What causes a million deaths a year?

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Tuesday, 6 February 2018

Dr Michael Head is a Senior Research Fellow, Research Investments in Global Health study at the Faculty of Medicine, University of Southampton. 

What causes a million deaths a year? Now, there’s a question.

And noting the wide confidence intervals that surround mortality estimates, there would be a few options open to you as answers. Tuberculosis would be a reasonable response, as would AIDS.

You’d be way out if you suggested malaria or diarrhoea, despite the significant health burdens they still pose.

I was, in fact, thinking of pneumonia. Some might find this surprising, some might nod and say, “yes, I knew that”. Either way, for such a high-burden disease – most of the estimated 920,000 annual deaths reported by a 2017 Save the Children publication are in young children in resource-poor settings – pneumonia remains strangely low-profile.

Where are all the advocates? 

If you’ll excuse the crudeness of the phrase, malaria and HIV are seen as ‘sexy’. Everyone knows about them and there are very public, high-profile advocates who in some way, shape or form bring attention to the disease. HIV and AIDS have had Bill Clinton and Nelson Mandela (among many others) attempting to unite a somewhat fearful and distrustful global audience across the 1980s and 1990s.

Bill and Melinda Gates are powerful global advocates for the elimination of malaria. And in the UK, Cheryl Cole (a pop singer formerly married to a famous footballer, in case you were wondering) contracted malaria on a trip to Tanzania in 2010 and has used her public profile to raise awareness of the disease ever since.

In fact, on the UK pop star theme, there’s also Craig David, who, in 2010, was made a Goodwill Ambassador for the Stop TB Partnership.

But pneumonia? I can’t think of anyone who is especially famous for suffering from the disease. Indeed, under-fives in Chad or India tend not to make the news before their untimely deaths of a lower-respiratory tract infection.

Recognition and diagnosis can be tricky 

There could be other reasons for the lack of public awareness around the disease. Pneumonia is tricky to diagnose and is potentially caused by multiple pathogens (bacterial, viral and fungal), in areas where skilled medics may be few and appropriate diagnostics non-existent.

Recognition of the disease among the general public in high-risk populations is also relatively poor, so presentation of the patient at a hospital is often late and the patient (usually a child) will be very sick. And so, many die.

Community members perform a scene to educate others on how to stay healthy. (USAID/Kasia McCormick) 2012
Community members perform a scene to educate others on how to stay healthy. (USAID/Kasia McCormick) 2012

Our data, through the Research Investments in Global Health (ResIn) study, suggest that pneumonia is a particularly underfunded disease compared to the other infections mentioned here, and research elsewhere shows that there is little development assistance for health funding focused on pneumonia.

Perhaps, though, the tide is turning, and advocacy efforts are slowly starting to raise the profile of this neglected disease. The 2017 Save the Children report was backed by the Gates Foundation with a foreword by Kofi Annan. These are influential actors within the global health landscape.

Data show lack of funding 

There are additional and ongoing behind-the-scenes activities, some involving us on the ResIn study, to quantify investment trends for pneumonia that will be used, in part, to boost advocacy efforts. It’s remarkable how putting a pound or dollar sign next to the problem can help to focus minds.

A major funder in Africa, the European and Developing Countries Clinical Trials Partnership (EDCTP) have now specifically included addressing pneumonia in their strategic business plan. There was even a 2018 article in the Financial Times covering similar issues.

And it is for all the above reasons that I went to Accra, Ghana in 2017 to meet with a range of colleagues there, all of whom have an interest in tackling the problems posed by pneumonia. The initial output of those conversations is a commentary in International Health that describes priority areas, such as the lack of diagnostics and educational interventions in high-risk populations.

Establishing these priority areas is intended as a starting point for discussion among patients, clinicians, policymakers, politicians, academics and advocates.

Please take a look at the article and contribute your thoughts!

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