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Pneumonia: the preventable health crisis the world has neglected – Health Awareness

Keith Klugman

Director, Pneumonia, Bill & Melinda Gates Foundation

Every year, 800,000 children die of pneumonia, a well-known but often-neglected disease. Though effective treatment and preventive vaccines exist, pneumonia remains the leading infectious cause of death for children.

Despite the high death toll, bacterial pneumonia – which is particularly serious for kids – only receives about 2% of global funding for neglected disease research and development[1].

Access to diagnostic tools and treatments
like X-rays, antibiotics, or oxygen also remains a challenge, particularly in
low-income countries where most pneumonia deaths occur.

The best option for children in these areas
is to prevent them from getting sick in the first place by giving them the
vaccines they need.

Pneumococcal conjugate vaccines have had major success in high-income countries

One particularly important tool in the
fight against pneumonia are pneumococcal conjugate vaccines (PCV), which have
reduced rates of severe pneumonia by more than half in the high-income
countries that have used them for nearly two decades.

But, while this important tool exists, many
communities in low- and middle-income countries still don’t have access to the
vaccines, leaving millions of children without protection against this deadly
disease.

Thankfully, a new vaccine will soon be on
the market that will help reduce this disparity and make PCVs available to more
children. The availability of this vaccine will help alleviate one of the
biggest barriers to sustainable access to PCVs that countries face – price.

A new
pneumococcal vaccine from the Serum Institute of India was recently approved for
use by the World Health Organization and is expected to be 30%
cheaper for low-income countries than existing vaccines.

Lower-priced vaccines

With the support of organisations like Gavi, the Vaccine Alliance, poor countries
will be better placed than ever before to introduce these vaccines into their
routine immunisation programmes.

Gavi helps increase access to vaccines in low-income countries and has already supported 59 low-income countries to introduce PCVs, reaching more than 183 million children.

With the availability of a more affordable vaccine,
countries will have more options to choose from. The lower price means they can
free up valuable resources for other health or development priorities.

There are encouraging signs of progress. Indonesia
announced in January that it
would make PCV part of its routine immunisation programme and committed to
vaccinating four million children each year. Rolling PCVs out in a country like
Indonesia, with a large population and a high burden of pneumonia, is a major step
forward.

Pneumonia prevention must be a priority

Reducing deaths from pneumonia in the
long-term will require putting pneumonia at the top of the global agenda and
keeping it there.

High-burden countries must make protecting
children from pneumonia through well-functioning primary healthcare systems a top
priority.

Donor governments must continue to
generously fund organisations like Gavi to ensure countries have the support they
need to introduce PCVs and sustain their use in every community.

To create a world free of preventable
disease, we must ensure every child can access these life-saving vaccines – no
matter where they live.

[1] (Policy Cures Research. G-FINDER 2019: Neglected Disease Research and Development: Uneven Progress, Jan 2020.)

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A new pneumococcal vaccine is here! Why this matters.

A new pneumococcal vaccine is here! Why this matters.

With a recent approval from the World Health Organization, this high-quality, more affordable vaccine is poised to help more countries access protection against the top cause of deadly childhood pneumonia.

Imagine it’s 2008. A pediatric pneumococcal vaccine has been available for years and made incredible strides against pneumonia and other pneumococcal diseases (like meningitis, sepsis, and disabling middle-ear infections). In the United States and other high-income countries, that is.

Hundreds of thousands of kids still die from pneumococcal disease unnecessarily in low- and middle-income countries. Barriers such as vaccine price and availability are preventing them from accessing this lifesaving tool. Furthermore, the vaccine doesn’t yet target some of the most threatening kinds (serotypes) of the pneumococcus bacterium for children in these parts of the world.

That same year, Serum Institute of India, Pvt., Ltd. and PATH kick off a collaboration with funding from the Bill & Melinda Gates Foundation to do the difficult job of developing a pneumococcal vaccine that not only provides the protection that children in these settings need but breaks down inherent price barriers to access.

Jump ahead to today and there’s reason to celebrate. The Serum Institute vaccine that was merely an ambitious idea over a decade ago has just been WHO-prequalified and will be made available to low- and middle-income countries for a target of US$2 per dose, an unprecedentedly low price for any pneumococcal vaccine.

