At a glance
- Pneumonia is the leading cause of death among children under age 5, with the majority of those deaths occurring in the developing world.
- Childhood deaths from pneumonia are preventable using existing vaccines, diagnostic tools, and treatments.
- We work to improve the development and delivery of pneumonia vaccines and expand the use of antibiotic treatments and diagnostic tools.
- We support the goals of the integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD), an effort led by the World Health Organization (WHO) and UNICEF to accelerate disease prevention and control.
Our foundation’s pneumonia strategy broadly reflects the Protect, Prevent, Treat framework used by the GAPPD. We focus on the most prevalent causes of childhood pneumonia—the pneumococcus, influenza, and respiratory syncytial virus (RSV)—and we are continuing our longstanding investment in vaccines against the meningococcus, which despite not being a major cause of pneumonia continues to cause epidemic meningitis. In addition, we are developing a platform for maternal immunization to protect mothers and their newborns from pathogens that cause a disproportionate mortality burden among newborns, including RSV, influenza, pertussis, tetanus, and the group B streptococcus.
Our key partner in increasing access to pneumococcal vaccines is GAVI, the Vaccine Alliance, a public-private partnership that funds vaccines for children in the world’s poorest countries.
Our top priority is to promote full-scale delivery of currently available pneumococcal and meningococcal vaccines and to support the development of new vaccines to improve coverage, efficacy, safety, and cost effectiveness.
Because vaccines cannot prevent all cases of pneumonia and because the incidence of this disease remains high, we also work to improve access to appropriate diagnostic and treatment options in public and private health care systems. Saving lives through improved access to diagnosis and treatment is particularly critical in countries where the introduction of vaccines is lagging. This includes interventions at multiple points in the continuum of care, ranging from improving care-seeking practices to guiding informal care providers in appropriate disease management.
Other priorities include improving the quality of pneumonia-related data collection, advocating for increased international funding, and researching the links between pneumonia and indoor air pollution.
Our strategy complements efforts by several other foundation programs, including those for vaccine delivery; nutrition; maternal, newborn, and child health; and enteric and diarrheal diseases.
Areas of focus
The pneumococcus is the leading cause of deadly pneumonia and kills nearly 400,000 children under age 5 each year, mostly in Africa and Asia. We work to broaden access to the two commercially available pneumococcal conjugate vaccines (PCVs) while also investing in the development, regulatory approval, and deployment of newer and improved vaccines.
We have worked with Gavi to implement the Advance Market Commitment for Pneumococcal Vaccines, an innovative financing mechanism that accelerates late-stage development and manufacturing of pneumococcal vaccines for developing countries. To help lower the price of these costly vaccines, particularly for high-burden areas, we worked with PATH and the Serum Institute of India to develop and introduce PCVs to the market. In December 2019, the new PCV PNUEMOSIL®, the most affordable option to date, was approved by WHO.
In an effort to eliminate epidemic meningitis A in Africa, we support the Meningitis Vaccine Project, a collaboration that also includes PATH, WHO, African health ministers, and the Serum Institute of India. The project has developed an affordable vaccine called MenAfriVac—the first vaccine developed specifically for Africa—that provides lasting protection from life-threatening meningococcal meningitis, a bacterial infection of the fluid surrounding the brain and spinal cord.
MenAfriVac was first introduced in Burkina Faso in 2010. More than 300 million people have already received the vaccine, and the meningitis A bacterium has nearly disappeared in places where the vaccine has been administered. Our strategy supports efforts to make MenAfriVac available to infants, to promote its inclusion in routine immunization programs, and to monitor the evolution of the disease and the potential need for meningitis interventions beyond this new vaccine.
Urgent work is needed to ensure that children who are sick with a severe respiratory illness receive appropriate care. Many children die because they are not able to receive appropriate care quickly. Children who do reach a provider might be misdiagnosed or not given the appropriate antibiotic, amoxicillin. Sometimes the provider might not recognize that the child’s condition is severe or that the child is at increased risk due to young age or malnutrition. In many instances, such cases require referral to a facility where supportive care interventions such as oxygen are available.
We work closely with other teams at the foundation to improve access to effective treatments for children with pneumonia, with a special focus on Nigeria, northern India, Ethiopia, the Democratic Republic of the Congo, and Pakistan—the countries with the greatest number of pneumonia deaths. Our work includes generating evidence to improve care for infants and children with pneumonia in limited-resource settings, advocating for policy changes and increased financial support to expand the availability of key treatment commodities (including amoxicillin DT, pulse oximetry, and oxygen), and demonstrating how appropriate pneumonia care reduces mortality in order to accelerate improvements in case management on a broad scale.
We invest in the collection and use of high-quality data on the causes and global burden of pneumonia, which will contribute directly to vaccine development, better treatments, improved service delivery, innovation in diagnostics and treatment, and better reporting on causes of death.
We also work to raise the profile of pneumonia as a critical child health issue. Our priorities include ensuring sufficient funding for critical vaccines, supporting vaccine and child health advocates, and building political will at the global and country levels for evidence-based pneumonia prevention and treatment. We also seek to increase resources dedicated to immunization programs and to ensure government follow-through on important global health initiatives such as the Global Vaccine Action Plan for the Decade of Vaccines.
