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.