First Annual World Pneumonia Day November 2, 2009 Final ...

First Annual World Pneumonia Day

November 2, 2009

Final Media Report

Global Coalition Against Pneumonia

WORLD PNEUMONIA DAY MEDIA COVERAGE FINAL REPORT

TABLE OF CONTENTS

Pages 1-3 World Pneumonia Day Partners

Page 4 Coverage Highlights

Page 5 Top-Tier Coverage

Pages 6-9 Graphical and Numerical Coverage Snapshots

Global map of coverage

Stories by outlet type

Stories by country

Stories by continent

Appendix A Select Media Clips

Appendix B Press Release

1

This report was prepared by the

International Vaccine Access Center (IVAC)

at the Johns Hopkins Bloomberg School of Public Health

on behalf of the

Global Coalition Against Pneumonia

Coalition Members

Africa Fighting Malaria (AFM)

American India Foundation

American Jewish Joint Distribution Committee (JDC)

Antibiotic Consensus Society of Uganda (ACSU)

Arab Pediatric Infectious Disease Society

Asian Strategic Alliance for Pneumococcal Disease Prevention (ASAP)

Best Shot Foundation

Boston University School of Public Health Center for International Health and Development

CARE

California Immunization Coalition (CIC)

Centre for International Child Health (CICH), University of Melbourne

Center for Vaccine Development-Mali (CVD-Mali)

Centre National d’Appui à la lutte contre la Maladie (CNAM)

Chinese Society of Pediatric Pulmonology

Columbia University Mailman School of Public Health

Croatian Center for Global Health

Destinee Charity Foundation

The Earth Institute, Columbia University

EmergingMarketsGroup, Ltd. (EMG)

Episcopal Relief and Development

Every Child by Two (ECBT)

GAVI Alliance

2

GiveVaccines.org

Global Action for Children (GAC)

Global Health Council

Global Science Academy (GSA), India

Hedge Funds vs. Malaria and Pneumonia

Hong Kong Pediatric Society

Immunization Action Coalition

Indian Academy of Pediatrics, West Bengal Branch

International Pediatric Association (IPA)

International Rescue Committee (IRC)

International Society for Tropical Pediatrics (ITSP) – Philippines

International Union Against Tuberculosis and Lung Disease (The Union)

International Vaccine Access Center (IVAC) at the Johns Hopkins Bloomberg School of Public

Health

John Snow Inc. (JSI)

Johns Hopkins Bloomberg School of Public Health

Jordan University Hospital (JUH)

Jordan University Medical School, Division of Pediatric Infectious Disease

Kageno Worldwide, Inc

The MacDella Cooper Foundation (MCF)

MACS Initiative (Monitoring and Accelerate Child Survival Initiative)

March of Washingtons

Measles Initiative

Medical Teams International

Millennium Villages Project

Ministry of Health – Mali

Ministry of Health – ARI Programme, Mali

National Foundation for Infectious Diseases (NFID)

National Institutes of Health (NIH)

The Nigerian School Project

NYU School of Medicine, Department of Medical Parasitology

ONE

The Paediatric Association of Nigeria

PATH

Pediatric Association of Tanzania

Paediatric Infectious Disease Society, Nigeria

Paediatrics Association of DRC

The Pediatric Infectious Disease Society of Thailand

Parents of Kids with Infectious Diseases (PKIDs)

3

PGIMER School of Public Health

Pneumococcal Awareness Council of Experts (PACE)

Pneumonia Advocacy and Working Group of Uganda

Philippines Foundation for Vaccination (PFV)

Population Services International (PSI)

The Public Health Foundation of India

The Rollins School of Public Health (RSPH) at Emory University

Sabin Vaccine Institute

Save the Children

Southern African Society of Paediatric Infectious Diseases (SASPID)

Taiwan Pediatric Society of Thorax

Task Force for Global Health

University of Edinburgh

Uganda Pediatric Association

US Coalition for Child Survival

US Fund for UNICEF

Vaccines for Africa Initiative (VACFA)

Vicks

Voices For Vaccines

Women’s Refugee Commission

World Vision

4

Coverage Highlights

Centralized media pitching and in-country outreach efforts combined to generate the following

coverage around the first annual World Pneumonia Day:

More than 330 English-language print, radio, television and online stories in

39 countries and on six continents

12 unique stories by prominent news wires, including:

o AFP

o Africa Science News Service

o Associated Press

o Reuters (2)

o Reuters AlertNet

o Reuters India

o Indo-Asian News Service (2)

o InterPress Service

o IRIN News

o Xinhua News Agency

Wire story pickup by 38 outlets in seven countries

Placement of 12 editorials/articles in peer-reviewed academic journals

Global Representation of WPD Media Coverage

5

Top-Tier Coverage

Domestically, coverage included stories in the following top-tier print, radio, television

and online publications with broad audiences in the United States:

ABC News

Air America

Boston Globe

Chicago Public Radio

CNN

CNBC

Denver Post

Diplomatic Courier

MSNBC.com

National Public Radio Blog

The New York Times Online

NBC Today Show

Seattle Post-Intelligencer

USA Today

US News and World Report

VOANews.com

Washingtonpost.com

Washington Post Express

Washington Times

Internationally, coverage included stories in the following top-tier outlets:

BBC Channel Africa

Calgary Herald (India)

Daily Monitor (Uganda)

Daily Nation (Kenya)

The Daily Star (Bangladesh)

Dawn (Pakistan)

The Guardian (Nigeria)

The Hindu (India)

Hindustan Times (India)

The Independent (U.K.)

The Jakarta Post (Indonesia)

The Kathmandu Post (Nepal)

The Korea Times (South Korea)

The Liberian Times (Liberia)

Manila Bulletin (Philippines)

The National Post (Canada)

New Straits Times (Malaysia)

Philippine Daily Inquirer (Philippines)

The Times of India (India)

Vanguard (Nigeria)

6

Coverage Snapshots

Outlet Type Number of Stories

Print 169

Online 103

Television 28

Academic Journals 12

Radio 12

Wire Stories 12

Print

50.3%

Online

30.7%

TV

8.3%

Journals

3.6%

Radio

3.6%

Wires

3.6%

Media Coverage by Type

7

Other

(all countries with less

than 5% of total

coverage)

30%

India

25%

United States

23%

Kenya

6%

Mali

6%

Bangladesh

5%

Indonesia

5%

Media Coverage by Country

8

Media Coverage by Country

Country Number of Stories

India 84

United States 77

Kenya 21

Mali 19

Bangladesh 17

Indonesia 16

Nigeria 10

Uganda 10

Pakistan 8

U.K. 8

Continental Africa 6

Thailand 5

China 4

Nepal 4

New Zealand 4

Philippines 4

South Africa 4

Switzerland 4

Democratic Republic of the Congo 3

Malaysia 3

Australia 2

Canada 2

France 2

Germany 2

Turkey 2

Belgium 1

Brazil 1

Czech Republic 1

Dominican Republic 1

Ethiopia 1

Ghana 1

Lebanon 1

Liberia 1

Mexico 1

Namibia 1

Netherlands 1

Papua New Guinea 1

Portugal 1

Senegal 1

Singapore 1

South Korea 1

9

Continent Number of Stories

Asia 148

North America 80

Africa 78

Europe 22

Oceania 7

South America 2

Asia

44%

North America

24%

Africa

23%

Europe

6%

Oceania

2%

South

America

1%

Media Coverage by Continent

By Maria Cheng

To fight pneumonia, the world’s top killer of children, United Nations officials say they need $39 billion (euro26.35 billion) over the next six years.

On the first World Pneumonia Day on Monday, the World Health Organization and UNICEF are releasing a global plan aiming to save more than 5 million children from dying of pneumonia by 2015.

The plea for money is less than what has been spent on more high-profile diseases like AIDS, despite the fact pneumonia kills more children than AIDS, malaria and measles combined.

“This is very simply the biggest killer people never hear about,” said Orin Levine, a pub-lic health expert at Johns Hopkins Bloomberg School of Health, who has advised WHO and UNICEF. Pneumonia accounts for about 20 per-cent of all child deaths every year; AIDS causes about 2 percent.

Some experts say the neglect of pneumonia is the health community’s own fault. “While pub-lic health experts have long known the scope and severity of the scourge, they haven’t effectively mobilized the backers to put pneumonia on the map,” said Mary Beth Powers, a child health ex-pert at Save the Children.

To change that, the U.N. is promoting a variety of strategies from vaccination to generalized interventions that address economic develop-

ment. Pneumonia deaths are strongly linked to malnutrition and poverty.

While officials agree pneumonia deserves a much larger share of the global health budget, not all are convinced the U.N. plan is on target.

“Trillions of dollars have been spent on pro-moting economic development over the last 50 years, with very little evidence such spending has made any difference,” said Philip Stevens, of the International Policy Network, a London-based think tank. “Much of the U.N’s nearly $40 billion will be wasted unless they stick to vaccination.”

Buying vaccines to protect children from pneu-monia is precisely what GAVI, a global alliance of U.N. agencies and private partners like the Bill & Melinda Gates Foundation, plans to do. GAVI hopes to raise $4 billion to vaccinate about 130 million children in 42 poor countries by 2015.

Since 2000, a vaccine to protect children from pneumonia has existed, but is only available in rich countries. “Children in poor countries have the same right to health, the same right to be im-munized as children in rich nations,” said Julian Lob-Levyt, GAVI’s CEO in a statement.

With renewed attention and resources on pneu-monia, health officials hope to slash the number of deaths in half in the next few years. “Until now, pneumonia has been off the radar,” Levine said. “But this is a big problem that can be solved.”

LONDON, UK NOVEMBER 2, 2009

UN: $39 billion needed for pneumonia

APPENDIX A:

SELECT CLIPS


U.N. says $39 billion would stem child pneumonia deaths

By Kate Kelland

Pneumonia kills more young children than any other

disease, but an investment of $39 billion, or just $12.9

per child, could save 5.3 million lives in developing

countries by 2015, the U.N. said Monday.

The disease, which attacks the lungs, kills 1.8

million children under the age of five every year, but

despite this toll, relatively few resources are put into

tackling it, the World Health Organization and U.N.

Children’s Fund said.

They made a joint appeal to fund a six-year plan for

pneumonia prevention and treatment in 68 developing

countries, mostly in Africa and Asia, plus parts of

Central and South America, where it is prevalent.

“We know the strategy will work, and if it is applied

in every high-burden country, we will be able to

prevent millions of deaths,” Margaret Chan, director

general of the World Health Organization, said.

The agencies called for strategies to urge mothers to

breast feed babies exclusively for the first six months,

increase use of vaccines, and boost proper treatment.

They also want policymakers to act immediately to

implement the plan.

Their proposed Global Action Plan calls for:

• Protecting children by assuring breastfeeding

for six months, providing adequate nutrition,

reducing low birth weight and indoor air

pollution and improving hygiene.

• Preventing children contracting pneumonia

with vaccinations against major triggers,

including measles, Hib, pneumococcus and

rotavirus, by preventing and treating HIV in

children, and by providing zinc for children

with diarrhea.

• Treating children who get pneumonia

with antibiotics and proper care in local

communities, health centers and hospitals.

It sets targets for 2015 to expand coverage of the

relevant vaccines and exclusive breastfeeding rates to

90 percent and increasing access to proper treatment

to 90 percent.

Reaching these goals would cut child pneumonia

deaths by 65 percent and cut the number of severe

pneumonia cases in children by 25 percent compared

to 2000 levels, it said.

Children in rich nations are routinely immunized

against diseases that cause pneumonia, but in much

of the developing world vaccine coverage is patchy.

Prevnar a vaccine made by Wyeth, now owned by

U.S. drug giant Pfizer, protects against seven strains

of S. pneumonia and is part of routine vaccinations

in rich countries.

Rwanda became one of the first developing countries

to launch a national pneumococcal immunization

campaign in April.

Several drug firms including Merck and

GlaxoSmithKline make Hib vaccines, which the non-

profit Global Alliance for Vaccines and Immunization

(GAVI) provides to 35 African nations.

NOVEMBER 2, 2009

FACTBOX: Pneumonia, leading cause of child deaths

By David Cutler

Investing $39 billion in preventing and treating

pneumonia, the disease that is the world’s leading killer

of young children, could save up to 5.3 million lives

by 2015, the World Health Organisation (WHO) and

the United Nations children’s fund (UNICEF) said on

Monday.

Here are some details about a global action plan its costs:

The Plan:

• WHO and UNICEF developed the Global Action Plan

for the prevention and control of Pneumonia (GAPP).

GAPP aims to increase awareness of pneumonia as a

major cause of child death and spur action to deal more

effectively with the problem.

What is Pneumonia?

• Pneumonia is an infection of the lungs that can be

caused by bacteria, viruses and fungi. Its severity can be

based on the type of organism causing it.

• Signs of pneumonia can include coughing, fever,

fatigue, nausea, vomiting, rapid breathing or shortness

of breath, chills, or chest pain.

• When bacteria, viruses or, rarely, fungi living in your

nose, mouth, sinuses, or the environment spread to your

lungs, you can develop pneumonia or other infections.

You can catch the bacteria or viruses from people who

are infected with them, whether they are sick or not.

The Toll:

• Pneumonia kills more children under five years of age

than any other illness in every region of the world.

Of the estimated total of 9 million child deaths in

2007, around 20 percent or 1.8 million, were due to

pneumonia.

• Mortality due to childhood pneumonia is strongly

linked to malnutrition, poverty and inadequate access

to health care. Consequently, more than 98 percent of

pneumonia deaths in children occur in 68 countries

where progress in reducing under-five mortality is most

critical.

The Costs:

• The cost of implementing the GAPP interventions in

68 high child mortality countries will be $39 billion for

2010 to 2015.

• Half of that is for scaling up these interventions in

China ($13 billion) and India ($7 billion).

• For the 68 countries, the costs will double over the

6-year period rising from an annual need of $3.8 billion

in 2010 to $8.0 billion by 2015.

• The Global Alliance for Vaccines and Immunisation

(GAVI) said on Friday it was seeking it was seeking

$4 billion in funds to vaccinate as many as 130 million

of the world’s poorest children against diarrhoea and

pneumonia.

Here are some details about the costs:

Global Cost for Scaling Up GAPP Interventions (breastfeeding, vaccination and case management)

in countdown countries, 2010-2015 (in millions of U.S. dollars)

68 countries 66 countries*

2010 2015 2010-2015 2010-2015

Vaccines and injection supplies $1,322.7 $1,697.9 $9,661.0 $6,660.6

Commodities and diagnostics for pneumonia management 3.1 23.9 141.0 109.4

Costs for delivering services 1,621.1 5,383.5 22,653.6 8,070.1

Programme and systems costs 916.9 987.4 6,507.8 4,006.5

TOTAL 3,862.8 8,092.7 38,963.4** 18 846.5

*China and India excluded from these estimates.

**Of this amount, $13 billion is for China and $7 billion for India.

Sources: Reuters/www.who.int/www.cdc.gov

GENEVA, SWITZERLAND OCTOBER 30, 2009

Aid group seeks $4 billion for life-saving vaccinesBy Laura MacInnis

A vaccine aid group said on Friday it was seeking $4 billion to protect as many as 130 million of the world’s poorest children against diarrhea and pneumonia.

Children in developed countries are routinely immunized against the bacteria causing those deadly diseases — namely Hib, pneumococcus and rotavirus — but in much of Africa, Asia and Latin America, young people remain dangerously exposed.

The Geneva-based GAVI Alliance, backed by the Bill & Melinda Gates Foundation, said a big immunization push could be “another giant leap toward reducing child mortality in our lifetime” in part thanks to a global decline in vaccine costs.

“Immunization is one of the most cost-effective ways to save lives,” Julian Lob-Levyt, head of the GAVI Alliance, said in a statement released ahead of World Pneumonia Day. “And improved health is a fundamental driver for long-term development.”

GAVI — or the Global Alliance for Vaccines and Immunization — is supported by the World Health Organization, the World Bank, UNICEF, vaccine makers and research centres, as well as the Microsoft founder’s philanthropic arm.

It raises money by leveraging long-term aid commitments from countries through capital markets, with regular offerings of “vaccine bonds” organized by the International Finance Facility for Immunization (IFFIm).

The United Nations and various aid groups have sought to replicate the GAVI approach with proposed “sanitation bonds” to pay for water infrastructure and latrines in poor countries.

GAVI spokesman Jeffrey Rowland told journalists that the $4 billion would finance pneumococcal and rotavirus vaccinations in addition to the large-scale campaigns already under way to fight a range of preventable diseases including hepatitis B, diphtheria, tetanus, whooping cough and Hib.

