By: Dignamartha Kakkanattu, Social Media & Communications Assistant, International Vaccine Access Center
During Thanksgiving in the U.S., much well-deserved gratitude goes to the obvious all-stars in our lives: family, friends, teachers. But one group that doesn’t seem to get enough thanks are child health advocates. During World Pneumonia Day on November 12, they broke the silence on pneumonia, the leading infectious killer of children under 5.
As an aspiring health advocate, I’ve had the opportunity to work with the Stop Pneumonia team at the International Vaccine Access Center to help turn up the volume. How? We created the Pneumonia Fumbler Challenge, which asked people to say the following tongue twister five times fast for the under-fives: Pretty please prevent pneumonia to protect precious lives.
Advocates, and children, who accepted the challenge lent their voices to the scores of children who have a high likelihood of catching and dying from pneumonia: the poorest of the poor in developing countries. In 2015, approximately 920,000 children died from pneumonia—ending more young lives than Zika, Ebola, malaria, tuberculosis, and HIV combined.
Among participants around the world were future public health professionals—my classmates—at the Johns Hopkins Bloomberg School of Public Health. They took on the Pneumonia Fumbler Challenge while attending a World Pneumonia Day reception co-hosted by the Child Health Society. Through a little confusion and lots of laughter, the students shed light on the need to stop pneumonia in order to improve child health globally.
We need more voices to bring attention to pneumonia, a disease so common that its deadly nature is overlooked by country leaders and policy makers. We need voices to ensure that protective and preventive interventions—such as breastfeeding, adequate nutrition, and vaccines—are available to children in developing countries. We need voices to educate health professionals and caregivers about identifying pneumonia in its early stages. We need voices to secure treatment measures, such as amoxicillin and oxygen therapy, in low-resource settings.
The Pneumonia Fumbler was just one fun way to remind the world that all children should have resources to achieve good health and avoid preventable diseases, such as pneumonia. This Thanksgiving, I’m grateful to everyone who participated, and for the countless other campaigns and events advocates organized. Thank you for your voice—and the opportunity to amplify it worldwide.
Dignamartha Kakkanattu is an MSPH student at Johns Hopkins Bloomberg School of Public Health working on pneumonia advocacy at the International Vaccine Access Center.
By Dr. Kate O’Brien, Executive Director, International Vaccine Access Center (IVAC)
Everyone may get 15 minutes of fame, however, for common illnesses such as pneumonia headlines are scarce. While Secretary Clinton’s pneumonia diagnosis is viewed by most through a political lens, the candidate’s announcement has also sparked a curiosity about an illness contracted by millions every year.
Pneumonia, an infection of the lungs, is exceedingly common around the world with an estimated 450 million cases annually. In the US, about a million people seek hospital care for pneumonia with a cost to the health system of more than $10 billion each year according to the American Thoracic Society.
While the cost of pneumonia in the US is staggering, in too many countries the price is even higher. In the US, we have ready access to trained physicians with the know-how and equipment to make a diagnosis and when necessary, antibiotics and oxygen to treat illness. While some may balk at the cost, these interventions have been proven effective, and the vast majority of people who contract pneumonia make a full recovery. Sadly, this is not true everywhere.
In parts of Africa and Asia resources are scarce, and HIV infections, crowding, and indoor air pollution are prevalent and put people at risk. Also, the prevention and treatment measures we take for granted, such as vaccines and hand washing, are too often not available. The price of pneumonia in these countries is higher infection rates, more illness and, sadly, more deaths, especially in children younger than five years of age.
For most of my career I have been engaged in the fight against pneumonia. I have worked with nonprofits, governments and businesses to help families everywhere have access to the tools they need to fight this illness. We have made considerable progress. Vaccines to prevent the most deadly causes of pneumonia are rapidly being deployed in countries in most need—thanks to Gavi, the Vaccine Alliance, and country governments. As more children have access to vaccines and medicine to prevent and treat pneumonia, we see less disease and fewer lives lost. Yet, much work remains. More than 900,000 young children still lose their lives to pneumonia each year, these children need access to the same tools as our children, to prevent, diagnose and treat this common illness.
