reports. "Pneumonia kills more children under five every year - 1.6 million - than measles, HIV/AIDS and malaria combined, according to the World Health Organization (WHO)," the news service writes (11/11).

The Pneumonia Report Card evaluates how well Afghanistan, Angola, Bangladesh, Burkina Faso, China, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Kenya, Niger, Nigeria, Pakistan, Tanzania and Uganda stack up against "the Global Action Plan for the Prevention and Control of Pneumonia (GAPP), issued by WHO and UNICEF in 2009," according to an IVAC press release.

Each country is given a score based on its implementation of seven key GAPP interventions, the press release explains. These include: prevention measures, such as the "use of measles, pertussis, pneumococcal and Hib vaccines, respectively; protection measures, including rates of exclusive breastfeeding in the first six months of life; and treatment, namely the rates of children with suspected pneumonia being taken to a health facility and of children with pneumonia receiving treatment with antibiotics."

Country scores for intervention coverage ranged between 23 percent and 61 percent - significantly below the GAPP's recommendation of 90 percent in order to reach Millennium Development Goal child survival targets (11/11). In terms of the total score, Afghanistan scored highest (61 percent), while Nigeria received the lowest score (23 percent), IRIN notes (11/11). "Importantly, not all countries had current coverage level estimates for all of the GAPP interventions, highlighting the importance of improving systems for collection of indicator information," according to the report. 

The report also notes: "Many of the top 15 countries are expected to introduce new pneumonia vaccines, have planned for the expansion of community-based case management and have ambitious plans for strengthening health systems. Assuring that these plans are implemented will require funding and continued public attention to pneumonia, which will help contribute to a substantial decline in childhood pneumonia deaths" (11/12). 

"We have safe, effective, proven interventions that can decrease under-five deaths by two-thirds, but they are simply not reaching the children who need them the most," said Orin Levine, IVAC's executive director, IRIN writes. "The beauty of pneumonia is that interventions are at hand. The action that it will take to get things moving are often the basics of public health - supply of drugs and vaccines and people to deliver them. It's not rocket science holding us back from saving millions of children," he added (11/11).

One of the challenges is broadening access to newer vaccines that protect against the leading cause of pneumonia - pneumococcal disease, VOA News writes. "So far, only two developing countries, Rwanda and Gambia, have been able to introduce pneumococcal vaccine as part of their routine immunization program," said Global Alliance for Vaccines and Immunisation (GAVI) Alliance CEO Helen Evans. "In the case of Rwanda, although it is only 12 months on, a bit more than 12 months on since it was introduced; the country now has a coverage rate for pneumococcal vaccine of around 90 percent, which is very impressive, particularly considering how much of Rwanda is rural and remote," she said.

"Evans says the GAVI Alliance, with its partners, plans to introduce pneumococcal vaccines in more than 40 countries by 2015. But she warns this goal will not be reached without significant new funding," the news service writes (Schlein, 11/12).

Panel Examines Global Pneumonia

Also to mark World Pneumonia Day, the Global Coalition Against Child Pneumonia organized a panel discussion on Friday in Washington, D.C. The panel featured: Ezekiel Emanuel, special advisor on health to President Barack Obama; Orin Levine, IVAC executive director; Shannon Duffy Peterson, an advocate with Parents of Kids with Infectious Diseases; and Salim Sadruddin, a child health and nutrition advisor for Save the Children. Cokie Roberts, a senior news analyst for NPR, moderated the discussion.  

Emanuel called pneumonia the "biggest solvable problem in global health," noting that current prevention and treatment tools are effective and relatively cheap. "For the cost of a Starbuck's latte, you can buy a dose of lifesaving vaccine," he said.

Emanuel said the Obama administration's Global Health Initiative (GHI) is focused on "integrating services" within health systems, at the policy level and with international partners. More integration, Emanuel explained, could lead to fewer pneumonia deaths in the developing world because health systems will be better equipped to deal with a range of health problems. For example, if a child presents with a fever, health workers need to be able to determine whether the child needs treatment for malaria or pneumonia, he said.

Emanuel said PEPFAR has shown that complex care can be delivered in rural areas and said the Obama administration seeks to build on those lessons and focus on integration. "Using all this information together is what the GHI is about," he said.

The struggle with the pneumonia vaccine has been that the "children who need it most have not been the ones receiving it," Levine said. But that's improving because better funding levels from the GAVI Alliance and other sources, have allowed the vaccine to "ship to St. Louis and Sierra Leone in the same year," he added.

Sadruddin focused on the role health workers in developing countries can play in reducing child mortality form pneumonia. Education for mothers is also important since they are usually the ones who decide when to get treatment for sick children, he said.

Peterson recounted the experience of losing her daughter to pneumonia just before her sixth birthday. She urged education about the vaccine, noting that her daughter was not vaccinated.

Levine also discussed various issues about pneumonia advocacy. "A lot of what's been missing is an organized movement," he said. But this year it's "really taking off," he said, noting the variety of awareness events from Kampala, Uganda, to Washington, D.C., to mark the day (Schiff, 11/12).

The following news outlets published stories looking at pneumonia in their countries.

The Daily Nation reports on the expect the launch of the PCV-10 pneumococcal vaccine in Kenya next year. PCV-10 "was licensed in 2000, has since been widely available in the West and in South Africa," according to the article. Kenyan researchers are also studying "whether vaccinating children offers additional protection to other members of the household" (Mwangi, 11/11).

The Times of India examines why pneumonia is a major killer of children in India. "Malnutrition, poverty, poor access to and inadequate healthcare services are responsible for the high death rate in children due to pneumonia. ... Another reason for fewer children with pneumonia receiving antibiotics is the selection of the drug by doctors," the Times of India writes (11/12).

A GAVI Alliance press release notes the World Pneumonia Day activities around the world (11/11).