The scale of GAVI’s purchasing and distribution has allowed it to secure much lower prices for vaccines, which are then made available to developing countries at a fraction of that cost.

“For instance, pneumococcal vaccine prices have dropped by more than 90 percent, from about $90 to $7,” said Rowland, who explained that GAVI’s developing country partners would pay between 10 cents and 15 cents for the jabs.

Pneumonia is responsible for one in four child deaths — more than HIV/AIDS, malaria and measles combined. Its two main bacterial causes are Hib and pneumococcus, which children in developed countries are routinely immunized against.

GAVI estimates that introducing pneumococcal and rotavirus vaccines in between 42 and 44 countries could save up to 11 million child lives by 2030.

The World Health Organisation and UN

child agency launched a global action

plan to fight pneumonia, which kills

some 1.8 million children under five ev-

ery year.

“Since we know what interventions

work, we need to urgently implement

them” to combat the ailment which is

also the biggest killer of children under

the age of five, said Anne Golaz, a senior

health adviser at Unicef, on Monday.

Golanz said 5.3 million young lives

could be saved between now and 2015 if

the measures were implemented.

The UN agencies stressed two key mea-

sures to combat the ailment: ensuring

that every child is vaccinated, and is

only breast fed for the first six months

at least.

The WHO said the security and efficien-

cy of vaccines have been proven. Golaz

stresses that children who are exclusively

breast fed during the first six months of

their lives have a 23 percent less chance

of contracting pneumonia.

“But only one third of children in devel-

oping countries are exclusively breastfed

for the first six months,” noted Golaz.

More than 98 percent of deaths linked to

pneumonia are recorded in the poorest

countries in the world, according to data

from the UN agencies.

GENEVA, SWITZERLAND NOVEMBER 2, 2009

UN launches plan to fight pneumonia among children

A Project of the UN Office for the Coordination of Humanitarian Affairs

Health organizations have joined forces

to launch the first World Pneumonia Day,

urging governments, donors and civil

society to act to prevent and treat the world’s

leading child killer.

Pneumonia kills over 4,000 children daily

— more than measles, malaria and AIDS

combined, says the UN Children’s Fund

(UNICEF). However, to date, stamping

it out has not been a priority for policy-

makers or donors, says the coalition of

over 50 health organizations launching the

pneumonia movement.

“There has been little traction on the

pneumonia issue for years but it now feels

like we are at a tipping point,” Orin Levine,

executive director of the pneumonia research

programme at Johns Hopkins Bloomberg

School of Public Health, told IRIN. “Now

it is critical for donors, international

partners and countries to make protection,

prevention and treatment available to all

children everywhere with no delay.”

UNICEF and the World Health Organization

(WHO) in a Global Action Plan for the

Prevention and Control of Pneumonia are

calling on donors and national governments to

commit US$39 billion to improve prevention

and treatment in 68 high-prevalence countries

between now and 2015.

Preventing pneumonia requires increasing

the number of children vaccinated against

common causes of pneumonia, such as

streptococcus pneumonia (pneumococcal

disease) and Haemophilus influenzae type

b (Hib), and improving community-level

treatment of pneumonia through training and

access to antibiotics, according to the plan.

The plan also calls for improving health,

hygiene and nutrition practices by

promoting exclusive breastfeeding, hand-

washing, reducing indoor air pollution and

giving zinc to children during diarrhoea

outbreaks.

“Nearly half of [pneumonia] deaths could

be prevented with existing vaccines and the

vast majority of cases could be treated with

inexpensive antibiotics,” Save the Children

Board member and former US Senator

Bill Frist said in a communiqué launching

Global Pneumonia Day. “Yet lives continue

to be lost from this preventable and treatable

disease, and until recently there was very

little outcry.”

Research groups specializing in pneumonia

say vaccine roll-out in Africa and Asia has been

slow due to lack of money and awareness.

Vaccines

Vaccines against two of pneumonia’s

common bacterial causes, Hib and

pneumococcus, are routinely used in

industrialized countries but are not yet

available in most of the developing world,

according to GAVI Alliance, a public-

private partnership providing immunization

and health system support worldwide.

“Vaccine coverage is improving but at a

slower pace than we would like to see,”

WHO spokesperson Olivia Lawe-Davies

told IRIN.

GAVI plans to speed up the introduction of

pneumococcal vaccines in 42 countries to

reach 130 million children by 2015.

“Millennium Goal four cannot be met without

this investment. Immunization is one of the

most cost-effective ways to save lives. And

improved health is a fundamental driver

for long-term development,” said Julian

Lob-Levyt, head of the GAVI Alliance, in a

2 November communiqué.

Millennium Goal four aims to reduce by

two-thirds the deaths of under-five children

by 2015.

Affordable treatment

GAVI Alliance has developed a funding

mechanism to encourage pharmaceutical

companies to produce a pneumococcal

vaccine at 10 percent of the normal price,

costing developing country governments on

average 15 cents per dose.

For those children who contract pneumonia

the antibiotics that could save their lives

cost less than $1, but currently less than 20

percent of children receive them, according

to WHO and UNICEF.

“Pneumonia contributes to 60 percent of

the in-patient admissions in any hospital in

Uganda, and the worst scenario is seeing a

mother walk into the emergency unit because

she was not aware of the seriousness of her

child’s illness, and seeing that child pass

away because it was too late to intervene,”

said Sabrina Bakeera-Kitaka, President of

the Uganda Paediatrics Association in a 2

November statement.

Donors who sign on to the Global Action Plan

at the 2010 World Health Assembly would

agree to increase the supply of antibiotics to

health clinics in hard-hit countries and train

community health workers in pneumonia

case management.

“With increased donor support, we can save

many more lives and make an incredible leap

towards further reducing child mortality in

the world. This is an historic opportunity

we must not ignore,” said GAVI’s

Lob-Levyt.

DAKAR, SENEGAL NOVEMBER 2, 2009

Reaching the pneumonia “tipping point”

Pneumonia facts Pneumonia takes the life of one

child every 15 seconds, and

accounts for 20 percent of under-

five deaths worldwide each year Pneumonia has the most deadly

impact — 98 percent of pneumonia

deaths — in South Asia and sub-

Saharan Africa In Africa pneumonia is the second

cause of under-five mortality after

diarrhoea

Source: World Pneumonia Day website

By Chryso D’Angelo

Seven-month-old Marta lived in the central

highlands of Guatemala when she came

down with a high fever and rapid, shallow

breathing.

The local community health worker diagnosed

her with severe pneumonia, gave her a dose of

antibiotics, and advised her grandfather to take

her to the hospital over 19 miles away. Marta

beat pneumonia, thanks to a proper medical

assessment and life-saving drugs, but nearly

two million other children in developing

nations won’t be as lucky.

“In the U.S., low-cost antibiotics have made

childhood deaths from pneumonia a rare

occurrence. But in developing countries, it is

estimated that only one in five children with

pneumonia receives antibiotic treatment,”

said Mary Beth Powers, chief of Save the

Children’s “Survive to 5” campaign.

The first ever World Pneumonia Day

on Monday, Nov. 2 strives to encourage

governments, health care professionals and

the public into action against this global

health crisis, which kills 1.8 million children

under age five each year — a toll greater

than measles, malaria, and AIDS combined,

according to the Global Coalition against

Child Pneumonia.

“Pneumonia is the biggest killer of children

that we never hear about,” said Dr. Orin

Levine, executive director of Pneumo ADIP

at the John Hopkins Bloomberg School

of Public Health and a member of the

100-strong coalition made up of global health

organisations and academic institutions,

including CARE, GAVI Alliance and Save

the Children.

The group is dedicated to bringing pneumonia

vaccines and antibiotics to developing

countries and training healthcare workers to

diagnose and treat the disease.

Vaccines against pneumonia (Streptococcus

pneumoniae and Haemonophilus influenzae

type b or Hib) exist, but their distribution

in the developing world is not at the levels

needed to prevent high childhood fatality

rates from pneumonia.

“While pneumonia affects children and

families everywhere, it has the most deadly

impact in South Asia and sub-Saharan

Africa,” according to Dr. Levin, “where 98

percent of pneumonia deaths occur.”

Deaths in Asia are attributed to the high

population and limited use of the vaccines,

according to the WHO, while Africa sees a

lack of vaccines, a high rate of HIV infection,

and poor basic medical care as contributors

to deaths.

Pneumococcal vaccination is standard in

some of the world’s high and upper-middle

income countries, but not until recently have

developing countries doled out vaccines.

That is changing, thanks to the Global

Alliance for Vaccines and Immunisation

(GAVI), a global health partnership, which

benefits from funding by the Bill and Melinda

Gates Foundation as well as various public

and private donors. GAVI offers low-income

countries pneumococcal vaccines for as little

as 15 cents per dose.

“Rwanda was the first African country to

launch the pneumonia vaccine,” Dr. Levine

told IPS. “They are rolling out community-

based management by scaling up the use of

village health workers so that treatment gets

as close to children’s home as possible.”

Eleven developing countries are on the

road to improved pneumonia prevention

and treatment, thanks to the GAVI Alliance.

Twelve additional countries have submitted

applications and are awaiting GAVI approval.

Eligibility is determined by national income

and only countries with a Gross National

Income (GNI) per capita below 1,000 dollars

in 2003 qualify.

“If fully rolled out in GAVI-eligible countries,

the pneumococcal vaccine could save the

lives of more than 440,000 children by 2015,”

said Dr. Julian Lob-Levyt, CEO of the GAVI

Alliance.

The next step in the fight against pneumonia is

the implementation of the Global Action Plan

for Prevention and Control (GAPP), released

Monday by WHO and UNICEF. The six-

year plan to control the disease has a three-

pronged pneumonia strategy, which includes:

creating a healthy environment for children

by promoting exclusive breastfeeding and

ensuring adequate nutrition and good hygiene;

vaccinating them against pneumonia; and

treating the illness in community clinics and

hospitals through effective case management

and with an appropriate course of antibiotics.

Dr. William Frist witnessed the benefits of a

community-based approach on a recent trip

to Mozambique.

“We visited a family whose eldest child was

ill. After a brief examination, the community

health worker was able to ascertain that the

child’s illness had progressed beyond a cold

to pneumonia,” recalled Frist, a pioneer in

heart-lung transplantation.

“We immediately placed the child on a

‘bicycle-ambulance’ where the community

health worker would drive him about two

miles to the nearest clinic. If the community

health worker hadn’t intervened when he did,

it is possible that the child would have died,”

Frist said.

As former U.S. Senate majority leader, Frist

added that the U.S. is committed to investing

in maternal, newborn and child health in

developing countries.

“The Maternal, Newborn and Child Survival

Act, now before Congress, would expand

the reach of life-saving tools - vaccines,

antibiotics and trained health workers - to

more mothers and babies in poor countries,”

said Frist.

The U.S. Senate released a companion

version of the bill, the Global Child Survival

Act of 2009, on Oct. 28. If passed, the bill

would put the United States in a position to

make highly effective health care measures

available to vulnerable mothers, newborns

and children in developing countries.

“This is an important next step toward

providing millions of parents with hope

that their babies will grow up healthy and

live to see their fifth birthday,” said Charles

MacCormack, president and CEO of Save

the Children.

UNITED NATIONS NOVEMBER 2, 2009

Vaccines, antibiotics could slash pneumonia deaths

A vaccine targeting the rampant pneumonia

haemophillus bacteria will soon be included in

the country’s routine immunisation programme,

health experts said Monday, also stressing the

need to raise awareness on the disease that an-

nually claims lives of 400,000 children in India

“Ten states will introduce the HiB vaccine into their routine immunisation programme next year,” said Panna Choudhury of the Indian Academy of Paediatrics (IAP), at an event to observe World Pneumonia Day (Nov 2) held as part of a campaign in 20 countries to focus on the disease.

The WHO estimates that two bacteria alone — HiB and pneumococcus — cause nearly 50 per-cent of pneumonia deaths in children under five years in India. There are vaccines to treat the diseases but these are, however, expensive and cost nearly Rs.400 for three doses.

With the inclusion of the HiB vaccine next year and pneumococcal vaccine in 2010, costs could be reduced drastically, bringing preventive treat-ment within the common man’s reach.

At the event, health experts from national as well as international advocacy and aid agencies like World Health Care Organisation, USAID, UNICEF, IAP and Public Health Foundation of India (PHFI) held detailed discussions on controlling the spread of pneumonia, which kills more children in the world than any other disease.

“Pneumonia is one of the most critical child health problem we face in India today. A com-mon integrated plan will help us in vanquishing pneumonia as the number one killer of children

under 5 in India,” said Health Minister Ghulam Nabi Azad, in a statement read out at the event.

“It is imperative to raise awareness among mothers, especially rural areas, about the early symptoms of pneumonia such as coughing and wheezing. Timely treatment could prevent the untimely deaths of many infants and toddlers,” said K. Srinath Reddy, president of Public Health Foundation of India (PHFI).

India accounts for 27 percent of the average 2 million deaths from pneumonia and has the high-est number of pneumonia cases in the world. The number of deaths is also high in Afghanistan, China, Pakistan and Bangladesh.

Henri Van Den Hombergh from UNICEF India said: “We need a full fledged war against the disease, not just peaks of advocacy. Funding is very crucial and building a support health care system for people to approach with trust is again essential.”

Another issue discussed was the treatment gap of children who suffered from pneumonia symptoms.

“According to the national family health survey, only 12.5 percent received antibiotics for their complaints of cough and difficult breathing that is suggestive of pneumonia. If antibiotic treat-ment was universally delivered to children with pneumonia, around 600,000 lives could be saved annually,” said Rajesh Mehta of WHO India.

Experts are also calling for improving training at the community level to rapidly provide care to children who otherwise may die of pneumo-nia at home without treatment.

Indo-Asian News Service

NEW DELHI, INDIA NOVEMBER 3, 2009

Health experts: More awareness on pneumonia needed

Indo-Asian News Service

NEW DELHI, INDIA NOVEMBER 2, 2009

Advertisements, campaigns and discussions marked the first World Pneumonia Day be-ing observed Monday. A number of awareness drives were held in the capital in an effort to sen-sitise people about this curable disease that kills 400,000 children every year in India alone.

According to Save the Children, an international NGO working on child rights issues, the number of children that killed by pneumonia every year is more than those dying because of HIV/AIDS, malaria and measles combined. The NGO par-ticipated in the Delhi half marathon Sunday to raise awareness on the issue.

Thomas Chandy, CEO of Save the Children India said: “Most people are unaware that pneu-monia kills more children than any other disease and that in fact, it is the single largest cause of death in children worldwide, taking the lives of more than two million children annually.”

Pneumonia takes the life of one child every 15 seconds, and accounts for 20 percent of all deaths of children under five worldwide. In India, West Bengal and Delhi have the highest number of pneumonia related deaths, Chandy added.

“We live in a world with limitless possibilities. Science has made it possible to have a heart transplant, medical advances happen every day. Yet, in the national capital hundreds of children die of pneumonia every year. This is outra-geous,” he said.

Issuing advertisements in public interest, the ministry of health and family welfare Monday said: “Early diagnosis and appropriate case management by rational use of antibiotics is the

most effective intervention to prevent deaths due to pneumonia”.

“Pneumonia is preventable. Pneumonia is treat-able,” it pointed out.

Listing the symptoms and the danger signs of the disease, the advertisement said: “Fever, cough and fast breathing in a child are signs of pneumonia. Inability to feed, lethargy, breathing trouble, grunting in a child with fever and cough are the danger signs.”

Nitin Shah, chairperson of the Indian version of Asian Strategic Alliance for Pneumococcal disease prevention (ASAP), said: “Pneumonia is largely preventable through vaccination. The main motive behind observing World Pneumonia Day is to provide necessary medication to the world’s most vulnerable countries.”

India with 27 percent has the highest number of pneumonia cases in the world, followed by Afghanistan, China, Pakistan and Bangladesh. Africa and Asia record the highest number of pneumonia deaths.

Chandy said: “The disease can be prevented with simple interventions, and treated effective-ly with antibiotics that cost less than a dollar. On World Pneumonia Day, we call on the govern-ment to implement life-saving pneumonia inter-ventions for those that need them the most.”

A campaign to spread awareness about the dis-ease is in momentum on the social networking site Facebook. “Wear blue jeans”, as the cam-paign is called, asks people to wear that in sup-port of all those who are victims of the disease.

Awareness campaigns galore on

World Pneumonia Day

WASHINGTON, D.C. NOVEMBER 2, 2009

Health Highlights

U.N. targets pneumonia deathsAbout $39 billion is needed over the next six years in order to greatly reduce pneumonia deaths among children, United Nations officials said Monday, the first World Pneumonia Day.

