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Tackling the 'forgotten killer'

Fergus Walsh | 11:49 UK time, Sunday, 23 January 2011

Baby Vanessa undergoing treatment for pneumonia

Millions of children, like baby Vanessa, fall victim to pneumonia in the developing world

Vanessa is struggling to breathe. Her lungs are full of fluid, and she is anaemic and malnourished. She is on a drip and receiving a blood transfusion at Mbagathi Hospital in Nairobi. The eight-month-old has bacterial pneumonia.

Her mother and grandmother watch over her in the tiny acute room at the hospital which she shares with four other children - there is barely room to move in the cramped space.

Pneumonia has been called the forgotten killer. It does not get the same attention as HIV/Aids or malaria. Yet it claims the lives of more young children worldwide than both of them combined.

A vaccine against the bacteria responsible for the majority of serious pneumonia is widely used in richer countries. I covered the introduction of the pneumococcal jab into the UK immunisation schedule in 2006. It prevents a good deal of sickness among children in Britain. But the real impact, in terms of saving lives, will be felt in poorer nations.

I'm in the Kenyan capital Nairobi, where I've witnessed the introduction of the pneumococcal vaccine. The jab protects against 10 strains of pneumococcal bacteria which can cause serious pneumonia, meningitis and blood poisoning.

Kenya is one of 19 countries receiving the vaccine from Gavi - the Global Alliance for Vaccines and Immunisation.

The health centre carrying out the immunisation is on the edge of the huge Kibera slum. Disease thrives amid the overcrowded, insanitary and squalid conditions. Many of the children living there suffer malnutrition, which means that they are less able to fight an infection like pneumonia.

It is estimated that a comprehensive roll-out of the pneumonia vaccine among developing countries could prevent more than half a million deaths a year.

In Britain, as in other developed countries, we tend to think that infectious diseases have been conquered by modern medicine. The ancient killers like tuberculosis, measles, pneumonia and diarrhoea have been largely consigned to history, thanks to improved living standards, immunisation and modern health care.

But the deaths of young children and adults from flu this winter demonstrate that viruses and bacteria remain a potent threat. The official death toll from swine flu in Britain runs into the hundreds.

But among poorer nations, deaths from infectious diseases run into the millions. Pneumonia kills around 1.7 million young children each year. Diarrhoeal disease claims another 1.3 million (Black et al, Lancet June 2010). Together they account for about one in three deaths of children under five.

As well as a jab against pneumococcal disease, there is also a vaccine available against rotavirus, the main cause of deaths from diarrhoea.

Gavi and Save the Children estimate the two vaccines could prevent at least one million deaths a year if they were comprehensively rolled out in developing nations. But Gavi says it is facing a funding shortfall for new and existing vaccines, of around £500m a year.

A major meeting on global immunisation is being held in London in June where world leaders will be under pressure to put more money into vaccines. The jabs against pneumonia and diarrhoea are far more costly than other childhood vaccines, but they could have a dramatic impact on mortality.

Other key issues to be addressed are the serious shortage of trained health workers in the developing world and the lack of access to basic healthcare for many - especially around childbirth, when four in 10 of all child deaths occur.

I have reported on the issue of neonatal and maternal mortality in Sierra Leone.

Back in 2000, world leaders set a target of cutting child mortality by two thirds, by 2015 (one of the Millennium Development Goals). There has been substantial progress. Deaths have fallen by a third. But that still means that eight million children a year never make it to their fifth birthday.

Immunisation should not be seen as a quick fix. But without wider use of new and existing vaccines, it is hard to see how the goal of cutting child deaths in the developing world can be achieved.


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  • 1. At 10:29am on 24 Jan 2011, Megan wrote:

    Always the hands are out begging... so perhaps it ought to be considered whether some of the vast sums already being given as 'aid' should be ringfenced to provide such basic healthcare to the citizens of poorer nations, or better still, rather than giving money to the wastrel governments of such nations, divert it to GAVI so that there is some assurance of responsible stewardship of aid money.

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  • 2. At 12:54pm on 24 Jan 2011, angelscomeinthrees wrote:

    This really hits me right now because I'm recovering from bacterial pneumonia and had I not had great medical care and access to antibiotics I really don't think I would be here - I have never felt so ill.

    I can only imagine what it must be like to watch your child dying from such an illness. To know that and to know that it is possible to save them but you can't get the drugs - unimaginable.

