Early in my career, I visited a remote village in West Africa where I saw a small girl in the local clinic who was struggling to breathe. I was told she probably wouldn’t survive - not because we didn’t have a cure for the disease she was suffering from, but because her parents couldn’t afford antibiotics.
As a scientist, I already knew that pneumonia was a deadly disease that claimed the lives of millions of children every year. But it was in that moment that pneumonia’s toll on children became real for me. With this new, personal understanding of the disease, I decided to dedicate my life to fighting it.
It was a formidable challenge. Trials for a pneumonia vaccine were just beginning and funding for research was limited at the time - which meant little kids were left vulnerable to illness. Like the small girl, these same children were also frequently unable to access life-saving treatment.
Now, 25 years later, we have vaccines that are effective against two leading causes of pneumonia and antibiotics that are cheaper and more widely available. This, along with improvements in water, sanitation and nutrition, have helped reduce childhood pneumonia deaths by 44% from 2000 to 2013.
Yet despite this, pneumonia continues to be the leading infectious killer of young children - in fact, every 35 seconds, the disease kills one child under the age of five.
Around the world, too many children still have limited access to tools that prevent pneumonia, and to timely health care, when they do fall ill. While countries in Europe and the Americas have made significant advancements, South Asia and Sub-Saharan Africa continue to account for the vast majority of pneumonia deaths.
This uneven progress is now also facing a new threat: the rising tide of antibiotic resistance, in which the bacteria that cause disease slowly evolve to become resistant to the antibiotics used against them.
A decade ago, the WHO drug of choice for treating pneumonia was cotrimoxazole. Since then, the drug has been used widely for a number of conditions - driving resistance toward cotrimoxazole itself and strengthening the ability of bacteria to resist antibiotics. Ultimately, the rise of antibiotic resistant pneumonia - even with better access to treatment - could compromise our ability to save children around the world.
One of the most cost-effective ways to prevent resistance to antibiotics - and preserve the progress we have made thus far - is to reduce the need to use them in the first place. When it comes to pneumonia, that means increasing access to pneumococcal conjugate vaccines (PCV).
Immunizing children will save lives now and slow the development of antibiotic resistant pneumonia. According to a study in the Lancet, expanding access to the PCV vaccine in 75 countries could avert 11.4 million days of antibiotic use per year in children under five - almost halving the number of antibiotics used.
Unfortunately, too many children still do not have access to these critical vaccines. Half of the world’s children live in areas where PCVs are not available through their national immunization program. In Africa, 41 out of the 53 countries have now introduced the vaccine into their national immunization programs - but we’re still not reaching many children who desperately need it.
When I think back to my visit to West Africa 25 years ago, I’m inspired by how far we have come. I also hold out hope that we might end childhood deaths from pneumonia within my lifetime - perhaps even by 2030, the target year of the Sustainable Development Goals.
But to do this, we must accelerate our efforts to reach all children with pneumonia vaccines, and when they do fall sick, ensure that they receive lifesaving antibiotics that work. With emerging antibiotic resistance, this is now more urgent than ever. It will take increased ownership and commitments at every level of government to ensure that the vaccines get to the kids who need them most.
Pneumonia is a daunting challenge, but one we are better equipped to tackle today than ever before. And if we can get vaccines to the children who need them most, we can save many from the same fate as that little girl I met decades ago.
Keith Klugman is the Director for Pneumonia at the Bill & Melinda Gates Foundation. He leads the foundation’s work to improve the development and delivery of pneumonia vaccines and expand the use of antibiotic treatments and diagnostic tools. Keith is a leading expert on antibiotic resistance in pneumonia pathogens and helped develop the pneumococcal vaccine that is now part of the immunization regimen for children born in the United States and is being rolled out globally.
Keith was the William H. Foege Professor of Global Health and Professor of Epidemiology in the Rollins School of Public Health at Emory University as well as Professor of Medicine in the Division of Infectious Diseases at the Emory School of Medicine. In addition, he still serves as Honorary Professor in the Respiratory and Meningeal Pathogens Research Unit at the University of the Witwatersrand in South Africa.