A Shot In Arm Prevents Children From Pneumonia

Pneumonia, the leading global killer of children under five, is a disease that occurs most commonly when a child’s still-developing defence system is weakened by malnutrition, air pollution, co-infections with HIV/AIDS and measles, and low birth weight. Appropriate therapies will cure most cases of paediatric bacterial pneumonia. But many children go untreated, and as a result as many as 20% of them die, sometimes within 3 days of onset. It is no wonder then, that pneumonia is responsible for almost 1.6 million deaths per year, which is about one-fifth of all paediatric deaths around the world. Apart from breastfeeding and improved living conditions, access to vaccines and antibiotics, and timely treatment can dramatically reduce deaths from childhood pneumonia in developing countries.

Vaccines to prevent diseases associated with streptococcus pneumonia and Haemophilus influenza type b are remarkably effective. Children in countries without these vaccines are 40 times more likely to die than those in countries where they are routinely administered. Wider use of measles vaccine (which covered 75% of the world’s children in 2004) can also lessen paediatric pneumonia significantly, as pneumonia can cause death among the 30 to 40 million children infected by measles every year.
Dr Gourdas Choudhuri, Professor and Head Gastroenterology Department, Sanjay Gandhi Post-Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, while acknowledging that the role of vaccines in preventing the disease cannot be overlooked, raises a few pertinent points regarding the issue. According to him, “Some vaccines, like the Hib vaccine, are good and a must, which should be given routinely. The pneumococcal vaccine is another good vaccine. But the issue is whether the strains causing the disease, which are present in the community, are the same as those present in the vaccine. Otherwise the vaccine will not work, and the money spent will not get the protection one is expecting. Pneumococcus, one of the germs that cause pneumonia in children, has many strains. The vaccine, which is currently available, has strains that are found chiefly in the western world, and its profile does not match with the strains found in our country. So a routine immunization with one vaccine may not work. As pneumonia, a serious infection of the lungs, can be caused by several germs—pneumococcus bacteria, influenza virus, swine flu virus, etc—a vaccine will work well against some of these but not all. So it is difficult to have a single complete vaccine for full protection.”

Pneumococcal conjugate vaccine (PCV13) protects against 13 out of the 20 most common pneumococcal strains known as serotypes; and reduces hospital admissions linked to child pneumonia by almost 40%. As of 2008, around 31 countries had introduced the pneumococcal vaccine and 15 others had applied for support from The Global alliance for Vaccines and Immunisation (GAVI) to fund the vaccine. Hib vaccine (Haemophilus Influenzae type b) is another highly effective vaccine and 136 countries have introduced it either nationwide or partly, and 102 countries have introduced it widely. 42 million children had received the vaccination. The vaccine is not routinely available in India (and many Asian countries), although available in Central and South America and most of Africa.

 In low income countries pneumonia kills 7320 out of 1000000 children under age 5, as compared to just 34 children in high income countries. Poverty remains a persistent barrier to immunization at the country and community levels. Mere availability of the pneumonia vaccines in the private pharmaceutical market does not ensure its use, primarily because of the prohibitive costs and also because of lack of information. 93% of the world’s children—121 million—had not received a pneumococcal vaccine and 71% or 93 million children had not received the Hib vaccine as of 2008.

According to Dr Dinesh Chandra Pandey, a Specialist in Paediatric Medicine at Nelson Hospital of Paediatrics and Neonatal Medicine, Lucknow, “Many multinational pharmaceutical companies are producing pneumonia vaccines, but their costs are prohibitively high and common public cannot afford them. Such a situation cannot work in India where 80% of the population lives in villages and is poor. So where the incidence of disease is high, availability of medicines is poor. Vaccines like Preminar strepto pneumonia are available in the market, but are very costly. The Hib Influenza vaccine, which prevents pneumonia, is not available in government programmes. Another influenza vaccine for prevention of HINI flu is also not there at affordable prices.”

Dr Ajay Misra, Managing Director of Nelson Hospital of Paediatrics and Neonatal Medicine, Lucknow, also airs similar views. He laments that “There are no pneumonia vaccines included in the government public health immunization programmes. Although pneumococcal vaccines available in the market, but they are very costly. Many people are not even aware of the vaccines available in the market.”

Timely access to medical care, including vaccines, and proper awareness of the disease is an important issue in increasing the survival rate of children from childhood pneumonia and other diseases. The burden of vaccine preventable diseases falls on the poor. According to the Acute Respiratory Infections Atlas, broader use of the Hib vaccine could save 400,000 lives, and the pneumococcal vaccine could prevent 262,000 deaths a year in 72 of the world’s poorest countries.

The GAVI is spearheading international efforts to increase access to pneumonia vaccines. It currently funds immunization campaigns in 72 low income countries. Millions of lives can be saved by 2015 if GAVI could implement its $7 billion campaign to distribute three vaccines: a 5 in 1 vaccine against Hib disease, diphtheria, tetanus, pertusis and hepatitis B; pneumococcal vaccines and vaccine to prevent rotavirus diarrhoea. But as of 2010, the organization had a shortfall of $3 billion, to implement its noble objectives.

Increasing immunization will depend not only upon availability of vaccines but also on a strong vaccine delivery infra structure, leadership and political will to integrate immunization programmes with other healthcare services, community awareness about the value of vaccines, and a much greater commitment from the international community to make universal immunization against childhood pneumonia and other diseases a dream come true for the indigent populations.

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: http://www.citizen-news.org/)

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