Pneumonia is the world’s leading infectious killer – claiming 2.5 million lives, including 672,000 children, in 2019.
COVID-19 will add 3.6 million to the death toll in 2021, bringing the total number of respiratory infection deaths to more than 6 million. No other condition causes this burden of death.
Yet, a disproportionately low amount of research funding is allocated to pneumonia compared with other leading infectious killers – such as HIV/AIDS and malaria – and relative to pneumonia’s heavy disease burden.
According to a 2020 Lancet study:
This amount of funding and narrow focus is not guided by the global disease burden, pandemic risks nor the priorities of researchers and policymakers.
Increasing the amount and scope of pneumonia funding is critical to improve the prevention, diagnosis and treatment of pneumonia, and subsequently reduce the huge burden of death and our vulnerability to respiratory infection pandemics.
The Every Breath Counts (EBC) Research Group engaged 108 leading pneumonia experts globally between November 2019 and June 2021 to develop a list of research priorities with the potential to accelerate reductions in child pneumonia deaths and enable countries to achieve the Sustainable Development Goals.
The EBC Research Group conducted an electronic Delphi (eDelphi) research prioritisation exercise from November 2019 to June 2021 – to update the research priorities for childhood pneumonia in the context of the COVID-19 pandemic and explore whether previous priority areas, set in 2011, had been addressed.
The Research Group collated an initial list of research topics which were subsequently ranked through an iterative process by pneumonia experts consisting of researchers, implementers and policy makers from across the world.
The process identified the top 20 paediatric pneumonia research priorities organized around four themes – prevent and protect, diagnosis, treatment and cross-cutting.
There were important differences in research priorities between high-income and low- and middle-income (LMIC) respondents, and between academic and non-academic respondents.
The top five priorities from implementers were focused on practical questions around capacity, service delivery and quality of care. Conversely, academic priorities focused on new interventions and improving case management and technologies. Key differences between HIC respondents was the focus on neonatal pneumonia, compared to vaccine and health system capacity in LMIC respondents.
Preventing neonatal pneumonia
Exploring interventions to prevent neonatal pneumonia was accorded the highest priority research topic; neonates contribute to almost half of under-five mortality. And while neonatal mortality has declined by 19 per cent since 2010, the rate has been much slower than for 1-59 month olds (36 per cent).
Notably, academic respondents from LMICs ranked interventions to prevent neonatal pneumonia 18th while non-academic respondents ranked it sixth – reflecting the marked difference in orientation.
It is important, however, that research on neonatal survival strategies is not siloed given the difficulty in distinguishing sepsis and pneumonia, and the multiple calls for systems-focussed approaches.
Pneumonia root causes largely absent
Questions on indoor air pollution, malnutrition and HIV/AIDS had low ranking, and key underlying causes of high morbidity and mortality while women’s empowerment, poverty and overcrowding did not feature in the final list. This may reflect the fact that these risks are already well-established and are not limited to paediatric pneumonia.
Cost-effective, affordable diagnostic tools
Developing inexpensive, rapid point-of-care diagnostic and aetiological tests that differentiate between bacterial, viral and malaria infections that are reliable in community settings and children’s facilities were given the highest priority. There was also a focus on implementation science questions around existing devices, such as pulse oximeters.
Health system capacity a key research need
Studying health system capacity was identified as a persistent research need – suggesting the tools to manage and treat pneumonia already exist, but that there are challenges with quality implementation and reaching different groups, including the most vulnerable, at scale.
Lack of focus on antiviral treatments
The lack of focus on antiviral treatments was significant – given the burden of viral pneumonia cases, the threat of antibiotic resistance, and the prioritisation of diagnostics to differentiate between bacterial and viral infections.
Adding COVID-19 resulted in the inclusion of new research areas, but only two were retained in the top 20 priorities. This may reflect the huge challenges in tackling COVID-19, such as weak health systems and limited oxygen capacity (already an issue for paediatric pneumonia), and the relatively low direct clinical impact on children that had been recorded to date. However, it is important to consider how COVID-19 control strategies have mitigated or exacerbated the paediatric pneumonia burden.
Linking evidence to advocacy to implementation…
What is clear is that linking evidence to advocacy, implementation and policy still needs to be strengthened. Including policy makers early in the research process could improve this gap, despite the challenges in engaging ministries of health in this process.
There is also an urgent need for more investment in pneumonia innovation and the application of complex systems thinking, as well as ensuring collaborations across disciplines.
To ensure that these child pneumonia research priorities influence global clinicians, policy makers and research funders in the countdown to 2030, the EBC Research Group will be engaging major infectious disease research funders to make the case for increased investments against these 20 priorities, with a special focus on financing LMIC-based researchers and institutions.
Find out more:
Listen to the webinar https://youtu.be/TrVPZRBWxuw