Pneumonia vaccination: Beyond reach for most children

Despite pneumonia is the lead killer of children below the age of five years still the government has not included pneumonia vaccination in the national vaccination programme for children that is provided free of cost in the government run public healthcare service centres. According to the 2008 data, 371605 children below the age of five years died due to pneumonia which is 20.3% of all deaths occurring in the under-5 children that year. Ironically children who are at an alarming risk of pneumonia are more likely to be poor, exposed to tobacco smoke or smoke from cook stoves, live in over-crowded and polluted surroundings with low levels of hygiene or cleanliness, among other risk factors that put them at a greater risk of pneumonia. These most-at-risk children are also least likely to get vaccinated against pneumonia as their parents or guardians are least likely to be able to afford the cost.

“As pneumonia can be caused by virus, fungi or bacteria or other parasites, vaccines too are specific in protecting children against specific types of pneumonia. Vaccination against pneumonia is specific to the causative agent. Vaccines against two of the main causes of life-threatening pneumonia - pneumococcal (Streptococcus pneumoniae) and Hib (Haemophilus influenzae Type b) have been developed and are currently being used in the developed countries. But coverage in third world countries like India (which accounts for almost 40% of the worldwide childhood pneumonia cases) is low, particularly of pneumococcal vaccines” said Dr Ritu Garg, senior Gynaecologist and Obstetrician, Yash Hospital, Lucknow. “Vaccination against pneumonia should be made available in government hospitals” said Dr Garg as most people find it difficult to afford it and thereby their children are at a heightened risk of pneumonia.

Vaccination against pneumonia is only available for children and not for adults, said Dr Nidhi Johri, senior Gynaecologist and Obstetrician, Hope Mother and Child Care Centre, Lucknow. The WHO has also recommended that exclusive breastfeeding a child for first six months, protecting the child from exposure to secondhand tobacco smoke or smoke coming out of cook stoves, maintaining high levels of hygiene and cleanliness, providing balanced nutritious diet to the pregnant woman and postnatal to mother and child (after 6 months, before 6 months mother’s milk is complete nutrition for the child), and other measures will help prevent pneumonia, said Dr Johri. Vaccination against pneumonia is currently not a part of the free vaccines provided to children in government hospitals, also said Dr Johri.

“Immunization protects children from pneumonia. All children have the right to this protection. The WHO immunization schedule for infants recommends that children receive Hib and Pneumococcal conjugate vaccine (PCV) in 3 doses over a period of the first 6 months. These are not available in government public sector hospitals. In government hospitals seven vaccinations are provided which includes DPT, polio, BCG, hepatitis B among others. However if parents want their children to be vaccinated against pneumonia then they have to buy it from the private pharmacies,” said Dr Santosh Rai, senior Paediatrician, Vatasalya Clinic, Lucknow.

“Pneumonia vaccination can cost up to Rs 15,500. The cost of vaccination against pneumonia is clearly out of reach of many people who might have otherwise got their children protected against certain forms of pneumonia” said Dr Ajay Kumar, senior Paediatrician, Hope Mother and Child Care Centre, Lucknow. Dr Kumar agrees too that vaccination against pneumonia is not available in the government public healthcare service centres. However this vaccination as per the WHO guidelines is available at his clinic.

Dr Ajay Kumar also said that it is not whether a child comes from a poor or rich family, rather the presence of risk factors that put a child at a greater risk of pneumonia. Even children from rich families can be malnourished or exposed to secondhand tobacco smoke for instance. Lack of health literacy and awareness on how to protect children from infections such as pneumonia are reasons why we see preventable infections in children despite efforts.

Neeraj Mailani - CNS
(Translation: Bobby Ramakant, CNS)