There is also a need to invest in innovations that will help those who contract pneumonia in the US and around the world. For example, pneumonia can have bacterial, viral, or occasionally fungal causes. Currently, there is no reliable test that will identify the cause of the infection in every case. The conventional method involves imaging, bloodwork, or cultures that are inconclusive in more cases than not. Physicians typically treat with antibiotics in case the infection is bacterial, but often the pathogen remains unknown. A test to identify the pathogen would help health workers everywhere to treat pneumonia appropriately and reduce unwarranted antibiotic use, this will help to address issues of antimicrobial resistance which threaten to undermine our ability to treat infections.
More than anything else, there is a need to put pneumonia on our collective radar as a public health problem that requires attention. Last year, pneumonia took more young lives than Zika, Ebola, malaria, tuberculosis, and HIV combined. Globally pneumonia is the leading cause of death for children under five years of age. Yet, pneumonia flies under the radar; it is so common that it is nearly invisible.
Can this change? Absolutely. This week, pneumonia is in the headlines and people are talking about their experience (or their parent’s or their child’s) with the illness. While pneumonia’s 15 minutes of fame may be about to run out, the chance to make a difference remains.
Kate O’Brien, MD, MPH is the Executive Director of the International Vaccine Access Center and Professor at the Johns Hopkins Bloomberg School of Public Health. She is a pediatric infectious disease physician, epidemiologist and vaccinologist.
This article was originally published on the VaccinesWork blog and is cross-posted here with permission.
A little girl with her vaccination card. Photo: Gavi/Doune Porter
Doctors from across Pakistan gathered in Islamabad last Thursday to fight a disease that’s threatening children across the country. This time it wasn’t polio they were working against, but pneumonia, which kills as many as 71,000 children every year in Pakistan.
The event, held to mark World Pneumonia Day, aimed to empower key influencers to better advocate to stop pneumonia and discuss challenges to its prevention. It took place at the Children’s Hospital, Pakistan Institute of Medical Sciences (PIMS), which itself sees many cases of the disease with a daily turnover of over 500 children in its outpatient department from in and around Islamabad.
The entrance to the seminar. Photo: Huma Khawar.
The pneumococcal vaccine was rolled out in Pakistan in 2012 as part of the routine immunization schedule, when it had already helped children in many other countries avoid pneumonia. It is also proving effective in Pakistan, as Dr. Asad Ali, from Aga Khan University Karachi, demonstrated by sharing preliminary findings from the vaccine impact assessment in Sindh. He explained that even one dose of pneumococcal vaccine is highly effective against the main germs that cause pneumonia (pneumococcus and Hib).
However, pneumonia is still one of the major killers of children under five years old in Pakistan. A major reason is limited routine immunization coverage – a little more than 50% of children are covered by a basic set of vaccines nationally, and the numbers of children immunized has even been declining in Balochistan. As a result, pneumococcal vaccine faces challenges reaching children across the whole country through this system, and so its population-level effects cannot yet be expected to be significant.
Doctors estimated that this underperformance is fuelled by caregivers’ lack of awareness. Too few parents know that the vaccine is necessary for child health, free-of-cost and available at immunization centers nationally. Yet improving vaccine coverage is crucial, as once infected, access to treatment options for infants remain limited especially in Pakistan’s rural, impoverished regions. Dr. Syed Saqlain Ahmad Gillani, National Immunization Program Manager, concluded the session by voicing support for a public-private health sector partnership to increase routine immunization coverage in the country.
One presentation from the day. Photo: Huma Khawar.
