In 2013, the World Health Organization and UNICEF issued the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD)—marking a new chapter in efforts to curb pneumonia and diarrhea, the top infectious disease killers of children under age five worldwide. The plan was bold and comprehensive. It recognized that gaining the upper hand would require hitting these scourges from multiple angles and leveraging overlapping tools in an integrated way.
Today, we're up against a new challenge—the COVID-19 pandemic. The coronavirus responsible causes respiratory disease and some of those infected go on to develop pneumonia. As questions swirl around how to deal with COVID-19, it’s worth taking stock of what we already know about fighting pneumonia. Initiatives like GAPPD have long-standing wisdom to impart about integrated approaches to respiratory disease and why they're so important. For nations with limited resources, large disease burdens, and weak healthcare systems, the stakes couldn’t be higher.
Severe respiratory disease has many causes. Therefore, one solution simply isn’t enough. Thankfully, it's possible to tackle multiple enemies at once—while conserving public health resources—by deploying a suite of measures and tapping their overlapping potential. This principle forms the backbone of strategies long in play against pneumonia. Similarly, a multi-pronged COVID-19 response approach (handwashing, social distancing, testing, vaccine/drug development, etc.) is already being emphasized by the experts.
So, what is the full suite of time-tested pneumonia tools and strategies to lean on in the COVID-19 era?
Preventing disease in the first place
The key to saving lives? Stopping infections before they start.
Respiratory diseases like COVID-19 are commonly spread by exposure to droplets from an infected person’s sneeze or cough, or contact with contaminated surfaces. As such, poor hygiene/sanitation and overcrowding are important drivers of transmission. Underlying health conditions resulting from malnutrition, poor air quality, and disease can compound things, making infections easier to get and worse. For these reasons, PATH and partners are supporting a combination of interventions that can prevent infection or reduce the chance of developing severe disease like handwashing with soap, basic sanitation, clean water, good nutrition, clean cookstoves to reduce indoor and outdoor air pollution, and exclusive breastfeeding.
Vaccines are another key in prevention. They are a global health best buy and a first line of defense against respiratory diseases, including many that PATH works on such as pneumococcus, respiratory syncytial virus, influenza, pertussis, group B streptococcus, and Nipah virus. In immunization, PATH leverages decades of hands-on experience developing, introducing, and improving vaccines and immunization technologies in multisector partnerships with manufacturers and resource-limited countries to advance and sustain country goals for immunization equity and vaccination coverage.
Although a COVID-19 vaccine isn’t yet available and won’t be for some time, we can still work to ensure that the vaccines we do have reach everyone who needs them. These efforts are especially critical now for epidemic preparedness because they protect people with underlying health problems, relieve overburdened health systems, and prevent co-infections where COVID-19 infection increases susceptibility. Furthermore, more affordable and accessible vaccines for pneumonia (like the newest pneumococcal vaccine) are crucial for freeing up healthcare resources and enabling herd immunity (a community-level cocoon of immunity that interrupts transmission and protects the most vulnerable).
“Gaining the upper hand on any severe respiratory disease requires hitting it from multiple angles and leveraging tools in an integrated way.”
Access to diagnostics and treatment
When respiratory infections do take hold, early access to diagnostics and treatment saves lives. By afflicting the lungs, pneumonia (COVID-19-related or otherwise) can result in fatal oxygen deficiency in the blood, or hypoxemia. Many such deaths could be prevented with reliable access to oxygen paired with pulse oximetry, but many health facilities are not equipped to treat hypoxemia, especially beyond surgical wards.
Furthermore, along with the highly publicized need for more COVID-19 testing, additional early diagnostic tools are also important. Devices like pulse oximeters that 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 some countries, barriers related to demand, supply, and adoption prevent access in some low-resource settings.
Additionally, the recommended first-line treatment for bacterial childhood pneumonia is the antibiotic amoxicillin. In its traditional forms, however, it can be difficult to use in some settings because of factors like heat and light sensitivity and the need for precise measurement. Solutions to resolve these barriers are critical to ensuring equity of access.
To meet these needs, PATH and partners have been working in support of these tools, including reliable oxygen delivery systems, improved access to pulse oximeters and clinical decision support tools to help health workers detect severe illness in sick children, and research to optimize amoxicillin for low-resource settings. Overall, success will require commitment from health program leaders to pass policies; finance training, procurement, and maintenance; and increase awareness of the burden of pneumonia and the importance of proper detection and treatment at all levels of care and politics.
From integration to impact
Since the GAPPD came out, PATH has been working alongside countries, NGOs, and other partners to make this global framework a reality in the communities hardest hit. Remarkable progress has been made thanks to evolving global and national policies, primary healthcare strengthening efforts, and improved reach of certain lifesaving tools. Between 2012 and today, for instance, annual childhood pneumonia deaths alone have fallen from roughly 1.1 million to 800,000. Diarrhea deaths have also seen dramatic reductions. Households and communities, more broadly, have also benefited from many of these interventions, enabling healthier lives for all.
Despite these gains, however, pneumonia remains the world’s deadliest infectious disease. In fact, many countries have fallen short of their GAPPD commitments, which has meant pneumonia death reductions have not kept pace with other infectious diseases efforts and that many countries may fail to reach the 2030 health targets laid out in the UN Sustainable Development Goals. The risk is that COVID-19 will further derail what progress has been made—unless concerted investment is made to push progress forward.
As COVID-19 takes us into the unknown, it’s important (and perhaps comforting) to remember that what we’ve known for a long time about pneumonia control can make a huge difference, especially in countries and communities where health inequities make the challenge even greater. We know that the odds of success are better when the full suite of tools can meet its full, equitable potential. So let’s take that learning to heart and apply it. Now more than ever.