Five years ago governments made an important promise to the world’s children. Enshrined in the Sustainable Development Goals (SDGs), the world’s ambitious but achievable targets for 2030 embraced by 193 countries, is a pledge to end the scourge of preventable child deaths. Redeeming the pledge will take a concerted drive to combat pneumonia, the deadliest child killer.
Most people think of pneumonia as a disease affecting the elderly. They are partially right. Pneumonia is the single biggest cause of death among seniors admitted to hospital in the US. Fatalities among children in rich countries are thankfully rare. But in developing countries pneumonia is now the single biggest infectious killer of children, claiming more than 800,00 lives – a death every 40 seconds.
No statistics can capture their suffering of the victims, the anxiety of their parents, or the distress of those providing care.
We have both witnessed the trauma that accompanies pneumonia. Caused by either bacterial or viral infection that fills the lungs with fluid, pneumonia leaves its child victims – quite literally – fighting for breath. As a nurse in Kenya told us: “It breaks your heart to have a two-year-old looking into your eyes while they are gasping for air. It feels like they are saying, ‘Fight for me, please fight for me’.”
We are not fighting hard enough. Today, pneumonia accounts for 15 per cent of all child deaths – more than malaria and diarrhoea combined. Yet progress in reducing fatalities has been significantly slower than for other major killers. This is despite the fact most cases of pneumonia can be prevented through vaccines or treated with anti-biotics costing less than 50 cents. More severe cases can be treated with higher-level anti-biotics and basic oxygen treatment.
So what is going wrong? And what can be done to cut the pneumonia death toll? These are the questions at the heart of the Global Forum on Childhood Pneumonia that our organisations are convening in Barcelona this week along with aid donors, philanthropists, researchers, and pharmaceutical companies. Health ministers and other government representatives from countries accounting for more than three quarters (77 per cent) of pneumonia deaths will be participating. Our aim: to make the 2020s a breakthrough decade on pneumonia.
The starting point must be a greatly strengthened commitment to equity in health planning. Throughout history childhood pneumonia has been known as a ‘disease of the poor’. Aided and abetted by poverty, malnutrition, unsafe water and indoor air pollution, it preys on the most vulnerable children.
Unfortunately, it is precisely children facing the greatest risks who have the least access to quality care. Poorer children with symptoms of pneumonia are less likely to be taken to a health clinic, often because their mothers are unable to afford the fees, or simply because there is no clinic. Being in the poorest 20 per cent of households almost doubles the risk of being left untreated compared to the wealthiest children. Gender discrimination is another barrier: girls in South Asia are less likely to be treated for pneumonia than boys.
These disparities in health provision are unjust and indefensible.
So is the poor quality of care received by too many children. Early and accurate diagnosis of pneumonia is critical for effective treatment. Yet far too often we have heard mothers recount stories of misdiagnosis or delayed treatment, placing their children in mortal danger. At the heart of this problem is a lack of training and support for health workers, allied to an absence of vital diagnostic technologies.
Nowhere is the technology gap more apparent than in the provision of oxygen. The combination of medical oxygen and timely diagnosis of hypoxia, the oxygen deficit that often accompanies severe pneumonia, can dramatically cut death rates. Yet oxygen is seldom available in the poorest countries beyond urban hospitals and private providers. Pulse oximeters, effective and inexpensive diagnostic devices for measuring blood oxygen levels, are similarly unavailable to those who need them most.
The Barcelona Forum can play a role in driving the national and international action needed to save lives. Progress in cutting deaths from diseases like malaria, measles and diarrhoea demonstrates the power of partnerships that link governments, philanthropists, aid donors and civil society organisations to a shared purpose. We need to unleash that power for the children now at risk of pneumonia.
An early opportunity will come next month as donors meet in the UK to agree financing for Gavi, the global vaccines initiative, for the period to the mid-2020s. Immunisation is one of the most cost-effective routes for saving young lives. Yet over 70 million children are not immunised against pneumonia, many of them in areas affected by conflict and humanitarian emergencies. We urge aid donors to scale up their investment and turn the spotlight firmly on the children left behind.
One thing the world does not need is another narrow disease-specific initiative. Pneumonia does not operate in isolation. It often comes with severe malnutrition, diarrhoea and malaria. Diseases like measles, meningitis and sepsis are often the precursor or the product of pneumonia. While every government with high child mortality must embed pneumonia action plans in their health strategy, the only lasting cure is universal health coverage, underpinned by public investment and a motivated health work force.
New research underscores this point. We asked researchers from the Johns Hopkins medical school to estimate the benefits of a wide range of critical interventions – immunisation, anti-biotic provision, breast-feeding and nutrition – for cutting pneumonia deaths, most of them concentrated at the community level. The results show that around 3.2 million pneumonia deaths could be averted, with a ‘ripple effect’ saving a further 5.7 million lives from diarrhoea, sepsis, and other causes of child deaths.
Put another way, success in the battle against pneumonia would bring us within touching distance of the promise to end preventable child deaths. In these politically polarised times, it’s easy to lose sight of the values that bind us as a human community. Is there any value more sacred than saving young lives? We must surely act on a principle every child understands: you don’t break a promise.