By Parag Deshmukh and Dr. Amanda Leach
Parag Deshmukh is Executive Director at the Serum Institute of India. Dr. Amanda Leach is Vaccine Development Director, Center for Vaccine Innovation and Access, PATH
At least five children – one every 43 seconds – will have died from pneumonia by the time you finish reading this page. More than 700,000 children under five years of age die each year from pneumonia, which kills more children than any other infectious disease.
It doesn’t have to be this way. Vaccines exist that save lives and have the potential to save many more. Tragically, though, they still aren’t reaching enough people.
This gap can be addressed. Having recently marked World Pneumonia Day, we must commit to protecting people from preventable diseases by supporting access to high-quality, affordable vaccines that can save lives from pneumonia now and help save lives in the future from rising antimicrobial resistance (AMR).
While pneumonia has many causes, the most common cause of deadly childhood pneumonia is the pneumococcus bacterium. Low- and middle-income countries bear the brunt of this disease burden. Pneumococcal conjugate vaccines (PCVs) are the best way to prevent pneumococcal disease, and several are available on the global market. Alongside improvements in prevention and treatment, these vaccines have been key to lowering the death toll. In addition to lowering infection rates, they also reduce the need for antibiotics.
While good progress has been made toward meeting the Immunization Agenda 2030’s pneumococcal vaccine coverage target of 90 percent, roughly 40% of the world’s children have still not received a PCV.
PCV pricing has historically been at the heart of global access challenges. To date, global rollout efforts have emphasized accelerating access in low-income economies eligible for financing support from Gavi, the Vaccine Alliance. This effort secured affordable prices that enabled procurement and investments in implementation needed to ensure widespread coverage. Although the job is not done to reach the last mile in Gavi-eligible countries, progress has been substantial.
Now, additional focus is needed to ensure that countries ineligible for Gavi support don’t fall through the cracks, including middle-income countries that are home to a significant portion of the global population. Many self-financing middle-income economies haven’t yet introduced PCVs, in large part, because vaccine price and budgetary constraints make procuring enough doses and investing in sustained PCV and other public health programming cost-prohibitive.
To help address vaccine inequity cost drivers, a partnership between Serum Institute of India and PATH developed the 10-serotype PCV (PNEUMOSIL®), which is World Health Organization-prequalified and on the global market. It’s designed to improve inherent affordability while preserving performance, quality, and serotype coverage optimal for countries with high disease burdens in Africa, Asia, and Latin America. At a target price of $2 USD per dose for Gavi-eligible countries and for non-Gavi-eligible middle-income countries, the vaccine is priced significantly lower than other available PCVs. The savings can support immunization implementation and free up funds to be invested in other important public health priorities.
Continuing to ensure that countries have affordable product choices is critical to closing immunization gaps and advancing vaccine program sustainability. PNEUMOSIL® is a great example of how Product Development Partnerships (leveraging the experience and expertise of private and nonprofit sectors) contribute to health equity. In less than five years since introduction, for instance, the vaccine has helped contribute to a global rise in PCV coverage, much of which is driven by Indiaadopting the vaccine and rapidly achieving coverage of 83 percent. It is also an option for countries that have already introduced PCVs, but face funding constraints. For example, South Africa, which has attained high levels of PCV coverage but is facing budgetary challenges, is switching to PNEUMOSIL®.
Ensuring equitable access to PCVs will not only save lives from pneumonia, but also from AMR. The U.S. Centers for Disease Control and Prevention have classified pneumococcus as a serious AMR threat. A recent WHO report found that vaccination with PCVs is effective at lowering infection rates and reducing the use of antibiotics, thus preserving their effectiveness, and recommends “high” vaccination levels among children. Further evidence shows PCVs can greatly reduce the prevalence of multidrug-resistant strains of disease and even reduce resistance to antibiotics. Though AMR has no quick solution, increasing coverage with already-existing vaccines and preventing pneumococcal disease before it starts is a step in the right direction.
Overall, the numbers are compelling: reaching the target pneumonia vaccination coverage of 90 percent could prevent more than 27,000 deaths annually and 1.5 million disability-adjusted life years, each of which represents the loss of the equivalent of one year of full health.
But this isn’t just about numbers. It’s about ensuring these numbers can become reality by providing affordable and accessible disease prevention options and giving every child a chance to live a healthy life.
