World Pneumonia Day 2012 – Reflections

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Jason Nickerson
Jason Nickerson is an operational researcher who focuses on health systems in humanitarian emergencies and fragile states. He trained as a respiratory therapist and maintains a clinical practice in anesthesia in Ottawa, and completed a PhD in population health. Beyond health systems issues, Jason focuses on access to essential medicines, surgical care, and the treatment of respiratory diseases. Jason is a Clinical Scientist with the Bruyère Research Institute in Ottawa, Canada.
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Today is World Pneumonia Day. While #WPD2012 should lead us to be optimistic about the capabilities we have to prevent and treat pneumonia around the world, it also provides a solemn reminder that despite being preventable and treatable, pneumonia continues to be the leading cause of death in children.

Looking back at the past year, much of my world has been shaped by thinking of respiratory health and of pneumonia, in particular. In February, I was given the wonderful opportunity to travel to Malawi to see the roll-out of the pneumococcal vaccine there and to see the myriad of ways that people are working to prevent pneumonia in their communities. I wrote about this several times, including some reflections on how the pneumococcal vaccine is being made accessible in low-income countries through an advanced market commitment, which has brought the price of the vaccine down considerably.

While there is much to celebrate since World Pneumonia Day 2011, there is still much work to be done. An effective vaccine exists for preventing pneumococcal pneumonia, but coverage needs to be expanded. In the Democratic Republic of the Congo, for example, a country ranked the third highest in the global mortality from pneumonia rankings, the PCV vaccine was introduced, yet coverage is only 9%. Effective treatments for pneumonia, including basic essential medicines such as amoxicillin and oxygen, exist and are low-cost, yet access to basic healthcare in many parts of the world remains poor. The challenges are vast and require us to think about not only pneumonia, but how to improve health systems so that not only is coverage of the pneumococcal vaccine or treatment of pneumonia expanded, but other health interventions as well. A stronger health system is more capable of preventing and responding to the health needs of the population, including the prevention and treatment of pneumonia.

This point is driven home by the Pneumonia Progress Report released today by the International Vaccine Access Center that says that:

“Nearly all pneumonia deaths occur in developing countries, and three-quarters take place in just 15 countries. The majority of pneumonia cases are preventable or treatable.”

This tells us that targeted interventions could produce big results for reducing child mortality caused by pneumonia. Doing so by strengthening health systems at the same time would undoubtedly deliver major improvements in population health and encourage the roll-out of other effective health interventions. The fact that childhood deaths caused by pneumonia are concentrated in just 15 countries tells us that the ability of the health system to cope with an all-too-common illness is weak; it’s a late indicator of a very sick health system.

As a respiratory therapist, this is an issue of great importance to me. Regrettably, many of my interactions with the pneumonia “world” have been in providing treatment to those who need it. Because of this perspective, I was delighted to read that a major initiative was launched today to ensure that amoxicillin – a first-line treatment option for childhood pneumonia, yet one that is too often unavailable – is available in the ten countries where childhood deaths from pneumonia are the highest (India (400,000 deaths), Nigeria (130,000 deaths), Democratic Republic of Congo (88,000 deaths), Pakistan (67,000 deaths), Ethiopia (41,000 deaths), Uganda (22,000), Niger (20,000), Bangladesh (19,000), Tanzania (18,000) and Kenya (18,000)). This is huge, and is certainly cause for celebration.

So, in the coming year, those of us in the fields of respiratory medicine and public health need to commit to eliminating childhood deaths from pneumonia and advocating for the scaling up of treatment and prevention of this deadly illness. We need newer, better, more innovative approaches to the delivery of basic respiratory health services in low-resource settings. Things that we take for granted, but that are all-too-frequently unavailable, like supplementary oxygen: a vital drug for treating pneumonia, but one plagued by logistical constraints making it rarely available in low-resource settings. We need to be innovators and advocators for respiratory health, and we need to take that responsibility seriously. There is much we can learn from the work that is being done between World Pneumonia Days, but there is still much work left to do.

Be sure to check out some of the many wonderful blog posts that have been posted today:

World Pneumonia Day’s Humble Beginnings – on Impatient Optimists, by Orin Levine

World Pneumonia Day: Remembering the Forgotten Killer – on the One blog

“Cyber-Doctors” Help Conquer Pneumonia in India – on Impatient Optimists, by Saul Morris

The Biggest Scandal in Global Health Today: Why are 2 Million Children Dying from Pneumonia and Diarrhea Every Year? – on Pneumo Blog, by Leith Greenslade

Watch the World Pneumonia Day video

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