Every Breath Counts Coalition

World’s first public-private partnership to support national governments to end preventable child pneumonia deaths by 2030

An unprecedented number of organizations have joined forces in the Every Breath Counts Coalition; the first public-private partnership to support national governments to end preventable child pneumonia deaths by 2030.

Pneumonia is the leading infectious killer of children under five, responsible for an estimated 810,000 deaths in 2017, according to the Global Burden of Disease. These deaths are declining, but at a slower rate relative to other infectious diseases. Between 1990 and 2017, child pneumonia deaths fell by 65% compared to 84% for measles, 70% for HIV/AIDS (from the peak of the epidemic in 2004), and 68% for diarrhea.

If this slow rate of change continues, many countries will struggle to drive child pneumonia deaths to below 3 per 1,000 live births, which is the rate required to achieve Sustainable Development Goal 3.2.

Children in many low and middle- income countries are especially vulnerable to death from pneumonia due to the combination of high child malnutrition and air pollution, low vaccine coverage and female literacy, and poor access to health services.

Focused national and international efforts to identify and close the gaps in pneumonia prevention, diagnosis and treatment in these countries could prevent most of the 810,000 child pneumonia deaths that are occurring each year.

To help governments in these countries end preventable child pneumonia deaths by 2030, the Every Breath Counts Coalition mobilizes members and supporters to help close the most critical gaps in pneumonia prevention, diagnosis and treatment.

In most countries expanding coverage of the pneumonia-fighting vaccines (Hib, PCV, and measles) is a top priority because current coverage rates are often low, while in others improving access to proper diagnosis and treatment services with better tools like pulse oximetry and increased access to child-friendly antibiotics, oxygen and therapeutic foods is key.

Working more directly with mothers and families to improve child nutrition, air quality, female literacy and careseeking for sick children will boost progress across all countries.

And now with COVID-19 not only causing increases in pneumonia deaths among adults but also contributing to increases in child pneumonia deaths from other causes due to disruptions in health services, many low and middle-income countries are facing “double-burdens” of pneumonia deaths among children and adults.

The Every Breath Counts Coalition has an initial focus on the following ten countries where large populations of children are extremely vulnerable to pneumonia and where national governments are struggling to make progress and also dealing with rising COVID-19 cases.

Specific activities the Every Breath Counts Coalition will prioritize in these ten countries in partnership with governments include:

  • developing national Pneumonia Control Strategies based on local cause-of-death and risk data, and local gaps in coverage of the highest impact interventions;
  • increasing the proportion of both domestic health resources and international development assistance allocated to pneumonia-related interventions (e.g. vaccination, nutrition, clean air, diagnosis with pulse oximetry and new tools, and access to child-friendly antibiotics and oxygen treatments);
  • supporting country efforts to prioritize child pneumonia in applications for funding from international agencies (e.g. Gavi, the Global Fund, and the Global Financing Facility in support of Every Woman, Every Child);
  • accelerating introduction of the PCV vaccine in countries with no coverage and increasing efforts to lift coverage to above 90% in low-coverage countries;
  • advancing Universal Health Coverage (UHC) schemes that fully cover the costs of  pneumonia vaccines, diagnostic and treatment services, including with  improved diagnostic tools, pulse oximetry, child-friendly antibiotics and oxygen therapies;
  • including critical pneumonia diagnostic and treatment tools on World Health Organization (WHO) guidance to national governments, including on Essential Medicines Lists;
  • increasing investments in innovations that improve the cost-effectiveness of pneumonia prevention, diagnosis and treatment, with a special focus on supporting local entrepreneurs with sustainable business models;
  • introducing advocacy campaigns to increase the investments needed to end preventable child pneumonia deaths by 2030, to raise awareness about child pneumonia deaths among all stakeholders including the general public, and to encourage behavioral change by caregivers and healthcare workers;
  • providing more technical assistance from international development agencies to assist Ministries of Health to accelerate reductions in child pneumonia deaths;
  • including a more robust set of pneumonia prevention, diagnosis and treatment indicators in official health surveys (e.g. MICs, DHS, SPA and SARA) and health impact tools, especially the Lives Saved Tool (LiST) model; 
  • coordinating efforts by humanitarian agencies to reduce child pneumonia mortality and testing new approaches to pneumonia prevention, diagnosis and treatment in conflict settings; and
  • increasing research to better identify the predictors of severe pneumonia and the children who require urgent referral or hospitalization.

Why focus on specific countries?

1. Efforts to reduce child pneumonia deaths can have their greatest impact on child survival and SDG 3.2 when they are targeted to the countries with the largest numbers of children at highest risk of death from pneumonia.

    • These are likely to be the countries with the largest numbers of child pneumonia deaths, the heaviest pneumonia burdens (15 to 20% all child deaths), the highest child mortality rates, the slowest progress in reducing those rates, the lowest pneumococcal vaccine coverage, breastfeeding and female literacy rates, the highest rates of child malnutrition (especially wasting), the heaviest dependence on solid cooking fuels, and high rates of urbanization (as crowding and air pollution are highly correlated with urbanization).
    • The countries that score the highest across this suite of indicators include, in order of priority: Chad, Nigeria, Angola, Niger, Somalia, Mali, Democratic Republic of Congo, Afghanistan, Pakistan, and Ethiopia.
    • The first five countries are in “urgent” need of greater levels of attention and investment to fighting child pneumonia, while the second five are a “priority” for action.

