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Ushering in a new era of pneumonia control

November 12, 2019 by PATH

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PATH’s Cambodia team and the Cambodian Ministry of Health train mothers on how to prevent and treat childhood pneumonia and diarrhea. Photo: PATH/Heng Chivoan (Cambodia)

Pneumonia remains the deadliest infectious disease worldwide, claiming the lives of more than 800,000 children under age five every year.

It can strike anywhere, but is most prevalent among marginalized groups of people. Pneumonia is a complex disease with many causes, including viruses, bacteria, and even fungi, and the appropriate tools to fight it are still not accessible to everyone who needs them.

Despite tremendous gains, progress in reducing pneumonia deaths has not kept pace with other leading infectious diseases. As a result, pneumonia deaths persist at levels so unacceptably high, they could prohibit many countries from reaching the 2030 health targets laid out in the UN Sustainable Development Goals.

To better serve marginalized people and accelerate global progress against pneumonia, PATH is harnessing an integrated array of cost-effective solutions that can hit the disease from multiple angles, including vaccines, access to appropriate diagnostic tools, and treatments.

Here’s how we are pursuing each:

Vaccines—simple interventions with enormous impact

Thankfully, vaccines already exist or are in development for many of the common causes of pneumonia. Tragically, many of these vaccines aren’t affordable to the low-resource nations that suffer the highest burden. Everyone should have equitable access to lifesaving vaccines. That's why PATH is supporting the development of several low-cost vaccines against pneumonia-causing diseases.

Worldwide, pneumococcal disease kills hundreds of thousands of children each year and is a leading cause of severe bacterial pneumonia. Effective pneumococcal conjugate vaccines—which protect against some kinds of pneumococcus—already exist and save lives around the world, but their high cost precludes many countries from using them. A Serum Institute of India, Pvt., Ltd. developed a vaccine designed specifically to protect children in low- and middle-income countries from the most common kinds of pneumococcus in Africa and Asia—and at roughly two-thirds the usual donor-supported price. PATH helped organize clinical trials for this low-cost vaccine, and it is now being considered for World Health Organization prequalification. Prequalification would authorize the vaccine to be procured by United Nations agencies for use in low-income countries—a critical step toward enabling access in low-resource settings.

Influenza and pertussis—better known as whooping cough—can both lead to viral pneumonia. We’ve supported manufacturers worldwide in efforts to shore up global seasonal and pandemic influenza vaccine supplies and are currently evaluating new pertussis vaccines for pregnant women designed to cost less and be more effective. (By vaccinating a woman while pregnant, antibodies can pass from her to her unborn child and provide protection during the first, most vulnerable months of life—a strategy called maternal immunization.)

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Vaccines designed for maternal immunization prevent some of the common causes of pneumonia and can help pregnant women like Mariatu Kamara, who previously lost a child to pneumonia. Photo: PATH/Doune Porter (Sierra Leone)

We’re also supporting new vaccines for maternal immunization against two major causes of infant illness and death: respiratory syncytial virus (RSV) and group B Streptococcus (GBS). Both diseases count pneumonia among their common complications. RSV is a top cause of respiratory infection and hospitalization among young infants, and PATH is helping ready the field for eventual introduction of a vaccine. GBS is the leading cause of sepsis and meningitis in young infants, and a PATH-supported vaccine candidate is in early-stage clinical development.

We’re even pursuing vaccines against unexpected causes of pneumonia, such as the deadly bat-borne Nipah virus.

Better access to smart tools to detect severe illness in children

When pneumonia strikes, it is critical that a child is seen by a health worker who can effectively diagnose and treat them—or refer them for special care. In order for health workers to make the right diagnosis, they must have the right tools.

Devices like pulse oximeters, which measure the amount of oxygen in the blood, or clinical decision support tools that help process patient information and symptoms through digital applications, are key for alerting health workers to signs of severe disease. While these tools are routinely used in high-income countries, barriers related to demand, adoption, supply, and delivery prevent access in some low-resource settings. When danger signs go undiagnosed or unaddressed, children’s lives are put at risk.

