Thousands of avoidable deaths have been attributed to delays in the introduction of a vaccination against pediatric pneumonia in four of the world’s poorest nations.
The pneumococcal conjugate vaccination (PCV), one of the most effective treatments for pediatric pneumonia, is still not available in South Sudan, Somalia, Guinea, and Chad.
Estimates from the Global Burden of Disease suggest 40,000 children died from the illness in the four countries in 2019, which are all off track to meet UN targets to reduce deaths of children under five by 2030.
Childhood pneumonia is the biggest infectious killer of children worldwide, claiming 700,000 lives annually. It is a disease of poverty, with almost all deaths occurring in low- and middle-income countries, and most of them are preventable.
“It’s unfair that this vaccine is not yet available because every child has a right to survive and thrive,” said Dr Ubah Farah, an adviser to Somalia’s health ministry.
She said pneumonia was a “big killer” in the country, and noted that the Covid vaccine had been rolled out quickly by comparison. “Why can’t we do the same for children?” she said. “It’s double standards.”
Prof Fiona Russell, a vaccinologist from the University of Melbourne and the Murdoch Children’s Research Institute, called the delays “a failure”.
“How many thousands of children have died while waiting to get this vaccine?” she asked.
The PCV targets the leading bacterial cause of pneumonia and was introduced in the US in 2000 and to South Africa in 2009. Most African states now have the vaccine, and studies show that hospitalisations and deaths fall significantly after rollout, including in Rwanda, South Africa and Kenya.
At the second Global Forum on Childhood Pneumonia, held in Madrid last week, delegates from South Sudan, Somalia, Guinea and Chad announced plans to roll out the vaccine in 2024 with the help of Gavi, a global health alliance that shares the cost that countries pay for vaccines.
The four countries first planned to introduce the vaccine three years ago but struggled to meet Gavi’s co-financing requirements. Gavi pays for most of the initial rollout, but countries must make a contribution, with a plan to eventually meet all the costs.
Last year, Gavi was urged to be more flexible with how much it expects countries to pay.
The rollouts were also delayed by Covid, and Guinea faced two outbreaks of Ebola, which hit the country and its health system hard, while South Sudan and Somalia are in the grip of a humanitarian crises caused by conflict and drought.
Gavi announced at the forum that South Sudan and Somalia, as fragile states facing massive humanitarian crises, would now not have to pay for the vaccine introduction.
“This is a revolution. Up until now, we never waived [the cost] for new [vaccine] programmes,” said Veronica Denti, a senior programme manager at Gavi. “The principle of Gavi is that we want [governments] to find a way to pay for it because that’s how you build sustainability.”
For Gavi funding, Denti continued, Chad and Guinea still need to raise $200,000 to $300,000 (£160,000–£240,000) annually.
The government wants to help these problematic and impoverished nations, but they are unable to locate the extra funds, according to Russell. It will be much harder for them to achieve their Sustainable Development Goal target [to reduce child death by 2030] since they don’t have the vaccine and the under-five mortality rate would still be very high.
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