2. Maintaining the status quo in these ten countries would result in minimal number of child pneumonia deaths prevented in 2030.

    • The GBD estimates that 324,000 children died from pneumonia in these ten countries in 2017. At current rates of progress an estimated 300,000 children would still be dying from pneumonia in 2030 across these ten countries. The status quo option would see little change in terms of number of deaths.
    • At current rates of progress, all of the ten countries would miss the target levels of child pneumonia deaths required to achieve SDG 3.2, most by more than 60%. For example, at current rates of progress, Nigeria will still be losing more than 100,000 children to pneumonia in 2030, compared to their GAPPD target of 26,000 child pneumonia deaths. Focus countries with the widest gaps include Angola, Chad, Nigeria, Somalia and Mali.
    • Slow progress on reducing child pneumonia deaths will likely prevent the achievement of SDG 3.2 in all of these countries.

3. Aggressively filling gaps in pneumonia control (prevention, diagnosis and treatment) in Chad, Nigeria, Angola, Niger, and Somalia (the five “urgent” action countries) could prevent an additional 160,000 child deaths from pneumonia in 2030.

    • Specific “pneumonia control” strategies would be required in each of the five countries with gaps in coverage identified and filled. For example, Chad and Somalia’s highest priorities might be introduction of the pneumococcal vaccine, while Nigeria’s and Afghanistan’s goals could be to rapidly increase coverage of the pneumococcal vaccine among the most vulnerable populations of children.
    • Countries with higher pneumococcal vaccine coverage (e.g. Mali, Democratic Republic of Congo, Pakistan and Ethiopia) could invest in improving rapid diagnosis of pneumonia and antibiotic treatment at the community level, while increasing access to pulse oximetry and oxygen in facilities.
    • Countries with low female literacy and high rates of child wasting and cooking with solid fuels (e.g. Niger) could prioritize family nutrition and mother education campaigns, while subsidizing clean cooking fuels.
    • Countries that score poorly across all indicators (e.g. Angola) should target action on all fronts to fight pneumonia.
    • In all of these countries national strategies to identify and close pneumonia control gaps and secure increased domestic sources of financing supplemented with external support only when necessary are critical.

4. Aggressively filling gaps in pneumonia control (prevention, diagnosis, and treatment) in the remaining five focus countries could prevent an additional 250,000 child deaths from pneumonia in 2030.

    • Specific “pneumonia control” strategies would be required in each of the additional five countries with gaps in coverage identified and filled.  For example, while pneumococcal vaccine coverage is rising in the additional five countries (Mali, Democratic Republic of Congo, Afghanistan, Pakistan, and Ethiopia), gaps in diagnosis and treatment are wide.
    • As female literacy is very low in the additional five countries, it should be a special focus of pneumonia control, including efforts to educate mothers to recognize the signs of pneumonia and to seek appropriate care quickly.
    • Investments in reducing reliance on solid cooking fuels will also be important in Mali, Democratic Republic of Congo and Ethiopia, while breastfeeding support and infant nutrition will be critical in all five countries as all suffer from low breastfeeding rates and 8%+ child wasting rates.

5. It is only possible to achieve the SDG-required child pneumonia mortality reductions in these countries if governments, business, and civil society join forces to invest in closing the gaps.

    • A public-private partnership with an ambitious, measurable goal – to end preventable child pneumonia deaths in the focus countries by 2030 – can crowd in resources to the most vulnerable populations of at risk children
    • Given the importance of the Global Financing Facility (GFF) as a leading source of external financial assistance for women’s, children’s, and adolescents’ health in eligible countries, there should be efforts to engage and offer support to the focus countries that are GFF-eligible (e.g. Chad, Angola, Niger, Somalia, Mali, Afghanistan, and Pakistan).

Who is the Every Breath Counts Coalition and what have they promised to do?

(In alphabetical order)

(1) The Access Challenge will work through campaigns, the recruitment of high profile influencers and through quiet advocacy in any and all of the focus countries to raise the profile of pneumonia and to catalyze resource mobilization and policy change in order to reduce child pneumonia deaths. Resource mobilization will include domestic support in the preparation of investment cases for Global Financing Facility funding and policy change will focus on increasing universal access to prevention tools like immunization, breastfeeding, nutrition and diagnostic and treatment tools.  A key focus will be on increasing grassroots demand for prevention, diagnostic and treatment tools through mother and caregiver focused campaigns. The Access Challenge will identify and engage African leaders to champion action on child pneumonia in the focus countries by working with former President Kikwete, HE Moussa Faki, the leadership of the African Union, the leadership at WHO AFRO, the Organisation of African Ladies against HIV/AIDS (OAFLA), a variety of sports institutions including the Confederation of African Football and other decision-makers and influencers. Building on the child pneumonia campaigns already executed in Nigeria with the First Lady, the Access Challenge will develop creative content for both advocacy and social behavior change targets, and assist with dissemination in other focus countries. The Access Challenge will focus at the global level on promoting awareness of the current mismatch between the global burden of pneumonia and the small amount of global funding allocated to pneumonia.  