Pneumonia kills more children than AIDS, ma-laria and measles combined. UNICEF and the World Health Organization released a plan to save more than 5 million children from dying of pneumonia by 2015, the Associated Press reported.

Pneumonia accounts for about 20 percent of all child deaths worldwide every year, while AIDS causes about 2 percent of child deaths.

The new program features strategies ranging from vaccination to economic development ef-forts. There’s a strong link between malnutrition and poverty and pneumonia deaths.

“This is very simply the biggest killer people never hear about,” Orin Levine, a public health expert at Johns Hopkins Bloomberg School of Health, who has advised WHO and UNICEF, told the AP. But Levine added that “this is a big problem that can be solved.”


U.N. plan calls for $39 billion to fight pneumoniaBy Maria Cheng (AP)


On the first World Pneumonia Day on Monday, the World Health Organization and UNICEF are releasing a global plan aiming to save more than 5 million children from dying of pneumo-nia by 2015.


“This is very simply the biggest killer people never hear about,” said Orin Levine, a pub-lic health expert at Johns Hopkins Bloomberg School of Health, who has advised WHO and UNICEF. “Pneumonia accounts for about 20 percent of all child deaths every year; AIDS causes about 2 percent.”


To change that, the U.N. is promoting a variety of strategies from vaccination to generalized in-terventions that address economic development.

Pneumonia deaths are strongly linked to malnu-trition and poverty.





“With renewed attention and resources on pneu-monia, health officials hope to slash the number of deaths in half in the next few years. Until now, pneumonia has been off the radar,” Levine said. “But this is a big problem that can be solved.”















O N T H E W E B

DECEMBER 31, 2009

By Geraldine Washington

The Ethiopian mother walked as fast as she

could. She had another two-hour trek to the

nearest health care facility to get help for her

very sick baby, Tarunesh. The 2-month-old

girl’s skin was gray and she was struggling to

breathe. She and her mother lived in a remote

village in the Liben District of Ethiopia and

had already walked three hours away from

home to seek medical care, according to the

Best Shot Foundation Web site.

A community health worker quickly

diagnosed Tarunesh with severe pneumonia.

He gave the infant a spoonful of antibiotics but

she needed more. At the health care facility,

she received a full course of medication and

treatment and when the community health

worker visited her home a short time later,

Tarunesh was healthy and bouncing on her

mother’s lap.

Around the globe, pneumonia is the leading

cause of death in children younger than

5, according to statistics on the World

Pneumonia Day Web site. Every 15 seconds,

a child dies from a disease that is both

preventable and treatable at little cost says the

United Nations Children’s Fund (UNICEF).

The latter reports that each day 5,500 young

lives are lost because pneumonia, which kills

more children worldwide than any other

disease, including malaria, measles, and HIV/

AIDS combined, is largely underestimated.

Ninety-eight percent of the death toll occurs

in developing countries like Ethiopia, India,

Peru, Pakistan and the Philippines.

After reading a blog about pneumonia in the

New York Times written by Nicholas Kristof,

David Rubenstein, who previously organized

the Save Darfur Coalition, founded the Best

Shot Foundation on Mother’s Day 2009.

A District-based nonprofit grass-roots

movement that focuses global awareness

and political engagement on childhood

pneumonia, Best Shot Foundation, according

to its Web site, is motivated by the belief

that increased public commitment will drive

increased health resource allocation.

This upcoming year, the Best Shot Foundation

will organize dodgeball tournaments on

college campuses across the country to raise

awareness and funds for the fight against

pneumonia, Mr. Rubenstein said. Each

team will compete for a chance to advance

to the national “Pnock Out Pneumonia”

Championship. Each dollar raised will bring

critical prevention and treatment services to

children most in need.

Practical solutions such as inexpensive

vaccines and antibiotics would save half of

these young lives, advocates say. NFL Legend

and Hall of Fame Quarterback Steve Young

of the San Francisco 49ers has signed on as

Honorary League Commissioner of the Pnock

Out Pneumonia Dodgeball Tournament.

“I was shocked to learn that pneumonia kills

more kids around the world than any other

disease, and terribly upset to learn that these

children are dying when there are simple and

inexpensive tools available now to keep them

alive,” he said.

On Nov. 2, Best Shot Foundation participated

as a partner in the first World Pneumonia

Day. A coalition of approximately 100

organizations sponsored 100 events in 30

countries on six continents. The World

Pneumonia Day coalition was established

by a health care coalition in April 2009 to

bring focus on pneumonia as a public health

issue and to prevent the millions of avoidable

deaths from pneumonia that occur each year.

The coalition is grounded in a network of

international government, nongovernmental

and community-based organizations, research

and academic institutions, foundations, and

individuals that have united to bring much-

needed attention to pneumonia among donors,

policymakers, health care professionals, and

the general public, organizers said.

Dr. Orin Levine, executive director of the

International Vaccine Access Center at Johns

Hopkins University’s Bloomberg School of

Public Health, said pneumonia is a constant

concern for families in developing countries

where most lack access to basic care and few

receive the same vaccines that children in the

U.S. routinely are administered.

“More funding is urgently needed to provide

vaccines, antibiotics and improve health

systems so that this disease does not remain

the leading killer of children for another

year,” Dr. Levine said.

Health care professionals are advocating that

countries should develop plans for controlling

pneumonia. The 2007 Global Action Plan for

the Prevention and Control of Pneumonia

outlined the key strategies for pneumonia

control as: case management with integrated

management of childhood illness at all levels;

vaccination; improvement of nutrition/low

birth weight; control of indoor air pollution;

and the prevention and management of HIV

infection.

Mr. Rubenstein remembered that Mr. Kristof

wrote that: “Children with AIDS and malaria

already have advocates, so anyone looking

for a cause should grab pneumonia and

run with it. Think of it not as a grim and

depressing initiative, but as potentially a

happy turnaround opportunity, for these kids’

lives can be so breathtakingly easy to save.”

Based on a story from the World Pnemonia

Web site, had Angie, a Liberian nurse and

mother who lost two young children to

pneumonia gained and endured unimaginable

hardship during Liberia’s civil war, gained

access to basic health care, her two children,

Weedor and Joel, might be alive and healthy

today.

Angie now works with the Liberian

government to ensure that all children receive

vaccinations against childhood diseases. Her

surviving child, Cynthia, is now also a trained

nurse and has a son.

Preventing children from contracting

pneumonia in the first place with vaccines is

key as often children, like Weedor and Joel,

receive treatment too late.

Best Shot Foundation is dedicated to stopping

the forgotten killer of 2 million children each

year and is optimistic that awareness has

increased greatly since the World Pneumonia

Day events, Mr. Rubenstein said.

“The press has begun to cover pneumonia much

more significantly since the World Pneumonia

Day and hopefully the lives of children around

the world will be saved,” he said.

CITIZEN JOURNALISM: Pneumonia Day raises awareness

The first ‘World Pneumonia Day’ will be ob-served in the country as elsewhere across the globe today.

At a press conference yesterday, medical experts urged the government to take necessary steps to combat pneumonia, the world’s leading killer disease for young children.

Dr Samir Saha, director of Child Health Research Foundation (CHRF), said around 50,000 chil-dren die of pneumonia every year in the country and most of them are under five. Bangladesh has the fifth highest number of pneumonia deaths in the world.

Coordinated efforts and cooperation from the government can help reduce the pneumonia mortality rate, he added.

Other speakers said pneumonia is a curable dis-ease. But it takes a huge number of lives of chil-dren every year. Creating awareness among the people and proper guideline to fight the disease can reduce the mortality rate of young children. The government in cooperation with the experts should take effective steps to fight the disease.

The CHRF organised the press conference at a city hotel.

To mark the day, CHRF will hold a rally in front of the National Press Club at 8:30am and arrange a symposium at 11:00am at a city hotel today to mark the World Pneumonia Day.

National Professor Dr MR Khan said that Bangladesh is in he process of eradicating po-lio, measles, tetanus and other deadly diseases. Similarly, childhood immunisation with pneu-mococcal vaccine can largely prevent pneumo-nia, he added.

Dr Zulfiqar Bhutta, head of the Division of Maternal and Child Health at the Aga Khan University Medical Centre in Pakistan; Prof Md Shahidullah, pro-vice chancellor of the Bangabandhu Sheikh Mujib Medical University (BSMMU); and Dr Desmond Turner, member of parliament of the United Kingdom were also present at the press conference.

DHAKA, BANGLADESH NOVEMBER 2, 2009

World Pneumonia Day Today

50,000 children die of pneumonia a year

DHAKA, BANGLADESH NOVEMBER 2, 2009

Combating pneumoniaAs reported recently in the media, some 70,000

children severely infected with pneumonia

die every year in Bangladesh, according to a

conservative estimate made by experts on health

services. Pneumonia, a severe inflammation of the

lungs usually caused by infection, is responsible

for one in four child deaths, more than HIV/

AIDS, malaria and measles combined. Each

year it kills approximately two million children

below five years of age, making it the leading

child killer. The number of pneumonia patients

is increasing in the hospitals, health facilities

clinics and private physicians’ chambers.

Many children of poor families suffer from

respiratory infections including pneumonia and

die, as they are from a have-not background

mostly in the rural areas and hardly can afford life

saving vaccines. Prevalence of pneumonia among

children is high usually between November and

February when temperatures drop and the winter

chill - coupled with humidity - affects the poor

children who are often malnourished and have

little resistance. Under-nutrition, exposure to

unhygienic conditions, lack of breast feeding,

indoor air pollution at homes and dust outside

are the causes of widespread incidence of

pneumonia.

According to the experts, the most effective

way to prevent pneumonia deaths is to provide

easy access to safe and affordable vaccines.

On the occasion of the First World Pneumonia

Day observed on November 2, the focus was

on global attention to this silent killer and spur

policymakers to prevent and treat pneumonia as

a disease. About 4 million of under-five children

across the country are expected to receive the

prescribed newly improved Hib-vaccine by June

2010. Hib-vaccine is a ‘five-in-one’ combination

that will protect children against Hib and four

other deadly diseases - diphtheria, tetanus,

pertussis and hepatitis B - children will need

only one injection at three different times during

their first year life.

CALGARY, CANADA NOVEMBER 2, 2009

UN says $39B would save lives of 5.3 million children

Pneumonia kills more young children than any other disease, but an investment of $39 billion US, or just $12.90 per child, could save 5.3 mil-lion lives in developing countries by 2015, the UN said early today.

The disease, which attacks the lungs, kills 1.8 mil-lion children under the age of five every year.

The UN Children’s Fund and the World Health Organization made a joint appeal to fund a six-

year plan for pneumonia prevention and treat-ment in 68 developing countries, mostly in Africa and Asia, plus parts of Central and South America.

“We know the strategy will work, and if it is ap-plied in every high-burden country, we will be able to prevent millions of deaths,” said Margaret Chan of the WHO.

By Heidi Kingstone

When Kate O’Brien’s 12-month old baby showed

signs of pneumonia, she rushed him down to the

emergency department at one of Washington, D.C.’s

hospitals, knowing that even at 2 a.m. staff would be

on hand to treat her child. Many parents will have

experienced a similar episode.

While Dr. O’Brien’s baby recovered quickly, parents

in the developing world face such overwhelming ob-

stacles that often they can only just watch as their

own pneumonia-stricken children gasp for breath.

Pneumonia is the number-one killer worldwide of

children under five — more than measles, AIDS

and malaria combined. The disease kills two million

children every year, one child every 15 seconds. The

two primary causes of pneumonia are streptococcus

pneumoniae and Haemophilus influenzae type b, also

known as Hib.

When her own child was sick, Dr. O’Brien, Associate

Professor at the Johns Hopkins Bloomberg School of

Public Health, jumped in the car to go to the doctor.

But of course, for children in the developing world,

it’s not that simple. The family may live hours away

from a health-care facility, and there may not be any

transport available aside from their own two feet.

Once they get to a clinic or hospital, there may be no

doctor, especially if it’s at night. Even if the physi-

cian is working, there might not be any electricity,

and they might not have any oxygen or antibiotics.

Even if antibiotics are available on that day, the doc-

tor might have to ask the parents to buy them, and

they might not have enough money. Even if they get

the drugs, the child may be too malnourished to re-

cover. “All of those limitations,” says Dr. O’Brien,

who was born in Edmonton and studied medicine at

McGill University in Montreal, “means that access-

ing care is really difficult and it’s a huge financial

burden on parents. In the end, they may not have the

money to save their child’s life.”

Those statistics are the reason behind the launch to-

day of the first World Pneumonia Day, to bring to the

attention of the public and policy-makers a simple

message: The best cure for this disease is prevention

— with a safe and effective vaccine that has been

used in the developed world for many years.

The World Pneumonia Day coalition was established

in April 2009 as an international association of gov-

ernment, non-governmental and community-based

organizations, research and academic institutions,

foundations and individuals — including actors

Gwyneth Paltrow and Hugh Laurie.

Children in poor countries are more at risk because

they are also more likely to be malnourished and

vitamin-deficient, making them less able to fight

the disease. They will likely live in crowded houses

with air pollution caused by indoor cooking fires.

Immunizing children in a systematic fashion is easier

and quicker than building up full-scale health-care

systems — which is also a worthy goal, but takes

years.

In the past, the financing of vaccines has been a ma-

jor issue. GAVI, the Global Alliance for Vaccines

and Immunisation, a global health partnership that

began with a $750-million donation from the Gates

Foundation, helped put a strategy in place. Along

with their partners, the World Bank, WHO and

UNICEF and five national governments, they started

the first-ever Advance Market Commitment (AMC),

which pledges money to help pay for vaccines.

Canada has played a leading role as one of the five

major donor countries, pledging $200-million in

an overall pool of $10-billion. (The others are the

U.K., Norway, Italy and Russia.) Canadians should

be proud of this. Other nations, and private donors,

should follow the Canadian example. The lives of the

world’s youngest and most vulnerable are at stake.

ONTARIO, CANADA NOVEMBER 2, 2009

Pneumonia: a killer like no other

INDIA NOVEMBER 1, 2009

By Dr. Anuradha Bose

Pneumonia is treatable yet it is one of the

leading causes of infant mortality. With

November 2 now observed as World

Pneumonia Day, we need to take a second

look at immunisation programmes.

Nearly one in ten children born in India will

not live to see their fifth birthday, the under-5

mortality, on an average, for India, being 85

per 1000. Nearly half these deaths occur in the

first month of life. If one survives that period,

the two ma in causes of death are diarrhoeal

disease and pneumonia.

However, the deaths due to pneumonia have

only recently been acknowledged, pneumonia

being identified as the “forgotten killer of

children” by UNICEF.

Simple strategies

A vast majority of children can be saved by the

implementation of prevention and treatment

strategies universally. Simple measures like

exclusive breastfeeding for six months can

prevent child deaths by a good 16 per cent.

Provision of adequate nutrition which would

correct deficiencies of micronutrients such as

zinc, have also been proven to be effective.

Thousands of deaths can be prevented by

prompt recognition of the severity of the

illness, appropriate diagnosis and adequate use

of antibiotics, by trained health personnel.

Pneumonia is an easily treatable condition,

and the organisms that cause these illnesses

respond well to available antibiotics.

The danger to life arises because of late

presentation to health care facilities. Is health

care access a problem in India? Does India

have inadequate healthcare resources? On

the contrary, there has been a tremendous

growth in healthcare resources and health

related manpower, with an adequate

doctor patient ratio. There is however,

a misdistribution with concentration of

resources in urban settings, and a distancing

of health care access from the population,

geographically, socio-economically and

even by gender.

With inequity in health care access, what are

the alternatives? Universally, immunisation

has been known to protect children against

life threatening illnesses. The use of vaccines

to reduce the burden of pneumonia is not a

new concept, targeting diseases which result

in pneumonia. The pertussis (whooping

cough) vaccine has been in use for the last

five decades, worldwide, and has been

available in India as part of the triple antigen.

Measles vaccine, in wide use since the

1980s is estimated to have saved 2.5 million

lives, and is part of the Government of India

immunisation programme. Both diseases

however, continue to be prevalent in parts

of India, in states where the immunisation

coverage is low, bringing home the point

that vaccines work only if given, and access

to health systems is critical for the well-

being of a society.

New vaccines

The two newer vaccines targeting pneumonia

(and meningitis), available in India in

the private sector, are the Hib conjugate

vaccine and the Pneumococcal Conjugate

Vaccine (PCV). These vaccines are relatively

expensive, costing approximately Rs. 200-

300 per dose for the HiB vaccine and over

Rs. 3000 per dose for the Pneumococcal

vaccine. Introduction of these vaccines into

the national immunisation schedule would

imply a huge ongoing financial commitment

for the Government, and the Government

would need to be sure that such a measure is

cost-effective.