    Fergus, what can we do about this? There is no 'them' and 'us', no 'developing' and 'developed' world, no 'West' and 'East'. These are our children that are dying as surely as those tragedies that you have reported here about swine flu. How can we help?

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  • 3. At 1:59pm on 24 Jan 2011, creditunionhero wrote:

    Has not Robert Preston recently said that the cost of bailing out the finacial meltdown, equates to about £1,500.00 for every man woman and child on the planet?

    dosn't seem like such a good deal to me.

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  • 4. At 3:22pm on 24 Jan 2011, BluesBerry wrote:

    Where there is NEED, there must be the WILL to address the need.
    In Britain, as in other developed countries, we tend not to give one thought to infectious diseases that run rampant in developing countries. The deaths do not touch us; the sorrow does not touch us.
    Gavi says it is facing a funding shortfall for new and existing vaccines of around £500M a year - not so much compared to the deficit(s), but the difference between life and death in developing nations.
    The major meeting on global immunisation must somehow bring the disaster into the meeting room; make the dying's pain, our pain; cause world leaders to identify with the victims. This is a hard thing to do.
    My guess is that there will be a momentary twinge of conscious which will easily be left at the meeting room door when the "guests" depart.
    So for the other issues as well: e.g. lack of heralthcare - especially around childbirth.
    There is an evil thing that walks this world and that thing is called indifference. Unless people are the victims, or see themselves in the bare feet of the victims, they will remain detached from the problem(s) while clinging to their money.
    I fear to say that there are even those who feel there are too many persons in developing countries; so a few less, would that be a bad thing?

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  • 5. At 4:47pm on 24 Jan 2011, collery wrote:

    You're so right Megan, give the money to the organization which is trying to make fabulously wealthy pharmaceutical companies even richer. They don't care about the appalling conditions people live in that result in them dying of pneumonia in huge numbers, they can just produce an expensive vaccine, give it out to anyone, whether they need it or not and send them home to pick up some other easily preventable and treatable but deadly disease. Giving the money to GAVI is a great idea. The same applies to that other big killer, cholera. GAVI can produce a vaccine and people can just go home, continue drinking water contaminated with their own feces and die of some other water borne disease.

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  • 6. At 08:55am on 25 Jan 2011, haufdeed wrote:

    Why this enthusiasm for vaccinating everyone against everything?

    Is it not the case that general health in the UK improved, and life expectancy increased dramatically over the last 150 years, not as a result of vaccinations or any medical intervention for that matter, but because of improved nutrition arising from a general increase in wealth, and the installation of the infrastructure to ensure a clean water supply and efficient sanitation?

    The developing world needs water and sanitation engineers, and some way of ensuring that everyone gets enough food. If huge amounts of money are available, spend it on those basics, and watch the health of the people improve rapidly and permanently, without any need for vaccination.

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  • 7. At 4:27pm on 25 Jan 2011, Clare wrote:

    Some of these comments worry me, vaccines are one of the greatest inventions of the 20th century and have potentially saved more lives than any other medical intervention. Yes better sanitation and living conditions for these people are desperately needed but vaccination is the only way to prevent infectious diseases spreading especially as antibiotic resistance is increasing.

    Vaccination is a relatively inexpensive way of protecting large segments of the population when huge amounts of money are not readily available. I may be wrong but a couple of injections will probably be less expensive than giving an entire country adequate sanitation and is definitely quicker!

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  • 8. At 5:39pm on 25 Jan 2011, haufdeed wrote:

    7. At 4:27pm on 25 Jan 2011, Clare wrote:
    Some of these comments worry me, vaccines are one of the greatest inventions of the 20th century and have potentially saved more lives than any other medical intervention.

    You really need to do some research, Clare. The number of lives saved by vaccines in the developed world is much, much smaller than you think, or rather than you have been led to believe. Just as an example, by the time the UK started vaccinating against measles, the annual number of deaths from measles was already extremely small, and falling without vaccination. Annual deaths were below 50 at the time the vaccine was widely introduced in the mid 70's. Mortality from mumps was even lower at the time vaccination was introduced.

    The medical profession's only significant contribution in terms of improving average life expectancy has been in the reduction of infant and maternal mortality.

    Improving living conditions is proven to be a far better way of preventing infectious diseases of all sorts than either vaccines or antibiotics, plus you get the added bonus that millions of people can live their lives in decent comfort, rather than living in vaccinated squalor.