(2) ALIMA is committed to meeting humanitarian challenges with new ideas and low-cost solutions designed for patients, including children with suspected pneumonia. ALIMA is proud to work with Unitaid to bring better tools such as pulse oximetry to improve the identification of children with pneumonia in West Africa. ALIMA’s grant of $US$14.9 million from 2019 to 2022 will test whether pulse oximeters can improve treatment outcomes for children in four countries – Burkina Faso, Guinea, Mali and Niger, incoudign two Every Breath Counts focus countries (Mali and Niger). ALIMA will team up with Institut National de la Santé et de la Recherche Médicale (INSERM), Solthis and Terre des Hommes to implement the program.

(3) Assist International is committed to supporting the Every Breath Counts priorities as we have previously demonstrated in Kenya and Rwanda, and now by establishing Assist International Medical Oxygen Production in Ethiopia with partners such as Grand Challenges Canada and the GE Foundation. AI is bringing a financially sustainable model of oxygen production and distribution, while also implementing a rigorous training program for local health workers. Assist International is also committed to continue to work with an increasing diverse group of partners and explore the opportunity to move forward in Nigeria and other countries to ensure that wherever possible, the prescribed need for medical oxygen is properly understood, diagnosed, and available to be used effectively to save lives.

(4) The Bill & Melinda Gates Foundation (BMGF) works to help all people lead healthy, productive lives, guided by the belief that every life has equal value. In support of the Sustainable Development Goals, the Foundation’s pneumonia strategy focuses on the most prevalent causes of childhood pneumonia. The top priority is to promote full-scale delivery of currently available pneumococcal and meningococcal vaccines, and to support the development of new vaccines to improve coverage, efficacy, safety, and cost effectiveness. Because vaccines cannot prevent all cases of pneumonia and because the incidence of this disease remains high, the BMGF also works to improve access to diagnostics and treatment options which include oxygen related systems improvements in the public and private health sectors. The BMGF is developing a platform for maternal immunization to protect mothers and their newborns from pathogens that bear a disproportionate mortality burden in the neonatal period. The BMGF will continue to work though partners like Gavi, the Vaccine Alliance, to increase immunization coverage in the world’s poorest countries, and the Global Financing Facility, to help countries reach those who do not yet have access to quality services and accelerate progress on reproductive, maternal, newborn, child, and adolescent health and nutrition.

 (5)  The Clean Cooking Alliance will raise awareness of the relationship between  exposure to air pollution in the home and the risk of child pneumonia across the health, environmental pollution, climate change and women’s empowerment sectors in the focus countries. The Alliance will also increase understanding, especially among governments in the focus countries with close to 100% dependence on solid fuels, that switching households to clean fuels (e.g. gas) will deliver the greatest impact on child health because it can reduce exposures by the greatest amounts. The Alliance will support efforts to include household air pollution exposure in the Lives Saved Tool (LiST) so the impact of improving exposure on child survival can be routinely assessed by all stakeholders.

(6) The Clinton Health Access Initiative (CHAI) will work with the Governments of Ethiopia and Nigeria to increase access in both the public and private health sectors to treatment for childhood pneumonia—including oxygen for hypoxemia, and amoxicillin dispersible tablets for non-severe cases, and pulse oximetry for diagnosis. CHAI is supporting the governments to develop and implement first-ever national roadmaps for scaling up oxygen access. With support from the Bill & Melinda Gates Foundation, CHAI is supporting governments to improve the policy environment and availability of these commodities in Ethiopia (Tigray, Oromia, Amhara, and SNNPR) and Nigeria (Kano, Kaduna, and Niger states). Results and lessons from the program will benefit CHAI’s efforts in three additional countries working to reduce pneumonia deaths—including Uganda, Kenya, and India (state of Madhya Pradesh).

(7) Concern Worldwide will ensure that its country teams understand the need for more coordinated efforts to reduce child pneumonia deaths and will prioritize programs to strengthen prevention (vaccination, WASH solutions and infant/young child nutrition, including breastfeeding), diagnosis and prompt treatment as close to home as possible.  Concern will intensify its efforts in the focus countries with large displaced or refugee populations to ensure that the most vulnerable children have good nutrition and safe and healthy shelter to protect them from pneumonia and other infectious diseases.

(8) The École Polytechnique Fédérale de Lausanne (EPFL) will, through the EssentialTech program hosted at the Cooperation and Development Centre, develop and deploy an innovative cost-effective, robust oxygen concentrator solution for use in the ten Every Breath Counts focus countries. This solution will include both technology and a sustainable business model, involving all aspects of the value chain such as manufacturing, logistics, commissioning, training, usability, maintenance, repair, obsolescence, and recycling. An alliance of public and private partners, based both in industrialized and in low-income countries, has been assembled to tackle this challenge.

(9) Engine|MHP, a proud partner of the Every Breath Counts Coalition, will build on the support we provided as the official communications partner of the first Global Forum on Childhood Pneumonia in Spain in January 2020, by continuing to seek ways to amplify the communications and advocacy strategies of Coalition partners and to work together to drive lasting reductions in deaths from respiratory illnesses like pneumonia, in the wake of the COVID-19 pandemic and beyond. Our support for the #EveryStepCounts campaign is an example of our commitment to highlighting the work of Coalition leaders.

