Pneumonia is the world’s biggest killer of children, killing almost 1 million children in 2015, and accounting for 16% of all deaths of children under age 5. That’s one child every 20 seconds.

If this happened in the United States every child under the age of 5 living in Boston, Los Angeles, New York City, San Francisco, Seattle, and Washington, DC would be dead within a year.

Effective vaccines have made these senseless deaths completely preventable. So why are they still happening? The answer is that in spite of these horrifying statistics pneumonia is still not being taken seriously as a global health priority.

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Over a decade ago the World Health Organization raised concerns that funding for international health activities was being allocated unevenly across different areas and diseases, with the majority of funding being directed towards AIDS, tuberculosis, and malaria.

While these diseases no doubt demand attention, pneumonia claims more children’s lives than all three of them combined, but receives comparably less financial attention.

Accordingly, the Pushing the Pace report found that only 2% of the $30.6 billion that was spent on global health in 2011 was directed at ending preventable pneumonia deaths, even accounting for the fact that pneumonia funding had doubled between 2008 and 2011.

This disparity in health funding is reflected in the lack of progress made in reducing child mortality from pneumonia compared to other diseases. Between 1990 and 2013, the number of child pneumonia deaths across the world fell by 58%, yet child deaths for diarrheal diseases dropped by almost 70% across the same time period, and measles-related deaths fell by 83%.

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This imbalance was even more exaggerated in countries with a high burden of pneumonia. For example, child deaths from diarrhea and measles in Nigeria dropped by 60% and 86% respectively between 1990 and 2013, while child deaths from pneumonia dropped by only 4%.

Vaccines that prevent the main causes of pneumonia including the pneumococcal, Hib, and rotavirus vaccines are crucial to preventing child mortality. However, the global lack of funding makes it harder to deliver vaccines in resource-poor settings, where pneumonia strikes hardest. As a result, many countries are finding it difficult to maintain immunization coverage for existing vaccines, like those for measles and polio, while introducing new vaccines into their routine immunization schedules, meaning that the uptake of vaccines that protect against pneumonia is lagging behind.

India, for example, has highest number of pneumonia-related child deaths in the world, but before this year the pneumococcal conjugate vaccine was only available on the private market in the country. The vaccine is currently being introduced into India’s Universal Immunization Program, yet even with support from Gavi, the Vaccine Alliance, the high cost of the vaccine means that the government cannot afford to introduce it to the program on a national scale, instead opting to roll-out the vaccine in just three states, such that millions of children throughout the country will still be at risk of falling fatally ill.

Accordingly, global coverage of the rotavirus vaccine has yet to reach 50% and, while most high-burden pneumonia countries have introduced the pneumococcal conjugate vaccine, global coverage remains low at 41%.

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A study published earlier this year shows that the global health funding imbalance is persisting, with the combined total of development assistance for diarrhea and pneumonia adding up to be significantly less than that allocated to malaria alone.

We need to make sure that children living in poverty don’t lose their lives needlesslessy. A larger financial commitment to end childhood pneumonia deaths by expanding access to vaccines is essential. Let’s make sure that pneumonia becomes the global health priority that it deserves to be. 

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