Joining forces to fight a silent and forgotten killer
SDGS IN ACTION! PARTNERSHIPS AND INNOVATION TO END PNEUMONIA
NEW YORK CITY, NOVEMBER 3RD, 2017
Unless you are one of the six million families whose children are alive today because of advances made over the last 25 years, you probably aren’t aware that we are right smack in the middle of one of the most important revolutions our species has engineered.
In just 25 years the number of children who die before they turn five has fallen from 12 million to under six million. Saved by improvements in education (especially among women), nutrition, incomes, clean water, sanitation, vaccinations and access to medicines, the rate at which our children die has never been lower.
And yet we are only half way home. We still need to prevent the deaths of over five million children under five, and we have just over a decade to do it, according to the new global goals that 193 countries have promised to achieve.
It’s not going to be easy. The children now at greatest risk of death live in the toughest places and face many challenges. We will need even better tools to prevent, diagnose and treat the leading threats to their survival, and, with limited resources, we will need to make tough choices about what to prioritize if we want to save the maximum number of lives.
In this context, how inspiring it was to see UNICEF, “la Caixa” Foundation and the Bill & Melinda Gates Foundation uniting to fight one of the biggest barriers almost every country will face in crossing the finishing line on child survival at “SDGs in Action! Partnerships & Innovation to End Pneumonia”, held on November 3rd in New York City.
Paloma Escudero, the Director of Communications at UNICEF (@PalomaUnicef), welcomed an audience of over 100 assembled at UNICEF headquarters and encouraged them to work harder and smarter to fight child pneumonia. Javier Martos, Executive Director of UNICEF Spain (@fjmartosm), introduced H.R.H the Infanta Cristina of Spain, Director, International Programmes at “la Caixa” Foundation (@FundlaCaixa), who proved again that “la Caixa” Foundation is one of the strongest and most consistent voices for more action in the fight against pneumonia.
Stefan Swartling Peterson, UNICEF’s Chief of Health (@stefanswartpet), kicked off the program arguing strongly that pneumonia’s heavy death toll (almost one million children every year and many more adults) and slow rate of decline relative to other infectious diseases, warranted a major, coordinated push from governments, UN agencies, companies, and development organizations to protect, prevent and treat the most vulnerable children.
To help determine exactly how to do that, Laura Frost (@laurajfrost) and Michael Reich (@GHP_HarvardChan) presented their “access framework”, a strategy to simultaneously address four factors essential to the uptake of new technologies — architecture, availability, affordability and adoption. By syncing these “4 A’s”, Frost and Reich argue, the market, government, and non-government agency failures that block the uptake of lifesaving technologies at the global, national, and local levels can be effectively counteracted.
To explore how the “4 A’s” might be applied to pneumonia, four innovators gave “TED talk-style” presentations. Kristoffer Gandrup-Marino, Chief of Innovation at UNICEF Supply Division (@unicefsupply), described the new “architecture” UNICEF has built to develop a new generation of pneumonia diagnostic devices as part of the Acute Respiratory Infection Diagnostic Aid (ARIDA), project while Jim Black, co-founder of the FRE02 Foundation(@FRE02_AU), outlined a radical rethinking of the concept of oxygen “availability” with an ingenious system that sources and stores oxygen in completely new ways.
Mary Muhindo, Principal Investigator in the “NoviGuide” trial in Uganda, demonstrated how nurse “adoption” of a new technology to improve newborn care developed by Global Strategies (@GlblStrategies) could reduce newborn deaths, including from pneumonia. Finally, Bernard Olayo from the Center for Public Health and Development (@CPHDev), laid out the impressive oxygen system his team has built in Kenya. This system, called Hewe Tele, provides oxygen installation, training and maintenance to clusters of hospitals at much more “affordable” prices.
One idea that captured the attention of many was the development of “pneumonia control strategies” by the countries struggling with large child pneumonia burdens and slow progress in reducing deaths. These strategies would set national target rates of reduction in child pneumonia mortality compatible with SDG achievement (e.g. 5% per year until 2030) and specific coverage targets for vaccines (e.g. 80% pneumococcal), nutrition (e.g. <5% wasting), diagnosis (e.g. 80% pulse oximetry) and treatment (e.g. 80% amoxicillin and/or 80% oxygen, for children appropriately diagnosed). In addition, governments would need to monitor female literacy, level of education and incomes, as well as child exposure to air pollution, including tobacco smoking, as part of national pneumonia control efforts. Most critically, governments would identify the largest populations of children most at risk of death from pneumonia and prioritize coverage improvements in these populations, reporting publicly at regular intervals.
Several promising new initiatives were announced at the summit. Carolyn Miles, CEO of Save the Children in the US (@carolynsave), Stefan Peterson, Ngozi Onwudiwe, and Lisa Bonadonna, Global Head of GSK-Save the Children Partnership (@lisa_bonadonna) announced the Every Breath Counts Coalition. The Coalition is a public-private partnership of 30 organizations who have joined forces to help ten countries with the largest numbers of children at highest risk of death from pneumonia end preventable child pneumonia deaths by 2030. Support offered will range across the pneumonia prevention, diagnostic and treatment landscape with the most life-saving interventions prioritized.
Carolyn Miles was then joined by Simon Wright, Head of Health (Policy & Advocacy) at Save the Children in the UK (@morningsimon), to launch a hard hitting new report, “Fighting for Breath. A call to action on childhood pneumonia”. The report signals the beginning of a global campaign led by Save the Children that promises to lift pneumonia advocacy to new heights.
Finally, continuing with the strong focus on access to oxygen throughout the day, Kristoffer Gandrup-Marino outlined a new WHO/UNICEF collaboration, “Increasing Access to and Utilization of Oxygen Systems,” and Ngozi Onwudiwe announced that the Government of Nigeria was releasing its first national access to oxygen plan and joining forces with the United4Oxygen Alliance to implement it. Nigeria is only the second African nation after Ethiopia to launch a national access to oxygen strategy.
Despite the strong push for a focus on childhood pneumonia throughout the day, there was no appetite to create another “vertical” disease effort, as it was widely acknowledged that although the flagship, stand-alone malaria and AIDS programs have prevented many deaths, especially among adults, they have also contributed to distortions in national health systems and drawn resources away from the leading killers of children. The summit stressed that any special push to accelerate uptake of pneumonia vaccines, diagnostic and treatment services should be delivered as part of the integrated delivery of health and related services at all levels of the health system.
It was my honor to moderate the day’s discussion, to applaud the leadership, partnership and innovation on display, and to reinforce that a great deal is at stake if all of the groups represented in the room fail to double down on their efforts to end preventable pneumonia deaths. Certainly the achievement of the global health goals will lie beyond the reach of many, many countries, but more critically, if governments, UN agencies, companies, and non-profit agencies make a conscious decision not to pay attention to an infection that is preventable and treatable, hundreds of thousands of children will continue to die each year.
Under this scenario, where will responsibility for their deaths ultimately lie?