Facing such a challenge, medical professionals are not the only ones who need to advocate for vaccination against pneumonia. Following the conclusion of the main session, an advocacy session tailored for teachers and headmistresses of public schools was initiated during which they were informed of the need to prevent pneumonia through other proven, low-cost techniques such as immunization, sound hygienic practices and balanced diets for infants and exclusive breast feeding for six months, ensuring good nutrition.
The teachers also shared various risk factors which make children more prone to pneumonia. Poor parental healthcare seeking was one: when children with severe pneumonia often undergo of trial and error at the field levels, before they actually reach the health facility for the right treatment in time.
Exposure to indoor smoke, which in rural Pakistan is an issue for more than 60% of families, is also damaging beyond imagination. There, an average household size is seven, which makes overcrowding (i.e the number of people sharing same room where children sleep) is another important factor contributing to pneumonia.
The teachers agreed that, more than ever before, we know how to protect and prevent children from catching pneumonia, and how to treat those suffering with this illness. They returned home to spread the message.
By Rachel Bierbrier, a Policy, Advocay and Communications intern working with IVAC.
International Vaccine Access Center (IVAC) is proud to celebrate the seventh annual World Pneumonia Day on November 12th, 2015.
Despite being preventable and treatable, pneumonia remains the leading killer of children under five years old; responsible for 16% of global under five mortality in 2015. More than half of these deaths occur in only six countries where gaps in access to life saving interventions exist.
Although World Pneumonia Day began seven years ago, IVAC’s commitment to reducing the burden of pneumonia originated much earlier with PneumoADIP; an innovative project that aimed to improve child survival and health by accelerating the evaluation of and access to new, life-saving pneumococcal vaccines for the world's children. Although this project is now complete, it was critical in sparking both the birth of IVAC as an organization and its ongoing commitment to increasing access to pneumonia prevention interventions, with a specific focus on vaccination.
IVAC is thrilled to announce the release of its annual Pneumonia and Diarrhea Progress Report. This year’s theme is Sustainable Progress in the Post-2015 Era. Using the most recent available data, the report documents the progress of the 15 countries with the greatest burden of pneumonia and diarrhea, in implementing high-impact interventions outlined in the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD) relative to GAPPD coverage targets. For the first time, the report includes in depth analysis of the challenges associated with the sustainability of pneumonia and diarrhea interventions in Gavi graduating countries as well as country specific analysis of the challenges and successes in three focus countries - India, Indonesia and Nigeria. The report and other great resources can be found at www.worldpneumoniaday.org.
Other events hosted by IVAC for World Pneumonia Day 2015 are taking place at the Johns Hopkins Bloomberg School of Public Health. An information table with World Pneumonia Day facts and goodies is set up from 12:00pm-1:00pm in front of the school’s Wall of Wonder – to share information with the future leaders of global health. In the evening, the Child Health Society is hosting a talk by IVAC’s own Dr. Laura Hammit. Dr. Hammit’s talk takes place from 5pm - 7pm in the Hampton House Auditorium.
In Abuja Nigeria, IVAC has joined forces with the government of Nigeria and the Pediatric Association of Nigeria to host a high-level symposium on pneumonia. During the symposium senate leaders, Senator Olanrewaju Tejuosho and Senator Mao Ohuabunwa, will unveil two creative projects on pneumonia – a World Pneumonia Day Calendar, created from paintings done by teenagers in Abuja, and a Pneumonia Social Media Video Challenge. Using the precision of science and the drama of arts, IVAC is helping to propel the message to #BeatPneumonia.
Student artists whose work were featured in the calendar. (Nigeria)
Today, IVAC continues to be active in many pneumonia-related initiatives. In addition to the PERCH project, the PCV Technical Coordination Project and many other innovative projects ongoing at our center, IVAC recently received generous support from the Bill and Melinda Gates Foundation to assume the role as a coordinator for the Global Coalition Against Childhood Pneumonia and Diarrhea. Under this grant, IVAC will work to increase collaboration and communication between members of the Coalition. These activities won’t stop on World Pneumonia Day, they are year round and include the creation and implementation of innovative advocacy tools and efforts.