Do these vaccines work against pneumonia?

How do we demonstrate that they work

against pneumonia? There is no confirmatory

diagnostic test for pneumonia, the closest

approximation being an x-ray. Protection

against pneumonia by vaccines is therefore

difficult to measure, and is often reported as

protection against radiologically confirmed

pneumonia. Demonstration of efficacy is a

difficult task.

The protection given by Hib vaccine varies

from 22 to 44 per cent in various studies

across the world. The Government of India,

based on available evidence, has made a

decision to introduce the Hib vaccine into

the national immunisation schedule, in a

phased manner. This would be done as a

pentavalent injection, combining diphtheria,

tetanus, whooping cough, hepatitis B and Hib

conjugate vaccine.

As for the pneumococcal vaccine, the

pneumococcal organism has many different

types (serotypes) and a vaccine is denoted

by its valency, i.e. the number of serotypes

it covers. The serotypes that cause disease

vary in different countries and the same

vaccine may not work with equal measure in

all countries. The version of this expensive

vaccine currently available in the private

sector in India is seven valent, and there is

some concern that this vaccine does not cover

all of the locally prevalent serotypes.

Pros and cons

There are justifiable arguments against the

successive introduction of newer and more

expensive vaccines into a country. The

existing immunisation programme is not

optimally utilised, immunisation rates being

as low as 50 per cent in some areas. Even

with financial support from agencies outside

the country, vaccine programmes involve

a great commitment in terms of finance,

organisation, manpower and other resources.

There are already pressing issues like water

and sanitation that need to be addressed.

Should the money be spent instead in making

health care access more equitable?

More than one million lives around the

world can be saved per year with simple and

effective interventions such as promotion of

breast feeding, attention to nutrition, scaling

up of treatment strategies, and ensuring

immunisation for the vulnerable. All carers

for children should become partners in this

fight against pneumonia, so that this easily

treatable condition does not continue to claim

such a large quantum of young lives.

A forgotten killer

BENGALURU, INDIA NOVEMBER 1, 2009

Every minute a child dies of pneumonia in IndiaBy Our Correspondent

A coalition of more than 50 child health organi-sations from all over the world will By the time you’ll finish reading this report, ten more children, below the age of five, would die of pneumonia. “Every minute, one child dies of pneumonia in India,” says the latest World Health Organisation (WHO) data published in a medical journal – The Lancet – last September. The data was released on the occasion of World Pneumonia Awareness Day, observed on Monday.

Underlining the same message, paediatricians in the state capital and across the country urged the governments to hold dedicated vaccination programmes to check pneumonia. Notably, reg-ular doses of vaccines should be given after six weeks, 10 weeks and 14 weeks and the booster dose should be given between 18 and 24 months to protect children from pneumonia.

Is there a lesson for UP? Answering this, hon-orary secretary, Indian Academy of Paediatrics (IAP), Dr. Sanjay Niranjan said, “There is an urgent need to save children from pneumonia if neonatal, infant and child mortality rates in the state have to be brought down. UP is the most populous state in India and pneumonia spreads faster in densely populated areas.”

Asked to comment on the same issue, Prof. YC Govil of Chhatrapati Shahuji Maharaj Medical

University’s (CSMMU) paediatrics department said that children in UP were vulnerable to pneu-monia because of high rates of malnourishment too. “The microbes causing pneumonia attack children with weak immunities, and every other child in the state has very weak immunity. Then, the state lags behind in general immunisation rates as well,” he said.

Health experts and representatives main-tain that India cannot achieve the Millennium Development Goal 4 of reducing child mortal-ity by two-thirds unless it tackles the pneumonia burden along with that of diarrhoea.

It may be pointed out that pneumonia kills more children than AIDS, measles, and malaria com-bined, and yet many children do not receive af-fordable solutions proven to prevent and control pneumonia. A coordinated and concerted global effort will help ensure that pneumonia gets the much needed attention that will lead stake hold-ers and governments to develop, implement, and monitor comprehensive programmes.

In addition, a major obstacle in getting these tools for the children is perception. Many people, es-pecially those in the developed countries, simply don’t know that pneumonia kills more children than any other disease. Global health funding and interventions are often allocated and imple-mented based on the perception of threat.

JAKARTA, INDONESIA NOVEMBER 2, 2009

UN: $39 billion needed for pneumoniaTo fight pneumonia, the world’s top killer of children, United Nations officials say they need US$39 billion (Euro 26.35 billion) over the next six years.

On the first World Pneumonia Day on Monday, the World Health Organization and UNICEF are releasing a global plan aiming to save more than 5 million children from dying of pneumonia by 2015.


“This is very simply the biggest killer people never hear about,” said Orin Levine, a pub-lic health expert at Johns Hopkins Bloomberg

School of Health, who has advised WHO and UNICEF. Pneumonia accounts for about 20 per-cent of all child deaths every year; AIDS causes about 2 percent.


To change that, the UN is promoting a variety of strategies from vaccination to generalized in-terventions that address economic development. Pneumonia deaths are strongly linked to malnu-trition and poverty.

NAIROBI, KENYA NOVEMBER 18, 2009

Opinion

Kenya: We must combat this silent killer By Fred N. Were

Pneumonia is a disease that follows an infection of

the lungs. A child who develops a cough, fever and

fast breathing is most likely to be suffering from it.

It has been estimated that at least two out 10 children

younger than five years suffer this illness every year,

while two out of every 10 deaths of children in Kenya

are attributable to the disease. We have two weapons

to combat this scourge - prevention and effective

treatment.

Infections that cause pneumonia are among the

most easily preventable through a variety of simple

technologies.

These include:

Adequate childhood nutrition especially with

mother’s milk: Children fed on mother’s milk alone

for the first six months have a 50 percent less chance

of dying from pneumonia compared to those who

aren’t. Unfortunately, only two out of 10 women

exclusively breastfeed for six months in Kenya.

Reducing environmental pollution: It has been

established that air pollution, including secondhand

cigarette smoke damage the lungs of babies, making

them much more prone to lethal pneumonia. There

should simply be no smoking near a baby.

Maintenance of general hygiene: Recent research

indicates that when we observe strict hand-washing

behaviour throughout the day, we reduce the chances

of contracting infections that cause pneumonia by

about 50 percent. Surely we can do this, can’t we?

Childhood immunisation: This is doubtlessly the

intervention with the greatest impact in combating

pneumonia and all infectious illnesses that affect

children in the world today. The initial introduction

of national immunisation programmes enlisting all

children contributed towards a reduction of more

than 50 percent of deaths among children between

the 1960s and the 1980s.

That was, indeed, phenomenal. The enhanced

immunisation programme initiated at the beginning

of this century led to a further reduction of child

deaths from 115/1,000 to 74/1,000.

This means Kenya loses 74 out of every 1,000 babies

born before their fifth birthday. The improvement

is applauded but still short of the Millennium

Development Goal target of 32/1000.

Kenya is poised to introduce perhaps the most

exciting childhood vaccine in the modern era in the

course of next year. This is the pneumococcal vaccine

which will do battle with the most common cause of

pneumonia among other diseases.

If properly applied, this vaccine will reduce both

pneumonia attacks and deaths considerably. It is

estimated that it may reduce annual childhood deaths

in Kenya by nearly 20 percent.

The success of this new vaccine, and indeed, any

others, depends on all children receiving it. At

present, only 70 percent of Kenyans are adequately

immunised. This needs to be closer to 90 percent.

When pneumonia attacks, it can be easily treated if

identified early. By the time the child described above

has developed difficulties breathing, the situation is

desperate. That child now has severe pneumonia and

is unlikely to survive without prompt treatment with

antibiotics.

This Saturday, the Kenya Paediatric Association will

conduct the second child health-run at the University

of Nairobi. It will be dedicated to pneumonia, a

disease dubbed by the WHO as “the forgotten killer

of the world’s children”.

Prof, Were is chairman, Kenya Paediatric Association.

SEOUL, KOREA 2009

Noise, not need, grabs health aidBy Philip Stevens

Pneumonia is a disease that follows an

infection of the lungs. A child who develops

a cough, fever and fast Health activists

Medecins Sans Frontieres (MSF, Doctors

Without Borders) claimed recently that the

global recession threatens AIDS funding,

putting millions of lives in Africa at risk.

Donors certainly have to think more

carefully about getting the biggest bang

for their buck but this is long overdue: for

too long, global health funding has gone

to diseases like AIDS with the most vocal

lobby groups and not to the diseases with

the greatest need.

HIV/AIDS is the world’s most high profile

disease. “World AIDS Day” garners an

astonishing 32.3 million hits on Google.

According to a 2007 poll conducted by

the Kaiser Family Foundation, people

questioned in eight out of 10 sub-Saharan

African countries consider AIDS to be their

country’s No. 1 health priority.

The same poll shows people in Asia also

believe HIV should be a major priority for

their governments, with those in India and

Bangladesh putting it at the top.

In fact, HIV/AIDS causes only 5.7 percent

of deaths in developing countries. Only

eight countries have a severe AIDS crisis,

all in sub-Saharan Africa. In India, the

prevalence rate is a tiny 0.3 percent.

That HIV/AIDS is at the front of ordinary

peoples’ consciousness is a result of

decades of campaigning by international

AIDS activists, perhaps the best organized

and most powerful health lobby the world

has ever seen.

A staggering 24,000 delegates, many of

them professional campaigners, attended

2008’s biannual International AIDS

conference in Mexico City ― and that’s

just the ones who could afford the airfare

and the $1,200 entry fee.

Since the early 1990s, thousands of AIDS

NGOs have sprung up all over the world,

producing a constant stream of publicity

and advocacy, holding public meetings and

thrusting themselves in front of politicians.

Major development pressure groups such as

Oxfam and Save the Children have put AIDS

at the heart of their lobbying. Big Western

multinational companies have got in on the

act too, most notably the “Red” campaign

backed by Gap, American Express, Apple

and Starbucks, among others.

As a result of this lobbying, the cash has

poured in. AIDS spending rose from 3.4

percent of all health aid to developing

countries in 1990 to 23.3 percent in 2007,

from $0.2 billion to $5.1 billion.

President Barack Obama has pledged to

increase spending on AIDS to 70 percent of

all U.S. global health spending in 2010: $8.6

billion, totaling $63 billion over six years.

AIDS also has the dubious distinction of

being the only disease to have its dedicated

U.N. agency, UNAIDS.

But much of this money has been poorly

spent. The AIDS industry boasts of the

millions of people on anti-retroviral

treatment but almost no progress has been

made in actually reducing the numbers

infected globally ― surely the only true

measure of success.

Meanwhile, diseases that kill many more

remain in relative obscurity.

The biggest killer in lower-income countries

are chest infections such as pneumonia,

accounting for 11.2 percent of all deaths,

mainly amongst children under five.

There is no U.N. agency for chest infections,

almost no dedicated funding and only a

sprinkling of NGOs. Bizarrely, the first

World Pneumonia Day was on Nov. 2 this

year, although this disease has always been

a scourge of humanity.

The third biggest killer in developing

countries, after heart disease, is diarrhea.

This kills 1.5 million children every year,

more than AIDS, malaria and tuberculosis

combined.

Yet there is no World Diarrhea Day and the

disease attracts a fraction of the funding

of HIV/AIDS. There is only one staff

member at the World Health Organization

working exclusively on childhood diarrheal

diseases.

Fortunately, thing are beginning to change.

The U.N. has begun pleading for funds to

improve health systems, so that “silent

killers” such as pneumonia and diarrhea can

be better tackled.

Some government aid agencies, such as

Britain’s Department for International

Development (DfID), plan in future to

spend money on improving healthcare

systems, rather than on specific diseases

such as AIDS.

Better healthcare systems also make it

easier to manage HIV patients, who tend to

also have other health problems.

The AIDS lobby rejects this reasoning.

“Some policymakers say AIDS is expensive,

we should focus on cheap and easy things,”

Tido von Schoen-Angerer from MSF told

reporters last week, adding: “This cannot be

an either-or game. It’s not that HIV is over-

funded. Global health is under-funded.”

The reality is that there will never be enough

money for global health. Governments

therefore have a duty to ensure taxpayers’

money saves as many lives as possible.

Taking the lobbying of the AIDS industry

with a pinch of salt would be a good place

to start.

Philip Stevens is a senior fellow at

International Policy Network, a development

think-tank based in London. He can be

reached at [email protected].

MONROVIA, LIBERIA NOVEMBER 18, 2009

First World Pneumonia Day, 2 November 2009 By Bobby Ramakant, CNS

Pneumonia is a disease that follows an infec-tion of the lungs. A child who develops a cough, fever and fast Pneumonia claims two million children under five each year, yet no new drug, vaccine or special diagnostic test is needed to save their lives. The answers are at hand, and ef-fective treatment is both inexpensive and widely available.

So why are children dying? This question is the driving force behind the first World Pneumonia Day (2 November 2009). The Global Coalition Against Child Pneumonia led by Save the Children has organized a Global Summit on Pneumonia in New York and other events around the world to mobilize efforts to stop a disease that kills one child every 15 seconds.

Actions, not answers, are needed to solve the problem, according to Penny Enarson, head of the Child Lung Health Division for the Paris-based International Union Against Tuberculosis and Lung Disease (The Union).

In an editorial “Who Speaks for the Children?” published this month in the International Journal of Tuberculosis and Lung Disease, Enarson et al point out that “recent data from 68 high-mor-tality countries showed that only 32 percent of children with suspected pneumonia receive an-tibiotics.” Other lapses in the delivery of care range from lack of trained staff and poor case

management to inadequate stocks of drugs and faulty equipment.

Over the past decade, The Union has developed a service delivery model that addresses the key challenges in providing effective care for chil-dren with pneumonia. Based on the widely used Union model for tuberculosis control known as DOTS, the Child Lung Health Programme (CLHP) is based on government commitment, standard diagnostic and treatment guidelines, staff training, a purchasing and distribution system that ensures an uninterrupted supply of drugs, recording and reporting mechanisms, and supervision and evaluation.

The CLHP was first implemented by The Union in partnership with the Malawi Ministry of Health and Population. Between 2000 and 2005, the case fatality rate for children under five with severe and very severe pneumonia dropped 54.8 percent. By 2008, the rate had declined by 60 percent, demonstrating the sustainability of the model. The CLHP has also been implemented with good results in pilot programmes in Benin, China, Sudan and Tanzania.

“If we’re committed to reaching the Millennium Development Goal of reducing child mortal-ity by 50 percent by 2015, we have to improve the way pneumonia is managed,” says Enarson. “The tools for saving these children exist. It is the political will to act and resources to support effective action that have been lacking.”

KATHMANDU, NEPAL NOVEMBER 1, 2009

Pneumonia major killer of childrenBy Dev Kumar Sunuwar

Every year, 11,000 children under five years of age die of pneumonia, despite the state’s claim that its efforts to contain child mortality are pay-ing off.

According to the Ministry of Health (MoH), over 58,000 children aged below five years die of various diseases, including pneumonia.

“We have made considerable progress in reduc-ing child mortality, but it’s true that thousands of children die of various diseases every year. Pneumonia is a leading child killer. We are not focusing as much as we should on containing the respiratory disease,” according to Dr. Shyam Raj Uprety, director at the MoH’s Child Health Division (CHD).

Dr. Uprety says protection, prevention and treat-ment are the only means available to save children from pneumonia. Feeding mother’s milk for six months after birth and nutritious food thereafter, vaccination against the pneumococcus bacteria

and Haemophilus influenze pneumonia are the ways to go. But these vaccines are quite beyond reach for many, for they are expensive.

From April 14, said the CHD director, the MoH initiated the first phase of vaccination against pneumonia in 25 districts of the West and Far-west regions. “The health ministry will launch the programme in other regions from mid-No-vember along with the government’s ongoing nationwide community-based integrated man-agement of childhood illnesses (CB-IMCI) programme.”

According to MoH statistics, over eight million babies are born every year, 82 percent of them at home in unprotected and unsafe condition. There is a high risk of neonatal mortality owing to the lack of skilled health professionals.

In its bid to curb neonatal mortality, the ministry has launched free delivery services in all district hospitals, primary heathcare centres, health posts and sub-health posts from Jan. 14 this year.

IBADAN, NIGERIA OCTOBER 27, 2009

200,000 kids die of pneumonia yearly, expert laments

From Iyabo Lawal, Ibadan

An expert yesterday raised alarm over the high rate of pneumonia, especially among the chil-dren in the country.

