21 May What do the new Global Burden of Disease estimates tell us about childhood pneumonia?
New estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) show that the number of children dying from pneumonia increased sharply from 502,000 in 2021 to 610,000 in 2023. This 20% increase was expected following the lifting of COVID-19 restrictions that reduced the spread of all pneumonia-causing infections.
Getting back on track with child pneumonia mortality reductions will require a razor focus on increasing coverage of existing pneumonia-fighting vaccines (i.e., Respiratory syncytial virus or RSV, pneumococcal conjugate vaccine or PCV, Haemophilus influenzae type b or Hib, measles, and pertussis), accelerating development of new vaccines (i.e., Group B Streptococcus, and Klebsiella pneumoniae), and improving diagnosis and treatment of the major, non-vaccine preventable causes of childhood pneumonia death (i.e., Staphylococcus aureus).
Simultaneous efforts to reduce the major risk factors for childhood pneumonia – malnutrition, household air pollution, and lack of access to handwashing with soap – will increase a country’s chances of success nat achieving the global child pneumonia target of three pneumonia deaths for every 1,000 births. Action on child pneumonia will also supercharge a country’s efforts to achieve the child survival Sustainable Development Goal (SDG) by 2030, as pneumonia remains the leading infectious killer of children in almost all countries struggling with heavy burdens of under-five deaths.
Childhood pneumonia cases have declined significantly
In 2023, there were 50 million new cases of childhood pneumonia, 40% fewer than in 2010. Although all regions experienced significant declines, sub-Saharan Africa experienced a much lower decline over the period – 30%. As this is the region where child pneumonia deaths now concentrate, controlling the spread of pneumonia infections among children across the continent should be a special focus over the next five years.
Pneumonia remains the greatest threat to child survival
In 2023, an estimated 610,000 children under five died from pneumonia, with 30% of deaths among 0-1 month olds and 70% among 1-59 month olds. Pneumonia remains the leading infectious cause of death for under-fives, followed by malaria (409,000) and diarrhea (317,000). More than half (52%) of all deaths occurred in sub-Saharan Africa, followed by 32% in South Asia. Although all regions experienced significant (37-57%) declines in deaths between 2010 and 2023, sub-Saharan Africa experienced a much lower decline (22%).
Ten pathogens cause 80% of child pneumonia deaths
Ten pathogens were responsible for 80% of child pneumonia deaths in 2023, including Streptococcus pneumoniae (32%), Klebsiella pneumoniae (12%), P aeruginosa (8%), Staphylococcus aureus (5%), Respiratory syncytial virus (4%), and Influenza (4%). Three of these are currently vaccine-preventable with PCV, RSV, and influenza vaccines, while vaccine for Klebsiella pneumoniae is in development.
However, PCV coverage remains relatively low at 67%, influenza vaccine coverage is not routinely measured, and RSV vaccines for pregnant women and new long-acting monoclonal antibodies (mAb) injections for infants have only just been approved in Europe and the USA and are currently too costly for use in most lower income countries. Now that Gavi, the Vaccine Alliance has announced it will support eligible countries who want to introduce the RSV maternal vaccine, countries with high burdens of RSV need to step up, introduce the vaccine, and measure the impact on pneumonia hospitalization and mortality.
Critically, Staphylococcus aureus is not vaccine-preventable and has higher rates of poor clinical outcomes, including sepsis and death, compared to Streptococcus pneumoniae – and the ability to develop resistance to multiple antibiotics. While child deaths from Streptococcus pneumoniae fell by more than 54% between 2010 and 2023, deaths from Staphylococcus aureus fell by just 1%.
It is still possible to end child pneumonia deaths
What does the new GBD tell us about how to achieve the end goal – the near elimination of child pneumonia deaths in every country by 2030? First it gives cause for optimism. Prevention works. If the spread of the major pathogens causing pneumonia could be so significantly reduced by infection control measures during COVID, a continued focus on prevention will work.
A key priority for pneumonia control in the next five years must be to achieve full coverage (>90%) of the PCV vaccine, especially in every country in Sub-Saharan Africa and South Asia. A second priority is to accelerate introduction of affordable RSV vaccines in the same regions so that the highest burden child pneumonia countries are protecting all children against RSV and pneumococcal disease in the first year of life. A third priority on seasonal childhood influenza vaccine coverage is also warranted, elevating it to the status of other routine vaccines including measles and Diphtheria, Tetanus, and Pertussis (DTP) and regularly reporting national, regional, and global coverage rates. And fourth, acceleration of effective and affordable Klebsiella pneumoniae vaccines.
Vaccines alone cannot end childhood pneumonia, so improvements in diagnosis and treatment with antibiotics, medical oxygen, and respiratory therapies have a strong role to play. This is especially so for leading bacterial killers like Staphylococcus aureus, which is not vaccine-preventable and increasingly resistant to antibiotics. A fifth priority is to develop new, low-cost, less-resistant antibiotics and ensure universal access to pulse oximetry and medical oxygen for children with hypoxemia, as recommended by the Lancet Global Health Commission on Medical Oxygen Security.
And finally, of all underlying conditions, childhood malnutrition was a factor in a massive 60% of child pneumonia deaths in 2023, according to the GBD. There needs to be integration of malnutrition prevention, diagnosis, and treatment interventions in all aspects of pneumonia control – in the home, at the point of vaccination, and when sick children are brought to health facilities and admitted to, and discharged from, hospitals. In reality, this won’t happen unless Ministries of Health institutionalize it and global health donors demand it of Gavi, the Vaccine Alliance.
Implementing the agenda just outlined in the 30 countries* that are home to 90% of child pneumonia deaths is our best collective bet of ending child pneumonia deaths by 2030. This is in line with the call for a new Child Survival Action agenda that brings the most cost-effective interventions to fight the leading causes of death among children at greatest risk of death.
We call on Ministries of Health in the 30 highest burden child pneumonia countries to join forces with global health agencies, including the World Health Organization, UNICEF, USAID, The Global Fund, Gavi, The Global Financing Facility, and their donors to achieve a child survival milestone that has always eluded humanity – the end of childhood pneumonia deaths.
*Nigeria, India, Pakistan, Chad, Ethiopia, Niger, Somalia, Burkina Faso, Democratic Republic of Congo, Indonesia, Tanzania, Madagascar, Bangladesh, South Sudan, China, Cameroon, Côte d’Ivoire, Myanmar, Mali, Egypt, Philippines, Afghanistan, Guinea, Uganda, Angola, Mozambique, Zimbabwe, Kenya, South Africa, and Malawi.
World Pneumonia Day, 12 November 2025