23 Nov Statement: World Antimicrobial Awareness Week
World Antimicrobial Awareness Week (WAAW)
18-24 November 2021
Pneumonia is the leading infectious cause of death in the world. An estimated 2.5 million people died from pneumonia in 2019 and COVID-19 will more than double the annual death toll from respiratory infections in 2021. While many pneumonia deaths are from bacterial and other causes that can be prevented with greater access to antimicrobials, especially among children, there is a large and growing number of deaths due to antimicrobial resistance.
How many? New estimates from the Global Research on Antimicrobial Resistance (GRAM) Project suggest that more than 300,000 pneumonia deaths are due to antimicrobial resistance. While this is still likely lower than the estimated deaths that could be prevented with greater antimicrobial access – 445,000 among children under five alone according to one study – that may be changing.
Increasing coverage of highly effective vaccines that target the leading bacterial causes of pneumonia (e.g., Hib and pneumococcal) are reducing the incidence of bacterial pneumonia and the need for antibiotics, especially among children. Recent studies have revealed that the largest proportion of childhood pneumonia cases and deaths across many low-resource settings are now from viral causes, especially Respiratory Syncytial Virus (RSV).
Despite this, widespread use of antibiotics among children in these settings is well documented with evidence from Haiti, Kenya, Malawi, Namibia, Nepal, Senegal, Tanzania, Uganda, China, Tanzania, and more. Higher child mortality as a result of antibiotic resistance has also been found, including in Bangladesh where one study concluded that “the pandemic of antibiotic resistance is shortening the lives of young children”. Experts even argue that current World Health Organization (WHO) pneumonia management guidelines are contributing to over-prescription of antibiotics and resistance.
The challenge is how to reduce the overuse of antibiotics for the treatment of pneumonia and close any remaining access gaps for pneumonia patients, especially children, who are missing out, without triggering further waves of antimicrobial resistance.
During World Antimicrobial Awareness Week, the Every Breath Counts Coalition is calling on governments and global health agencies to take seven actions to reduce antibiotic overuse in the treatment of pneumonia, at the same time closing any remaining antibiotic access gaps, especially for children, including:
1) Reduce the incidence of pneumonia and the demand for antimicrobials by tackling the leading risk factors for pneumonia death – air pollution (household and outdoor), child wasting, and low birth weight;
2) Accelerate coverage of the vaccines that target the leading bacterial causes of childhood pneumonia (pertussis, measles, Hib, and pneumococcal) to above 90% in every nation (and 80% in every district);
3) Increase the proportion of children with pneumonia symptoms who see a healthcare provider trained in the rational use of antibiotics in the public and private health sectors;
4) Develop new, affordable diagnostic tools that can differentiate between bacterial and viral causes of pneumonia and facilitate their wide adoption at all levels of health systems (this should include the adoption of pulse oximetry which has been found to curb the distribution of antibiotics in low-resource settings);
5) Ensure a steady supply of child-friendly amoxicillin (e.g., in dispersible tablet form) including by co-financing its distribution with international donors and implementing agencies in specific low-resource settings where necessary;
6) Adopt a robust indicator to measure antibiotic treatment coverage by children with WHO-defined pneumonia (e.g., the % of children with a diagnosis of pneumonia who completed the recommended dose of antibiotics, by type of antibiotic) in Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS), and other information collection tools routinely used by health authorities; and
7) Support a WHO review of the current definition of pneumonia in children to measure its impact on antibiotic overuse and resistance and recommend changes that would reduce the risk of antibiotic overprescription as a result of the WHO guidelines.
This body of work should form part of national and international efforts to both reduce all-cause pneumonia mortality and reduce antimicrobial resistance. Both communities of practice should work together to measure progress to these seven actions.
It is important to remember that we are still losing an estimated 672,000 children to pneumonia each year and the world is not on track to achieve the global target of less than three child pneumonia deaths per 1,000 births by 2025. Many countries are at risk of failing to achieve the Sustainable Development Goal (SDG) for child survival by 2030 as a result. And the pandemic has dramatically increased the number of adults dying from pneumonia in almost every country.
At the same time the scourge of antimicrobial resistance threatens to derail one of our most powerful public health tools and unleash a massive burden of death.
Our collective challenge is to adopt public policies and develop new tools that can reduce antimicrobial resistance and close remaining antibiotic access gaps for the populations most vulnerable to pneumonia at the same time.