A Professor of Paediatrics at the University College Hospital (UCH), Ibadan, Professor Adegoke Falade, lamented the increasing rate of pneumonia cases in Nigeria, at a press briefing on forthcoming maiden World Pneumonia Day billed for Monday, November 2. He tasked the Federal Government to urgently put measures in place to combat the spread of the scourge.

Falade, who is the former President of Paediatric Infectious Diseases Association of Nigeria (PIDAN), said over 200,000 children die yearly in the country from pneumonia-related cases, warning that more deaths might be recorded among children of ages one to five, unless some-thing urgent was done to tackle the disease.

Falade noted that Nigeria ranks as the fifth among the nations with the highest cases of pneumonia.

He pointed out that the scourge was more deadly than the Acquired Immune Deficiency Syndrome (AIDS), measles and malaria. Falade said government must be ready to subsidize the cost of vaccines needed by patients to combat the dreaded scourge.

He said: “The burden of pneumonia is on the children under the age of five. Globally, pneu-monia is the number one killer of children. It can lead to respiratory and heart failure, which can ultimately lead to death.

“In UCH alone, we see an average of two new cases per day, making about 60 new cases of pneumonia,” he said.

As a way of preventing the spread of the scourge, Falade stressed the need for government to tack-le the prevailing problem of malnutrition among the children. He encouraged exclusive breast feeding among nursing mothers.

On the first World Pneumonia day, Professor Falade said the day was set aside to sensitize Nigerians on the need to resist the spread of the disease.

GENEVA, SWITZERLAND NOVEMBER 2, 2009

UN launches plan to fight pneumonia among children

An expert yesterday raised alarm over the high The World Health Organisation and UN child agency on Monday launched a global action plan to fight pneumonia, which kills some 1.8 million children under five every year.

“Since we know what interventions work, we need to urgently implement them to combat the ailment which is also the biggest killer of chil-dren under the age of five,” said Anne Golaz, a senior health adviser at Unicef.

Golanz said 5.3 million young lives could be saved between now and 2015 if the measures were implemented.

The UN agencies stressed two key measures to combat the ailment: ensuring that every child is vaccinated, and is only breast fed for the first six months at least.

The WHO said the security and efficiency of vaccines have been proven. Golaz stresses that children who are exclusively breast fed during

the first six months of their lives have a 23 per cent less chance of contracting pneumonia.

‘But only one third of children in developing countries are exclusively breastfed for the first six months,’ noted Golaz.

More than 98 per cent of deaths linked to pneu-monia are recorded in the poorest countries in the world, according to data from the UN agencies. —AFP

If the appropriate measures are implemented 5.3

million young lives could be saved between now and

2015: Unicef. —Photo by Reuters

KARACHI, PAKISTAN NOVEMBER 2, 2009

First-ever World Pneumonia Day observedPneumonia kills more children than measles, malaria and AIDS combined

By Amar Guriro

Health experts of the Aga Khan University (AKU) have said that pneumonia is one of the most lethal diseases in the world and it kills more children, under five years of age, as compared to other fatal diseases like measles, malaria and AIDS, even if all three are combined.

As a part of the message on World Pneumonia Day, cel-ebrated around the world on November 2, the experts said the world’s leading child killer is not measles or malaria, but in fact pneumonia, which can be prevented by existing vaccines or treated with inexpensive antibi-otics. They also said that while the disease affects chil-dren and families everywhere, it has the most impact in South Asia and sub-Saharan Africa, where 98 percent of all deaths occur due to pneumonia.

In Pakistan, the World Health Organisation (WHO) es-timates that one in every five child deaths are caused by pneumonia. This disease must be tackled if the United Nations Millennium Development Goal 4 for reducing child mortality is to be met.

In a statement issued by AKU Department of Public Affairs Media Executive Fabeha Pervez, the experts at AKU said that safe and effective vaccines exist to pro-tect children from the leading causes of pneumonia such as Hib and pneumococcal diseases.

“The Hib vaccine is already available and Pakistan was the first country in South Asia to introduce the vaccine through its national immunisation programme, includ-ing the pneumococcal vaccine, which will be included in the Expanded Programme on Immunisation (EPI) for Pakistan by January 1, 2011,” said Pakistan National Immunisation Technical Advisory Group Chairman Dr Tariq Bhutta.

“As the pneumococcal vaccine is currently available in Pakistan, at Rs 12,000, it is too expensive for most people. Under the EPI, the vaccine will be available free

of cost at all EPI centres around the country. Resources should not be an excuse to avoid tackling this problem,” said Bhutta.

Researchers at AKU are providing reliable estimates per-taining to how many children are affected by Hib and pneumococcal infections in Pakistan, while demonstrat-ing the highly positive effects of vaccinating children against pneumonia. AKU Department of Paediatrics and Child Health (DPCH) Professor Dr Anita Zaidi present-ed early results from a large research study of pneumonia in children in Karachi, Hyderabad, the Matiari district of Sindh and Jhelum in Punjab, showing that use of the Hib vaccine has reduced the incidence of pneumonia cases.

Besides preventing the disease, protecting and treating children is equally important. “Breastfeeding the baby for the first six months of its life, along with good nutri-tion and hygiene can prevent many cases of pneumonia” said AKU DPCH Professor Dr Gaffar Billoo. He also stressed on the need to recognise the signs of pneumo-nia, which include heavy breathing, wheezing and fever, since providing timely health care with low-cost antibi-otics can save lives.

Sweden Karolinska Institutet Emeritus Professor Dr Bo Lindblad highlighted that organisations from around the globe have joined hands to urge governments to fight pneumonia. The first steps for this fight are outlined in the Global Action Plan for the Prevention and Control of Pneumonia, released by the WHO and UNICEF today, to mark the first World Pneumonia Day.

AKU DPCH Professor and Interim Chairman Iqtidar A Khan, delivering the closing remarks, further said that new vaccines can only have their full effect on reduc-ing pneumonia related deaths, if efforts are stepped up by parents, doctors and the health officials of all dis-tricts to make sure every child receives a full course of vaccines.

MANILA, PHILIPPINES NOVEMBER 1, 2009

Pneumonia vaccine included in government immunization plan

By Jenny F. Manongdo

Barely two years old, Rosario, ill for several days, struggles to breathe in a hospital in Manila. Thinking that the sickness was the work of evil spirits, Rosario was brought by his parents to a quack doctor, with burn marks on his chest from candle drippings used by the quack doctor presumably to send the evil spir-its away. But the baby was not cured, prompting his parents to bring him to a doctor.

Rosario was diagnosed with pneumonia, a disease that affects three million Filipino children below five years old every year and kills 9,000 annually.

Luckily, Rosario was seen by doctors at the National Children Hospital before her condition turned to worse.

Pneumonia is an infection of the lungs that makes breathing difficult. Tobacco smoke, overcrowding, malnutrition and other kinds of pollution increase the risk of young children to develop this disease.

Dr. Lulu Bravo, Executive Director of the Philippine foundation for Vaccination and the country’s anti-pneumonia champion stresses that the local figure on pneumonia does not include the over-all number of young pneumonia patients, a disease that is both preventable and treatable if health leaders would just focus on vaccines that would arrest the bacteria and illnesses that could lead to pneumonia through vaccination.

“There are more children dying from pneumonia than A (H1N1). Most children who contracted A

(H1N1) died of pneumonia. All children are at risk for pneumonia although the capacities to undergo treatment varies,” Bravo said, emphasizing the need for the Hib (Haemophilus influenza b) and the pneu-mococcus vaccine to be included in the Expanded Program for Immunization (EPI) of the Department of Health (DoH).

Bravo made the announcement in a conference that gathered various health sectors in celebrating the first world pneumonia day on November 2.

She is making a study on the incidence and experi-ences of young pneumonia sufferers in the country to convince authorities that urgent action is needed to save innocent lives. Her visits to patients in a dump-site in Manila has been documented by the British Broadcasting Company and will be presented during the world pneumonia day that will be held in New York.

“Hib and the pneumococcal vaccine can help reduce the incidence of pneumonia and these have to be in-cluded in the EPI,” Bravo said in a press conference organized by the Philippine College of Physicians recently.

Under the EPI, the government gives free vaccina-tions such as Diptheria, Pertussis-Tetanus vaccines and oral polio vaccines to children below 12 months of age. “These vaccines are already being given for free in Brazil and Mexico. I hope this will be avail-able in the Philippines soon. This is important be-cause there is a pneumonia strain that can kill within five days if left untreated.”

UGANDA NOVEMBER 1, 2009

Why is pneumonia still a forgotten pandemic?

By Dr. Daniel Tumwine

If a child with cough, fever and fast breathing came up to

you, would you be able to tell that they have pneumonia?

One in five adults cannot. Yet childhood pneumonia is

the world’s most deadly disease. The statistics alone can

take your breath away.

There will be 150 million episodes of pneumonia in

children under five years this year alone. Of these, 11 to 20

million will be severe enough to require hospitalisation.

Unfortunately 2 million of these children will die — the

vast majority, in a place like Uganda. If nothing is done

about it, one in five parents or guardians will still not be

able to tell that their child has pneumonia.

Pneumonia will continue to cause more deaths than

measles, malaria and AIDS combined, and life will go

on.

Pneumonia can lead to death within the first 48 hours. It

is an easily preventable disease and is, for the most part,

completely treatable. A full dose of treatment costs about

$30 (sh60,000).

In Uganda alone, 27,000 children (the size of Ibanda,

Luweero or Adjumani towns) will die before their fifth

birthday because of pneumonia this year. Yet it continues

to receive little press, modest funding, inadequate

attention from governments, local health programmes, bi

and multilateral funding partners and there is a shortage

of modern era research into how to better manage the

disease.Pneumonia is also the most common cause

of illness, hospitalisation and death in HIV-infected

children.

In fact, 90% of HIV-infected children will develop a

respiratory illness during the course of their HIV disease

— and most of these illnesses will be due to pneumonia.

An HIV-positive child is almost 10 times more likely to

die from pneumonia than one who is not.

Other risk factors for pneumonia include malnutrition,

indoor air pollution with solid fuels, overcrowding, and

any other form of lowered immunity.

Proven preventive measures include immunisation,

promotion of exclusive breastfeeding during the first

few months of life, zinc supplementation, control of

indoor air pollution, prevention of mother-to-child HIV

transmission and pneumonia prophylaxis in high HIV

prevalent areas.

So why do so many children continue to die from a

disease that is completely preventable and treatable in a

day and age when East Africans are taking tours in outer

space?

Why do such staggering figures not indict governments,

and world bodies to mobilise a global effort to address

pneumonia? Why is pneumonia still a forgotten

pandemic?

The main cause of the high mortality from pneumonia is a

failure of recognition of the early signs and symptoms of

pneumonia by guardians, parents and medical workers.

There is also lack of access to effective health services.

One cannot access health care when they do not see a

need to. Caretakers, therefore, should be conversant with

signs of pneumonia.

A child with pneumonia will have a cough and fast

breathing. If, in addition, there is a fever, drowsiness,

flaring of the nostrils, prominence of ribs on breathing in,

or difficulty in breathing, then the child may need urgent

hospitalisation with or without oxygen.

Remember, pneumonia kills within 48 hours and is by

a stretch the world’s largest killer of children. Let not

ignorance lead to the death of a loved one. For it was

a wise being who wrote, “my people die for lack of

knowledge.”

SINGAPORE OCTOBER 27, 2009

$55b to save 5.3m livesPneumonia kills more young children than any

other disease, but an investment of US$39 bil-

lion (S$54.7 billion), or just US$12.9 per child,

could save 5.3 million lives in developing coun-

tries by 2015, the UN said on Monday.

The disease, which attacks the lungs, kills 1.8

million children under the age of five every

year, but despite this toll, relatively few re-

sources are put into tackling it, the World Health

Organisation and UN Children’s Fund said.

They made a joint appeal to fund a six-year plan

for pneumonia prevention and treatment in 68

developing countries, mostly in Africa and Asia,

plus parts of Central and South America, where

it is prevalent.

“We know the strategy will work, and if it is ap-

plied in every high-burden country, we will be

able to prevent millions of deaths,” Margaret

Chan, director general of the World Health

Organisation, said.

The agencies called for strategies to urge moth-

ers to breast feed babies exclusively for the first

six months, increase use of vaccines, and boost

proper treatment. They also want policymakers

to act immediately to implement the plan.

PAPUA NEW GUINEA NOVEMBER 13, 2009

The forgotten killer Elizabeth Miae reports on the

scourge of pneumonia, which is

still PNG’s deadliest disease

Pneumonia needs to be put high on the national and global agenda if Papua New Guinea and other countries want to achieve the United Nations’ 4th Millennium Development Goal: to reduce childhood deaths by 2015.

According to the PNG Medical Research Institute (PNGIMR), pneumonia is a very serious preventable disease in PNG, more serious in fact than malaria, but receives very little attention. Therefore, the Government must seriously look at implementing ways to reduce the high burden of pneumonia in children. With the increasing rate of HIV/AIDS, pneumonia deaths in HIV positive people would only add to this burden.

PNG joined the rest of the world last Monday to observe the World Pneumonia Day. According to national health statistics (National Health Plan 2000-2010), pneumonia is the leading cause of death in PNG – 19.4 deaths per 100,000. It is the leading cause of death in children under 12 months of age and second only to malaria in children under five.

Globally, an estimated 156 million cases of pneumonia in children under five are reported each year, resulting in an estimated two million deaths. Most of these deaths occur in developing countries, including PNG. A study in Goroka by PNGIMR scientists estimated that deaths from pneumonia in children less than six months of age to be 250 deaths per 100,000.

Malaria and pneumonia are the top two causes of deaths in PNG and the two diseases that bring most people to hospital. There are a number of germs that cause pneumonia, including viruses, bacteria and parasites. In PNG, the most common causes of pneumonia are two bacteria, the pneumococcus

and haemophilus. Doctors and health workers diagnose pneumonia by watching the rate of breathing in a sick child. Children with cough and normal breathing are not treated.

Children with cough and fast breathing must be treated with antibiotics at an outpatient department. This is considered mild pneumonia. Severe pneumonia is when a child has marked chest indrawing and goes blue because the lungs cannot get enough oxygen.

Pneumonia is thought to begin from bacteria growing in the nose and at the back of the throat, and studies by the PNGIMR have shown that PNG children carry these deadly bacteria from a very early age, which puts them at risk of getting this serious disease while they are still babies.

Poor hygiene, poor nutrition, overcrowding and environmental pollution are all risk factors for pneumonia by allowing the germs to be transmitted easily via airborne droplets and to weaken the host’s resistance against these infections. By improving these conditions, especially observing good hygiene practices, maintaining a nutritious diet, reducing overcrowding in houses and improving ventilation to reduce smoke from wood fires, can help reduce pneumonia deaths in children.

Vaccination is one strategy to prevent pneumonia deaths. For the bacteria that cause pneumonia in PNG, there are three vaccines available. The haemophilus vaccine, against Haemophilus influenza type b (Hib), the most dangerous of the haemophilus bacteria, was rolled out last year. This vaccine has already reduced deaths due to this infection in most countries that have introduced it into their schedules. There are two vaccines against pneumococcus, a 23-valent polysaccharide vaccine and a 7-valent conjugate vaccine. The 23-valent vaccine is recommended for children from

two years onwards and the 7-valent is recommended for children under two years. The 23-valent vaccine has been successful in preventing deaths from pneumonia in PNG, even in children as young as nine months of age, but this study has not been repeated anywhere else in the world.

Both pneumococcal vaccines are expensive and the National Department of Health (NDoH) does not have the money to implement routine immunisation with these vaccines. However, moves have begun through the Global Alliance for Vaccines and Immunisation (GAVI) to assist developing countries and PNG has applied through the NDoH to introduce an expanded 10-valent version of this vaccine in 2010 or 2012.

“Before the vaccine can be introduced, we need to find the best schedule of this vaccine for PNG,” said William Pomat of the PNGIMR.

“In developed countries, three doses of 7-valent vaccine are given at two, four and six months. Because children in PNG are colonised by the bacteria earlier, an earlier schedule will be necessary to prevent pneumonia in young babies,” he explained.

He added that PNGIMR, in collaboration with the Telethon Institute for Child Health in Perth, Australia, is currently running a trial of the 7-valent vaccine looking at the effect of an earlier dose at birth, one and two months or at one, two and three months with a booster dose of 23-valent vaccine at nine months.

The preliminary results, Mr. Pomat said, were promising and it was likely that an earlier schedule would be recommended to the NDoH for implementation. He said others such as measles and flu vaccines could further reduce deaths from pneumonia.