(10) The Every Woman Every Child (EWEC) Innovation Marketplace will support innovations that target the leading killers of children under five including pneumonia. Through it activities of curation and brokering, the marketplace will identify and help to catalyze investments in child-friendly medications and devices which will improve diagnosis and treatment of pneumonia in children in low and middle-income countries.

(11) FHI 360 works globally to address the complex challenges of human development with a unique mix of multidisciplinary, integrated solutions with areas of practice including health, civil society, communication and social marketing, economic development, education, youth, gender, nutrition, research, technology and the environment. FHI 360 strongly endorses the mission of the Every Breath Counts Coalition to end preventable child pneumonia deaths, and will work to expand access to prevention, diagnosis and treatment of pneumonia and related respiratory conditions among children and adults by leveraging our global programmatic, technical, policy, and research platforms across disciplines and across geographies.

(12) Gavi will engage governments in the focus countries with no pneumococcal conjugate vaccine (PCV) coverage to explore accelerated introduction of the vaccine and increase coverage of the vaccine in those focus countries with very low coverage.  When introducing or expanding PCV coverage in the focus countries, Gavi will work with governments and other partners to ensure that other aspects of pneumonia prevention, diagnosis and treatment are integrated with vaccine promotion, training and delivery to increase impact on child lives saved and strengthen health systems.

(13) The GE Foundation in partnership with Government Ministries of Health, multi-lateral agencies and civil society partners will continue to expand access to medical oxygen in select countries.  With oxygen solutions focused on public-private partnership and innovative financing, GE and GE Foundation are committed to eliminating oxygen deserts globally. 

(14) GlaxoSmithKline (GSK) will continue to play a key role in the sustainable and accessible supply of childhood immunizations, notably through the PCV Pneumococcal Conjugate Vaccine Synflorix, as well as respiratory, and cough & and cold medicines.  Synflorix is currently used in Universal Mass Vaccination programs in more than 40 countries and, since 2010, more than 300 million doses of Synflorix have been delivered to developing countries through GSK’s partnership with Gavi under the Advanced Market Commitment (AMC). As part of this ongoing commitment, GSK will make 720 million doses of Synflorix available by the mid-2020s to help protect children in developing countries. GSK has also pledged to provide Synflorix to Civil Society Organizations (CSOs) delivering immunization programs for refugees in circumstances where governments are not able to respond. GSK and PATH are collaborating to support the implementation of the WHO recommendations for the treatment of childhood pneumonia and neonatal sepsis with amoxicillin dispersible tablets. The study is focused on understanding the current pneumonia and neonatal sepsis treatment landscapes in Bangladesh and Kenya and identifying key bottlenecks that may prevent greater access to, uptake of, and appropriate use of amoxicillin dispersible tablets in these countries. Depending upon the findings of the study and in collaboration with local stakeholders GSK intends to co-develop a strategy to address critical determinants of access and to address gaps in supply, demand and appropriate use. GSK is also committed to partnering with organizations on joint advocacy efforts to help increase awareness of the impact of pneumonia, as well as gain support from donor and local governments.

(15) Global Alliance on Health and Pollution (GAHP), a collaborative body made up of more than 60 members and dozens of observers that advocates, will raise global and national awareness about the impacts of air pollution on health, especially that of children and teenagers, and assist countries to take action to reduce disease and mortality from air pollution. GAHP helps countries requesting assistance to prioritize their pollution problems, and identify the sources of pollution and cost-effective solutions that deliver measurable improvements to health. GAHP also supports research, and engages in globally advocacy efforts to increase attention and resources to pollution problems, including ambient and indoor air pollution. GAHP will make this support available to the Every Breath Counts focus countries and will contribute to global advocacy efforts to raise awareness about the need to reduce children’s exposure to air pollution to achieve the child survival SDG.

(16) Global Good/Intellectual Ventures will develop for the focus countries new technologies to improve child pneumonia treatment, including a reservoir mask and an oxygen storage system that can significantly increase access to oxygen in settings with unreliable treatment capacities due to unsustainable logistics or interrupted power. In addition, Global Good/Intellectual Ventures will develop better, simpler, more affordable vital sign monitoring tools to enable better management of pediatric patients. Global Good will ensure that stakeholders in the focus countries are aware of these new treatment and patient management technologies and their potential impact on child survival and of the need to invest in the critical health treatment infrastructure that can sustain oxygen systems – from generation, to delivery, to maintenance.   

(17) Grand Challenges Canada (GCC) will evaluate for possible support through its Transition-to-Scale program pneumonia innovations that have the potential to save and improve the lives of pregnant women, newborns and children under five years of age in the focus countries. GCC is committed to stimulating the pipeline for more cost-effective innovations to improve the market for pneumonia diagnosis and treatment in low- and middle-income countries, with a focus on sustainable scale. GCC is also committed to identifying and supporting entrepreneurs and innovators with promising pneumonia technologies from the focus countries.

(18) ICV Group (Investment Community Visibility) connects hard-to-reach Family Offices and leading Fund Investors to evaluate opportunities that create a social impact beyond a financial return. ICV is committed to mobilizing the funding required to find solutions to the Sustainable Development Goals. In this context, ICV will bring visibility to the burden of pneumonia and catalyze investment in innovations and breakthrough technologies that target the leading killer of children under 5 as part of our overall effort to save women’s and children’s lives.

