Prevent

We know how to prevent most pneumonia deaths

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 child growth failure), 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 65% decline in childhood pneumonia deaths from an estimated 1.4 million in 2000 to 502,000 in 2021. But despite recent progress, there are still massive gaps in coverage of these vaccines – particularly for PCV. More than one in three children under five globally are still not fully protected and more than half of child pneumonia deaths are in countries with no and low pneumonia vaccine coverage. And 28 countries do not even 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.

Air pollution

Air pollution is the leading risk factor for death from pneumonia across all ages, according to the Global Burden of Disease. In 2021, almost one third of all pneumonia deaths – 651,200 – were attributable to polluted air. Household air pollution was a factor in more deaths – 360,600 – while outdoor air pollution contributed to 290,600 deaths. 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, 70% of air pollution-related deaths are concentrated in just 20 countries – ten in Africa, nine in Asia, and one in Latin America. In many of these countries, air pollution contributes to more than 50% of all pneumonia deaths. And while globally pneumonia deaths from household air pollution have declined since 2010 (-38%), they are tragically rising due to outdoor air pollution (6%). This trend is more pronounced in Asia where household air pollution-related pneumonia deaths have declined by 46% and outdoor-related deaths have increased by 26%.

Child malnutrition

Malnutrition is the leading risk factor for child pneumonia deaths, contributing to more than 80% of all deaths in 2021, according the Global Burden of Disease. This includes children who fail to grow and are underweight (low weight-for-age), stunted (low height-for-age), and/or wasted (low weight-for-height), and those who are born with low birth weight (<2,500 grams/5.5 pounds). Malnutrition-related child pneumonia deaths are concentrated among children under one year and evidence suggests malnutrition often begins much earlier in the womb. Twenty countries account for 80% of malnutrition-related child pneumonia deaths; 12 in Africa and eight in Asia. These countries need to integrate malnutrition prevention, diagnosis, and treatment with other health services, especially vaccination which is typically already reaching 80% of children. Countries should prioritize actions to counter the causes of malnutrition that are driving most child deaths in their countries. Without reductions in child malnutrition, many countries will not reach child survival goals and investments in vaccinations and other child health services will have limited impact.