Securing supplies of drugs to hospitals and health facilities continues to be a big problem for the NDoH. Drug supplies to rural health

facilities are further hampered by deterioration in infrastructure and the cost of transporting supplies to inaccessible areas. In most hospitals, there are problems with the supply of diagnostic reagents and the maintenance of equipment. X-ray machines which are important for diagnosis and confirmation of pneumonia by clinicians do not always function properly because of procurement issues. Oxygen is vital to treat severe pneumonia but its supply is limited.

Currently there are not enough statistics from around the country to provide accurate data on pneumonia deaths by region because many deaths in the villages are not properly recorded. Most of the data are from studies conducted in the Highlands region. From the National Health Plan, the Highlands and Momase regions have the highest recorded deaths from pneumonia at 21.6 deaths per 100,000 and 22.7 deaths per 100,000 respectively. In the remaining two regions, pneumonia is still in the top three causes of death. Accurate surveillance mechanisms would almost certainly increase the figures presented here.

In recognition of this, the PNGIMR will be hosting a Colloquium on Pneumonia in August next year to celebrate 40 years of research on pneumonia in PNG. Former staff and colleagues from here and abroad who have done research on the disease are expected to attend the celebrations which will be held in Goroka with the theme; “Action against pneumonia: A celebration of 40 years of pneumonia research in PNG and finding the best way forward.” As a celebration, the colloquium will highlight pneumonia to the mass media as the forgotten killer and bring the attention of the public to something that needs to be looked at seriously to achieve the Millennium Development Goals.

The National

DURHAM, NC NOVEMBER 2, 2009

World Pneumonia Day puts deadly disease in global spotlight

By Rose Hoban

About one in five children around the world dies from pneumonia — more than from measles, ma-laria and HIV combined. But not many people know that. That’s why the World Health Organization is sponsoring the first World Pneumonia Day, Monday, November 2nd.

Pneumonia is a preventable and treatable disease

About two million children worldwide die from the disease each year, and Mary Beth Powers, from the non-governmental organization, Save the Children, says, “the sad thing is this is a disease that is largely preventable, and highly treatable. So the reason kids are dying is often because they didn’t get vaccinat-ed, they are not properly breast-fed or they [don’t get] proper antibiotic treatment for pneumonia.” She notes that only one out of five children who has pneumonia receives appropriate medical treatment.

Powers says many of these deaths could be prevented if children were vaccinated. “Bacterial pneumonia happens after you have a viral disease like measles. So vaccination against measles and diphtheria can help prevent pneumonia cases.”

And there are two other vaccines specific to mi-croorganisms that cause pneumonia — one against Hemophilus influenza B, called HiB, and the other

against pneumococcal bacteria. Many countries don’t include these in their regular vaccination programs, but Powers says they’re slowly being incorporated.

Early recognition of symptoms is key

Powers says one thing that is happening now is orga-nizations such as hers are training community health workers in many countries to recognize and treat the symptoms of pneumonia. She says they can give a first dose of antibiotics and then refer the child to the nearest clinic or hospital for further treatment.

“It’s critical that these children who have very easy to recognize symptoms, such as rapid breathing, or what we call chest in-drawing where the chest wall sort of collapses as the child gasps for breath... an average person can in fact diagnose that this is not just your average cold. The child is much sicker, it’s presumed pneumonia and the child needs to be treated.”

In addition to World Pneumonia Day, leaders from the WHO and UNICEF are releasing a global plan to combat pneumonia. Save the Children’s Mary Beth Powers says she hopes increased attention to the disease prompts both donor countries and poorer countries to put more resources towards addressing this urgent issue.

NOVEMBER 1, 2009

World Pneumonia Day: Tipping point for pneumonia?

After years as the forgotten killer of children, pneu-

monia is finally going to have its day. Literally.

Monday November 2nd is the first ever World

Pneumonia Day and by all appearances this could be

the tipping point for this disease. What makes me

think so?

For the longest time, no one knew pneumonia and

few realized that it was global health’s most solv-

able problem. We had situation after situation where

global health leaders discussed global health without

ever mentioning the leading killer of children.

But we’re beginning to see evidence of changes.

In the last week, we’ve seen that Bill and Melinda

Gates know pneumonia (see their TV interview with

ABC news’ Charlie Gibson). David Lane, president

of ONE, knows pneumonia – and you know that if

ONE works on it that U2’s Bono must know pneu-

monia. Former Senate Majority leader Bill Frist

and Rwandan Minister of Health Richard Sezibera

– physicians who have become government leaders

– published an editorial in this week’s issue of The

Lancet calling for more emphasis on pneumonia.

On Monday in New York City, I’ll be joining inter-

national musical star Angélique Kidjo, ABC News’

Rich Besser, and international economic guru Jeff

Sachs at a Global Pneumonia Summit where we’ll

issue a call to action and highlight a three-pronged

approach to pneumonia control and prevention

that can dramatically reduce pneumonia’s impact

worldwide.

As nice as it is to have international leaders recog-

nize pneumonia the reason I think that we’re at the

tipping point is because of the response I’m seeing

from the very countries where pneumonia is the lead-

ing killer of children. In Shanghai, China, recently

I was approached by a pediatrician from Bandung,

Indonesia who detailed her plans for public events

with the media on World Pneumonia Day. A few days

later I got an email from a colleague in Kinshasa who

arranged a soccer match between local journalists and

hospital staff that was followed by interviews that

appeared on national TV in Congo. Most recently,

it’s the walk for pneumonia in the capital of Nigeria,

Abuja. This list goes on and includes The Gambia,

Bangladesh, Brazil, China, Nigeria, and from India,

a statement from the Health Minister!

These countries represent the very places on earth

where nearly all child deaths from pneumonia occur.

The range of innovative ideas is all the more encour-

aging because they come from the local voices that

are key to sustaining any progress made on world

pneumonia day. And that is why it feels like the tip-

ping point.

Pneumonia takes the life of a child every 15 seconds.

You can make a difference on world pneumonia day

by doing something different from your everyday

routine. You can send a letter to your elected offi-

cials, or let the leaders of your local church, syna-

gogue or mosque know about pneumonia. You can

wear blue jeans on Monday or get involved in the

dodgeball tournament being organized by the Best

Shot Foundation. Make a donation to the GAVI

Alliance or Save the Children or sign the World

Pneumonia Day pledge. Or better yet generate your

own ideas.

But in taking a few minutes from your Monday know

that you’ll be joining thousands of people around the

world – from Bandung to Brazil - and who knows,

maybe you’ll help make this the tipping point for

pneumonia control and prevention.

NOVEMBER 2, 2009

Pneumonia: a bigger killer than swine fluBy Josh Ruxin

There’s a lot of debate among parents in the U.S. about

the H1N1 vaccine. Some of the parents of small children

I’ve spoken to over the last week are seriously debating

whether to get it. Many are deciding not to give their

child yet another vaccine.

However, what if H1N1 was the leading killer of children,

responsible for one out of every five childhood deaths in

the United States? There wouldn’t be any debate at all

about it. Every parent would want their child innoculated

immediately, and the current stockpiles of the vaccine —

already in short supply — would be totally inadequate to

keep pace with demand.

The fact is, in the developing world, that situation exists,

but the killer isn’t H1N1; it’s pneumonia.

This may be a surprise to you since the perception is

that pneumonia is a disease that tends to kill elderly

people with pre-existing medical conditions. I’ll bet that

you’re surprised to learn that pneumonia is the leading

killer of children worldwide, causing 20 percent of all

childhood deaths, more than AIDS, malaria and measles

combined. Pneumonia kills a child every 15 seconds,

and yet, is easily prevented through a vaccine and just

as easily treated with antibiotics. However, these simple

and effective tools are just not available as broadly as

they’re needed and as a tragic result, two million kids die

needlessly every year.

Here in Rwanda, people see the devastating effects of

pneumonia on children far too often. Pneumonia affects

children everywhere, but its most deadly impact is in

South Asia and sub-Saharan Africa; 98% of pneumonia

deaths occur in these hot spots.

To draw attention to the disease, and to marshal much-

needed resources to fight it, nearly 100 global health

organizations have came together to make November 2

the world’s first annual World Pneumonia Day. These

partners (which include the U.S. Fund for UNICEF,

Save the Children, The Millennium Villages Project, the

Johns Hopkins Bloomberg School of Public Health, the

National Institutes of Health, and many others) are urging

governments worldwide to take the necessary action

to stop the clock on pneumonia. The steps necessary

to launch this fight are put forward in a Global Action

Plan released by the World Health Organization and

UNICEF. The six-year plan is calling for a scale up of

the interventions to control the disease. The goal is to

prioritize pneumonia.

For many years, the global community has focused on

fighting diseases with plans that are resource-heavy

and which require massive commitments to stage their

interventions. That’s important work but the time has

come to integrate diseases such as pneumonia into existing

efforts. The greatest barrier to pneumonia prevention and

treatment is not the need for an elusive vaccine or drug,

but rather, the political will and commitment of resources

to fight.

Luckily, key public figures are ringing the alarm:

“We live in a world with infinite possibilities,” writes

former U.S. Senate Majority Leader and Save the

Children Board member, Bill Frist, MD and Dr. Richard

Sezibera, Rwanda’s Minister of Health, who have co-

authored a report on pneumonia in this week’s edition of

The Lancet. “Hearts are transplanted, DNA is decoded,

and new medical advances are made every day. Yet

we continue to be stymied by how best to reach those

in resource-poor settings with the most basic care and

medicines that we take for granted...Resources and

political will are standing between children and their

futures. With the right tools, we should not fail the next

generation of leaders and doctors.”

www.landesbioscience.com Human Vaccines 779

Human Vaccines 5:11, 779-780; November 2009; © 2009 Landes Bioscience

COMMENTARY COMMENTARY

Key words: neumonia, Streptococcus pneumoniae, Haemophilus influenzae, vac-cines, mortality, World Pneumonia day

Submitted: 07/30/09

Accepted: 09/16/09

Previously published online: www.landesbioscience.com/journals/ vaccines/article/10100

*Correspondence to:

Keith P. Klugman; Email: [email protected]

The UN’s Millennium Development Goal 4 aims for a two-thirds reduc-

tion in deaths among children under five by 2015. With pneumonia being the number one killer of children under five,1 this can only be achieved if we prevent and protect children from pneumonia-related deaths—and that will take global commitment and investment in life-sav-ing interventions, like vaccines.

Of the nearly 10 million children who die each year around the world,2 pneumo-nia is to blame for more than 2 million.3 According to WHO, pneumonia kills more children than AIDS, malaria and measles combined.3 With proper measures in place to protect, prevent and treat pneumonia, millions of lives can be saved. The science, the tools and the funding solutions exist to prevent deaths and alleviate the financial and emotional toll that pneumonia exerts on families.

Vaccines are one of the best tools to pre-vent deaths and protect families from the financial strain of pneumonia. Safe and effective vaccines are available to combat the leading bacterial causes of pneumonia, Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae. Vaccines against measles and pertussis also contribute.4

For Hib, there is a highly safe and effective vaccine routinely used in the industrialized world for over 15 years. In the developing world, clinical trials and national programs in Chile,5 The Gambia,6 Kenya7 and Bangladesh8 have shown a dramatic reduction in disease due to vaccination, similar to that achieved in the United States and other industrialized countries. Currently, there are a large num-ber of vaccine manufacturers producing

and developing Hib-containing vaccines. For GAVI-eligible countries, suppliers produce pentavalent, monovalent and tet-ravalent Hib-containing vaccines.9

Safe and effective vaccines also exist to prevent pneumococcal disease in chil-dren and adults. In 2000, the 7-valent pneumococcal conjugate vaccine (PCV7) became available and is currently used in over 70 countries. Newer vaccines with even broader protection are now becom-ing available. A 10-valent vaccine, which is expected to prevent 66–88% of pedi-atric pneumococcal disease,10 is currently marketed in a number of developed, and developing countries. A 13-valent vac-cine, which would prevent an estimated 73–92% of pneumococcal disease among children,10 received its first regulatory approval this year in Chile and more are expected before the end of 2009.

Cost has traditionally prevented coun-tries from taking steps to introducing the Haemophilus influenzae type b (Hib) and pneumococcal vaccines. However, signifi-cant progress had been made for develop-ing countries seeking to implement these vaccines as part of their national immu-nization schedules. The GAVI Alliance—and through it, new funding mechanisms such as the pneumococcal Advance Market Commitment (AMC)—have helped low-income countries introduce Hib and pneu-mococcal conjugate vaccines within their public vaccination programs. In fact, with GAVI financing, nearly every low-income country has or is planning to soon intro-duce the conjugate vaccine.

With 99 percent of pneumonia deaths occuring in the developing world, sus-tained progress is required.10 In fact, for every one child that dies of pneumonia in

Pneumonia vaccines for all who need them

Keith P. Klugman1,* and Ron Dagan2 for the Pneumococcal Awareness Council of Experts (PACE)1William H. Foege Chair in Global Health; Rollins School of Public Health; Atlanta, GA USA; 2Pediatric Infectious Diseases Unit; Soroka Medical Center;

Beersheba, Israel

www.landesbioscience.com Human Vaccines 779

Human Vaccines 5:11, 779-780; November 2009; © 2009 Landes Bioscience

COMMENTARY COMMENTARY

Key words: neumonia, Streptococcus pneumoniae, Haemophilus influenzae, vac-cines, mortality, World Pneumonia day

Submitted: 07/30/09

Accepted: 09/16/09

Previously published online: www.landesbioscience.com/journals/vaccines/article/10100

*Correspondence to:

Keith P. Klugman; Email: [email protected]

he UN’s Millennium Development Goal 4 aims for a two-thirds reduc-

tion in deaths among children under five by 2015. With pneumonia being the number one killer of children under five,1

this can only be achieved if we prevent and protect children from pneumonia-related deaths—and that will take global commitment and investment in life-sav-ing interventions, like vaccines.

OfOfOfOfOfOfOfOfOfOfOfOf t t t t t t thehehehehehehehehehehe n n n n n n n n n n neaeaeaeaeaeaeaeaearlrlrlrlrlrlrlrlrlrlrly y y y y y y y y y y 1010101010101010101010 m m m m m m m m m m milililililililililililliliononononononononononon c c c c c c c c c c chihihihihihihihihihihihildldldldldldldldldldldrerererererererererereren n n n n n n n n n n n whwhwhwhwhwhwhwhwhwhwhwho o o o o o o o o o o didie each year aroundnd t the worldld,,2 pneumo-ninininininininininininia a a a a a a a a a a isisisisisisisisisisisis t t t t t t t t to o o o o o o o o o o blblblblblblblblblblblamamamamamamamamamamame e e e e e e e e e e e fofofofofofofofor r r r r r r r r r r momomomomomomomomomomorererererererererererere t t t t t t t t t t thahahahahahahahahahahahan n n n n n n n n n n 2 2 2 2 2 2 2 2 2 2 2 mimimimimimimimimimimillllllllllllllllllllllioioioioioioioioioioioion.n.n.n.n.n.n.n.n.n.n.33

AcAcAcAcAcAcAcAcAcAcAcAccocococococococordrdrdrdrdrdrdrdrdrdinininininininininining g g g tototototototo W W W W W W W W W W WHOHOHOHOHOHOHOHOHOHO, , pnpnpnpnpnpnpneueueueueueueumomomomomomomomoninininininininininia a a a a a a a kikikikikikikikikikilllllllllllllllllllllls s s s s s momomomomomomomorererererere children than AIDS, malaria and measles combined.3 With proper measures in place to protect, prevent and treat pneumonia, millions of lives can be saved. The science, the tools and the funding solutions exist to prevent deaths and alleviate the financial and emotional toll that pneumonia exerts on families.

Vaccines are one of the best tools to pre-vent deaths and protect families from the financial strain of pneumonia. Safe and effective vaccines are available to combat the leading bacterial causes of pneumonia, Haemophilus influenzae type b (Hib) and eStreptococcus pneumoniae. Vaccines against measles and pertussis also contribute.4

For Hib, there is a highly safe and effective vaccine routinely used in the industrialized world for over 15 years. In the developing world, clinical trials and national programs in Chile,5 The Gambia,6 Kenya7yaya and Bangladesh8 have shown a dramatic reduction in disease due to vaccination, similar to that achieved in the United States and other industrialized countries. Currently, there are a large num-ber of vaccine manufacturers producing

and developing Hib-containing vaccines. For GAVI-eligible countries, suppliers produce pentavalent, monovalent and tet-ravalent Hib-containing vaccines.9

Safe and effective vaccines also exist to prevent pneumococcal disease in chil-dren and adults. In 2000, the 7-valent pneumococcal conjugate vaccine (PCV7) became available and is currently used in over 70 countries. Newer vaccines with even broader protection are now becom-ininininininininininining g g g g g g g g g avavavavavavavavavavavavaiaiaiaiaiaiaiaiaiaiailalable. A 10-valent vaccine, which is expected to prevent 66–88% of pedi-atric pneumococcal disease,10 is currently marketed in a number of developed, and developing countries. A 13-valent vac-cine, which would prevent an estimated 73–92% of pneumococcal disease among children,10 received its first regulatory approval this year in Chile and more are expected before the end of 2009.

