Every Breath Counts Coalition

World’s first public-private partnership to support governments to reduce pneumonia deaths

An unprecedented number of organizations have joined forces in the Every Breath Counts Coalition – the first public-private partnership to support governments in low- and middle-income countries (LMICs) to reduce deaths from respiratory infections by 2030.

Pneumonia is the leading infectious killer of children and adults, responsible for an estimated 2,500,000 deaths in 2019, including 672,000 deaths among children under five, according to the Global Burden of Disease (GBD). This does not include the 3.5 million deaths from COVID-19 that occurred in 2021.

Prior to COVID-19, pneumonia deaths were declining, but at a much slower rate than other infectious diseases. Between 2000 and 2019, pneumonia deaths fell by just 14% compared to 86% for measles, 45% for HIV/AIDS, 37% for diarrhea and malaria, and 31% for tuberculosis deaths, according to the GBD.

Now with the pandemic disrupting routine health services, especially for children, many countries will struggle to drive child pneumonia deaths to below three per 1,000 live births, which is the rate required to achieve Sustainable Development Goal (SDG) 3.2. And with COVID-19 increasing respiratory infection deaths among adults, many countries will also struggle to achieve many of the other health SDGs.

Children in LMICs are especially vulnerable to death from pneumonia due to the combination of child malnutrition, air pollution, low birth weight, low vaccine coverage, limited female literacy, and poor access to health services. Adults, especially older adults, are also vulnerable to pneumonia when they are exposed to air pollution, tobacco smoking, and low temperatures. Co-morbidities have also placed adults at an increased risk of death from pneumonia caused by COVID-19.

Focused national and international efforts to identify and close the gaps in pneumonia prevention, diagnosis, and treatment for vulnerable populations could prevent most of the pneumonia deaths that are occurring each year. And when COVID-19 vaccines are at full coverage, deaths from SARS-CoV-2 should also fall dramatically.

To help governments in LMICs experiencing high burdens of pneumonia deaths among both children and adults, including from COVID-19, the Every Breath Counts Coalition is mobilizing members and supporters to help close the most critical gaps in pneumonia prevention, diagnosis, and treatment.

In most of these LMICs expanding coverage of the pneumonia-fighting vaccines (pertussis, Hib, PCV, measles, and now COVID-19) is a top priority because current coverage rates are often low. Improving access to proper diagnosis and treatment services with better tools like pulse oximetry and increased access to recommended antibiotics, oxygen, and therapeutic foods is also key.

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

And now with COVID-19 increasing pneumonia deaths among adults and also contributing to increases in child pneumonia deaths from other causes due to disruptions in health services, the Every Breath Counts Coalition is further focusing its efforts on  “double-burden” countries where large populations of both children and adults are dying from pneumonia and where COVID-19 deaths are high.

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 and Every Breath Counts on LinkedIn.

Updated September 2022

Specific activities the Every Breath Counts Coalition is prioritizing 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 diagnostic tools, and access to recommended antibiotics and oxygen treatments);
  • supporting country efforts to prioritize pneumonia in applications for funding from international health and development agencies (e.g., Gavi, the Global Fund, and the Global Financing Facility for Women, Children and Adolescents);
  • 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 improved diagnostic tools, pulse oximetry, recommended antibiotics, and oxygen therapies;
  • including pneumonia diagnostic and treatment tools and therapies 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 reduce pneumonia deaths by 2030, to raise awareness about 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 health and development agencies to assist Ministries of Health to accelerate reductions in 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 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 and adults who require urgent referral or hospitalization.

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) Air Liquide recognizes that the issue of access to medical oxygen in emerging markets is critical for treating such life-threatening conditions as childhood pneumonia and will contribute diligently to help achieve the Coalition’s mission. As a leading provider of medical oxygen and with it’s global presence, Air Liquide is committed to closing critical oxygen gaps to end preventable child deaths with sustainable business solutions and innovations. Our main objective is to ensure a high-quality, medical oxygen supply for the long term including equipment and services (maintenance, medical and technical, training, logistics etc.) based on validate and replicable processes. Medical oxygen needs to be available at every level of the health pyramid in emerging markets. Air Liquide will strive to offer solutions that meet the needs of hospitals and primary healthcare facilities, especially those serving rural areas. We note our continuing efforts in Senegal with our “Access Oxygen” inclusive business project developed by the i-Lab, Air Liquide’s innovation laboratory, in collaboration with the Healthcare teams and the Group’s entity in Senegal. Designed on the basis of observations of people’s actual needs, Access Oxygen is an all-in-one healthcare offer that includes the equipment and services needed to use medical oxygen in the treatment of acute communicable and non-communicable diseases in small suburban and rural healthcare centers.