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  • 9. At 7:59pm on 25 Jan 2011, eeyore wrote:

    Err I think Clare has the lead on Haufdeed. There is no question that both smallpox and (hopefully soon) polio have been eradicated by mass vaccination. I doubt also that Dr Jenner and his cowpox experiments would have borne fruit and saved lives, had not his patients, their families and friends seen the success of using cowpox as a live vaccine protecting against smallpox. What works works.

    However it is undeniable that the product of improved living conditions and sanitation in general has been the major driver in improving health statistics. One thing to remember is that vaccination is generally aimed at the baby's and infants and causes improved survival in this age group, whereas living and sanitation effects all age groups. Thus the effect of vaccination and immunisation is additive to the effect of improved living standards. It is not either or, it is both.

    On a different tack. Having endured weeks (or so it seemed) of blogs and thousands of comments on flu, I see no evidence of those who commented en mass on flu (apologies to those present on this board), appearing here to discuss this question of mass immunisation in the developing world. 8 comments or 9 if this one makes it in 36 hours. I think that this seeming lack of interest by Fergus watchers is disappointing in the least.

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  • 10. At 8:54pm on 25 Jan 2011, angelscomeinthrees wrote:

    Eeyore, I agree completely. I don't get the either/or arguement when it comes to vaccination versus sanitation/diet. Both are necessary, not least because thousands - millions? - of lives will be lost before everywhere in the world has decent sanitation and access to good, nutritious food (and if recent reports re food security are to be believed then the latter will never happen if we continue to produce food as we do now). It's not just clean water and food either; we need to factor in air pollution such as that in the cities of South America, for example.

    As to why people aren't here posting, this is a story that affects 'them', isn't it? Just like with flu, there's a sigh of relief at the stats showing that most people who die have underlying health conditions - 'them' again, as opposed to 'us'.

    I really admire Fergus for bringing this to our attention but it is presented as a 'developing world' problem. I think this just re-inforces the perception that this is 'their' problem, not ours, it is 'their' children who are dying. But as a mum myself I see no difference between these babies and my own. These are our children that are dying, our kindred families that are suffering; it makes no difference at all which country this is happening in, except in terms of what is done about it.

    Writing a cheque or making a paypal payment isn't enough; every single one of us needs to look at our lifestyles and how it impacts on the rest of our global community. Why should we have cut flowers grown in parts of the world that have water shortages? Why do we air-freight in baby mange tout grown in Ghana???

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  • 11. At 08:59am on 26 Jan 2011, Questionsaplenty2 wrote:

    I think some of the posters here are being a bit harsh. Sorry they are disappointed, I didn't post under this issue as I didn't have anything useful to contribute. Not that I wasn't interested or saddened by the story. I'm sure this is the case with many others who posted on the swine flu articles.

    Does that make me a bad uncaring person? I don't believe it does.

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  • 12. At 09:02am on 26 Jan 2011, Questionsaplenty2 wrote:

    I don't think anybody has to "endure" anything on the internet. If you don't enjoy reading about something, then don't read it. Personally I found the swine flu posts very helpful as I suffer from a lot of anxiety about the issue.

    I do agree with you vaccination has helped tremendously against the fight against eradicating disease - there you have my comment for what it is worth.

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  • 13. At 09:19am on 26 Jan 2011, Questionsaplenty2 wrote:

    I also don't believe most people who comment on an issue here are necessarily regular Fergus watchers. I didn't even know about his blog until the first swine flu wave, but I was very thankful when I found it. Also the main BBC news page highlights a link to Fergus's blog ocassionally when the issue under discussion is closely associated with a headline story. It did this recently for one of the swine flu articles. As a result the number of contributors went up dramatically. The comments for the swine flu articles have fizzled out during the last few days as people have become more reassured. Most of those people are probably are not even aware of the latest articles on here so it is unfair for criticising them for not commenting.

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  • 14. At 11:02am on 26 Jan 2011, Mike wrote:

    The biggest threat of all is believing that medical intervention, drugs and prescriptions can save you. This is totally false. The majority of illnesses can be prevented through proper exercise and eating correctly. Sadly less than 5% of people do this and either makde token gesture by having some broccoli with a meat pie.

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  • 15. At 2:46pm on 26 Jan 2011, angelscomeinthrees wrote:

    Mike, I exercise. I'm vegetarian. I do yoga and I meditate, get more like ten a day and mostly organic, too. I've even been taking the fables VitD.

