12 Nov Calls to Action on World Pneumonia Day
Article posted on November 12, 2016
Interventions to lower child death toll from pneumonia and diarrhea need advocacy and political will, experts say
- From 1980-2015, global deaths among kids under-5 from pneumonia dropped by 80% and those from diarrhea by 90%
- Yet pneumonia and diarrhea continue to be leading infectious killers of children under the age of 5 worldwide
- Innovations in disease management may accelerate the pace of progress
By Salma Warshanna-Sparklin, International Vaccine Access Center
An ultrasound machine used to take images of a child’s lungs. A noninvasive device that accurately measures a child’s blood oxygen levels. These are among new tools that can be used to combat pneumonia—the leading infectious killer of children under-5 worldwide—that experts explored during the event, World Pneumonia Day: Keeping Child Health on the Global Agenda.
The event, held at the Johns Hopkins Bloomberg School of Public Health (JHSPH), featured results from the 2016 Pneumonia and Diarrhea Progress Report: Reaching Goals Through Action and Innovation, produced by the International Vaccine Access Center (IVAC). The annual Progress Report evaluates the progress in implementing high-impact interventions among the 15 countries with the greatest number of under-5 pneumonia and diarrhea deaths.
Global Progress and Gaps
“It’s just remarkable what’s happened in the last 35 years,” said Mathuram Santosham, MD, MPH, described as a hero and international expert in oral rehydration therapy, childhood vaccines, and the dissemination of pediatrics interventions around the world. Between 1980 and 2015, global deaths among children under-5 from pneumonia plummeted by 80% and those from diarrhea by 90%, Santosham explained.
He credited this significant headway to oral rehydration salts, Haemophilus influenzae type b vaccines, pneumococcal conjugate vaccines (PCV), and rotavirus vaccines. These interventions are outlined in the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD), which also includes clean air and water, adequate nutrition and supplements, and antibiotics.
“We know how to protect, prevent, and treat pneumonia and diarrhea,” said Santosham, senior advisor at IVAC. “There is no reason why a child should die from diarrhea or community acquired pneumonia at this day and age.”
As it stands, however, pneumonia and diarrhea continue to be leading infectious killers of children under the age of 5 worldwide, accounting for about 1.5 million deaths in this population each year.
“People of any age, in any country, are at risk, but the vast majority of all childhood deaths occur in poor countries,” said Santosham, who shed light on the longstanding issue of inequity. In fact, 72% of the global burden of pneumonia and diarrhea child deaths occur in only 15 countries, even though they are home to only 55% of the world’s under-5 population.
Drawing from the Progress Report’s analysis, Santosham explained the stagnation in child mortality. For example, only six of the highest-burden countries (Angola, Ethiopia, India, Niger, Sudan and Tanzania) have introduced rotavirus vaccines in their routine immunization program. In addition, five of the highest pneumonia burden countries (India, Indonesia, Chad, China and Somalia) are still not using PCV in their routine immunization programs.
Experts identified innovations in pneumonia disease management that may accelerate the pace of progress. One idea is using lung ultrasound imaging, rather than chest x-rays, to improve pneumonia diagnosis in resource-poor settings.
William Checkley, MD, PhD, associate professor at the Johns Hopkins University School of Medicine, explained the benefits, including how it may help catch cases that are missed when using WHO’s guidelines for classifying pneumonia. Ultrasound devices are portable, battery-operated, and could be made widely available. They can be used in under 10 minutes without disrupting workflow. The biggest advantage: “There is no radiation, which means it can be used repeatedly,” said Checkley.
The audience also heard from Eric McCollum, MD, associate professor at the Johns Hopkins University School of Medicine, who explained how hypoxemia—low oxygen concentration in the blood—can be a fatal complication of pneumonia. Using pulse oximeters is an accurate way to detect it in time to provide oxygen therapy. This device is non-invasive, with a probe placed on a child’s finger or toe.
“Pulse oximetry can be used to identify children with the greatest pneumonia mortality risk and potentially improve retention on the care pathway to reduce mortality, if linked to treatment,” explained McCollum. Challenges remain, however, including how machines used to deliver oxygen need power, which is often spotty in low-resource countries. Plus, pulse oximeter devices with probe sizes appropriate for children are currently too expensive.
The experts explored the issue of cost of new innovations during a panel discussion, moderated by Joshua Sharfstein, MD, Associate Dean of Public Health Practice and Training at JHSPH.
“Cost is obviously important,” Santosham said. “But we’ve learned from the vaccine experience; once you’ve reached up to scale globally, we can bring those costs down dramatically.”
It takes more than science, he added, to reach all children everywhere.
“We need political will, accountability, and community engagement and mobilization to implement these powerful interventions,” Santosham emphasized. “We call on all countries to protect their children’s health and well-being through action and innovation to accelerate progress in combatting pneumonia and diarrhea.”