Pneumonia remains the leading killer of children under the age of five despite being both preventable and treatable. Decreasing the global burden of pneumonia cannot and will not occur without continued advocacy, innovation and collaboration. As a global community, we must continue to work together beyond World Pneumonia Day to ensure that all children have access to sustainable, life saving pneumonia interventions. We have the tools to fight pneumonia; we now need to ensure that these tools are being distributed equitably around the globe.
By Dr. Anne von Gottberg, Respiratory and Meningeal Pathogens Research Unit, National Institute for Communicable Diseases
This article was originally published onwww.vaccineswork.org and is cross-posted here with permission.
If you had looked at South Africa’s invasive pneumococcal disease (IPD) surveillance data before 2002, you would have never guessed that one day that data would land on the pages of the New England Journal of Medicine.
Even I thought such a feat was impossible. Surveillance for IPD was passive and patchy – certainly not the kind of data you could use to examine trends or measure impact. In 2002, experts in pneumonia and respiratory disease suggested that we completely revamp the system: start measuring antimicrobial resistance and serotypes, obtain clinical data from cases to explore risk factors for resistance. Although this was long before the pneumococcal conjugate vaccine (PCV) was introduced, we knew any investments we made in the surveillance system now would pay huge dividends later, and possibly allow us to measure the impact of PCV introduction.
An example of disease surveillance activities. Here, Noluthando Duma works in the lab. Photo: NICD.
Revamping a national surveillance system was not an easy task. Our institute managed the process - from employing surveillance staff throughout the country to collecting data - and we had many, many challenges. This project seemed so unusual, so impossible, that it was difficult to convince anyone to join us. We would interview surveillance officers at remote regional sites who wondered how they could report to a central office in Johannesburg, given that they had never even been there; they couldn’t imagine how such a big, unwieldy national program could ever work. We would answer their questions with what I hoped sounded like confidence, but the truth was that we were figuring out the answers as we went along.
Despite these human resource challenges, we charged ahead, but it was a slow-and-steady race. At our national surveillance officer and principle investigator meetings, we had to bring together key stakeholders to discuss the surveillance network. We had to get buy-in on the methods, the case definitions, the flow of data, and sharing of information, and then we had to hire staff to operationalize our ambitious plans. Many new hires had never been on an airplane before, and some had never seen the ocean – the surveillance network really made South Africa smaller, bringing people together in the “new South Africa” in ways that I could not have predicted. So we anxiously booked window seats, made time for quick excursions to the beach, and hoped for the best. And although we had our fair share of hiccups along the way, our small team continued to grow, the years passed, and we kept on finding ways to silence the naysayers!
Meanwhile, things did not stay still around us. The South African government suddenly found the political will to tackle the HIV/AIDS epidemic, and with a tremendous effort, the government and civil society rapidly improved care of HIV-infected pregnant women, HIV-infected children, and adults in general. With these sudden improvements in healthcare, IPD also changed, making it more difficult to attribute any declines to the vaccine, even with the new surveillance system. But through a series of discussions with local and international colleagues and friends, countless conference calls, and careful review of the data, it finally became possible to tell the story that was in the data, collected for so many years by our dedicated surveillance teams.
By maintaining our slow-and-steady approach remembering to “ask a friend” when we were stumped, and above all continuing to plow on in the face of challenges, we were able to turn data that at first glance may have looked like a mess into a meaningful and robust assessment of the impact of PCV.
This study is part of the the Vaccine Implementation Technical Assistance Consortium (VITAC) - a collaboration of PATH, CDC, and IVAC - supports the achievement of the mission to save lives, prevent disease, and promote health through timely and equitable access to new and underused vaccines. VITAC is focused on accelerating the introduction and sustained use of vaccines by creating the evidence base, advocating for evidence-driven decision making, and establishing a platform for countries to assess the resources needed for sustained and optimal use of vaccines.