(19) The Barcelona Institute for Global Health (ISGlobal) will provide technical assistance in the specific areas of epidemiology, diagnostics, antimicrobial resistance and post-mortem methodologies, and their links to pneumonia. ISGlobal’s expertise in infectious diseases and respiratory health at a global level, and more particularly on the African continent, will be offered to the Every Breath Counts Coalition and ISGlobal will act as a local and global advocate to enhance pneumonia’s visibility and strengthen its recognition as one of the major threats to child survival.

(20) The International Vaccine Access Center (IVAC) at the Johns Hopkins Bloomberg School of Public Health accelerates equitable and sustainable access to vaccines in low- and middle-income countries by generating, synthesizing and using evidence to inform decision making and action. IVAC works with governments and major research institutions in 38 countries (including all of the Every Breath Counts countries) on over 15 vaccine-preventable diseases and syndromes, including the pneumonia-fighting vaccines, pneumococcal conjugate vaccine (PVC) and Hib. IVAC also produces several studies, reports and online tools relating to pneumonia, including the Pneumonia and Diarrhea Progress Reports, and the VOICE – Value of Immunization Compendium of Evidence –  tool. IVAC will ensure that the Every Breath Counts Coalition is able to use IVAC evidence, tools and case studies in the development of national pneumonia control strategies and in global and national advocacy efforts. More broadly, IVAC will provide guidance to the EBC countries on how to use these tools to inform the development and implementation of policies and programs that accelerate progress to the GAPPD target.

(21) Jhpiego will support the mission of the Every Breath Counts Coalition to close critical gaps in prevention, diagnosis and treatment of pneumonia among children by facilitating strategic partnerships in maternal and child health in many low and middle income countries where Jhpiego operates as well as globally. Jhpiego will advocate for expanded access to programmatic and technological solutions to improve access to diagnostics, including pulse oximetry for children and adults alike in the era of COVID-19 and beyond, and provide technical assistance to community based organizations, governments, and other local stakeholders to expand access to integrated services for children and their families.

(22) “la Caixa” Foundation will work to reduce pneumonia-related child mortality by increasing coverage of the PCV vaccine for pneumonia prevention; improving the diagnosis of pneumonia through the use of innovative solutions that automatically measure the respiratory rate (ARIDA) and oxygen saturation (pulse oximetry); increasing the procurement of amoxicillin dispersible tablets and access to oxygen therapy for pneumonia treatment; investing in capacity-building of frontline community health workers as they can have a significant impact in reducing child mortality by timely diagnosis and correct treatment; and raising awareness through advocacy and sensitization campaigns which would, in the medium to long term, strengthen global action and the Sustainable Development Goals agenda to end child deaths by pneumonia by 2030.

(23) LeanMed will ensure that its first product, the O2 CUBE, contributes to the goals of the Every Breath Counts Coalition by facilitating unparalleled community access to timely diagnosis and treatment of respiratory infection. This will be accomplished through robust provision of pulse oximetry and supplemental oxygen within the setting of the rural health center and during patient referral, where their frequent lack may otherwise result in delayed care and patient fatality. From its initial introduction in Malawi, LeanMed aims to expand implementation of its O2 CUBE system into multiple target countries of the Coalition, including Nigeria and Ethiopia.

(24) Lifebox will distribute Lifebox pulse oximeters to anesthesia providers in the focus  countries and train healthcare and related staff in their use, procurement and maintenance. Further, Lifebox will make the new “newborn and child-friendly” Lifebox probe available in the focus countries in partnership with Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH), the Institute for Global Health at University College London (UCL), and Johns Hopkins University (JHU).

(25) McCann Global Health is committed to providing strategic communications, branding and marketing to raise awareness and deepen the impact of Every Breath Counts globally and in the focus countries. Support could include engaging influencers, executing “deep” communication efforts in the populations of mothers whose children are most at risk in the focus countries and coalescing the voices of all of the various child pneumonia stakeholders into a unified shout through a global brand platform.

(26) Malaria Consortium will develop a “Child Pneumonia Research Roadmap” to expose knowledge gaps and set research priorities, with special attention to the focus countries. Major research priorities in childhood pneumonia could include, (1) identifying the predictors of development of severe pneumonia and the children who require urgent referral or hospitalization, (2) understanding the main barriers to care seeking for children with pneumonia in different contexts, and which social and behavior change communication strategies can be effective in increasing demand for formal health services, and (3) developing diagnostic tests or diagnostic algorithms than can better detect pneumonia in children.

(27) Masimo will develop a combined pulse oximeter and respiratory rate timer specifically suited to low resource settings and increase its uptake in the focus countries, working with partners to train healthcare staff in its use, procurement and maintenance. With an initial focus on Nigeria and Ethiopia, Masimo will develop models of country engagement that can be expanded to other focus countries in future years.

(28) The Newborn Foundation will expand routine pulse oximetry testing of newborns born in hospitals in the focus countries, with an initial focus on Ethiopia and Nigeria, in partnership with Masimo. The Foundation will also explore the applications of promising new technologies that can reduce newborn deaths, especially from pneumonia, in the focus countries, including lung ultrasound – an early-stage pneumonia diagnostic innovation.

