12 November 2012

Calling Attention to the Leading Killer of Children

An estimated 1.3 million children under the age of five die from pneumonia each year. Children can be treated with antibiotics, but as many as 30% of children with pneumonia are unable to access the antibiotics that can save their lives. Prevention of pneumonia starts at birth and includes ensuring that children are not malnourished and are immunized against pneumonia and other diseases that put them at risk. The UN Commission on Life-Saving Commodities issued a recent report estimated that the lives of over 1.5 million children can be saved over the next five years if amoxicillin is made available in a dissolvable tablet.

The number one killer of children under five oftentimes flies under the radar. “Pneumonia can be prevented and cured. Yet, for too long it has been the leading cause of global deaths among children. We know what to do, and we have made great progress – but we must do more. We must scale-up proven solutions and ensure they reach every child in need,” said United Nations Secretary-General Ban Ki-moon marking today's World Pneumonia Day.

Brett Keller pointed out this morning that many people incorrectly guess the leading killers of children.
To date, most of the political class and policymakers get the pop quiz wrong, and badly so. At Hopkins’ school of public health I took and enjoyed Orin Levine‘s vaccine policy class. (Incidentally, Orin just started a new gig with the Gates Foundation — congrats!) In that class and elsewhere I’ve heard Orin tell the story of quizzing folks on Capitol Hill and elsewhere in DC about the top three causes of death for children under five and time and again getting the answer “AIDS, TB and malaria.” 
Those three diseases likely pop to mind because of the Global Fund, and because a lot of US funding for global health has been directed at them. And, to be fair, they’re huge public health problems and the metric of under-five mortality isn’t where AIDS hits hardest. But the real answer is pneumonia, diarrhea, and malnutrition. (Or malaria for #3 — it depends in part on whether you count malnutrition as a separate cause or a contributor to other causes). The end result of this lack of awareness — and the prior lack of a domestic lobby — of pneumonia is that it gets underfunded in US global health efforts.
It does feel like there are a lot of awareness days, especially this time of the year, but Keller makes the argument that they are important, especially in the case of pneumonia, to ensure that lesser known, but important issues are widely known.

Without making it making the problem seem too simple, the problem of pneumonia is particularly frustrating because it is an example of a deadly disease kills far more people than it should. Malaria, TB and AIDS are more visible. Keller notes that that is in part thanks to the Global Fund, but it is also because they are very hard to control. There are ways to make each better and efforts should certainly hone in on ways to reduce infection rates, but the fact that the world's leading killers of children are so highly preventable is an unacceptable reality.

“Today, pneumonia will kill thousands of children. And tomorrow. Every day. It is unconscionable that each year 1.3 million die from such a preventable disease. This need not be so,” said Dr. Anthony Lake, Executive Director of UNICEF. “There are simple, low cost solutions, such as hand washing with soap, vaccines and treatment like amoxicillin that can save these children’s lives. So what possible excuse can there be for a failure to do still more in the fight against this killer of children?”

Lake's rhetorical question is important, but the answers are not all that hard. Poverty sits at the heart of the problem and it is amplified by poor health systems, logistical issues regarding drug access and further problems. USAID Administrator Shah points out the importance of the problem in both a moral and economic sense saying, "Ensuring that no family needlessly suffers the loss of a child would be one of the great moral victories of our time. It would also be a great economic victory, because it helps lower population growth, and, through the demographic dividend, accelerate economic growth."

Progress against pneumonia deaths is mixed. Bangladesh and Tanzania have improved their vaccine coverage rates, but still struggle to reduce mortality, says the International Vaccine Access Center's Pneumonia Progress Report. The Center monitors fifteen countries as they attempt to meet the Global Action Plan for Prevention and Control of Pneumonia (GAPP) goal of 90% coverage for vaccines, breastfeeding and antibiotics. The WHO and UNICEF estimated at the launch of GAPP that meeting the target could prevent as many as two thirds of childhood pneumonia deaths.

This is adapted from a post I wrote earlier for the PSI Impact Blog.