Each year, nearly 400,000 children under five years of age die globally from pneumococcal disease, mostly in Africa and Asia. WHO prequalification opens the door for this new vaccine, PNEUMOSIL®, to bolster the prevention toolkit and fulfill its purpose—to save more lives by enabling access that countries in these regions can afford and sustain long term.

Why is price so important?

Pneumococcal vaccines that can be given to children are conjugate vaccines, which are the most complex kinds of vaccine to manufacture and relatively expensive as a result. In Pan American Health Organization countries, for instance, they run around US$12.85 to 14.50 per dose depending on the vaccine. And these vaccines require at least three doses in kids. Working together through complex financing mechanisms, global health donors and vaccine manufacturers have helped pneumococcal conjugate vaccines become available for low-income countries at significantly reduced prices—enabling rollouts in these settings to begin in 2009. This supported price is around $3 per dose today, which countries co-pay with heavy contributions from Gavi, the Vaccine Alliance.

Although such support has enabled broader access and saved countless lives, pneumococcal vaccine programs continue to be difficult for many low-income countries to sustain due to cost and are at even greater risk once countries graduate from Gavi financial support. Other countries ineligible for financial support (especially middle-income nations) have never even introduced pneumococcal vaccines into their national immunization programs, one factor being because prices are prohibitive. Paying for pneumococcal vaccines also consumes a disproportionate amount of donor resources compared to other vaccines—nearly half of Gavi’s funding for vaccine acquisition, for example.

Overall, PNEUMOSIL®’s target $2 per dose price is roughly 30% lower than the Gavi price and dramatically lower for non-Gavi low- and middle-income countries. Such savings will not only help more countries sustain and/or introduce pneumococcal immunizations, but donor and country funds could be freed up for other important public health priorities—contributing even more broadly to improving health and survival. Lower prices also complement other efforts to leverage common resources to fight multiple diseases at once such as pneumonia and diarrheal disease.

 

A child receives routine immunizations, including pneumococcal vaccine, at a clinic in The Gambia—a representative setting where a more affordable pneumococcal vaccine could be beneficial. Photo: PATH/Lauren Newhouse

What does it take to bring the price down?

Prior to partnering on PNEUMOSIL®, Serum Institute and PATH had already worked together with other partners on another high-quality, low-priced conjugate vaccine against meningitis A—MenAfriVac®. Developed upon request from health ministers in Africa’s meningitis belt, the vaccine has essentially wiped out meningitis A disease where introduced. For this successful vaccine, Serum Institute optimized more efficient conjugate vaccine manufacturing processes that it, in turn, applied to bring PNEUMOSIL®’s price down as well. Overall, innovating on PNEUMOSIL®’s conjugation technology and working out the process to generate very high yields contributed greatly to producing higher volumes of vaccine more quickly—and helped lower the prices substantially.

Selecting the most appropriate serotypes to target with PNEUMOSIL® was also key to minimizing cost. The pneumococcus has over 90 serotypes that vary by region, but conjugate vaccines are only able to cover a limited number of them. Since each serotype added to a conjugate vaccine adds cost, those included in PNEUMOSIL® are among the 10 likeliest to sicken and kill children in Africa, Asia, and Latin America. This maximizes coverage where the vaccine is intended for distribution without the added cost of unnecessary serotypes. In this way, PNEUMOSIL®’s coverage is estimated to be comparable in these regions to other prequalified pneumococcal vaccines on the market.

WHO prequalification opens the door for this vaccine to save more lives by enabling access that countries can afford and sustain long term.

And then there were three

Two other pneumococcal vaccines for kids are currently WHO prequalified and are effective at preventing disease caused by the serotypes of pneumococcus they are designed to protect against. Achieving the landmark of WHO prequalification for a new PCV, however, is not easy. Since the initial licensure of the first PCV 19 years ago, only one other vaccine manufacturer has managed to achieve this goal. To become WHO prequalified, a vaccine must meet international standards for manufacturing quality and perform well in a series of rigorous preclinical and clinical evaluations designed to demonstrate safety and acceptable immune responses.

