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A critical shot in the fight against deadly childhood pneumonia

Pneumonia presents a cruel paradox. It kills more children than any other infectious disease. Yet it’s an illness we know how to prevent and treat.

Pneumonia has long been the ‘forgotten killer’. But approval at the end of last year of a new pneumococcal vaccine that promises lower immunisation costs has unleashed a powerful new weapon in the fight against childhood pneumonia.

Deadly threat

Pneumonia is a form of acute respiratory infection affecting the lungs. It’s caused by Streptococcus pneumoniae bacteria. And every year it claims the lives of more than 800,000 children under the age of five.

Children in the poorest, most marginalised communities bear the brunt of the death toll. The reason? Lack of access to simple, low-cost interventions. The kinds of interventions that would offer:

  • Protection through exclusive breastfeeding and adequate nutrition
  • Prevention through immunisation and addressing environmental factors such as air pollution
  • Treatment through early and accurate identification, using pulse oximeters, and with quality-assured antibiotics and oxygen therapy.

The most powerful of these interventions is a pneumonia vaccine, known as the pneumococcal conjugate vaccine (PCV).

Supply and demand

PCV usage has grown dramatically in recent years:  by 2017, three-quarters of the world’s countries (142 out of 194) had introduced or were in the process of introducing this key vaccine. Much of this progress is down to the work of Gavi, the Vaccine Alliance, which has supported the immunisation of more than 183 million children against pneumococcal disease.

Until now, the PCV market has been served by two main vaccines: PCV 10 (Synflorix), produced by GSK, and Pfizer’s PCV 13 (Prevenar-13). The existence today of these pneumonia vaccines is largely thanks to an innovative financing mechanism, the Advanced Market Commitment (AMC). It’s a legally binding agreement designed to incentivise manufacturers to develop vaccines for high-burden diseases – by assuring manufacturers that funds will be available to purchase their vaccine once it reaches the market.

However, in spite of the AMC, more than 1 billion doses over the next seven years are uncontracted – representing, with three doses per child, the needs of 361 million children. That should send manufacturers a signal of supply opportunities. It also highlights the need to expand the supplier base of quality-assured PCV manufacturers.

Low-cost – but still costly

The cost of PCV presents a huge challenge, particularly for middle-income
countries. These countries account for 75% of the world’s population, 62% of the world’s poor people, and the majority of child deaths from pneumonia. India, Nigeria and Pakistan – lower-middle-income countries – are all in the top five countries for childhood pneumonia deaths (see map).

But lower-middle-income countries are not eligible for GAVI support, and most don’t have access to pooled procurement mechanisms (such as PAHO’s revolving fund). On average, middle-income countries that have introduced the pneumonia vaccine spend 34% of their immunisation budget on PCV – with some spending as much as 66%.

New vaccine, new hope

There were welcome signs that the crippling cost of PCV may start to come down. In December the World Health Organization gave its seal of approval to a third pneumonia vaccine: PNEUMOSIL®, produced by the Serum Institute of India – the world largest vaccine manufacture by volume. Achieving WHO prequalification, means it can be purchased by UN agencies and GAVI.

This is a big deal. First, the vaccine is being offered to GAVI at a price of US$2 per dose, which is around 30% less than average price for other pneumonia vaccines. Given that the PCV vaccine accounts for 23% of the global vaccine market by value and is GAVI’s most expensive vaccine,  it’s set to produce colossal savings. Fundamentally, it will mean more children can be reached through savings made within Gavi funds.

What’s more, entry of a third quality-assured supplier will foster competition in the pneumonia vaccine market. This has potential to have a profound impact far beyond Gavi’s immediate reach. Crucially, that impact will be felt most in middle-income countries.

Lower prices for PCV will massively help countries transitioning from GAVI support to ensure access to PCV and sustain the gains already achieved. Non-Gavi, non-PAHO middle-income countries will be in a much stronger position to introduce the PCV vaccine as part of their routine childhood immunisation programmes.

Make this count

The arrival of a new lower-cost vaccine is welcome news. But the fight against the biggest infectious killer of children is far from over.

In the quest to ensure no child dies from pneumonia and other preventable causes, we’re pushing for a successful GAVI replenishment. And we’re calling for all stakeholders to work together to ensure continued availability, affordability and equitable access – facilitated by increased competition and healthy markets – to life-saving vaccines against pneumonia.

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