Pneumonia will kill 1.7 million of India’s children by 2030. Why is this the case for a disease that is both preventable and treatable?
A study published to mark World Pneumonia Day estimates eleven million children under the age of five are likely to be killed by pneumonia over the next twelve years worldwide. Only Nigeria is projected to have a higher death toll from the disease than India. However, the difference between the two nations is marginal.
The estimates are based on current trends. However, there is some hope. The study identifies certain measures with the potential to save millions of lives if implemented soon enough.
Increasing vaccination coverage at the global level to over ninety percent of children under the age of five may potentially save 610,000 lives. Increasing access to affordable antibiotics could save 1.9 million.
The intervention with the potential to save the most lives is ensuring children have access to good nutrition. This measure alone could potentially save 2.5 million lives by 2030. If all three overlapping interventions were carried out by 2030, the model suggests a total of 4.1 million deaths could be averted.
Though Nigeria is projected to have more deaths due to pneumonia by 2030, India currently holds the highest burden of the disease. According to the Pneumonia and Diarrhea Progress Report by the International Vaccine Access Center (IVAC) at the Johns Hopkins Bloomberg School of Public Health, the number of deaths of children under five years due to pneumonia in 2016 was 158,176 in India.
Though treatable, numerous causes of the disease can often make it difficult
Vaccination against pneumonia is only partially effective due to the variety of causes for the condition. Pakistan, for example, provides free vaccinations. However, it still loses 92,000 children’s lives to the disease every year.
Pneumonia can be caused by a number of infections. Bacteria, viruses, fungi, and mycoplasmas can all be responsible for an infection. As such, the right kind of treatment can often be difficult if the infection is serious.
What links these different infections is the complications they cause. Pneumonia occurs specifically in the lungs. The infection causes swelling and inflammation in the alveoli of the lungs. This results in them filling with fluid or pus, resulting in breathing difficulties.
The infection may be mild, resulting only in coughing, sneezing and a mild fever. However, symptoms can become far more severe. Shortness of breath can become an issue, particularly in individuals with preexisting conditions. Severe chest pain, nausea and vomiting may also occur in more severe cases. At-risk groups include young children, the elderly and immunocompromised individuals such as those with HIV or people undergoing chemotherapy.
Depending on the original infection that caused the pneumonia, the disease can also be infectious. This is true of most kinds of pneumonia. The infection is passed on in droplets expelled when sneezing or coughing.
Progress in India
The report stated that progress in India had been “mixed”. The report praised the increasing coverage of Haemophilus influenzae type b (Hib) vaccines, as well as the introduction of the rotavirus vaccines first used in mid-2016. It credits these two interventions with a bump in India’s score from last year’s report.
However, the report picked up on distinct disparities between the levels of access to vaccinations between states. “Introduced in 2017, the pneumococcal conjugate vaccine (PCV) has been included in only six states to-date,” said the report. “Further scale-up of the vaccine to all states should be considered.”
This issue is far from confined to India. “Progress to stop child deaths is being hampered by persistent inequities in countries around the world,” said Kate O’Brien, MD, MPH, a professor in the Bloomberg School’s Department of International Health and IVAC’s executive director. “Addressing these inequities will demand greater levels of funding, strong political commitment, accountability supported by better data, and a coordinated global effort that prioritizes the most vulnerable.”
Noted within the study is that even in countries where vaccination coverage is improving, it is often children in remote, geographically isolated regions that are suffering the highest numbers of pneumonia cases. This may be especially true of India, where the rural/urban divide in access to healthcare is considerable.
Staff shortages are common in rural areas. Many doctors refuse to work in rural locations, stating they lack even the most basic of medical resources. This results in them not being able to provide simple services. This often draws the ire of the community they are serving. Some doctors have suggested even the most basic medical supplies such as paracetamol are all but unavailable in the most remote clinics.
If sufficient supplies of antibiotics are not reaching India’s rural clinics, it is inevitable that diseases such as pneumonia — as well as a host of other infectious diseases — will continue to claim lives. These disparities must be addressed if India is to gain sufficient ground against infectious diseases. However this will no doubt be a long-term endeavour, requiring considerable funding and political commitment to allow for improved healthcare infrastructure the country over.