RSV is one of the most common causes of childhood lung infections, mainly in the first six months of life. Unlike other causes of pneumonia addressed by our strategy, there is no existing vaccine for RSV. We support efforts to develop maternal RSV vaccines. We also work to improve global data collection on mortality and morbidity related to RSV and on the long-term consequences of severe RSV infections. This information will help in evaluating the potential impact and cost effectiveness of RSV vaccines that are under development.
We aim to address gaps in data on influenza in developing regions, assess existing strategies to stimulate demand for seasonal influenza vaccines, and ensure that pregnant women and young children in resource-limited settings can access affordable, effective vaccines.
Existing influenza vaccines are the basis of our maternal immunization strategy, which may pave the way for additional vaccines for pregnant women. We work with global partners to identify and address scientific, technical, regulatory, operational, and financial challenges to broadening maternal immunization efforts, which serve to protect pregnant mothers and their babies. We also support research to further understand the benefits of maternal influenza immunization on the developing fetus and work to develop improved influenza vaccines for children under age 2.
Along with our efforts to broaden immunization against pneumonia and improve treatment, we work to reduce environmental risk factors. Adequate nutrition and breastfeeding—addressed as part of the foundation’s nutrition strategy—are key factors in ensuring that children’s immune systems are equipped to fight off infection.
Reducing indoor air pollution is also likely to lessen the risk of pneumonia by decreasing chronic inflammation in the lungs. We invest in limited research to fill fundamental gaps in knowledge about the dose-response relationship between indoor air pollution and childhood pneumonia. We also support efforts to improve monitoring technology to measure personal particulate matter exposure and to establish surrogate endpoints for subsequent clinical trials. Our work in this area will evolve as our understanding of the link between indoor air pollution and pneumonia grows.
Why focus on pneumonia?
Even as global child deaths have declined by nearly 50 percent over the past two decades, pneumonia has remained the world’s leading cause of death among children under age 5. Despite available interventions, pneumonia claims the lives of 800,000 children per year and is responsible for 15 percent of deaths of children under age 5 worldwide—nearly all of them in developing countries, particularly in sub-Saharan Africa and South Asia.
Because pneumonia can be caused by a number of viruses and bacteria, multiple interventions are needed to reduce childhood mortality from the disease. Effective vaccines are available for Streptococcus pneumoniae (the pneumococcus) and Haemophilus influenzae type b (Hib), the most common bacterial causes after the first month of life. But some viral and bacterial pathogens disproportionately kill infants before they can be immunized.
Childhood deaths from pneumonia are preventable using vaccines, diagnostic tools, and treatments, but issues of availability, access, and cost remain obstacles in the developing world. Nearly half of early childhood deaths from pneumonia are estimated to result from lack of or delay in appropriate diagnosis and treatment. In resource-limited settings, factors such as malnutrition, HIV infection, and indoor air pollution increase children’s risk of developing pneumonia.
The global health community has adequate tools and is developing better ones to significantly protect children from pneumonia in the developing world.
Vaccines have already helped to substantially reduce childhood pneumonia. But vaccine coverage must be improved, and lower-cost vaccines will have a major impact where the burden of pneumonia is highest, particularly in India and Nigeria. Vaccinating women during pregnancy has the potential to protect young infants through the passage of natural antibodies from mother to baby. But maternal immunization has yet to be widely implemented beyond prevention of newborn tetanus. WHO has created some momentum recently by recommending influenza vaccination for pregnant women as the focus of its strategy to prevent deaths from influenza. Early treatment is also critical. If properly diagnosed, childhood pneumonia can be effectively treated with a three-day course of antibiotics, at a cost of only 21 to 42 U.S. cents.
Fortunately, awareness of pneumonia as a major global health problem has increased. In 2013, WHO and UNICEF launched GAPPD, which calls for the use of proven interventions, including vaccination against measles, pertussis, pneumococcus, and Hib; exclusive breastfeeding in the first six months of life; and improved case management in communities.
Gavi is an international organization created in 2000 to improve access to new and underused vaccines for children living in the world's poorest countries. Gavi has helped vaccinate more than 822 million children in the world’s poorest countries, preventing more than 14 million future deaths.
Located in the Johns Hopkins Bloomberg School of Public Health, IVAC builds knowledge and support for the value of vaccines to help increase access around the world.
MVP is a partnership between PATH and WHO whose mission is to eliminate meningitis as a public health problem in sub-Saharan Africa through the development, testing, introduction, and widespread use of conjugate meningococcal vaccines.
PATH is a global organization that works to accelerate health equity by bringing together public institutions, businesses, social enterprises, and investors to solve the world’s most pressing health challenges.
The world’s largest provider of vaccines, UNICEF supports child health and nutrition, safe water and sanitation, quality education and skill building, HIV prevention and treatment for mothers and babies, and the protection of children and adolescents from violence and exploitation.
WHO directs and coordinates international health within the United Nations system. Its main areas of work are health systems; health through the life-course; noncommunicable and communicable diseases; preparedness, surveillance, and response; and corporate services.
Every Breath Counts is a global coalition of UN agencies, businesses, donors, and nongovernmental organizations that have committed to supporting governments in countries with a high burden of pneumonia. The 48 members provide support to close gaps in pneumonia prevention, diagnosis, and treatment.