Prevent
There is no more effective way to reduce pneumonia deaths than to prevent infection in the first place. To do this, countries will need to improve coverage of the powerful basket of “pneumonia-fighting” vaccines that can prevent many causes of pneumonia infection. This basket includes the pertussis and Hib components of the pentavalent vaccine – which also targets diphtheria, tetanus, and Hepatitis B – the measles vaccine, the pneumococcal conjugate vaccine (PCV), as well as seasonal vaccines for influenza and COVID-19.
In addition, countries will need to tackle the major risk factors for pneumonia death among both children and adults. For children, malnutrition (especially wasting), air pollution (especially household), and low birth weight are the major risks for pneumonia death. For adults, air pollution, smoking, and lack of hand washing with soap pose the major risks.
When countries combine vaccine protection with reductions in these risks, they can experience dramatic reductions in pneumonia deaths across all ages. However, currently most countries and global health agencies are focused on vaccination alone, without integrating the delivery of vaccines with efforts to improve childhood nutrition, air quality, smoking cessation, and hygiene, especially in the home.
Pneumonia-fighting vaccines
There are highly effective vaccines to prevent pneumonia. These include the pneumococcal conjugate vaccine (PCV) and the haemophilus influenzae type B vaccine (Hib), which target the leading bacterial causes of childhood pneumonia, as well as vaccines against diphtheria, tetanus, and pertussis (DTP), measles (MCV), flu, and COVID-19. The expansion of this “basket” of pneumonia- fighting vaccines has contributed to a 57% decline in childhood pneumonia deaths since 2000, from an estimated 1.6 million to 672,000. But despite recent progress, there are still massive gaps in the coverage of these vaccines – particularly PCV. Four out of every 10 children under five globally are still not fully protected and more than half of child pneumonia deaths are in countries with low pneumonia vaccine coverage – most notably, Nigeria and India. 52 still countries do not offer the PCV, including some with the heaviest burdens of child pneumonia deaths – China, Somalia, Chad, Guinea, Egypt, and South Sudan. Critically new vaccines are becoming available that target a leading cause of viral pneumonia – respiratory syncytial virus or RSV – and a vaccine to prevent a leading bacterial cause of pneumonia – klebsiella pneumoniae – is in development.
Read more in the Every Breath Counts PCV Coverage Scorecard.
Air pollution
Almost a third of all pneumonia deaths – 750,000 – are attributable to polluted air each year. Household air pollution contributes to 420,000 of these deaths while outdoor air pollution contributes to 330,000. While outdoor air pollution, especially from pollutants emitted by industries and car exhaust smoke, disproportionately affects older adults, children are more susceptible to household air pollution in homes that regularly use polluting fuels and technologies for cooking, heating, and lighting. Of great concern, 90% of air pollution-related deaths are concentrated in 40 low- and middle-income countries, and in many African countries, air pollution contributes to more than 50% of all pneumonia deaths. And while pneumonia deaths from household air pollution are declining in Africa, they are tragically rising due to outdoor air pollution. This is also the case for Asia.
Read more in the Every Breath Counts Air Pollution and Pneumonia Scorecard.
Child wasting
Wasting is the leading risk factor for child pneumonia deaths, contributing to more than half of all deaths in 2019. A child is wasted when they have extremely low weight-for-height, indicating recent and severe weight loss, although it can also persist for a long time. Wasting usually occurs when a child has not had food of adequate quality and quantity and/or they have had frequent or prolonged illnesses. Wasting-related child pneumonia deaths are concentrated among children aged one month to one year. Evidence suggests wasting often begins much earlier in the womb and that children who are born with low birth weight are more likely to become wasted. More than 70% of the estimated 47 million wasted children live in high-burden pneumonia countries. India alone is home to 20 million wasted children. In 14 Sub-Saharan African countries more than 60% of child pneumonia deaths are attributable to wasting. Wasting is a much greater risk factor for child pneumonia death than stunting and being underweight.
Read more in the Every Breath Counts Wasting and Pneumonia Scorecard.