It’s Time To Take On The World’s Most Lethal Killer Of Children
Five years ago a three- month-old Kenyan baby called Umi became a symbol of survival and hope. Brought to a Save the Children emergency clinic at the height of a devastating drought in the Horn of Africa, Umi was malnourished, dehydrated and on the brink of death. Her extraordinary recovery made the BBC News and the front pages of newspapers worldwide.
Sadly the story does not have a happy ending. In 2013, Umi’s life was cut short by pneumonia – the world’s most lethal killer of children.
By the time you finish reading this article, another four children will have died from pneumonia. This is a disease that kills almost a million children a year – more than malaria, measles and AIDS combined.
Yet pneumonia remains a hidden killer. It receives little media attention, and the response of governments, aid donors and the international community writ large has been desperately and fatally inadequate.
All of which helps to explain why the UN’s World Pneumonia Day, which happens to be today, generates such studied indifference.
The time has come to abandon the apathy. Last year, the world’s governments came together in a bold pledge to eradicate avoidable child deaths by 2030. Achieving that goal will require decisive action against pneumonia, which now accounts for 16% of all deaths of children under five.
Perhaps the most shocking aspect of the global epidemic of indifference towards pneumonia is that the disease is eminently beatable. Some of the gravest background risks – such as undernutrition, lack of safe water and sanitation, and indoor air pollution – can be tackled through targeted interventions. Exclusive breastfeeding in the first 6 months reduces the risk of death from pneumonia by a factor of 15.
Vaccination is another line of defence. The two primary killer strains associated with pneumonia are both preventable through effective vaccines that are readily available and supplied through the Global Alliance on Vaccines Initiative (GAVI).
When prevention fails, lives can be saved through low-cost treatment. Early and accurate diagnosis by a skilled health worker followed by a prescription for antibiotics can save a life for less than 40p.
So why are so many children struck down by a disease that is so readily preventable and treatable? The answer has less to do with technology, know-how and finance than inequality and power.
Pneumonia is a risk for all children but most of its victims are poor. These children live overwhelmingly in disadvantaged, often remote areas, and lack access to effective and affordable health care. Each year around 66 million children with suspected pneumonia are not taken to health clinics, either because there isn’t one in the area or because the parents can’t afford the treatment. Only one-third of children with suspected pneumonia in Nigeria receive antibiotics.
Invariably, it is the poorest children who are last in line. In Pakistan, only half of those from the poorest 20% reporting pneumonia symptoms receive antibiotic treatment – a figure that rises to 80% for the wealthiest households.
One of the reasons Umi died from pneumonia was that she lived in Kenya’s poor northeastern region, miles from the nearest clinic and even further from a hospital equipped to provide effective treatment. Children in Nairobi’s middle-class suburbs rarely die from pneumonia. When it comes to fatality, this is overwhelmingly a disease of the poor.
Universal health coverage is the most critical condition for tackling pneumonia. The starting point is to bring care close to the most disadvantaged children through properly resourced community health provision. Yet as a Johns Hopkins University report has identified, countries such as India, Nigeria, Pakistan and Indonesia, which are among those with the greatest burden of pneumonia deaths, are failing to extend the reach of their health care systems. Some of these countries – including India – have yet to bring pneumonia vaccines into national immunisation programmes. Even where the vaccine has been introduced, as in Nigeria, coverage is highly unequal.
The international community has been equally culpable. Less than 2% of global development aid is directed to pneumonia. Contrasts with malaria are striking. Donors have invested heavily in cutting malaria deaths, and with striking results. Child mortality has almost halved since 2000, falling at twice the rate for pneumonia.
Perhaps it’s the perception that malaria offers donors a simple, value-for-money metric that makes the difference. Bed-nets treated with insecticide are tangible and save lives, while fighting pneumonia is seen as complex. But it is surely not beyond our collective wit and creativity to make pneumonia a global campaigning cause.
Expanding the reach of life-saving vaccines is one area in which international cooperation can make a difference. Currently, vaccine costs are too high to be affordable to the poorest countries. This is an area in which a vibrant public-private partnership, working through GAVI, could make a difference, with aid donors committing to purchase more vaccines in return for lower prices from pharmaceutical companies.
World Pneumonia Day is in danger of becoming one of those hackneyed UN rituals that delivers a stream of irrelevant declarations. But it doesn’t have to be this way. Today, should be a day of remembrance for Umi and the millions of children like her who have been victims of a killer we have the power to stop.
We should honour her memory by shaking off our collective torpor, forging new coalitions for change and building a global campaign that saves lives.