Realizing that reducing child deaths from pneumonia is the need of the hour, the Global Action Plan for the Prevention and Control of Pneumonia (GAPP) has come up with recommendations on specific goals and targets to reduce mortality from pneumonia. It also aims that every child is protected against pneumonia through a healthy environment, and has access to preventive and treatment measures. I am reminded of the words of Dr Margaret Chan, Director-General of World Health Organization (WHO), which I read recently: "This action plan provides the strategy to prevent and control pneumonia, which today kills more children than any other illness."
The GAPP’s simple three-pronged vision of "protect, prevent and treat" has the potential to save more than a million children who die of pneumonia each year.
(i) Protecting every child by providing an environment where they are at low risk
(ii) Preventing children from becoming ill with pneumonia (with vaccination against its causes: measles, pertussis, Streptococcus pneumoniae and Haemophilus influenzae b)
(iii) Treating children who become ill with pneumonia with the right care.
This strategy is hoped to lead to a reduction in child pneumonia deaths by 65% and cut the number of severe pneumonia cases in children by 25%.
The GAPP's vision-Pneumococcal vaccine uptake will be gradual and in some countries it will only be introduced in 2014, thus 90% coverage by 2015 will not apply to it.), Easy4, Hibirix, tetrad Hib (4% reduction in all child deaths with Hib.
In the context of child survival strategies, countries should address pneumonia control by way of vaccinations and health care programmes. As pneumonia is caused by various organisms like- Pneumococcus, Sreptococcus, Haemophilus influenzae or Mycoplasma etc, the vaccine is guided by the type of organisms causing pneumonia. So there are a number of vaccines available, like Pneumococal Vaccine and the Haemophilus influenzae or Hib Vaccine. Others include the BCG vaccine for tuberculosis, DPT vaccine for diphtheria and pertusis which are the infections of the upper respiratory tract, and measles vaccine which indirectly prevents pneumonia, because a child with measles becomes very weak and is more prone to the super added infection of pneumonia. Three doses of Hib vaccine along with DPT are effective against Haemophilus influenza (which is a very virulent bacterium and responsible for a highly fatal pneumonia in children) and reduce incidence of mortality among children by 22%–34%. WHO has urged that countries with high rates of mortality in children aged under 5 years, and countries with a high prevalence of HIV, should consider introducing pneumococcal conjugate vaccines into the national immunization program and Hib vaccine for infant immunization in all countries. But as of now, this is only implemented in the developed countries while the developing countries are still striving for it. GAPP's vision is that the Pneumococcal Vaccine uptake will be gradual and in some countries it may only be introduced in 2014.
These life saving vaccines come with a high price tag and are not pocket friendly. Hence it becomes difficult for the common masses to afford them. It is for this reason that they are not included in the Government health care programmes in India. According to Dr. Vijaya Mohan (Consultant Pediatrician, Vivekananda Polyclinic and Institute of Medical Sciences) "The affluent class can afford the vaccine but the problem of common masses is that it is costly."
Another important hurdle in preventing pneumonia is the lack of information. The general public is mostly not aware of these vaccines, as they are not mentioned in the government health care programme. The mother of a three years old child Atharva, who was admitted in Chhatrapati Shahuji Maharaj Medical University with acute pneumonia, said," If I ever knew that there is a vaccine available against pneumonia, I would have made all efforts to get my child vaccinated to prevent him from such dreadful conditions as he is facing now."
The achievement of the global objectives for pneumonia prevention and control will require coordination among the concerned individual programmes at country and regional levels and expanded support from development agencies.
Shikha Srivastava - CNS