Accordingly, PNEUMOSIL® has undergone the required clinical development program in The Gambia and India, including a pivotal Phase 3 clinical study in The Gambia whose results support the vaccine’s safety and ability to elicit comparable infant immune responses to a prequalified vaccine. In short, this means that the vaccine is expected to perform on par with other vaccines in its class, expanding the suite of options from which countries can choose.

What now?

As PNEUMOSIL®’s prequalification marks a huge milestone allowing the vaccine to be put to use, now’s the time to set about additional work that will help it achieve its full public health potential and impact. In this vein, ongoing studies include a Serum Institute-sponsored evaluation in India for marketing authorization within the country, as well as a study conducted by PATH and partners in The Gambia to examine an additional WHO-recommended dosing schedule. Spreading the word about this new addition to the toolkit is also important so that countries can make informed decisions for pneumococcal prevention and other public health priorities. Additional studies will also be needed to evaluate the vaccine’s performance in real life prevention of pneumococcal disease, once introduced into communities.

Now, after more than a decade of anticipation, we finally have a new tool that could help overcome some of the most persistent roadblocks plaguing pneumococcal disease prevention. Let’s make sure to put it to good use.

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New pneumococcal vaccine from Serum Institute of India achieves WHO prequalification

New pneumococcal vaccine from Serum Institute of India achieves WHO prequalification

This milestone marks a key step toward improving pneumococcal conjugate vaccine affordability and enabling sustainable access for low- and middle-income countries

Media contacts:

  • Michael Vernekar, Serum Institute of India Pvt. Ltd., +91 20 2699 3904, michael.vernekar@seruminstitute.com
  • Megan Sather, GMMB, +1 206-399-7780, megan.sather@gmmb.com
  • Anil Cherukupalli, PATH India, +91 99998 33440, acherukupalli@path.org

Pune, India and Seattle, United States, December 19, 2019—PNEUMOSIL®, a vaccine against a leading cause of deadly childhood pneumonia—the pneumococcus bacterium—has achieved prequalification by the World Health Organization (WHO). Developed though a collaboration spanning over a decade between Serum Institute of India, Pvt., Ltd. (SIIPL) and PATH and with funding from the Bill & Melinda Gates Foundation, the vaccine is expected to provide protection for children on par with other pneumococcal conjugate vaccines at a price that is more affordable for low- and middle-income countries.

Prequalification allows PNEUMOSIL® to be procured by United Nations agencies and Gavi, the Vaccine Alliance. This news marks an important milestone toward alleviating one of the biggest barriers to sustainable access to pneumococcal conjugate vaccine that countries face—price.

“PNEUMOSIL® can be manufactured at high volume with current capacity at 100 million doses per annum, which will be augmented to over 150 million doses per annum in two to three years. It will be made available at a target Gavi price of around US$2 per dose, which is roughly 30% less than the current Gavi price for these kinds of vaccines,” says Dr. Rajeev Dhere, executive director of SIIPL.

“The vaccine provides an alternate vaccine for low- and middle-income countries to ensure lifesaving access to pneumococcal disease prevention over the long term,” explains Dr. Mark Alderson, director of PATH’s pneumococcal vaccine project.

Pneumococcal conjugate vaccines have helped significantly reduce pneumococcal deaths and illness where introduced but are difficult for many countries to afford without considerable donor financial support. Although such support has been instrumental in helping to expand country access, implementing and sustaining pneumococcal vaccine programs continues to be difficult for many countries due to the vaccine price. PNEUMOSIL® addresses a need for a more affordable option that can make access easier for nations and free up country and donor funds for other health priorities.

“There has been unprecedented demand for the pneumococcal vaccine from Gavi-supported countries,” says Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “Within the last decade, we have supported the vaccination of 185 million children against this leading killer of children—but there is still work to be done. This new vaccine gives us more options in the fight to ensure no child dies from this preventable and treatable disease.”

“Vaccines are one of the best investments we can make to give every child a healthy start at life and build stronger communities and economies,” said Dr. Keith Klugman, director of the pneumonia team at the Bill & Melinda Gates Foundation. “As pneumonia continues to be the leading cause of death for young children worldwide, we welcome this new vaccine that will allow for more children to be protected from this debilitating disease.”

In addition to pneumonia, the pneumococcus bacterium causes other serious, life-threatening diseases like meningitis and sepsis. It is estimated to cause nearly 400,000 deaths in children under five years of age each year worldwide.

