The Missing Piece I

Why continued neglect of pneumonia threatens the achievement of health goals

There have been several excellent reports about pneumonia in recent years. What is different about, The Missing Piece Report: why continued neglect of pneumonia threatens the achievement of health goals, is that it uses new Global Burden of Disease (GBD) 2017 data from the Institute for Health Metrics and Evaluation (IHME) to show pneumonia’s massive burden of death and disability across the lifecycle, and includes a new analysis by Development Initiatives of the relatively low levels of international development assistance allocated to pneumonia between 2007 and 2016.

Together, they tell a new story about pneumonia and present a compelling argument for course correction. First, the GBD data show that pneumonia is now the leading infectious disease killer in the world by a wide margin, responsible for an estimated 2.6 million deaths in 2017. Three-quarters of deaths are concentrated among the very young and the very old, and two-thirds occur in a diverse group of 20 low-, middle-, and high-income countries. Despite progress in reducing child pneumonia deaths, many countries still have a long way to go to end preventable child deaths by 2030. Others are facing rising deaths among adults, and especially among the elderly, and some are challenged with large “double burdens” of pneumonia deaths among both children and the elderly.

Second, the very low levels of domestic spending and international development assistance allocated to fighting pneumonia have contributed to the lack of progress in reducing deaths. None of the high-burden countries specifically target pneumonia in their national health strategies, and pneumonia continues to attract a tiny portion of international development assistance for health. These lower levels of investment are a major reason pneumonia deaths are not falling at the same rate as other leading infectious killers, and why pneumonia has emerged has the major “missing piece” in the communicable disease agenda.

This report offers several course correction strategies. First and foremost, it recommends that high-burden countries should introduce pneumonia control strategies to fully protect their most vulnerable populations with the pneumonia-fighting vaccines (Hib, PCV, measles, and RSV, when available), and ensure access to proper diagnosis and treatment, including access to pulse oximetry and oxygen therapy, recommended antibiotics, and therapeutic foods, where necessary.

Focused action is also needed to reduce the major risk factors for pneumonia death, especially child wasting, air pollution, and preterm birth among children, and smoking and alcohol use among adults. The move to Universal Health Coverage (UHC) is a major opportunity for countries to protect their populations from the threat of pneumonia by fully covering the cost of prevention, diagnosis, and treatment, especially for the most vulnerable children and the elderly. Global actors should support country efforts to better align domestic health spending with national disease burden, and should also increase R&D investments in breakthrough pneumonia-fighting technologies.


You will recall the recently released Research Investments in Global Health (ResIn) study that found just 3% of infectious disease R&D was allocated to pneumonia between 2000 and 2015, despite pneumonia causing more than 25% of all infectious disease deaths over the period.

Don’t have time to read the full report? Take a look at The Missing Piece: Main Messages. Support by sharing on X @Stop_Pneumonia and @JustActions. The Missing Piece I report was launched in November 2018.