07 Nov World Pneumonia Day – a decade on
In 2009, a diverse group of committed doctors, advocates, academics, UN officials and business people came together to change the way the world responded to pneumonia – the “forgotten killer of children”. When they launched the first World Pneumonia Day in November, pneumonia was killing 1.2 million children each year. But despite causing more deaths than HIV/AIDS, tuberculosis and malaria combined, pneumonia barely attracted the levels of support commensurate with its disease burden. There were no global health organisations championing the fight, very limited coverage of the pneumonia-fighting vaccines and no national governments with plans to reduce child pneumonia deaths.
Much has changed in the decade since. In 2013, WHO and UNICEF released the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea, which set a target of less than three child pneumonia deaths per 1,000 live births in every country by 2025. Gavi began rapid introduction of the pneumonia-fighting vaccines – the Hib vaccine and the pneumococcal conjugate vaccine (PCV) – in Gavi-eligible countries. In 2013, the International Vaccine Access Center (IVAC) released the first Pneumonia and Diarrhea Progress Report and in 2015, the rapidly growing Pneumonia Innovations Network hosted the Pneumonia Innovations Summit. In 2017, the Every Breath Counts Coalition was launched – the first public-private partnership to support governments to achieve the GAPPD target – and Save the Children and UNICEF, two of the founding members of the Coalition, announced a strategic alliance to reduce child pneumonia deaths in nine “beacon” countries.
Sadly, as promising as these efforts are, the world is still losing more than 800,000 children to pneumonia each year, and just two of the 20 countries with more than 10,000 annual child pneumonia deaths are on track to achieve the GAPPD target. If the current rate of progress continues, the world will lose 11 million more children to pneumonia by 2030 and many low- and middle-income countries will fail to achieve the Sustainable Development Goal (SDG) for child survival.
We can and must make faster progress in reducing child pneumonia deaths in the next decade.
Key factors for success
Our success will depend on three factors.
- The introduction of pneumonia control strategies in the countries with the largest numbers of children at greatest risk of death from pneumonia in Africa and Asia. Governments should use the latest burden of disease data at the sub-national level to identify the child pneumonia “hotspots” within their borders, and target prevention, diagnosis and treatment efforts to these children, paying special attention to reducing the risks of child malnutrition and air pollution. Building primary healthcare systems that can reach and identify the children most at risk of death, and move quickly to treat them with child-friendly antibiotics and medical oxygen, where necessary, will also be critical.
- International health agencies must support government pneumonia control efforts and prioritize assistance to the most vulnerable populations of children. By aligning their activities in the high-burden countries, in the spirit of the Global Action Plan for Healthy Lives and Well-being for All, Gavi, the Global Fund, the Global Financing Facility, the World Bank, the World Food Programme, UNICEF, WHO and Unitaid can accelerate child pneumonia mortality declines and boost national progress to both the GAPPD target and SDG 3.2.
- Every Breath Counts Coalition must continue to provide a strong platform for government and non-government actors at the national, regional and global levels to join forces to reduce child pneumonia deaths by prioritizing the world’s most vulnerable children. The Fighting for Breath Call to Action – End Childhood Pneumonia Deaths released today is a powerful example of what can happen when organisations join forces. And Fighting for Breath: the Global Forum on Childhood Pneumonia, which will be held in January 2020, will be the first time governments, UN and multilateral agencies, NGOs, academics and companies have rallied to help countries achieve the GAPPD target.
Pneumonia still remains the leading killer of children under five but it is no longer “forgotten”. A decade of World Pneumonia Days has played a major role in keeping the focus on the GAPPD target and assembling the broad coalition of actors now well-positioned for greater impact. What this Coalition is able to achieve over the next decade will largely determine whether or not pneumonia remains a leading killer of children beyond 2030. In the meantime, World Pneumonia Day will be a reminder that the lives of 11 million children are at stake and that slowing down is simply not an option.
By Leith Greenslade, Coordinator, Every Breath Counts Coalition
 World Health Organization and UNICEF, Pneumonia: the forgotten killer of children, 2004.
 JustActions, The Missing Piece: why continued neglect of pneumonia threatens the achievement of national health goals, 2018 and Research Investments in Global Health (ResIn) Study, Sizing Up Pneumonia Research: assessing global investments in pneumonia research 2000-2015, 2018.
 World Health Organization and UNICEF, Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD), 2013.
 Institute for Health Metrics and Evaluation (IHME), Global Burden of Disease, 2017.
 Bangladesh and Indonesia will achieve the target according to estimates provided by Save the Children, Fighting for Breath: a call to action on childhood pneumonia, 2017.
 Sustainable Development Goal 3.2 requires every country to achieve a Child Mortality Rate of at least 25 deaths per 1,000 births by 2030.
 Reiner, R.C., Welgan, C.A., Casey, D.C. et al. Identifying residual hotspots and mapping lower respiratory infection morbidity and mortality in African children from 2000 to 2017. Nat Microbiol, 2019.
 GBD 2017 Lower Respiratory Infections Collaborators, Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: an analysis for the Global Burden of Disease Study 2017, Lancet Infectious Diseases, 2019.
 World Health Organization, Global Action Plan for Healthy Lives and Well-being for All: Strengthening collaboration among multilateral organizations to accelerate country progress on the health-related Sustainable Development Goals, 2019.