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Pneumonia is the single biggest killer of children in world’s poorest countries

Sir, Simon Kuper turns a powerful and much needed spotlight on pneumonia (“ Why some killer diseases are overlooked”, February 3). Most of your readers will think of the disease as an affliction of the elderly in rich countries. They will doubtless be shocked to learn it is the single biggest killer of children in the world’s poorest countries, claiming almost 900,000 lives annually.

More than shocked; they should be outraged. Bacterial childhood pneumonia can be prevented through vaccination, yet millions of the most vulnerable children are unimmunised. With early and accurate diagnosis most cases can be treated with simple antibiotics, yet two children will die from the disease in the minute it takes to read this letter. Despite the relentless tide of fatalities, most governments are failing to prioritise pneumonia prevention and treatment. Meanwhile, aid donors, the UN, the World Bank and other international development actors continue to treat pneumonia, the world’s most lethal killer of children, as a sideshow.

Responsibility for changing the picture described by Mr Kuper rests overwhelmingly with governments in developing countries. They need not just to increase investment in under-financed health systems, but also increase the efficiency and equity of that investment. Pneumonia is overwhelmingly a disease of the poor. Ensuring that decent quality healthcare is accessible and affordable to the parents of the most marginalised children is critical. Any strategy for beating pneumonia has to place a premium on equity and universal health coverage.

Aid donors and pharmaceutical companies have a role to play. Development agencies should be attaching as much weight to pneumonia as they are to other killers, like malaria. That means supporting the development of national action plans to combat the disease, while building more effective public-private partnerships. Far more could be done through Gavi, the Global Vaccines Alliance, to lower the price and extend the reach of vaccines. We also believe aid donors and companies could be doing more to ensure that advances in diagnostic technologies and treatments reach the most disadvantaged children.

Three years ago governments gathered with great ceremony to agree a set of 2030 development goals, including an end to preventable child deaths. They promised a focus on the most disadvantaged children. The ambition behind these pledges is laudable. But actions on pneumonia will speak louder than words.

Kevin Watkins CEO, Save The Children UK
Harry Campbell Professor of Genetic Epidemiology and Public Health, Edinburgh University
Kim Mulholland Professor of Child Health and Vaccinology, LSHTM
Devi Sridhar Professor of Global Public Health, Edinburgh University

This article was originally published in FT.

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