    None of which stopped me, a healthy 39 yr old with no previous lung problems, getting pneumonia. I was so ill; if it hadn't been for antibiotics I don't think I'd be here to be frank. And I count myself very lucky that it was abacterial infection, and that antibiotics worked.

    And the idea that the children that this article features will ever get a proper diet is laughable, sadly.

    Questions, this should be as big a story and of as much concern as swine flu, if not bigger. This is a story about *millions* of children dying. I do understand what you are saying, I spent a long time away from this blog once the last wave of sf went. I don't think it is so much that people don't care, it is that people believe that they can do nothing to help 'them'. But we would try and find something to do to help if this were happening in the next town to us.

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  • 16. At 5:32pm on 26 Jan 2011, Flumonitor wrote:

    'The answer' if there is a single one is a tough one to come up with.

    My personal belief is that the WHO needs its own vaccine mass production capabilities for production and distribution of vaccines that protect against diseases of international concern. Such production could be funded by individual country donations calculated as a fixed proportion/percentage of GDP, so that richer countries pay more and poorer ones pay less but it is those poorest of countries that would receive the greatest gains through mass vaccination of its populations. Production on a non-profit basis using newer technologies on a mass scale might see a far greater return on investment in this area than 'cash donations' which can often be lost in corruption or needless beurocracy. All countries, rich and poor, would receive vaccine according to thier populations needs and access would be equal between countries. For 'once in a lifetime' vaccines we could go some way to disease eradication in relatively short order, before moving the targets to say, pneumovax or whatever else happens to be the particular global threat that year.

    The counter argument is that research and innovation (currently led by the pharmaceutical sector) would be stifled. However, bearing in mind that we are still locked into vaccine production technologies that were developed in the 1950's I dont think that argument holds much water. It has only been the threat of an H5N1 pandemic which has galvanised investment in newer production technologies; should this ever achieve pandemic status, it will affect all countries populations withut discrimination in fairly short order - even the West's healthcare systems would be overwhelmed quite quickly.

    In my mind, it really is a question of the international will and mindset to eradicate diseases; I see far too much use of disease and its control as a political bargaining chip in international negotiations - just look at the issues around HIV treatments and access to them in the last decades for an example.

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  • 17. At 1:37pm on 27 Jan 2011, Mike wrote:


    The majority of illnesses can be prevented with correct diet (inc. avoiding meat and dairy) and exercising using the whole body. But most people will never even get close to this. They either don't want to be heathly or don't want it enough (which is the same thing). Instead they focus on squeezing fad diets into their poor lifestyles or use fitness for appearance - which should not be considered as a fitness category, but a beauty category!

    Pneumonia would eventually kill us all - even Jack LaLanne recently - but he died peacefully. Death and Taxes.

    Medical cures are much, much lower than anybody would think. Taking a pill or vaccine is the route of least resistance for both doctor and patient. However, as I've said, eating and exercise have far more health reaching benefits but people have to try and doctors don't like confrontation - "who's next in line for some pills". Whilst the ones doing the research and selling the drugs are benefiting from you being ill. And then there's the companies giving nutritional advise who market & sell meat and dairy, blackmailing mothers by telling them that they don't give their children enough calcium, whilst selling them a product laced with chemicals and sugar.
    How can society have got to this state? It's a disgrace.

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  • 18. At 10:33pm on 27 Jan 2011, Rachel wrote:

    A substantial amount of high income illness can be prevented with diet, yes, people are fat and lazy etc….. However, in low income countries, with little or no sanitation (the corner stone of controlling infectious disease), starvation and little or no access to healthcare, the highest mortality arises from treatable and preventable disease like respiratory infections and diarrhoeal diseases, emphasised in this article and this ultimately hits infants the hardest. This, alongside dramatically higher risk of death associated with birth (for mum too), infection soon after birth or early birth.
    It is true there is no easy fix, people are absolutely right in saying that sanitation, nutritional status and medical supplies (simple things like re-hydration salts, antibiotics as well as vaccines) and facilities must all be addressed. It would be good to read more about what the charitable and global organisations are doing as well as our own governments policies. It is also true that the context of this article is under-reported, but not that it is universally ignored.
    My final thought comes back to the word ‘indifference’ I’m not entirely sure how to make people care, all I know for sure is how to keep my own heart open and my conscience alive.

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