(3) 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.

(4) 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.

(5) 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 through 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.

(6) Bloom Standard will support Every Breath Counts to increase access to automated, hands-free ultrasound for pediatric lung and cardiac applications to reduce newborn and child deaths from respiratory and health conditions. 95% of the world’s children currently lack access to pediatric ultrasound or echocardiography largely due to lack of affordable, portable equipment and skilled technicians to acquire and interpret images.

(7) Build Health International (BHI) will leverage their expertise in designing, building, and equipping healthcare infrastructure in low-resource settings to implement sustainable oxygen solutions. BHI will lend technical expertise on topics central to developing oxygen systems — such as PSA plants, piped oxygen, cylinder procurement, and solar power — to assist other organizations in combating oxygen inequities with on-the-ground solutions. Drawing on over a decade of experience building healthcare infrastructure in LMICs, BHI commits to working with partners within and beyond the Every Breath Counts Coalition to share learnings. BHI will work with partners to determine which oxygen solutions will be best suited for various settings and consult on how to sustain oxygen systems once installed. As a member of the Every Breath Counts Coalition, BHI will advocate for international investment in oxygen infrastructure and workforce development to support oxygen systems.

(8) 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.

(9) 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).

(10) 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.

(11) 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.

(12) 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 the diagnosis and treatment of pneumonia in children in low and middle-income countries.

(13) 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.

(14) Gavi, the Vaccine Alliance will engage governments in the focus countries with no pneumococcal conjugate vaccine (PCV) coverage to explore the 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 the impact on child lives saved and strengthen health systems.

(15) 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 partnerships and innovative financing, GE and GE Foundation are committed to eliminating oxygen deserts globally. 

(16) 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 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.

(17) 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 global 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.

(18) Global Health Labs 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 Health Labs will develop better, simpler, more affordable vital sign monitoring tools to enable better management of pediatric patients. Global Health Labs will ensure that stakeholders in the focus countries are aware of these new treatments 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.  

(19) 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 a sustainable scale. GCC is also committed to identifying and supporting entrepreneurs and innovators with promising pneumonia technologies from the focus countries.

(20) 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.

(21) 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.

(22) International Federation on Ageing (IFA) is a global point of connection and network of experts and expertise to influence and shape age-related policy global.  The IFA’s Vaccines4Life program in the context of healthy ageing is framed by three pillars – prevention, access, and equity – with the goal of improving uptake rates of adult vaccination. Vaccination is an important prevention strategy for combatting morbidity and mortality due to pneumonia. In alignment with the strategic priorities of the Immunisation Agenda 2030 and connecting principles of the UN Decade of Healthy Ageing, the IFA supports a life-course approach to pneumococcal vaccination which reaches priority adult groups and delivers integrated and person-centred immunisation services. IFA is aligned with Every Breath Counts in their mission to enable national governments to reduce the burden of pneumonia and prioritize immunisation throughout life to maximize health and well-being. 

(23) 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.

(24) 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.

(25) 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.

(26) 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 the 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 the implementation of its O2 CUBE system into multiple target countries of the Coalition, including Nigeria and Ethiopia.

(27) 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).

(28) 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.

(29) 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 the 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.

(30) 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.

(31) 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.

(32) 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.

(33) 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 Organization 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.

(34) 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 enterprises. OLI’s unique role is as an implementing partner, bringing a holistic and evidence-based approach to the provision of oxygen to patients in the hospital – for Nigerians, by Nigerians.

(35) Partners in Health (PiH) will use its close proximity to patient care and connections with Ministries of Health and other policymakers 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 the 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.

(36) 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 health 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. 

(37) 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.

(38) 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.   

(39) 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.

(40) 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 LMICs; 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.

(41) 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.

(42) Sentient Bionics will support the Every Breath Counts mission by helping LMICs increase access to the technologies that are essential for reducing deaths from respiratory illnesses. The company has developed a portable oxygen machine called “SentOx” to WHO specifications and commits to providing SentOx machines, ranging from free units supplied by donor funding, through to high-volume machines supplied by manufacturing partners. Sentient will support in-country manufacturing, technology transfer, training, support, localization, and supply of service parts to build a robust “Through Life Support” (TLS) system for SentOx. The aim is to supply a high volume of reliable, supported, robust SentOx machines for under $US500 per machine. Sentient Bionics’ primary goal is to save one million lives by delivering at least 7,400 SentOx machines to where they are needed most.

(43) 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.

(44) 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.

(45) 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.

(46) 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).

(47) 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.

(48) 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 training 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.

(49) 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 our 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.

(50) 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 supporting 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).