Posted by: blog4globalhealth | 11/02/2009

Fighting Pneumonia the Key to Achieving MDG4

The following posting is by Leith Greenslade, Director on the Board of GAVI Alliance Immunize Every Child. The opinions expressed in this posting are solely hers and not necessarily of the Global Health Council.

As welcome as the news was that 3.7 million fewer children are dying before they reach their 5th birthday, the reality is that the pace of change is nowhere near fast enough to reach Millennium Development Goal 4 by 2015.

One disease holds the key to this goal – pneumonia – and achieving MDG4 will depend on the degree to which pneumonia is singled out for special attention by the global health and donor communities.

This is not just because pneumonia is the No. 1 killer of children, killing some 2 million children under age 5 every year. Fighting pneumonia is the key to MDG4 because we have proven cost-effective interventions to prevent and treat pneumonia. If efforts to get them to the world’s poorest children can be accelerated, millions of child deaths could be averted.

On the prevention side we have some very powerful vaccines.  Alongside the basic pertussis and measles vaccines – which UNICEF acknowledged have been major drivers in the new, lower child mortality rate – there are newer vaccines that specifically target the leading causes of child pneumonia – the pneumococcal and Hib vaccines.

The Lancet published new figures last week that showed that pneumococcus and Hib bacteria cause 1.2 million under-5 child deaths every year, almost all of them in developing countries where vaccines are not available. So successful have the Hib and pneumococcal vaccines been in the developed world that Hib deaths among children are basically nonexistent and pneumococcal disease among children has declined by 77percent, with a 39 percent decline in hospital admissions for pneumonia among children under 2.

In the very few developing countries where these vaccines have been introduced similar results have occurred. In Uganda, four years after the introduction of the Hib vaccine, Hib meningitis fell by 85 percent and by year 5 it dropped to zero.  However, of the 72 poorest countries served by the GAVI Alliance currently just two – Rwanda and the Gambia – routinely offer both Hib and pneumococcal vaccination.

Making sure these two vaccines are routinely available to children in the poorest and most pneumonia-ridden countries in the world is one of the single most important ways to reach MDG4.

On the treatment side, the right antibiotics and oxygen correctly administered by trained health workers can reduce deaths in children who are severely ill with pneumonia. Where this case management approach has been applied in hospitals, deaths have been reduced by up to 40 percent. Making this approach available to children in their communities can yield the same results and is vitally important in those communities which are far from clinics and hospitals and where vaccination is not yet available.

The Global Action Plan for the Prevention and Control of Pneumonia[1] concluded that vaccination and antibiotics, in combination with improved nutrition, control of indoor air pollution, and prevention and management of HIV infection, could reduce child pneumonia deaths by more than 1 million every year.

What could these 1 million-plus deaths mean for MDG4? The difference between success and failure. Even at the new, faster rate of child mortality decline (2.3 percent), MDG 4 will not be reached until 2040.  To achieve MDG4 by 2015 requires an annual rate of decline of 10.5 percent, more than 4 times the current rate!

Child Mortality MDG4

To put it another way, the child mortality rate target set by MDG4 is 30 deaths per 1,000 live births. In 2015 that could equate to roughly 4.2 million deaths among children under age 5, compared with the 8.8 million under-5 deaths in 2008 reported in September by UNICEF. Between now and 2015 the challenge is to find ways to prevent in the order of 4.6 million child deaths every year.

Annual MDG4

With pneumonia-fighting interventions potentially contributing 1 million plus, or 25 percent, of the deaths that need to be prevented, it is hard to imagine how MDG4 will be reached without pneumonia being front and center on the global health agenda.

There are welcome signs that this is already starting to happen. The GAVI Alliance, Save the Children, UNICEF and many other organizations have mounted a global advocacy effort to raise awareness about the life-saving potential of pneumonia prevention and treatment.

To date some 70 organizations have joined the Global Coalition against Child Pneumonia. Today, the Coalition will launch the first World Pneumonia Day, with events planned in several cities throughout the world and a Global Pneumonia Summit in New York City.[2]

It remains to be seen whether this Coalition can successfully advocate for greater funding for pneumonia and pave the way for the integrated delivery of prevention and treatment services, particularly in India and Nigeria and the other high pneumonia countries[3], because this is what it will take to significantly reduce child pneumonia mortality.

It also remains to be seen whether the Coalition can engage the broader global health community in the pneumonia challenge. It shouldn’t be too difficult. The interactions between pneumonia and maternal and child health[4], HIV/AIDS[5], malaria[6] and the mounting H1N1[7] threat all make for obvious partnerships.

But it shouldn’t stop with the global health community. As the biggest child health challenge that many developing countries are facing, pneumonia is something that private corporations and donors should clearly be paying attention to. For those companies and donors looking for big impact social investments in the developing world, investing in pneumonia prevention is the best opportunity around.

 Ms. Leith Greenslade is a Director on the Board of GAVI Alliance Immunize Every Child ( She has served the Australian government in a variety of capacities, including as an advisor to the health minister and deputy prime minister, chief of staff to the shadow minister for social security and the status of women, and economic adviser to leader of the opposition.  Ms. Greenslade holds a Masters in Public Administration from the Harvard Kennedy School and a Masters in Business Administration from the Chinese University of Hong Kong.  

[1] An initiative of the WHO, UNICEF and the GAVI Alliance funded PneumoADIP and the Hib Initiative,
[2] See for a full list of Coalition members and activities planned for World Pneumonia Day.
[3] Pakistan, Afghanistan, Ethiopia and the Democratic Republic of the Congo have the highest numbers of child pneumonia deaths.
[4] Pneumonia causes up to 20% of deaths in the first month of life.
[5] In southern Africa babies and children with HIV account for about 5% of the under 5 population and 60-80% of child pneumonia deaths.
[6] In many developing countries pneumonia is misdiagnosed and mistreated as malaria.
[7] Studies indicate that a leading cause of death among children with the H1N1 virus was the interaction of the virus with bacterial infections that cause pneumonia.

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  1. From the EU-VAP/CAP Study Group. Our research is about Pneumonia in Patients requiring mechanical ventilation in European Intensive Care Units. Pneumonia is a global enemy. Our respect and support.
    Dr Despoina Kulenti (study coordinator)

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