(29) No Wasted Lives recognizes that wasting is a global risk factor for pneumonia death in children under five years of age. Actions to reduce wasting will therefore have a major impact on preventable pneumonia deaths. No Wasted Lives will raise awareness about the relationship between pneumonia and wasting, and will continue to work in partnership with governments, community groups, companies, NGOs, UN agencies, research and academic institutions, and donors, to change the course of this injustice, championing the acceleration of a child survival revolution.

(30) Novartis/Sandoz will help prevent the deaths of millions of children worldwide. Our generics division Sandoz supplies pediatric amoxicillin treatment courses to UNICEF and MSF, playing a leading role in the response to the growing global need for this formulation of anti-infective recommended by the World Health Organisation as the first-line treatment for pneumonia in children under five. Novartis will work with Coalition partners to help countries target and increase investments to close critical gaps to end preventable child deaths, including expanding pneumococcal vaccine coverage alongside increasing access to better diagnosis and treatment tools, especially pulse oximetry, child-friendly amoxicillin, and oxygen. Through Novartis Social Business, we will continue to contribute to initiatives that are improving healthcare and access to medicines for children, including the expansion of access to community education, improved infrastructure, and affordable healthcare products targeting high-burden diseases for children and families in South Asia and Sub-Saharan Africa.

(31) The Oxygen for Life Initiative (OLI) will work with Federal and State governments, Local Government Authorities, donors, and the private sector to scale-up pulse oximetry and oxygen activities and improve case-management of pneumonia in Nigerian hospitals and primary health care centers. OLI is a non-profit, non-governmental organization that was founded in 2017 to expand the work of the Nigeria Oxygen Implementation Project, which helped hospitals in 4 south-west states to improve their oxygen systems and reduce case fatality rate (funded by the Bill & Melinda Gates Foundation). OLI works through strategic partnerships with individual hospitals, state and federal government departments, donor agencies, and private enterprise. OLI’s unique role is as an implementing partner, bringing a holistic and evidence-based approach to the provision of oxygen to patients in hospital – for Nigerians, by Nigerians.

(32) Partners in Health (PiH) will use its close proximity to patient care and connections with Ministries of Health and other policy makers to advocate for increased resources for childhood pneumonia at the global level, and in the countries in which we work. PiH can also provide technical assistance to national governments and partners operating in the focus countries on how to strengthen all levels of pediatric pneumonia care – from the community to primary care centers to secondary- and tertiary-level hospitals. Further, PiH can support application of the Mentorship and Enhanced Supervision for Health Care and Quality Improvement (MESH-QI) program, which uses clinical experts to build national capacity and train providers on best practices for the diagnosis and care of childhood pneumonia and  other common illnesses.

(33) PATH will support efforts to prevent, diagnose and treat child pneumonia in the 10 focus countries as well as globally, with a particular emphasis on vaccines, oxygen therapy, and antibiotic treatment. PATH will continue to apply its expertise in vaccine development and delivery to accelerate the development of new pneumococcal vaccines with an emphasis on ensuring they are effective, affordable, and sustainably accessible for the countries who need them most. To help make oxygen therapy more available and accessible, PATH will advocate at the global, national, and sub-national levels for the importance of oxygen in achieving national and global heath goals, especially as they relate to maternal, newborn and child survival. Through dissemination of Oxygen is Essential: A Policy and Advocacy Primer, PATH will arm country advocates with evidence-based resources and messages to inform and engage decision-makers and policy influencers to stimulate their support for increased access to oxygen. In the DRC specifically, PATH will assess the child pneumonia continuum of care landscape, identifying opportunities to strengthen the health system and markets. PATH will also pursue policy change in the DRC that specifically advances access to oxygen therapy with pulse oximetry, and support implementation of this policy down to the sub-national level. Globally, PATH will also work with select manufacturers of oxygen technologies to ensure that they design devices to meet the unique needs of low resource settings. PATH will support efforts to include pulse oximetry and oxygen coverage on the Lives Saved Tool (LiST) and integrate coverage into existing global health data surveys and hospital audits. Finally, PATH will also advance the antibiotic innovation agenda by developing new heat stable, ready to use, child friendly formulations of antibiotics like “NutMox” a new formulation of amoxicillin in a peanut butter matrix.

(34) Pfizer will build on the commitment to supply up to 740 million doses of our pneumococcal conjugate vaccine (PCV) through 2025, via our partnership with Gavi the Vaccine Alliance. Pfizer also provides support for programs and disease awareness, which is intended to help improve vaccination rates. In Niger, Mali and the DRC, Pfizer supported health care worker training intended to help people recognize the early signs of pneumonia and inform caregivers of the importance of vaccination.  Plans are in place to extend this training to Angola. In addition, the Pfizer Foundation supports several programs aimed at increasing access to, and the quality of, immunizations and other health interventions. These programs are considered important to child health and survival in several countries in sub-Saharan Africa, including Ethiopia, Uganda, Malawi, Kenya and Benin. Note the Pfizer Foundation is a charitable organization established by Pfizer Inc.  It is a separate legal entity with distinct legal restrictions.  

(35) Philips will work in partnership with governments, UN agencies and civil society partners to make the ChARM device available in the focus countries and will explore testing the new integrated Spot Check Monitor in one of the focus countries. In addition to improving diagnosis, Philips is committed to devices that better capture patient data and provider performance cost-effectively and which can be easily shared across large networks informing further performance improvement.   