PNEUMOSIL® covers the types of the bacterium most likely to cause serious illness in low- and middle-income countries. Its manufacturing process has been optimized to make it more efficient—reducing costs while preserving vaccine quality and making the vaccine a more affordable option for countries with the highest burdens of pneumococcal disease.

“Pneumococcal conjugate vaccines are among the most complex vaccines to manufacture. As a vaccine developed and produced in India that will benefit the world, PNEUMOSIL®’s WHO prequalification is a landmark achievement,” adds Mr. Neeraj Jain, PATH country director in India.

Prior to WHO prequalification, a recent PATH-sponsored Phase 3 clinical study of PNEUMOSIL® in infants in The Gambia was conducted at the MRC Unit in The Gambia—part of the London School of Hygiene and Tropical Medicine. The study provided the pivotal results for the data package required for WHO prequalification. In the study, the vaccine met all primary and secondary endpoints with key findings showing the vaccine to have an acceptable safety profile and to generate a protective immune response similar to a WHO-prequalified comparator pneumococcal vaccine without interfering with other routine childhood immunizations. These results were presented at the 2019 European Symposium on Pediatric Infectious Diseases and a study manuscript is in preparation for peer-reviewed publication. Other study collaborators included FHI Clinical and the WHO Reference Laboratory for Pneumococcal Serology at the Great Ormond Street Institute of Child Health, University College London.

Additional resources for media: About Serum Institute of India, Pvt., Ltd.

Serum Institute of India, Pvt., Ltd. (SIIPL), based in Pune, India, today is the largest manufacturer of diphtheria, tetanus, pertussis (DTP) and measles, mumps, rubella (MMR) vaccines and supplies its products to United Nations agencies and more than 160 countries. SIIPL’s MenAfriVac® meningococcal serogroup A conjugate vaccine, which was specifically developed for sub-Saharan Africa, is acknowledged as a remarkable success by the vaccine community. It is a policy and commitment of SIIPL to make new vaccines available at affordable prices to the children of the developing world. www.seruminstitute.com.

About PATH

PATH is a global organization that works to accelerate health equity by bringing together public institutions, businesses, social enterprises, and investors to solve the world’s most pressing health challenges. With expertise in science, health, economics, technology, advocacy, and dozens of other specialties, PATH develops and scales solutions—including vaccines, drugs, devices, diagnostics, and innovative approaches to strengthening health systems worldwide.

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Ushering in a new era of pneumonia control

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ATH’s Cambodia team and the Cambodian Ministry of Health train mothers on how to prevent and treat childhood pneumonia and diarrhea. Photo: PATH/Heng Chivoan (Cambodia)

Pneumonia remains the deadliest infectious disease worldwide, claiming the lives of more than 800,000 children under age five every year.

It can strike anywhere, but is most prevalent among marginalized groups of people. Pneumonia is a complex disease with many causes, including viruses, bacteria, and even fungi, and the appropriate tools to fight it are still not accessible to everyone who needs them.

Despite tremendous gains, progress in reducing pneumonia deaths has not kept pace with other leading infectious diseases. As a result, pneumonia deaths persist at levels so unacceptably high, they could prohibit many countries from reaching the 2030 health targets laid out in the UN Sustainable Development Goals.

To better serve marginalized people and accelerate global progress against pneumonia, PATH is harnessing an integrated array of cost-effective solutions that can hit the disease from multiple angles, including vaccines, access to appropriate diagnostic tools, and treatments.

Here’s how we are pursuing each:

Vaccines—simple interventions with enormous impact

Thankfully, vaccines already exist or are in development for many of the common causes of pneumonia. Tragically, many of these vaccines aren’t affordable to the low-resource nations that suffer the highest burden. Everyone should have equitable access to lifesaving vaccines. That’s why PATH is supporting the development of several low-cost vaccines against pneumonia-causing diseases.

