Explaining pneumonia’s big global decline on a tiny budget

A Somali child in severe respiratory distress in a hospital in Mogadishu, Somalia, suffering from HIB (haemophilus influenzae type B) infection - the bacteria that causes both meningitis and pneumonia. (AP Photo/Ben Curtis)

By Nancy Fullman, special to Humanosphere

There appears to be a disconnect between the global burden of pneumonia and how much money is spent on attempting to reduce this burden, which Humanosphere recently summed up as: Pneumonia leads in killing children, but not in global health financing.

Pneumo2IHMEIn 2011, the latest year for which reliable spending estimates are available, development assistance for health that targeted pneumonia accounted for just 2 percent (or $663 million) of total funding for global health efforts. Yet pneumonia caused 5 percent of all years of life lost and 14 percent of child deaths (in 2013).

This (im)balancing act is noteworthy, as more funding to fight pneumonia would be expected to save thousands more lives.

But a question arises when you look at the overall disease trends for this killer over time: If so little was spent on pneumonia, how did the world achieve a nearly 60 percent decline in child pneumonia deaths between 1990 and 2013?

The easy answer is that India and China were the main drivers of global gains in reducing child pneumonia deaths (see the graphic below), and neither country received much, if any, pneumonia-specific external aid funding in 2011.

Their impressive progress in decreasing child pneumonia deaths was likely either financed through domestic budgets or related to broader gains in socioeconomic development.

Pneumonia case closed … right? So perhaps we shouldn’t be as worried about the disproportionately low level of global health funding for fighting pneumonia if India and China can make such progress on relative global health pennies, can’t the rest of the world expect to do the same?

Probably not.

Here’s why: While India and China have traditionally been countries with the largest number of child pneumonia deaths, they have never been the places with the highest rates of pneumonia mortality, given their population size. These countries’ experiences with childhood pneumonia – and how they addressed the disease – are likely different from places where pneumonia kills with greater abandon.

Take China for example. The numbers of children who died from pneumonia in China and Tanzania were fairly similar in 2013 (26,095 and 25,290, respectively). Their mortality rates, however, were not: 29 children died per 100,000 in China, whereas 293 child pneumonia deaths per 100,000 occurred in Tanzania.

PneumoIHME

Why does this matter? Well, as populous India and China recorded large numbers of child pneumonia deaths, their mortality rates for childhood pneumonia were substantially lower than those of relatively smaller countries. In addition, progress in India and China may be more related to improvements achieved for certain populations or in broader risk factors for pneumonia, such as household air pollution and malnutrition.

On the other hand, some countries face more nationwide health challenges that can heighten the risk of dying from pneumonia, such as national vaccination programs that have yet to be fully implemented and may benefit from additional financial support from development partners.

Consider that India might see even greater progress against childhood pneumonia if the country introduced the pneumococcal conjugate vaccine (PCV), a key immunization against many lethal strains of bacteria that cause pneumonia. And China might have lower rates of preventable child deaths in some areas of the country if health disparities between urban and rural areas were addressed.

There isn’t a one-size-fits-all solution for childhood pneumonia, and taking on the disease from many angles, from expanding vaccine access to improving childhood nutrition, will likely save more lives. Worldwide gains in reducing child pneumonia deaths are important to highlight, but without further investigation into what’s really driving this progress, the global picture can be deceiving. And in this case, it might mask what could be achieved in other high-burden countries with more pneumonia funding.

Nancy FullmanNancy Fullman is a policy translation specialist at the University of Washington’s Institute for Health Metrics and Evaluation. Her areas of expertise include malaria research, policy, impact evaluations and health system assessment.

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