Every Breath Counts. A Breath of Fresh Air for Pneumonia

[This article has been published in Spanish in El País-Planeta Futuro]

Pneumonia is the main infectious cause of infant mortality, accounting for one in every six paediatric deaths. And, that is a statistic which should make us feel ashamed

The global health community has reason to congratulate itself for the amazing successes achieved in recent years in reducing infant mortality worldwide. For the first time in the history of humanity, “only” 6 million children under five are dying each year—less than 5% of the approximately 130 million children born annually. This reduction has been made possible by remarkable advances in the prevention, diagnosis and management of major childhood diseases.

Pneumonia—a catch-all term for lower respiratory tract infections associated with many different aetiologies—is still the main infectious cause of infant mortality, accounting for one in every six paediatric deaths. And, that is a statistic which should make us feel ashamed. Although, we should perhaps be even more ashamed of the fact that nine out of every ten children who die of pneumonia live in the world’s poorest countries, a statistic that highlights the inherent inequity in the impact of this disease that feeds on—and at the same time generates—poverty.

The disease continues to claim the lives of 920,000 children every year. In other words, it kills 2,500 children every day

It is also striking to note that while pneumonia is still a major causes of illness in both children and adults in rich countries, its lethal potential in that setting is radically reduced by prompt and adequate management. Furthermore, in contrast to what has happened with the other major causes of childhood mortality (malaria, diarrhoeal diseases, AIDS and measles), we have not seen great reductions in pneumonia-related mortality, and the disease continues to claim the lives of 920,000 children every year. In other words, it kills 2,500 children every day.

You may wonder why so many children are still dying of pneumonia in poor countries? This is a straightforward question. The answer is also relatively simple and revolves around access to care. Although it might seem paradoxical, we do have highly effective tools to prevent and treat pneumonia. Large-scale vaccination against pneumonia has dramatically reduced the incidence of the disease. We also have highly effective antibiotics that cost very little (less than 32 cents for a complete course of treatment lasting three to five days).

Pneumonia particularly affects the poorest of the poor, and among such highly vulnerable groups access to healthcare is very problematic

Oxygen, which is needed to manage hypoxemia (one of the most serious complications of pneumonia), is cheap and easy to produce. However, as we have already said, pneumonia particularly affects the poorest of the poor, and among such highly vulnerable groups access to healthcare is very problematic.

In rural Nigeria, for example, one of the countries with the highest rates of pneumonia-related mortality in the world, access to even a very basic health care facility can be a daunting undertaking. In addition, fragile health systems and infrastructures may lack essential drugs or the trained personnel needed to make an accurate diagnosis or a timely assessment of disease severity, and systems for referring patients to other hospitals or clinics with better facilities may not exist or be highly dysfunctional. Finally, the expense involved in a visit to a health centre may be beyond the reach of families who are often living in chronic poverty and struggling to survive.

The struggle for air endured by many children with pneumonia is comparable to the suffocating sensation a fish would experience if we were to empty its tank of water

The struggle for air endured by many children with pneumonia is comparable to the suffocating sensation a fish would experience if we were to empty its tank of water. Unfortunately, international efforts to tackle the problem of pneumonia in a concerted and coordinated manner have been intermittent and generally ineffective.

For some inexplicable reason, pneumonia, which should have been assigned a high priority in many global health interventions, has in the past been one of the most neglected diseases, especially since the heaviest burden has been confined to the world’s poorest countries.

However, a breath of fresh air is now revitalising efforts to combat pneumonia in the form of a new international coalition bringing together more than 30 international institutions

However, a breath of fresh air is now revitalising efforts to combat pneumonia in the form of a new international coalition bringing together more than 30 international institutions, including the ”la Caixa” Banking Foundation—one of the most important and coherent philanthropic actors in the field of pneumonia—and the Barcelona Institute for Global Health (http://www.isglobal.org/en).

Every effort to prevent or lessen the effects of pneumonia worldwide is morally non-negotiable and absolutely justified

This coalition—called Every Breath Counts—must fill the vacancy in the leadership for the fight against pneumonia, reminding us every second, minute, hour and day of our lives (and not just once a year on World Pneumonia Day), that every breath counts, and that every effort to prevent or lessen the effects of pneumonia worldwide is morally non-negotiable and absolutely justified.