That’s why PATH, with financial support from Unitaid, is partnering with Swiss Tropical and Public Health Institute; the ministries of health in India, Kenya, Myanmar, Senegal, and Tanzania; and international thought leaders on the Tools for Integrated Management of Childhood Illness (TIMCI) initiative. This ambitious four-year project aims to equip frontline health workers with the tools they need to detect severe disease like pneumonia in sick children. The initiative will both improve access to existing tools like pulse oximeters and clinical decision support tools, and improve the tools themselves to make them smarter and more relevant for health workers in low-resource settings.

TIMCI will also strengthen the market for critical diagnostic tools in low-resource settings through action, evidence, and innovation. Specific measures include by putting pulse oximeters and novel clinical decision support tools in the hands of health workers in 360 primary health facilities across the five countries, and generating missing data on feasibility, cost-effectiveness, and health impact of these tools to address evidence gaps and inform global guidance. We will also work to accelerate the development of multimodal devices that can measure additional vital signs, such as respiratory rate, hemoglobin, and temperature.

Over the next ten years, this work will increase coverage of pulse oximeters and clinical decision support tools in the five countries from nearly 0 to 65 percent.

By demonstrating that these tools improve the management of childhood illness—and that they can be sustainably implemented—TIMCI will generate evidence-based demand, increase donor engagement, and provide incentives for manufacturers to innovate and for governments to pursue adoption.

Better access to safe oxygen

Hypoxemia, insufficient oxygen in the blood, affects millions of people each year suffering from a range of common conditions—including newborn complications, obstetric emergencies, and pneumonia. Globally, at least 13 percent of children admitted to a hospital with severe pneumonia have hypoxemia, corresponding to approximately 1.5 to 2.7 million children requiring oxygen therapy for treatment of pneumonia annually. Furthermore, global estimates suggest that one in five sick newborns has hypoxemia upon admission to a hospital and 15 percent of all pregnant women develop potentially life-threatening complications, many of which require treatment with oxygen.

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Access to safe oxygen is a complex health systems problem. Photo: PATH/Eric Becker.

However, access to reliable oxygen delivery systems (the provision of oxygen in coordinated use with pulse oximetry) is often difficult in low-resource settings for a variety of reasons. Our most recent work—the increasing access to safe oxygen and maternal, newborn, and child health (MNCH) devices project—is building on PATH’s work in safe oxygen delivery with an eye toward expanding to other essential medical devices specifically for MNCH. This two-year project aims to provide technical assistance and build capacity in support of oxygen delivery scale-up at the country level. To do so, we are partnering with the ministries of health in India, Indonesia, Kenya, Malawi, and Senegal to develop and roll-out a toolkit of planning and management resources that aid in improved reliability of oxygen and pulse oximetry access.

In addition to being an essential component of severe pneumonia treatment, oxygen is critical to high-quality treatment for a number of indications. And, while we’ve learned that certain challenges are specific to the unique aspects of oxygen, which functions as both a drug and a medical device, many are applicable to a wide range of essential medical devices. As a result, PATH’s work also focuses on extending the impact of more reliable treatment for hypoxemia and pneumonia to a much broader conversation around cost-effective deployment strategies for priority MNCH medical devices and treatments.

A comprehensive approach for pneumonia control

In addition to developing and adopting breakthrough technologies for pneumonia prevention, diagnosis, and treatment, the global community also needs appropriate investment in and robust leadership of pneumonia control strategies. It is paramount that champions at local, national, and international levels put pneumonia control high on the agendas of donors, governments, and the international health and development agencies.

Many of the broader interventions that help prevent pneumonia—such as breastfeeding, nutrition, sanitation, and hygiene—have overlapping benefits to prevent other childhood diseases, like diarrhea. Integrated and coordinated approaches across diseases and sectors can maximize impact, decrease costs, and increase efficiency.

Together, we can usher in a new era of pneumonia control and take a massive step toward ending child deaths and realizing a healthier, more equitable world.

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