Cost has traditionally prevented coun-tries from taking steps to introducing the Haemophilus influenzae type b (Hib) and epneumococcal vaccines. However, signifi-cant progress had been made for develop-ing countries seeking to implement these vaccines as part of their national immu-nization schedules. The GAVI Alliance—and through it, new funding mechanisms such as the pneumococcal Advance Market Commitment (AMC)—have helped low-income countries introduce Hib and pneu-mococcal conjugate vaccines within their public vaccination programs. In fact, with GAVI financing, nearly every low-income country has or is planning to soon intro-duce the conjugate vaccine.

With 99 percent of pneumonia deaths occuring in the developing world, sus-tained progress is required.10 In fact, for every one child that dies of pneumonia in

Pneumonia vaccines for all who need them

Keith P. Klugman1,* and Ron Dagan2 for the Pneumococcal Awareness Council of Experts (PACE)1William H. Foege Chair in Global Health; Rollins School of Public Health; Atlanta, GA USA; 2Pediatric Infectious Diseases Unit; Soroka Medical Center;

Beersheba, Israel

780 Human Vaccines Volume 5 Issue 11

6. Mulholland K, Hilton S, Adegbola R, Usen S, Oparaugo A, Omosigho C, et al. Randomised trial o f Haemophilus influenzae type-b tetanus protein conjugate vaccine for prevention of pneumonia and meningitis in Gambian infants. Lancet 1997; 349:1191-7.

7. Cowgill KD, Ndiritu M, Nyiro J, Slack MPE, Chiphatsi S, Ismail A, et al. Effectiveness of Haemophilus influenzae type b conjugate vaccine introduction into routine childhood immunization in Kenya. JAMA 2006; 296:671-8.

8. Baqui AH, El Arifeen S, Saha SK, Persson L, Zaman K, Gessner BD, et al. Effectiveness of Haemophilus influenzae Type B Conjugate Vaccine on Prevention of Pneumonia and Meningitis in Bangladeshi Children: A Case-Control Study. Pediatr Infect Dis J 2007; 26:565-71.

9. PneumoADIP. Hib Vaccines (2009). [Online]. Available: http://www.preventpneumo.org/vac-cine_status/hib_vaccines/index.cfm.

10. PneumoADIP. Pneumococcal Vaccines (2009). Available: http://www.preventpneumo.org/solu-tions/pneumococcal_disease/pneumococcal_vac-cines.cfm.

11. UNICEF. Progress for Children: A World Fit for Children Statistical Review (2007). [Online]. Available: http://www.unicef.org/publications/index_42117.html.

Vaccinologists should, can and will have an important role to play.

Get involved today. To learn more, visit www.worldpneumoniaday.org or www.sabin.org/PACE.

References

1. UNICEF. Pneumonia: The Forgotten Killer of Children (2006). [Online]. Available: http://www.unicef.org/publications/index_35626.html.

2. Doherty, Hannah. “Child Mortality.” Worldwatch Institute (2008). [Online]. Available: http://www.worldwatch.org/node/5875.


4. Madhi Shabir A, et al. Pneumococcal conjugate vaccine is efficacious and effective in reducing the burden of pneumonia. Bulletin of the World Health Organization 2008; 86:737-816.

5. Levine OS, Lagos R, Muñoz A, Villaroel J, Alvarez AM, Abrego P, et al. Defining the Burden of Pneumonia in Children Preventable by Vaccination against Haemophilus Influenzae Type b. Pediatr Infect Dis J 1999; 18:1060-4.

the industrialized world, 2,000 more die in developing nations.11 Already 15 of the 71 GAVI countries eligible for pneumococ-cal vaccines have applied to get them and more are expected in 2009. Extraordinary efforts will be required however to assure that the vaccine reaches every child in all 71 countries.

On Nov. 2, 2009, a coalition of global health organizations, including the Sabin Vaccine Institute’s Pneumococcal Awareness Council of Experts (PACE), are uniting to bring pneumonia to the fore-front of the global health agenda through the first annual World Pneumonia Day. World Pneumonia Day will bring together scientists, academics and global health pro-fessionals to underscore this public health crisis and build the public and political will to finish the fight against pneumonia.

780 Human Vaccines Volume 5 Issue 11

6. Mulholland K, Hilton S, Adegbola R, Usen S, Oparaugo A, Omosigho C, et al. Randomised trial o f Haemophilus influenzae type-b tetanus protein econjugate vaccine for prevention of pneumonia and meningitis in Gambian infants. Lancet 1997; 349:1191-7.

7. Cowgill KD, Ndiritu M, Nyiro J, Slack MPE, Chiphatsi S, Ismail A, et al. Effectiveness of Haemophilus influenzae type b conjugate vaccine eintroduction into routine childhood immunization in Kenya. JAMA 2006; 296:671-8.

8. Baqui AH, El Arifeen S, Saha SK, Persson L, Zaman K, Gessner BD, et al. Effectiveness of Haemophilus influenzae Type B Conjugate Vaccine on Prevention eof Pneumonia and Meningitis in Bangladeshi Children: A Case-Control Study. Pediatr Infect Dis J 2007; 26:565-71.

9. PneumoADIP. Hib Vaccines (2009). [Online]. Available: http://www.preventpneumo.org/vac-cine_status/hib_vaccines/index.cfm.

10. PneumoADIP. Pneumococcal Vaccines (2009). Available: http://www.preventpneumo.org/solu-tions/pneumococcal_disease/pneumococcal_vac-cines.cfm.

11. UNICEF. Progress for Children: A World Fit for Children Statistical Review (2007). [Online]. Available: http://www.unicef.org/publications/index_42117.html.

Vaccinologists should, can and will have an important role to play.

Get involved today. To learn more, visit www.worldpneumoniaday.org or www.sabin.org/PACE.

References


2. Doherty, Hannah. “Child Mortality.” Worldwatch Institute (2008). [Online]. Available: http://www.worldwatch.org/node/5875.


4. Madhi Shabir A, et al. Pneumococcal conjugate vaccine is efficacious and effective in reducing the burden of pneumonia. Bulletin of the World Health Organization 2008; 86:737-816.

5. Levine OS, Lagos R, Muñoz A, Villaroel J, Alvarez AM, Abrego P, et al. Defining the Burden of Pneumonia in Children Preventable by Vaccination against Haemophilus Influenzae Type b. Pediatr Infect eDis J 1999; 18:1060-4.

the industrialized world, 2,000 more die in developing nations.11 Already 15 of the 71 GAVI countries eligible for pneumococ-cal vaccines have applied to get them and more are expected in 2009. Extraordinary efforts will be required however to assure that the vaccine reaches every child in all 71 countries.

On Nov. 2, 2009, a coalition of global health organizations, including the Sabin Vaccine Institute’s Pneumococcal Awareness Council of Experts (PACE), are uniting to bring pneumonia to the fore-front of the global health agenda through the first annual World Pneumonia Day. World Pneumonia Day will bring together scientists, academics and global health pro-fessionals to underscore this public health crisis and build the public and political will to finish the fight against pneumonia.

Breathing new life into pneumonia epidemiologyOrin S. Levine

Department of International Health, Johns Hopkins Bloomberg

School of Public Health, Baltimore, MD 21205

Keith P. Klugman

Hubert Department of Global Health, Rollins School of Public

Health, Atlanta, GA 30322

Pneumonia kills more children than any other illness, according to

the WorldHealth Organization.1 In spite of its disease burden and

the fact that there are effective health interventions, pneumonia is a

disease that has received neither the public attention nor the funding

that it deserves.2 In a recent review sponsored by The George

Institute for International Health, pneumonia research was the most

glaringly underfunded of all the major “neglected” diseases.3

The gap in research is perhaps most evident in the field of

pneumonia epidemiology. A recent systematic review ofchildhood

pneumonia by the World Health Organization found that of 2,200

published manuscripts, only 28 were deemed of adequate quality

for inclusion in a review and modeling exercise.4 The first-ever

World Pneumonia Day — November 2, 2009 — provides a useful

opportunity to consider the challenges and opportunities for

epidemiologic research in pneumonia.

The epidemiologic study of pneumonia is hampered by many

methodological challenges. Case definitions for the clinical

syndrome of pneumonia have traditionally been inconsistent.

Interobserver variations in the interpretation of chest radiographs

and chest auscultation, for example, have limited the utility of these

relatively specific diagnostic techniques.5 Other techniques, such as

counting respiratory rate or observing signs of difficult breathing

such as chest in-drawing, are more readily standardized but have

lower specificity, particularly in areas with a high rate of malaria.6

Etiology-specific diagnoses are similarly hampered by traditional

methods. The use of blood cultures, for example, is highly specific

but insensitive, in that it detects only a fraction of the bacterial

causes of pneumonia and becomes even less sensitive if the patient

has received antibiotics before specimen collection. Sampling the

upper respiratory tract, on the other hand, may yield agents that are

being carried (i.e., colonizing organisms) and not the cause of the

acute episode. Lastly, the study of very severe and fatal childhood

pneumonia is complicated by the fact that most episodes occur in

the very populations not served by adequate health systems (i.e.,

children in developing countries); as a result, these populations are

often left out of epidemiologic research.

With advances in diagnostic technology and collaborative

interactions, the challenges of the past are increasingly solvable.

Digital radiographs, for example, can help minimize interobserver

variation by transmitting all images to a single reviewer. Using new

techniques to detect nucleic acids rather than relying on isolation of

viable pathogens should also help with etiologic-specific diagnoses.

Finally, the use of geographic information systems and community-

based researchers can help assure that all populations are studied

and, where they are missed, that bias and underreporting are

quantified. With approximately two million child deaths every year

due to pneumonia, and hundreds of millions of cases each year in

both children and adults, new efforts to study the epidemiology of

pneumonia worldwide — using the latest techniques andmethods

— are urgently needed.1 The effort to generate a new evidence

base of pneumonia epidemiology will require concerted action by

investigators, sponsors, and journals. Investigators must work to

develop standardized methods and case definitions while pursuing

creative approaches to overcoming historical obstacles. Sponsors

need to realign their funding investments to levels commensurate

with the burden of pneumonia worldwide. Journals, such as this

one, can also play a part by encouraging the reporting of pneumonia

epidemiology studies in ways that allow the quality of the research

to be carefully assessed and any biases determined and quantified.

Together, these actions could provide a much-needed increase in the

quality and representativeness of epidemiologic data on pneumonia

that in turn breathe newlife into the fight against this important

killer.

REFERENCES

1The United Nations Children’s Fund (UNICEF)/World Health Organization

(WHO).Pneumonia: The forgotten killer of children. (2006) (http://www.unicef.

org/publications/index_35626.html). (Accessed September 4, 2009).

2Shiffman J. Donor funding priorities for communicable disease control in the

developing world. Health Policy Plan (2006) 21(6):411–420.[Abstract/Free Full

Text]

3Moran M, Guzman J, Ropars AL, et al. Neglected disease research and development:

How much are we really spending [electronic article]? PLoS Med (2009) 6(2):e30.

[CrossRef][Medline]

4Rudan I, Boschi-Pinto C, Biloglav Z, et al. Epidemiology and etiology of childhood

pneumonia. Bull WorldHealth Organ (2008) 86(5):408–416.[CrossRef][Web of

Science][Medline]

5Cherian T, Mulholland EK, Carlin JB, et al. Standardized interpretation of paediatric

chest radiographs for the diagnosis of pneumonia in epidemiological studies. Bull

World Health Organ (2005) 83(5):353–359.[Web of Science][Medline]

6English M, Punt J, Mwangi I, et al. Clinical overlap between malaria and severe

pneumonia in Africa children in hospital. Trans R Soc Trop Med Hyg (1996)

90(6):658–662.[CrossRef][Web of Science][Medline]

A day to focus and act on pneumoniaPavla Křížová

member of PACE National Institute of Public Health,

Prague, Czech Republic

On behalf of Pneumococcal Awareness Council of Experts

(PACE)

Every year, two million children die of pneumonia, the

world’s leading infectious child killer.1 The disease claims

another young life every 15 seconds — more than measles,

malaria and AIDS combined2 — yet many clinicians, health

workers and policy makers remain unaware of the scale of

this preventable epidemic. The New York Times recently

dubbed pneumonia the “orphan of global health”.

The first World Pneumonia Day — launched by a coalition

of child health organizations, including the Sabin Vaccine

Institute’s Pneumococcal Awareness Council of Experts

(PACE) — to raise awareness of this public health

crisis and spur urgent action to address it takes place

on November 2nd. Pneumonia deaths in children are

largely unnecessary and an example of a sizeable health

inequity because more than 2,000 children in developing

countries die for every one child that dies of the disease

in an industrialized country.1 As such, it is critical that as

doctors and scientists we lend our voices and networks to

the fight.

While early diagnosis and treatment can save lives,

vaccines are the single most effective way to prevent

pneumonia. There are safe, effective vaccines against the

common bacterial causes of pneumonia, Haemophilus

influenzae type b (Hib) and pneumococcus. The routine

use of these vaccines has had great success in preventing

deaths in many countries. It is a tragedy that access to

these life-saving vaccines remains an outcome determined

by where a child is born, not whether a child needs it.

And the same is true for treatment: some 600,000

children’s lives could be saved each year if all youngsters

with pneumonia were properly diagnosed and treated with

antibiotics costing less than US$1 per course.3,4 More than

double — an estimated 1.3 million lives — could be saved

each year if both prevention and treatment interventions

were implemented universally.1

Affordable vaccines are available to developing countries

through new mechanisms such as the pneumococcal

Advanced Market Commitment (AMC) (see www.

vaccineamc.org). The concept behind the AMC is simple:

wealthy donors commit to buying the vaccines in bulk

at a fixed price, thereby creating a potentially huge and

profitable early market as an incentive to manufacturers.

In turn, as part of these agreements, the manufacturers

may agree to supply the vaccines to poor countries at a

significant discount. In this way, these countries are able

to receive the vaccines up to 20 years before historical

precedent and at prices their governments can afford.

Controlling pneumonia is key to Millennium Development

Goal #4, a pledge by the world’s governments to reduce

the under-five mortality rate by two-thirds between

1990 and 2015. To make progress, we must raise

awareness of the scale of this disease among policy

makers, the health community and the general public.

There is no reason this scourge must claim innocent

lives forever. World Pneumonia Day affords us all an

opportunity to join together to do what is right for the

world’s most vulnerable. Together, and through our

professional organizations, practices and health agencies,

we have the resources to end pneumonia’s grim reign as

the # 1 killer of the world’s children.

To learn more, visit www.worldpneumoniaday.org or

www.sabin.org/PACE.

REFERENCES

1United Nations Children’s Fund. Progress for children: a world fit for

children statistical review [monograph on the Internet]. New York:

UNICEF; 2007 [cited 2009 Sep 25]. Available from:http://www.unicef.

org/publications/index_42117.html

2United Nations Children’s Fund. Pneumonia: the forgotten killer of

children [monograph on the Internet]. New York: UNICEF; 2006 [cited

2009 Sep 25]. Available from: http://www.unicef.org/publications/

index_35626.html

3Bryce J, Black RE, Walker N, Bhutta ZA, Lawn JE, Steketee RW.

Can the world afford to save the lives of 6 million children each year?

Lancet. 2005 Jun 25-Jul 1;365(9478):2193-200.

4Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS; Bellagio

Child Survival Study Group. How many child deaths can we prevent

this year? Lancet. 2003 Jul 5;362(9377):65-71.

Protect, treat, prevent Javier Garau

ESCMID President

For the first time ever, pneumonia will have its day

on the world stage. Pneumonia kills two million

children every year — more than AIDS, malaria and

measles combined.1 With the designation of the first

World Pneumonia Day this November 2, the common

goal is to change that, and to urge policymakers

to prioritize pneumonia as an urgent public health

matter.

The World Pneumonia Day identifies a three-tiered

approach to tackling the world’s deadliest killer of

children.