(36) PneumoLight: Light for the Education and Prevention of Pneumonia is a non-profit, collaborative project committed to increasing the visibility of pneumonia worldwide and to raising public awareness of its risks. The ability to identify early pneumonia symptoms and the readiness to seek emergency medical care are crucial to the initiation of early treatment, especially in major risk groups like children under the age of five, the elderly, and persons with co-morbidities. The PneumoLight  will bathe emblematic buildings in blue light on World Pneumonia Day each year. Increasing the visibility of pneumonia will allow us to educate the public and spread scientifically-proven data on this disease. PneumoLight will engage the global scientific community in responding to the questions of the general public and health practitioners about all aspects of pneumonia: its management, risk groups, short and long-term complications, mortality, rehabilitation and other preventive measures. Educational information about pneumonia will be spread using the hashtag #PneumoLight via social networks.

(37) Results for Development (R4D) will support activities to increase the availability and use of child pneumonia treatments in public health facilities in Ethiopia. In partnership with the Government of Ethiopia and other key stakeholders, R4D will increase awareness of amoxicillin dispersible tablets as the first-line treatment for pneumonia among health practitioners and policymakers at the regional and district levels; ensure that robust quantification and financial gap analyses for amoxicillin dispersible tablets are conducted; engage with high-quality manufacturers of tablets to encourage registration in country; and continue to administer catalytic procurement funding while supporting the Federal Ministry of Health to mobilize domestic funding sources for these tablets. Additionally, R4D will share learnings from its formative research in Tanzania to ascertain rates of over- and under-diagnosis of pneumonia and to identify and pilot interventions that could drive increased rational use of amoxicillin dispersible tablets. R4D’s findings could be leveraged in Coalition focus countries to improve the quality of care around childhood pneumonia.

(38) Save the Children (StC) will partner in four of the focus countries (and  others) to change the trajectory of child pneumonia deaths through programming, policy, advocacy, innovations, research and campaigns. StC will work to build global political attention for pneumonia mortality within the movements to end all preventable child deaths, to improve women’s children’s and adolescents’ health and  nutrition, and Universal Health Coverage. StC will champion innovative and equitable approaches to pneumonia prevention, diagnosis and treatment by expanding the reach and impact of the Pneumonia Innovations Network, a 350 strong global network of innovators advancing better ways to prevent, diagnose and treat child pneumonia, which will be hosted by Save the Children, and StC will champion reductions in PCV vaccine pricing to reduce the costs to non-Gavi eligible countries. Save the Children’s global advocacy to end preventable child pneumonia deaths will include the education and engagement of a new generation of “influencers”, the publication of reports, and the inclusion of child pneumonia at high-level gatherings of development leaders. Save the Children will also  lead and co-ordinate advocacy activities within the Every Breath Counts Coalition as part of its wider, long-term partnership with GSK to help end preventable deaths for children under 5 from infectious diseases.

(39) Sesame Workshop, the nonprofit organization behind Sesame Street and educational media initiatives around the world, is committed to improving health outcomes for vulnerable populations, and is proud to join the Every Breath Counts Coalition with the aim of helping to end preventable child pneumonia deaths by 2030. Sesame Workshop’s international work focuses on providing access to early education, critical health messages, and tools for vulnerable children. With a combination of mass media and targeted distribution, Sesame Workshop’s multi-platform initiatives promote behavior change by empowering children, parents and caregivers with the knowledge and skills they need to stay healthy. Using the unique power of media and muppets, Sesame has addressed some of the world’s most challenging health crises, including HIV/AIDS awareness and destigmatization in South Africa, and malaria prevention in Tanzania. Sesame Workshop is currently engaged in a multi-country behavior change communication initiative specifically addressing WASH, throughout sub-Saharan Africa, South Asia, and the Middle East. Sesame Workshop will work with the Every Breath Counts Coalition to help families and educators in these regions protect children from pneumonia.

(40) UNICEF will work in partnership with WHO and other stakeholders to accelerate child pneumonia mortality declines in the focus countries by: (1) advancing WHO pre-qualification for the medicines used to treat pneumonia, including amoxicillin dispersible tablets and antibiotic injectables for sick newborns, (2) Encouraging countries to participate to the WHO collaborative procedure for accelerated registration, and incorporating mutual recognition of registration which will help improve access where product registration could have been a barrier, (3) supporting the development of local markets and production for quality amoxicillin dispersible tablets and other medicines used to treat pneumonia, (4) improving access to new tools for early and more effective diagnosis and management of pneumonia and hypoxemia with support from “la Caixa” Foundation, and (5) improving procurement mechanisms for oxygen technologies, with support from the Bill & Melinda Gates Foundation. Further, UNICEF will provide technical support to focus countries for pneumonia prevention and treatment – including efforts to improve household air quality, breastfeeding rates and child nutrition, and PCV vaccine coverage, as well as increasing understanding of the links between these investments and child pneumonia mortality reductions. UNICEF will work closely with the US Fund for UNICEF to raise awareness and mobilize resources from US donors for the prevention, diagnosis and treatment of childhood pneumonia.