Worldwide, pneumococcal disease kills hundreds of thousands of children each year and is a leading cause of severe bacterial pneumonia. Effective pneumococcal conjugate vaccines—which protect against some kinds of pneumococcus—already exist and save lives around the world, but their high cost precludes many countries from using them. A Serum Institute of India, Pvt., Ltd. developed a vaccine designed specifically to protect children in low- and middle-income countries from the most common kinds of pneumococcus in Africa and Asia—and at roughly two-thirds the usual donor-supported price. PATH helped organize clinical trials for this low-cost vaccine, and it is now being considered for World Health Organization prequalification. Prequalification would authorize the vaccine to be procured by United Nations agencies for use in low-income countries—a critical step toward enabling access in low-resource settings.

Influenza and pertussis—better known as whooping cough—can both lead to viral pneumonia. We’ve supported manufacturers worldwide in efforts to shore up global seasonal and pandemic influenza vaccine supplies and are currently evaluating new pertussis vaccines for pregnant women designed to cost less and be more effective. (By vaccinating a woman while pregnant, antibodies can pass from her to her unborn child and provide protection during the first, most vulnerable months of life—a strategy called maternal immunization.)

Vaccines designed for maternal immunization prevent some of the common causes of pneumonia and can help pregnant women like Mariatu Kamara, who previously lost a child to pneumonia. Photo: PATH/Doune Porter (Sierra Leone)

We’re also supporting new vaccines for maternal immunization against two major causes of infant illness and death: respiratory syncytial virus (RSV) and group B Streptococcus (GBS). Both diseases count pneumonia among their common complications. RSV is a top cause of respiratory infection and hospitalization among young infants, and PATH is helping ready the field for eventual introduction of a vaccine. GBS is the leading cause of sepsis and meningitis in young infants, and a PATH-supported vaccine candidate is in early-stage clinical development.

We’re even pursuing vaccines against unexpected causes of pneumonia, such as the deadly bat-borne Nipah virus.

Better access to smart tools to detect severe illness in children

When pneumonia strikes, it is critical that a child is seen by a health worker who can effectively diagnose and treat them—or refer them for special care. In order for health workers to make the right diagnosis, they must have the right tools.

Devices like pulse oximeters, which measure the amount of oxygen in the blood, or clinical decision support tools that help process patient information and symptoms through digital applications, are key for alerting health workers to signs of severe disease. While these tools are routinely used in high-income countries, barriers related to demand, adoption, supply, and delivery prevent access in some low-resource settings. When danger signs go undiagnosed or unaddressed, children’s lives are put at risk.

That’s why PATH, with financial support from Unitaid, is partnering with Swiss Tropical and Public Health Institute; the ministries of health in India, Kenya, Myanmar, Senegal, and Tanzania; and international thought leaders on the Tools for Integrated Management of Childhood Illness (TIMCI) initiative. This ambitious four-year project aims to equip frontline health workers with the tools they need to detect severe disease like pneumonia in sick children. The initiative will both improve access to existing tools like pulse oximeters and clinical decision support tools, and improve the tools themselves to make them smarter and more relevant for health workers in low-resource settings.

TIMCI will also strengthen the market for critical diagnostic tools in low-resource settings through action, evidence, and innovation. Specific measures include by putting pulse oximeters and novel clinical decision support tools in the hands of health workers in 360 primary health facilities across the five countries, and generating missing data on feasibility, cost-effectiveness, and health impact of these tools to address evidence gaps and inform global guidance. We will also work to accelerate the development of multimodal devices that can measure additional vital signs, such as respiratory rate, hemoglobin, and temperature.

Over the next ten years, this work will increase coverage of pulse oximeters and clinical decision support tools in the five countries from nearly 0 to 65 percent.

By demonstrating that these tools improve the management of childhood illness—and that they can be sustainably implemented—TIMCI will generate evidence-based demand, increase donor engagement, and provide incentives for manufacturers to innovate and for governments to pursue adoption.

Better access to safe oxygen

Hypoxemia, insufficient oxygen in the blood, affects millions of people each year suffering from a range of common conditions—including newborn complications, obstetric emergencies, and pneumonia. Globally, at least 13 percent of children admitted to a hospital with severe pneumonia have hypoxemia, corresponding to approximately 1.5 to 2.7 million children requiring oxygen therapy for treatment of pneumonia annually. Furthermore, global estimates suggest that one in five sick newborns has hypoxemia upon admission to a hospital and 15 percent of all pregnant women develop potentially life-threatening complications, many of which require treatment with oxygen.