Protect children from pneumonia by ensuring their

proper nutrition, starting with exclusive breastfeeding

for the first six months of life. Adequate nutrition

makes children less vulnerable to pneumonia and

other infectious diseases; exclusive breastfeeding

acts as a child’s first immunization by providing

the nutrients needed to fight off disease. Boosting

weakened immune systems with zinc supplements

can reduce the incidence of childhood pneumonia

by up to 41 percent.2 Limiting a child’s exposure

to indoor air pollution and tobacco smoke can also

reduce a child’s risk of pneumonia-related morbidity

and mortality.3

Treat pneumonia cases immediately with an

appropriate course of antibiotics. The major

challenge in treatment and prevention of

pneumonia-related morbidity and mortality is

recognition of the symptoms. Parents and caregivers

are the first line of defense, and teaching them to

recognize the warning signs is vital, especially in

developing countries where chest x-rays are often

not an option. When symptoms are present, early

diagnosis and treatment using antibiotics that cost

less than a dollar can save tens of thousands of lives

a year, yet few children with pneumonia receive

the antibiotic therapy they need.

Prevent children from developing pneumonia in the

first place. Given the economic toll of pneumonia

treatment on families and the chances that this disease

will result in death, particularly in the developing

world, vaccination remains critical for controlling

pneumonia morbidity and mortality. There are safe,

effective vaccines against the common bacterial

causes of pneumonia, including pneumococcal

disease and Haemophilus influenzae type b (Hib).

These vaccines are used widely in wealthy countries,

and the results are telling: for every child that dies

from pneumonia in the industrialized world, more

than 2000 die in developing countries.4 Funding is

now available through the GAVI Alliance for low-

resource countries to purchase these vaccines, and

the time for governments to apply for these funds is

now. As scientists, this information is not new to us.

It is up to us to use the World Pneumonia Day to help

more people worldwide and — most importantly, to

let those who make public health policy decisions

understand that the price of action will be measured

in dollars, but the price of inaction will be measured

in lost lives.

To learn more, visit www.worldpneumoniaday.org.

REFERENCES

1UNICEF. Pneumonia: The Forgotten Killer of Children (2006). [Online].

Available: http://www.unicef.org/publications/index_35626.html.

2Black RE. J Nutrition 2003; 1485S-1489S.

3UNICEF. Pneumonia: The Forgotten Killer of Children (2006). [Online].

Available: http://www.unicef.org/publications/index_35626.html.

4Ibid.

Pneumonia prevention gets a fresh opportunityCiro A. de Quadros, MD, MPH

PACE Co-Chair

Sabin Vaccine Institute, Washington, DC

e-mail: [email protected]

Orin S. Levine, PhD

PACE Co-Chair

PneumoADIP at Johns Hopkins Baltimore,

Maryland, USA

Every 15 seconds, a child dies from pneumonia. 1 While

the numbers are staggering, the solutions are at hand —

and as doctors and scientists, we have both the power and

the responsibility to advocate among policy makers for

solutions that are within our reach.

Treatment of pneumonia with inexpensive antibiotics can

cure most children who get pneumonia, and vaccinating

children against pneumonia can prevent cases altogether.

Vaccines for pneumococcal and Haemophilus infl uenzae

type b (Hib) pneumonia have the capacity to save millions

of children’s lives. The launch of the Advance Market

Commitment (AMC) is making pneumococcal vaccines

available to developing countries up to 20 years ahead

of historical precedent and at prices their governments

can afford. Launched just 2 months ago, the AMC is

off to a fast start, with 15 of the 71 eligible countries

already having applied, but much work remains to ensure

universal access to these life-saving interventions.

The Sabin Vaccine Institute’s Pneumococcal Awareness

Council of Experts (PACE), a group of leading global

experts in infectious diseases and vaccines from around

the globe, is leading the fi ght to change this. Through

collaboration with countries, NGOs, academia and

industry, PACE is engaging global networks to elevate

the issue of pneumococcal disease on the global health

agenda, inform policy makers about the global threat of

pneumococcal disease, advocate for the prevention of

pneumococcal disease, and secure commitments from

countries to combat it.

In 2008, PACE and 114 professional medical societies

and organizations joined forces to issue a Global Call

to Action on Pneumococcal Disease Prevention, urging

governments, donors, advocates and industry to work

together to assure access to pneumococcal vaccines for

every person who needs them worldwide. Their efforts

have helped spur national governments around the world

to introduce pneumococcal vaccines into their national

immunization programs and save children’s lives.

PACE, along with a coalition of other child health

organizations, will also help mobilize efforts to fi ght

pneumonia on a global stage during the fi rst annual World

Pneumonia Day, which will take place this November

2nd. This global effort presents an opportunity to get

involved in activities around the globe designed to raise

awareness among policy makers and urge countries to

prioritize pneumonia prevention and save lives.

The fight against pneumonia can be won. We have the

vaccines, the treatments, the fi nancing mechanisms

and the demand to prevent pneumonia. It is time for

governments to take advantage of these innovations and

bring them to the people who need them most. It is up to

us to make sure this message is heard. The price of action

will be measured in dollars.

The price of inaction will be measured in lives lost to this

preventable disease.

To learn more, visit www.worldpneumoniaday.org or

www.sabin.org/PACE.

REFERENCE

1United Nations Children’s Fund. Progress for children: a world fi t for

children. Statistical review (no. 6). New York, NY, USA: UNICEF, 2007.

http://www.unicef.org/publications/i ndex_42117. html Accessed September

2009.

A preventable killer: pneumonia World Pneumonia Day, 2 November 2009

K. P. Klugman

Departments of Global Health, Epidemiology and Medicine,

Emory University, Atlanta, GA, USA

on behalf of PACE (Pneumococcal Advisory Council of

Experts)

J. Garau

Department of Medicine, Hospital Universitari Mutua de

Terrassa, Barcelona, Spain

on behalf of ESCMID (European Society of Clinical

Microbiology and Infection)

When you think of the most pressing health concerns facing

the world today, pneumonia is probably not the first disease

that comes to mind. Yet this eminently treatable disease is

the number one child killer, claiming the lives of two million

children under five years of age annually—more than AIDS,

malaria and measles combined.1 Pneumonia is also the leading

infectious cause of death in adults.

While the steady toll of pneumonia far surpasses the threat

of new afflictions such as avian flu and swine flu, it barely

registers in the news or on the world health agenda. A coalition

of health organizations aims to change that, declaring this

November 2 the first annual World Pneumonia Day.

While many lives can be saved through early diagnosis and

treatment of pneumonia, the sheer scale of the disease demands

a more proactive and systemic approach that prioritizes

prevention. The widespread implementation of vaccines for

pneumonia’s common bacterial causes, including Haemophilus

influenzae type b (Hib) and the pneumococcus, could help save

millions of children’s lives. Without a doubt, increasing access

to these low-cost vaccines, which have virtually eliminated

such infections in infants in the industrialized world, is the

single most effective way to solve this ongoing health crisis.

Pneumococcal vaccination of at-risk adults and pneumococcal

conjugate vaccination of all infants are also important

components to include in any influenza pandemic preparedness

plan.2 Immunization of children reduces pneumonia not only in

those immunized, but protects the whole community through

interruption of the transmission of vaccine type pneumococci

to older susceptible adults. A recent study by the National

Institute of Allergy and Infectious Diseases and the National

Institutes of Health found that the majority of the estimated 50

million deaths caused by the 1918 Spanish flu pandemic were

likely the result of secondary bacterial pneumonia.3 There are

also signs that bacterial superinfections led to pneumonia and

death during the flu pandemics in 1957 and 1968, as well as

recent data from the 2009 H1N1 (Swine Flu) pandemic.4

Clinicians in developing countries, while understandably

focused on important diseases such as tuberculosis and malaria,

must also be concerned with pneumonia, as it hits children in

developing countries the hardest, and is the major cause of death

in HIV-infected adults. For every child who dies of pneumonia

in an industrialized country, more than 2000 die of the disease

in the developing world.1 If uncontained and untreated, severe

pneumonia can devastate families, causing needless deaths and

exacerbating the cycle of poverty. Fortunately, pneumonia is

the most solvable issue in global child health today. We know

what it will take to put an end to this deadly killer: greater

awareness and universal introduction of vaccines in the places

where they are needed the most. As scientists, we have the

ability and the responsibility to use evidence to make the case

for a greater investment in pneumonia prevention. Take it upon

yourself to do at least one thing this November to raise this

issue through your colleagues, practices or elected officials.

TRANSPARENCY DECLARATION

Both authors declare, also on behalf of PACE, no conflict of interest with

respect to World Pneumonia Day.

REFERENCES

1UNICEF. Progress for children: a world fit for children statistical review

(2007). [Online]. Available: http://www.unicef.org/publications/ index_42117.

html.

2Klugman KP, Madhi SA. Pneumococcal vaccines and flu preparedness.

Science 2007; 316: 49–50.

3Morens DM, Taubenberger JK, Fauci JS. Predominant role of bacterial

pneumonia as a cause of death in pandemic influenza: implications for

pandemic influenza preparedness. J Infect Dis 2008; 198: 262–270.

4Bacterial infections in lung tissue specimens from fatal cases of 2009

Pandemic Influenza A (H1N1) — United States, May–August, 2009. MMWR,

2009; 58(early release): 1–4.

APPENDIX B:

PRESS RELEASE

EMBARGO: Not for release before: MEDIA CONTACTS:

1:01 am CET (Geneva/Paris) Monday, November 2, 2009 Eileen Burke, Save the Children

7:01 pm ESD (New York) Sunday, November 1, 2009 +1 203-221-4233

[email protected]

Lois Privor-Dumm

Johns Hopkins Bloomberg School of Public Health

+1 484-354-8054, [email protected]

Mala Persaud +1 202-841-9336

[email protected]

Leading Organizations Join Forces to Launch First Annual World Pneumonia Day,

Fight World’s Leading Child Killer WHO and UNICEF Release Global Action Plan to Combat Pneumonia as Part of Historic Effort

“Resources and political will are standing between children and their futures,”

Write Senator Bill Frist and Rwandan Minister of Health Dr. Richard Sezibera

WASHINGTON, D.C. (November 2, 2009) – Nearly 100 leading global health organizations from around the

world joined forces today to recognize the first-annual World Pneumonia Day and urge governments to take

steps to fight pneumonia, the world’s leading killer of young children. The first steps in this fight are outlined

in the Global Action Plan for the Prevention and Control of Pneumonia, released today by the World Health

Organization (WHO) and UNICEF.

“It surprises most people to learn that pneumonia kills more children than any other disease – taking more

than 2 million young lives annually,” write former U.S. Senate Majority Leader and Save the Children Board

member, Bill Frist, MD and co-author Dr. Richard Sezibera, Rwanda’s Minister of Health in this week’s edition

of The Lancet. “Nearly half of these deaths could be prevented with existing vaccines and the vast majority of

cases could be treated with inexpensive antibiotics. Yet, lives continue to be lost from this preventable and

treatable disease, and, until recently, there was very little outcry.”

Pneumonia takes the lives of more children under 5 than measles, malaria, and AIDS combined. The disease

takes the life of one child every 15 seconds, and accounts for 20% of all deaths of children under 5 worldwide.

While pneumonia affects children and families everywhere, it has the most deadly impact in South Asia and

sub-Saharan Africa, where 98% of pneumonia deaths occur. It can be prevented with simple interventions,

and treated with low-cost, low-tech medication and care.

“Today the world is coming together like never before to address the number one threat to the world’s

children,” said Orin Levine, executive director of PneumoADIP at the Johns Hopkins Bloomberg School of

Public Health. “Together we call on country governments to implement life-saving pneumonia interventions

for those that need them most.”

Global Action Plan for Prevention and Control of Pneumonia

The Global Action Plan for the Prevention and Control of Pneumonia (GAPP), released today by WHO and

UNICEF, outlines a six-year plan for the worldwide scale-up of a comprehensive set of interventions to control

-more-

-page two-

the disease. Countries are urged to implement a three-pronged pneumonia control strategy that:

protects children by promoting exclusive breastfeeding and ensuring adequate nutrition and good

hygiene;

prevents the disease by vaccinating them against common causes of pneumonia such as Streptococcus

pneumoniae (pneumococcal disease) and Haemophilus influenzae type b (Hib); and

treats children at the community level and in clinics and hospitals through effective case management

and with an appropriate course of antibiotics.

The GAPP estimates the cost of scaling up exclusive breastfeeding, vaccinations and case management in the

world’s 68 high child mortality countries. Together, these countries account for 98% pneumonia deaths

worldwide. With this investment, the GAPP projects that by 2015, the scale-up of existing interventions can

decrease child pneumonia mortality substantially.

Ensuring Treatment, Achieving Prevention

Studies show that implementing pneumonia prevention and treatment interventions worldwide could save

more than one million lives each year and significantly reduce the burden of families and communities that

must cope with pneumonia-related illnesses and deaths. Pneumonia can be treated effectively with

antibiotics that cost less than a dollar, but less than 20% of children with pneumonia receive the antibiotics

they need, according to WHO.

Safe and effective vaccines exist to provide protection against the primary causes of pneumonia,

Streptococcus pneumoniae (pneumococcal disease) and Haemophilus influenzae type b (Hib). However, use of

Hib vaccine has only recently expanded to low-income countries and pneumococcal vaccine is not yet included

in national immunization programs in the developing world, where children bear the highest risk for

pneumonia and where most pneumonia-related child deaths occur.

As the result of collaborative efforts by WHO, UNICEF, the GAVI Alliance, academia, foundations, vaccine

manufacturers, and donor and developing country governments, low-income countries can now access

existing and future pneumococcal vaccines with a small self-financed contribution of as little as US $0.15 per

dose. To date, 11 countries have received GAVI Alliance approval for support to introduce pneumococcal

conjugate vaccine (PCV) and 12 additional countries have submitted applications.

"For the first time in history, we have the commitment from countries and the tools and systems in place to

deliver new life-saving vaccines to protect millions of children against the world’s biggest childhood killer

pneumonia," said Dr. Julian Lob-Levyt, CEO of the GAVI Alliance. “With increased donor support, we can save

many more lives and make an incredible leap in progress towards further reducing child mortality in the

world. This is an historic opportunity we must not ignore.”

World Pneumonia Day: A Global Effort

The Global Coalition against Childhood Pneumonia, made up of nearly 100 influential global health

organizations has led the World Pneumonia Day effort. Events are taking place in more than 25 countries

around the world.

“Pneumonia takes a devastating toll on families and communities in resource-poor countries, so it is vitally

important that this message be amplified throughout the developing world,” said Mary Beth Powers, chief of

Save the Children’s Survive to 5 campaign. “The involvement of these countries in this effort is an important

step toward reducing pneumonia deaths.”

World Pneumonia Day events and activities will raise awareness, outline solutions and call upon governments

to act to combat pneumonia. In New York City, more than 100 leaders in science, politics and global health will

gather for the first World Pneumonia Day Summit. Other activities will include week-long activities in Nigeria including educational events, policy briefings and rallies; a policymaker roundtable and symposium in

-more-

-page three-

Bangladesh; a Run for Survival in Kenya; pediatrician workshops in Nepal; a health symposium in the

Philippines; and a briefing in London at the House of Commons. Additional events are planned in China, the

DRC, Ethiopia, India, Malawi, Mali, Pakistan, the Philippines, South Africa, Thailand, and Uganda. An event list

can be found at http://worldpneumoniaday.org/events/upcoming-events/. These events all underscore the

need for urgent action to protect the lives of children everywhere.

“We live in a world with infinite possibilities,” write Frist and Sezibera. “Hearts are transplanted, DNA is

decoded, and new medical advances are made every day. Yet we continue to be stymied by how best to reach

those in resource-poor settings with the most basic care and medicines that we take for granted.” They

continue, “Resources and political will are standing between children and their futures. With the right tools,

we should not fail the next generation of leaders and doctors.”

To learn more about World Pneumonia Day and the Global Coalition against Child Pneumonia, visit

http://worldpneumoniaday.org. To download the Global Action Plan for Prevention and Control of

Pneumonia, visit http://whqlibdoc.who.int/hq/2009/WHO_FCH_CAH_NCH_09.04_eng.pdf.

###

About The Global Coalition against Child Pneumonia

The Global Coalition against Child Pneumonia and the World Pneumonia Day Coalition, was established in April

2009. It seeks to bring focus on pneumonia as a public health issue and to prevent the millions of avoidable

deaths from pneumonia that occur each year. The coalition is grounded in a network of international

government, non-governmental and community-based organizations, research and academic institutions,

foundations, and individuals that have united to bring much-needed attention to pneumonia among donors,

policy makers, health care professionals, and the general public. Learn more at www.worldpneumoniaday.org

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