The pneumonia-fighting vaccines and the child survival revolution

Not all vaccines are created equal

Some target the leading killers of children and so their widespread use can prevent hundreds of thousands of deaths, every year.

Like the two pneumonia-fighting vaccines – pneumococcal and Hib.

Not only do these vaccines target the two leading causes of severe pneumonia – the bacteria Streptococcus pneumoniae and Haemophilus influenzae type b – but they are super-effective at what they do.

For example, seven years after the introduction of the pneumococcal vaccine in the US, rates of infection among children fell from 80 per 100,000 to less than 1 (CDC).

We are just starting to see impact in the low and middle income countries that have introduced the pneumonia-fighting vaccines in recent years.

Take Mali, the Demoratic Republic of Congo, Pakistan and Ethiopia.

In 2010, children in Mali did not get pneumococcal vaccine and an estimated 24,200 died from pneumonia. Now with 70% coverage of the vaccine, child pneumonia deaths have more than halved to 11,000.*

In 2011, 89,000 children died from pneumonia in the Democratic Republic of Congo. By 2016, pneumococcal and Hib vaccine coverage was almost 80% and child pneumonia deaths had fallen to 46,000.

In Pakistan and Ethiopia, child pneumonia deaths have fallen by more than 20% in the last five years following introduction of the pneumococcal and Hib vaccines.

Pneumonia-fighting vaccines impact the child mortality rate

As pneumonia is the #1 killer of children in most low and middle income countries, reductions in child pneumonia deaths feed straight into reductions in the child mortality rate, helping countries make good on their promise to drive child mortality rates to below 27 by 2030 and achieve Sustainable Development Goal 3.2.

For example, in 2008, 125 out of every 1,000 children in Niger did not reach their 5th birthdays. Since the introduction of pneumococcal and Hib vaccines, the rate has dropped to 91.

In 2012, 164 out of every 1,000 children in Angola did not reach their 5th birthdays. With Hib and pneumococcal vaccine coverage now around 60%, the number has dropped to 83.

In 2013, 100 out of every 1,000 children in Afghanistan did not reach their 5th birthdays. With Hib and pneumococcal vaccine coverage above 60%, the number had dropped to 70.

If progress at this rate continues, Niger, Angola and Afghanistan will all achieve the child mortality goal by 2030 (World Bank).

In contrast, the countries with high child mortality that have not prioritized coverage of the pneumonia-fighting vaccines are continuing to pay a heavy price.

Somalia, with very low Hib and no pneumococcal vaccine coverage, is losing the same number of children from pneumonia in 2016 as it did in 2012 – 14,000.

In Nigeria, an estimated 128,000 children under five died from pneumonia in 2012. Fast forward to 2015 and the same number of children are dying. The very low rates of both Hib (49%) and pneumococcal (26%) vaccine coverage are partly to blame.

Chad is the most alarming of all. With very low rates of Hib and no pneumococcal vaccine coverage the number of children who die from pneumonia has actually risen since 2012 from 15,000 to 19,000.

Vaccines are necessary but not sufficient

But although wide adoption of the pneumonia-fighting vaccines is a necessary precondition for dramatic reductions in child pneumonia deaths in most low and middle income countries, it is not sufficient to end them.

This is because the pneumonia-fighting vaccines only protect against half of the causes of severe pneumonia, and even with most children fully immunized, up to 50% of a country’s child pneumonia deaths will likely remain.

To close this gap, countries will need to have robust pneumonia control strategies that target their biggest vulnerabilities.  In many countries, child malnutrition will keep child pneumonia mortality high and countries will need to double down on support for breastfeeding and complementary feeding, as well as treatment for child wasting. In others, major barriers will be low levels of family awareness of pneumonia and poor care seeking behavior, and governments will need to support family education campaigns and remove barriers to care seeking, focusing on the most at-risk populations.

Still in other countries, increasing access to proper diagnosis and treatment will be the top priority, and will require wide adoption of diagnostic tools like pulse oximetry, and access to child-friendly amoxicillin and oxygen. Many countries cannot continue to ignore the impact of household air pollution on child health and will need to target tobacco smoking and cooking with wood and animal waste.  

To help governments identify and fill their specific pneumonia control gaps, more than thirty organizations have joined forces in the Every Breath Counts Coalition. The Coalition was launched in November 2017 and has identified ten focus countries** with very large populations of children at greatest risk of death from pneumonia where the case for external support to national government efforts is strong.

Coalition members will begin their work in Nigeria in 2018, supporting government efforts to increase the rate of reduction in child mortality by zeroing in on Nigeria’s leading killer of children under five – pneumonia. Preliminary analysis shows that closing Nigeria’s child pneumonia diagnosis and treatment gaps, together with increasing vaccine coverage and reducing child wasting will have the greatest impact on child survival, especially if focused on the newborns and children under five living in the northern states.

*All child mortality data from UNICEF, A Promise Renewed Progress Reports, 2012-2015.

**Chad, Nigeria, Angola, Niger, Somalia, Mali, Democratic Republic of Congo, Afghanistan, Pakistan and Ethiopia.

How you can support

  1. Share this statement from the founding leaders of the Every Breath Counts Coalition – UNICEF, Save the Children, PATH, the Clinton Health Access Initiative, GSK, and Masimo
  2. Support the Every Breath Counts Pneumonia-Fighting Vaccines Campaign on social media using the hashtags #vaccineswork #protectedtogether #everybreathcounts #stoppneumonia and #childhealth
  3. Join the Every Breath Counts Coalition by contacting Leith Greenslade