Looking beyond mortality to grasp pneumonia’s full impact

The devastating health effects of pneumonia are widely known. Just this year, pneumonia became the top cause of death in the world.  Yet, in order to fully grasp the impact of pneumonia, we must look at its indirect – and often long-term – effects on families, communities, and health systems.

Immunizations offer a break in the recurrent pattern of pneumonia and diarrhea infections. The relationship between these infections traps vulnerable children in a viscous cycle of poor health. A global study on nutrition and infectious diseases found that over half (52.3%) of pneumonia deaths were attributable to undernutrition. Furthermore, because undernutrition is a risk factor for pneumonia, vaccines protecting against pneumonia play an important role in breaking the cycle of poor health for the most at-risk children. In addition, when administered to pregnant mothers and infants, these immunizations may even improve intrauterine and infant growth, respectively.

The impact of pneumonia is also greater among immunocompromised populations. HIV-positive individuals in Kenya are more likely to carry pneumococcal strains resistant to penicillin. Prevention of pneumonia is therefore especially important among HIV-positive individuals, and a study in South Africa showed that pneumococcal conjugate vaccine (PCV) averted 10 times as many pneumonia cases in HIV-positive children than in HIV-negative children.

Pneumonia infections have the potential to cause health issues later in life. A review of studies in Africa found that one quarter of children who survived pneumococcal or Hib meningitis had neuropsychological deficits. Similarly, a study in the Gambia showed that the majority (58%) of children who survive pneumococcal meningitis had major disability that “prevented normal adaption to social life”, such as mental retardation, hearing loss, and motor abnormalities.

Pneumococcal vaccination can have the greatest impact in poor children and can improve wealth equity. A study in Ethiopia found that 30-40% of all deaths averted by introducing PCV would occur in children in the lowest wealth quintile, while also providing financial risk protection to the poorest families. Because treating pneumonia can be costly, families in Bangladesh are heavily borrowing money or loosing assets to afford treatment for their children. Similarly, in the Gambia, families are paying up to 10 times their daily household budget to cover the direct and indirect costs of treating pneumonia. Yet, because healthcare in the Gambia is designed to be free of charge to patients, pneumonia treatment is costly to the health system, with treatment for one case of inpatient pneumonia costing four times the annual per capita expenditure for health.

Alternatively, vaccination to protect against pneumonia can be integrated with other health services – like nutrition or indoor air pollution programs – to maximize child health and provide the greatest health yield per dollar spent. Also, PCV can also cause protection in non-vaccinated individuals, consequently improving the cost-effectiveness of vaccination programs.  With antibiotic resistance becoming an increasing threat, vaccines that avert pneumonia cases work to keep existing treatment options effective and available.

Overall, the impact of pneumonia is felt by individuals and families long after symptoms subside. Understanding the broader value in preventing infection can expand our thinking, encourage sustainable investments, and ultimately, protect health and well-being.