Why we must secure the future of the Integrated Global Action Plan for Pneumonia and Diarrhoea 

Why we must secure the future of the Integrated Global Action Plan for Pneumonia and Diarrhoea 

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Akokote has been receiving treatment for pneumonia in Turkana County, Kenya.  Credit: Save the Children

May 2021

Pneumonia and diarrhoea remain the leading killers of children and together are responsible for 24% of all deaths among children under five. Children living in countries that bear disproportionate impacts of pneumonia and diarrhoea are also battling with the catastrophic fallout of the COVID-19 pandemic. This threatens to reverse decades of progress in protecting the world’s children from these preventable illnesses.

An ambitious goal

In 2013, the World Health Organization (WHO) and UNICEF launched the Integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD) to reduce the massive burden of pneumonia and diarrhoea deaths among children. The GAPPD was the first global framework to set national pneumonia and diarrhoea mortality targets. By 2025 all countries were to have reduced child pneumonia deaths to less than three for every 1,000 babies born and diarrhoea deaths to less than two for every 1,000 babies born.

Targets were also set for prevention, diagnosis and treatment services: including 90% coverage of pneumonia-fighting vaccines; 90% access to recommended treatments; at least 50% coverage of exclusive breastfeeding during the first six months of life; and more.

The unfinished agenda for child survival

Since the GAPPD was launched, child pneumonia and diarrhoea deaths have fallen by 27%. But despite this progress:

  • 30 low- and middle-income countries (LMICs) with the highest numbers of child pneumonia deaths will not achieve the GAPPD pneumonia mortality target by 2030, compromising their achievement of the SDG for child survival.
  • 80% of all child pneumonia deaths occur in these 30 countries, with 50% in Nigeria, India, Pakistan, Ethiopia and Niger alone.

Strengthening the ambition of GAPPD in the countdown to 2030

To ensure these countries maintain a strong focus on reducing child pneumonia and diarrhoea deaths, Every Breath Counts Coalition is calling on the World Health Assembly (WHA) to:

  • Review and publish national progress to the GAPPD targets and invite Health Ministers to present results at the 2022 World Health Assembly
  • Update the GAPPD mortality and service coverage targets to 2030 (e.g., two pneumonia deaths per 1,000 live births)
  • Strengthen targets for the major risk factors of pneumonia and diarrhoea deaths (e.g., wasting, low birth weight, preterm birth, air pollution etc.) and major diagnostic tools and treatments (e.g., pulse oximetry, oxygen, ORS/zinc etc)
  • Extend the GAPPD deadline from 2025 to 2030, fully aligning with the SDGs

Accelerating action to reduce child pneumonia deaths

Every Breath Counts also encourages the WHA to focus on the gaps in service coverage that are contributing to the continued high death toll from pneumonia, including:

  • slow rollout of the pneumococcal conjugate vaccine (PCV), which only 48% of children under five currently receive
  • lack of progress reducing the major risk factors for pneumonia deaths (e.g., child wasting, low birth weight, preterm birth, and air pollution)
  • potential for new pneumonia-fighting vaccines (e.g., Respiratory syncytial virus/RSV, influenza, COVID-19) to further accelerate declines in child pneumonia deaths 
  • lack of a rapid diagnostic test for pneumonia to improve the speed and accuracy of diagnosis and treatment and reduce antimicrobial resistance
  • limited financing for the recommended pneumonia antibiotics (e.g., amoxicillin dispersible tablets), frequent stock-outs, and limited distribution by community health workers 
  • lack of access to pulse oximetry and oxygen as critical tools to prevent child pneumonia deaths

Many of these gaps were highlighted as urgent priorities for action by LMIC health leaders and international partners participating in the Global Forum on Childhood Pneumonia and subsequent LMIC government roundtables.


Read the report and graphs with the countries off-track to the GAPPD pneumonia mortality target