Every 2 minutes three children will die from pneumonia, the leading infectious cause of child mortality globally, killing more children than diarrhoea and malaria combined.
Most were younger than 2 years old. Almost all pneumonia deaths could be prevented through vaccination or early diagnosis and treatment with antibiotics costing less than $0·50. Yet childhood pneumonia deaths are falling far more slowly than other major killers. On current trends, there will be 735 000 pneumonia deaths in 2030.
In 2016, the disease killed an estimated 880 000 children.
Pneumonia barely registers on the radar of global health priorities. No major aid donor has taken up the reins of leadership on pneumonia. Nor is this a disease that galvanises high-profile international campaigns asserting the rights of children at risk.
Severe pneumonia is the ultimate disease of poverty. The children at greatest risk are drawn overwhelmingly from the most disadvantaged sections of society. They are more likely to be malnourished, and the least likely to be immunised, accurately diagnosed, and treated. Evidence from south Asia also points to marked gender disparities in treatment rates, with boys accounting for a far greater share of hospital admissions for pneumonia than predicted by disease incidence. This reflects wider social and cultural practices that lead to delays in parents seeking medical help for girls.
The more affluent with the strongest political voice in shaping health priorities are insulated from pneumonia risks. Unlike cholera, measles, or HIV/AIDS, severe pneumonia is not easily transmitted across social boundaries. The fact that pneumonia mostly affects impoverished rural areas and urban slums, where communities have limited potential for political mobilisation, diminishes the stake of middle-class constituencies in public action. While prioritising pneumonia makes sense in terms of national health benefits, cost-effectiveness, and equity, these are not the primary drivers of political choice. Interest groups with specific diseases and concentrated urban populations with a political voice are more successful in asserting their claims than highly dispersed, rural, and poor groups confronted by poorly understood disease. Pneumonia is not only socially contained within countries, it is also a disease that poses no global epidemic risks through transmission across borders into rich countries. This matters because the aid priorities of high-income countries are highly sensitive to perceptions of the health security interests of donors. In short, pneumonia is a disease that can be contained in poor communities of poor countries—and this is a prescription for public policy inertia.
What is clear is that the continued neglect of pneumonia by national governments and the international community will ensure the SDG pledge to end preventable child deaths becomes a broken promise.
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