 

Access to safe oxygen is a complex health systems problem. Photo: PATH/Eric Becker.

However, access to reliable oxygen delivery systems (the provision of oxygen in coordinated use with pulse oximetry) is often difficult in low-resource settings for a variety of reasons. Our most recent work—the increasing access to safe oxygen and maternal, newborn, and child health (MNCH) devices project—is building on PATH’s work in safe oxygen delivery with an eye toward expanding to other essential medical devices specifically for MNCH. This two-year project aims to provide technical assistance and build capacity in support of oxygen delivery scale-up at the country level. To do so, we are partnering with the ministries of health in India, Indonesia, Kenya, Malawi, and Senegal to develop and roll-out a toolkit of planning and management resources that aid in improved reliability of oxygen and pulse oximetry access.

In addition to being an essential component of severe pneumonia treatment, oxygen is critical to high-quality treatment for a number of indications. And, while we’ve learned that certain challenges are specific to the unique aspects of oxygen, which functions as both a drug and a medical device, many are applicable to a wide range of essential medical devices. As a result, PATH’s work also focuses on extending the impact of more reliable treatment for hypoxemia and pneumonia to a much broader conversation around cost-effective deployment strategies for priority MNCH medical devices and treatments.

A comprehensive approach for pneumonia control

In addition to developing and adopting breakthrough technologies for pneumonia prevention, diagnosis, and treatment, the global community also needs appropriate investment in and robust leadership of pneumonia control strategies. It is paramount that champions at local, national, and international levels put pneumonia control high on the agendas of donors, governments, and the international health and development agencies.

Many of the broader interventions that help prevent pneumonia—such as breastfeeding, nutrition, sanitation, and hygiene—have overlapping benefits to prevent other childhood diseases, like diarrhea. Integrated and coordinated approaches across diseases and sectors can maximize impact, decrease costs, and increase efficiency.

Together, we can usher in a new era of pneumonia control and take a massive step toward ending child deaths and realizing a healthier, more equitable world.

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One child dies of pneumonia every 39 seconds, agencies warn

Omid from Afghanistan

LONDON/NEW YORK/BARCELONA, November 12, 2019 —Pneumonia claimed the lives of more than 800,000 children under the age of five last year, or one child every 39 seconds, according to a new analysis.

Most deaths occurred among children under the age of two, and almost 153,000 within the first month of life. [1]

Sounding the alarm about this forgotten epidemic, six leading health and children’s organisations are today launching an appeal for global action. [2]

In January the group will host world leaders at the Global Forum on Childhood Pneumonia in Spain.

Henrietta Fore, Executive Director of UNICEF, said: “Every day, nearly 2,200 children under the age of five die from pneumonia, a curable and mostly preventable disease. Strong global commitment and increased investments are critical to the fight against this disease. Only through cost-effective protective, preventative and treatment interventions delivered to where children are will we be able to truly save millions of lives.”

Pneumonia is caused by bacteria, viruses or fungi, and leaves children fighting for breath as their lungs fill with pus and fluid.

More children under the age of five died from the disease in 2018 than from any other. 437,000 children under five died due to diarrhoea and 272,000 to malaria.

Kevin Watkins, Chief Executive of Save the Children, said: “This is a forgotten global epidemic that demands an urgent international response. Millions of children are dying for want of vaccines, affordable antibiotics, and routine oxygen treatment. The pneumonia crisis is a symptom of neglect and indefensible inequalities in access to health care.”

Just five countries were responsible for more than half of child pneumonia deaths: Nigeria (162,000), India (127,000), Pakistan (58,000), the Democratic Republic of Congo (40,000) and Ethiopia (32,000). [3]

Children with immune systems weakened by other infections like HIV or by malnutrition, and those living in areas with high levels of air pollution and unsafe water, are at far greater risk.

The disease can be prevented with vaccines, and easily treated with low-cost antibiotics if properly diagnosed.

But tens of millions of children are still going unvaccinated – and one in three with symptoms do not receive essential medical care. [4]

Children with severe cases of pneumonia may also require oxygen treatment, which is rarely available in the poorest countries to the children who need it.

Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, said: “The fact that this preventable, treatable and easily diagnosed disease is still the world’s biggest killer of young children is frankly shocking. We have made strong progress over the last decade, with millions of children in the world’s poorest countries now receiving the lifesaving pneumococcal vaccine. Thanks largely to Gavi’s support, pneumococcal vaccine coverage in low-income countries is now higher than the global average, but we still have work to do to ensure every child has access to this lifesaver.”

Funding available to tackle pneumonia lags far behind other diseases. Only 3% of current global infectious disease research spending is allocated to pneumonia, despite the disease causing 15% of deaths in children under the age of five.

Leith Greenslade, Coordinator of Every Breath Counts, said:

“For decades the leading killer of children has been a neglected disease and the world’s most vulnerable children have paid the price. It’s time for governments, UN and multilateral agencies, companies and NGOs to join forces to fight pneumonia and protect these children.”

In a joint call to action, the organisations urge:

• Governments in the worst-affected countries to develop and implement Pneumonia Control Strategies to reduce child pneumonia deaths; and to improve access to primary health care as part of a wider strategy for universal health coverage;
• Richer countries, international donors and private sector companies to boost immunisation coverage by reducing the cost of key vaccines and ensuring the successful replenishment of Gavi, the Vaccine Alliance; and to increase funding for research and innovation to tackle pneumonia.

Notes to Editors:

Content and case studies available here  and here.

[1] UNICEF analysis produced in September 2019, based on WHO and Maternal and Child Epidemiology Estimation Group (MCEE) interim estimates and the United Nations Inter-agency Group for Child Mortality Estimation estimates for the year 2018.

[2] ISGlobal, Save the Children, UNICEF, Every Breath Counts, Unitaid and Gavi, the Vaccine Alliance are calling for concrete commitments from high-burden countries and international donors to tackle pneumonia. Together with the “la Caixa” Foundation, the Bill and Melinda Gates Foundation and USAID, the group will host the Global Forum on Childhood Pneumonia in Spain on 29-31 January.

[3] The top 15 countries by pneumonia deaths for children under the age of five in 2018, were:

Country Name Estimated number of pneumonia-related deaths in children under five, 2018
1. Nigeria 162,000
2. India 127,000
3. Pakistan 58,000
4. Democratic Republic of the Congo 40,000
5. Ethiopia 32,000
6. Indonesia 19,000
7. China 18,000
8. Chad 18,000
9. Angola 16,000
10. United Republic of Tanzania 15,000
11. Somalia 15,000
12. Niger 13,000
13. Mali 13,000
14. Bangladesh 12,000
15. Sudan 11,000
Global 802,000

Source: UNICEF analysis, based on the United Nations Inter-agency Group for Child Mortality Estimation estimates for the year 2018 and WHO and Maternal and Child Epidemiology Estimation Group (MCEE) interim estimates

[4] In 2018, 71 million children did not receive the recommended three doses of pneumococcal conjugate vaccine (PCV), putting them at higher risk of pneumonia. Globally, 32% of children with suspected pneumonia are not taken to a health facility. That figure rises to 40% for the poorest children in low- and middle-income countries.

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Moving towards equitable access to vaccination