(41) Unitaid  is committed to accelerating the availability, adoption and scale-up of  portable, new-generation pulse oximeters that can quickly identify which children are in immediate danger of death—those with severe disease—so that they can be referred, hospitalized and treated without delay. Unitaid is also exploring opportunities to support the development of tools that can better distinguish between bacterial and non-bacterial infections at the point of care. These new tools hold the potential to help many children survive pneumonia and other causes of child mortality in lower-resource countries.

(42) The United4Oxygen Alliance, which includes companies, non-profits, and UN and government agencies, will expand its work to Nigeria, specifically to support the Government of Nigeria’s national plan to improve access to pulse oximetry screening and oxygen therapy. United4Oxygen will mobilize existing partners and engage new partners with a presence in Nigeria to, (a) increase the availability of pulse oximetry screening and oxygen therapy in health facilities, (b) train local staff in the use of new technologies, (c) establish sustainable financing solutions for the procurement, installation, and maintenance of new equipment, and (d) support the government to measure the impact of the initiative on national child survival goals. This work will be launched as a second CGI Commitment to Action and will build on best practices from the Alliance’s work in Ethiopia. United4Oxygen partners include Adara Development, Assist International, GE Foundation, Bill & Melinda Gates Foundation, Centre for International Child Health, Diamedica, Center for Public Health and Development, Gradian Health Systems, Grand Challenges Canada, Malaria Consortium, Masimo, PATH, Philips, Pneumonia Innovations Network, Save the Children, UNICEF, University of Alberta, USAID, and the World Federation of Societies of Anaesthesiologists (WFSA).

(43) The University of Melbourne’s Centre for International Child Health will support hospitals and governments in Nigeria and Ethiopia to implement effective oxygen systems through oxygen and pulse oximetry training, equipment installations, technical support, and testing of novel oxygen systems. The Centre will share results and materials from these activities for wider learning and dissemination.

(44) USAID is partnering with UNICEF to support country-led strategies to fight pneumonia within the context of their basic package of services. This will involve understanding the supply and demand-side barriers to pneumonia prevention, diagnosis, and treatment, and will draw on best practices and innovations to overcome existing obstacles. USAID continues to focus on the prevention, diagnosis, and treatment of pneumonia as part of our overall effort to save women’s and children’s lives.

(45) Vital Strategies is a global public health organization that works in partnerships with governments to develop evidence-based public health policies, manage programs efficiently, strengthen public health systems, conduct research, and design strategic communication campaigns for policy and behavior change. Our Environmental Health division works with governments and key civil society partners to accelerate clean air progress to improve health. Vital Strategies is committed to increasing public awareness about the relationship between air pollution exposure and the risk of child pneumonia as well as strengthening the technical capacity of civil society (e.g. journalists, clinicians) and decision makers to understand, address, and communicate about air pollution as an environmental health threat beyond the traditional span of public health control. Similarly, Vital Strategies will work across sectors to prevent child pneumonia by controlling air pollution. Vital Strategies will continue to build the capacity and reach of Inspire: Health Advocates for Clean Air – a global coalition of mobilized clinicians, public health professionals, and organizations to advocate for clean, healthy air – by providing resources and conducting trainings for clinicians on air pollution and its adverse health outcomes, including child pneumonia. Furthermore, Vital Strategies will continue to collaborate with partners including UNICEF, Clean Air Asia, Climate and Clean Air Coalition, World Health Organization, and Eastern African GEOHealth Hub to raise the profile of outdoor and household air pollution as major risk factors and engage the health sector in promoting clean air and accelerating access to clean household energy. Vital Strategies will partner with cities across the globe to implement cost-effective and easily scalable urban health innovations to promote clean air. Vital Strategies will also continue working with government partners in Indonesia to design an air quality management plan for DKI Jakarta that prioritizes the reduction of adverse health outcomes like child pneumonia.

(46) VIA Global Health will work with the Every Breath Counts Coalition to leverage its eCommerce platform and services to enable low- and middle-income countries (LMICs) to access life-saving medical equipment and supplies to reduce deaths from respiratory infections, including from COVID-19 and other causes. We will ensure that out platform offers the information, supplies and services necessary to enable our customers in the public, private and NGO/FBO sectors to improve the respiratory health of their communities during the pandemic and beyond. VIA will partner with suppliers, implementing partners and innovators with expertise in respiratory-related technologies and offer customers support with scale, fulfillment services (transactions and logistics), market insights from different geographies and customer segments, and content to support informed decision-making in the purchasing process.

(47) ZMQ, a “technology-for-development” non-profit, will continue to support LMICs to use ICT tools, solutions, systems and mobile apps to increase awareness about pneumonia and improve referral and care.  We further commit to working with partners to develop customized grassroots stories in regional and vernacular languages which will be promoted and disseminated through two of ZMQ’s pioneering programs – YST (YourStoryTeller) and MIRA Channel. YST and MIRA will also support data capturing to assess behavior change. ZMQ is committed to support total turn-key solutions to reduce pneumonia deaths in LMICs, including as a consequence of COVID-19, by using information and communications technologies for development (ICT4D).

The Every Breath Counts Coalition is in support of the United Nations (UN) Sustainable Development Goals, especially SDG 3.2, the Global Strategy for Women’s, Children’s and Adolescents’ Health, and the UN Secretary-General’s Every Woman, Every Child movement.

For more information visit StopPneumonia.org and follow @Stop_Pneumonia on twitter.