Zero dose PCV children – dangerously exposed to pneumonia

23 Apr Zero dose PCV children – dangerously exposed to pneumonia

Children living in countries that do not offer the pneumococcal conjugate vaccine (PCV) are dangerously exposed to pneumonia, the biggest infectious killer in the world. Prior to the COVID-19 pandemic, pneumonia killed an estimated 2.5 million people each year – more than any other infectious disease. During COVID-19 this number rose exponentially and could again if another respiratory pandemic hits. In this context, it is vital that all countries are protecting their populations, and especially their most vulnerable populations, with every tool available to prevent pneumonia from any cause.

The pneumococcal vaccine is one of the most powerful tools we have to prevent pneumonia, because it targets the leading bacterial cause – streptococcus pneumoniae. It is a highly effective vaccine. For example, after Kenya introduced the vaccine in 2011, the average annual incidence of severe pneumococcal disease dropped by 92% among children under five and hospital admissions fell sharply. Accordingly, the World Health Organization (WHO) recommends that all children under five receive the pneumococcal vaccine and some national governments also recommend that the elderly receive it, as pneumonia is also a major cause of death among adults aged over 70 in most countries.

But not every country has followed these recommendations, and there are currently hundreds of millions of vulnerable children and adults who do not receive the pneumococcal vaccine. They are dangerously exposed to pneumonia and at risk of spreading infection to others. All vulnerable populations deserve to be protected with the pneumococcal vaccine, but this is even more critical during a pandemic of viral pneumonia. This is because high coverage of the pneumococcal vaccine not only reduces the risk of bacterial pneumonia among children and the elderly, but protects vulnerable populations from co-infections that can increase the risk of death from COVID-19. Both reduce demands on already stretched health systems.

This is why every country in the world needs to protect children and the elderly with the pneumococcal vaccine.

While Gavi, the Vaccine Alliance has a strong track record of supporting low-income countries to introduce the pneumococcal vaccine for children, middle- and high-income countries should immediately take the initiative and introduce the vaccine to fully protect their children and elderly populations.

How many zero dose PCV children are there in the world?

There are approximately 430 million children under the age of 15 living in countries with zero coverage of the PCV vaccine. This means that more than one out of every five children under 15 is not protected from the leading cause of bacterial pneumonia.

Where do zero dose PCV children live?

There are 54 zero dose PCV countries spread across every region of the world.  The Western Pacific region is home to 290 million (67%) zero dose PCV children, followed by the Eastern Mediterranean with 67 million (16%), and Africa with 27 million (6%). In contrast, Europe is home to 20 million (5%), Southeast Asia to 17 million (4%), and the Americas to 11 million (2%).

What price are zero dose PCV countries paying?

The cost of this exposure is ultimately measured in children’s lives lost due to pneumonia – an estimated 90,000 every year in the zero dose PCV countries, or 10% of all pneumonia deaths among children under 15.

The zero dose PCV countries with the heaviest burdens of child pneumonia deaths include China, Chad, Egypt, South Sudan, Somalia, Guinea, Tajikistan, Viet Nam, Iraq, and North Korea. Together these ten countries account for 94% of the 90,000 child pneumonia deaths occurring in zero dose PCV countries.

As most of the 54 zero dose PCV countries are also experiencing heavy burdens of pneumonia deaths among their elderly populations, protecting children with the PCV should have a significant impact on reducing infections and deaths from pneumonia among the elderly.

Although there are no routine estimates of pneumonia deaths prevented among the elderly with PCV vaccination among children, studies suggest that childhood PCV vaccination leads to substantial protection across the whole population within a decade.