Progress in childhood immunisations has stalled for almost a decade. According to new data from UNICEF and WHO, only 86% of children worldwide received life-saving vaccinations for diseases such as diphtheria, pertussis, and measles in 2018, with little change from 84% in 2010. The Global Vaccine Action Plan, which aims to ensure equitable access to vaccines by 2020, is not on track to meet its targets.
This stagnation hampers global health and development and is a key issue for Gavi, the Vaccine Alliance, to address in its third replenishment round from 2021–25. The Gavi investment case was launched at a meeting in Japan at the end of August, ahead of a conference in London next year where funds will be pledged by governments and other donors. The next Gavi 5-year plan calls for investment of at least US$7·4 billion (slightly down from $7·5 billion in the period 2016–20), with the objective of immunising 300 million children against 18 diseases and saving up to 8 million lives. At the same time, the governments of low-income countries that partner with Gavi will be asked to put $3·6 billion into their vaccine programmes, up from $1·6 billion in the previous period.
The Gavi plan puts a focus on immunising children who are not currently receiving adequate vaccine coverage. Almost half of under-vaccinated children live in just 16 countries, where lack of access, conflict, and displacement are important barriers to vaccination. To tackle these issues, Gavi proposes to invest $3·3 billion in strengthening immunisation systems through infrastructure development, an objective that Seth Berkley, the Chief Executive Office of Gavi, says amounts to “building out the primary health-care system”.
Another potential impediment to equitable vaccine access is the sustainability of programmes in countries that, as they become wealthier, are no longer eligible for Gavi support or low vaccine prices. Berkley has indicated that ways should be found to support countries with pricing and procurement in this post-transition period. Because of the cost of vaccines, children in middle-income countries that have never been eligible for Gavi support are now those least likely to have access to recommended vaccines—70% of the least vaccinated children will be in these countries by 2030. To help tackle this crucial coverage gap, up to 3% of Gavi’s budget will go towards vaccination programmes in transitioning and middle-income countries.
However, none of the laudable objectives of Gavi can be achieved without adequate funding. When it was last replenished in 2015, Gavi received more than the $7·5 billion it asked for. But the world of 2015 feels a long way away. The UK, Gavi’s biggest funder, was then led by Prime Minister David Cameron in a pre-Brexit era. How will Boris Johnson, freshly installed as UK prime minister, approach funding for Gavi? Johnson has questioned the budget and priorities of the Department for International Development and has mooted support for ending its existence as a cabinet-level department. The UK will host Gavi’s 2020 replenishment pledging conference—when on home soil, anything but the strongest commitment would surely be an embarrassment to the host government.
The USA provided the second largest national contribution in 2015, doubling its financial commitments, which was one of the key reasons that expectations were exceeded. President Trump’s continued commitment to the President’s Emergency Plan for AIDS Relief has been counterbalanced by a decrease in money for the Global Fund to Fight AIDS, Tuberculosis and Malaria to the USA’s lowest contribution in a decade. And then there is China, the world’s second largest economy. It committed a paltry $5 million in 2015. What prospect is there that China will embrace a more multilateral approach to global health when Gavi calls for support?
Potential donors should consider building on the great progress that has already been achieved and exploiting new opportunities. More children than ever before (116·3 million) received three doses of diphtheria-tetanus-pertussis vaccine in 2018. Global immunisation with a second dose of measles vaccine has climbed, from 39% in 2010 to 67% today. Switching to Pneumosil, a new, cheaper pneumonia vaccine could free-up $1 billion.
Achieving global equitable vaccination will boost economies, improve global health security, and help achieve the Sustainable Development Goals: not just those related to health, but also poverty, inequalities, education, and more. A well funded and strategically astute Gavi is essential to reaching this goal. It needs strong support now more than ever before.
source the lancet – moving towards equitable access to vaccination
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Low-cost pneumonia vaccine breaks into global market

Pneumococcal vaccination could become less costly for Gavi, The Vaccine Alliance, as a new, cheaper, alternative hits the market. Ann Danaiya Usher reports.

source the lancet – low cost pneumonia vaccine

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Fighting for Breath: The Global Forum on Childhood Pneumonia

Date29/01/2020 – 31/01/2020
Hour8.30 h – 17.00 h
PlaceCosmoCaixa
(Isaac Newton, 26) Barcelona

ISGlobal, Save the Children, UNICEF, Every Breath Counts, the Bill & Melinda Gates Foundation, GAVI, ”la Caixa” Foundation, USAID and Unitaid have joined forces to address one of the greatest —and most serious— health threats that children face around the world.

“Fighting for Breath: the Global Forum on Childhood Pneumonia” is an international effort to put pneumonia —the leading infectious cause of death in children— on the global health agenda. The organisation aims to increase awareness of the scale of this disease challenge and set out practical pathways to end preventable child pneumonia deaths by 2030 through stronger, more equitable health systems and the development of Universal Health Coverage (UHC).

Moreover, it expects to mobilise the donor community to ensure that we achieve the SDG goal on child survival and the Global Action Plan for Pneumonia and Diarrhea (GAPPD) target of three child pneumonia deaths per 1,000 live births by 2030. This will also be a moment to support Gavi 2020 replenishment efforts.

The meeting will combine high-level keynote speeches together with panel presentations, individual TED-style talks and ‘chat-show’ discussions, with ample opportunities for audience interaction, as well as side meetings.

source is global – the global forum on childhood pneumonia

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