Opinion: Tailored assistance can solve pneumonia vaccine bottlenecks

Vaccines alone don’t save lives, vaccinations do. The fact that pneumonia, a disease that is one of the biggest infectious killers of children aged under 5 across Africa, is largely preventable through vaccines attests to this. Developing and sustaining new ways of reaching communities with the most acute needs is key to avoiding further preventable deaths. Currently, pneumonia still claims the lives of 2,000 children globally every day, even though many of these deaths could have been prevented through safe and effective vaccines that are both recommended by the World Health Organization and which all countries have had access to for more than a decade. And even though there are enough doses to go around, there are still significant bottlenecks preventing them from doing so. Ever since Gavi, the Vaccine Alliance, started to make pneumococcal conjugate vaccines, or PCV, available to lower-income countries in 2010, we have seen huge progress in increasing global coverage, with 63 countries introducing it, preventing an estimated 940,000 deaths. However, ensuring that all the necessary pieces are in place so that doses reach people requires considerable investment, political will, planning, resources, and technical assistance. As we have seen through COVID-19, this can be extremely challenging, particularly in lower-income countries, where resources are often more limited and health systems relatively frail. Given that the last to be reached are often the hardest to reach, we now urgently need to address these bottlenecks if we are to continue to make progress and save even more lives. That task has been made even more challenging in the wake of COVID-19. The initial impact of the pandemic on health systems, many of which were already weak, has been devastating. With some countries now struggling with resourcing, the Gavi board has agreed to help those facing widespread disasters or crises by offering to temporarily waive their co-financing payments, the contributions that governments make toward the cost of the vaccines. However, this can only ever be a short-term solution. The ultimate goal is not just to protect as many children today as possible from pneumonia, but also to ensure that children in the future will continue to be protected, through the creation of national vaccination programs that even the most resource-constrained countries can continue to sustain. So far, PCV has helped reduce pneumonia-related deaths in children under 5 from more than 1 million deaths in 2010 to almost 672,000 in 2019. Getting the number of these vaccine-preventable deaths down to as close to zero as possible will mean not just increasing coverage but sustaining it. For that, countries need strong supply chains, adequate human resources, technical support, and resilient health systems that can continue to maintain existing immunization activities. Reaching children in fragile settings with new vaccines adds an extra layer of complexity, not just for PCV-specific challenges, but a range of other basic services. Globally, Africa bears the highest burden of pneumonia deaths in young children, with the impact felt deeply in the countries that have not yet introduced PCV. In the coming year, for example, Chad, Guinea, Somalia, and South Sudan are all seeking to introduce the vaccine, while likely dealing with multiple priorities, humanitarian challenges, and financing hurdles. Still, all efforts should focus on these introductions going ahead, as, based on our calculations, the pneumonia vaccine is expected to avert more than 60,000 deaths from 2025 to 2030 in these four countries. A solution to supporting these countries is to introduce vaccination programs and sustain coverage by developing new ways of working and fostering partnerships that can reach communities more reliably and efficiently, with an integrated package of services that makes the best use of limited resources. Tailored and flexible technical assistance from global health partners is imperative to address the unique challenges faced by each country, region, district, and community. Doing this effectively means leaning upon and learning from the expertise of humanitarian partners, local civil society organizations, and community leaders. It also means putting in place new mechanisms to address specific bottlenecks. The good news is that not only are there enough doses to go around but there is a dedicated group of partners and advocates supporting the countries that need it most to make all this happen. In April, the group came together at the second Global Childhood Pneumonia Forum in Madrid to make commitments toward the work ahead. In the face of different outbreaks and the large number of children that are yet to receive a single dose of a routine vaccine in Africa, reaching unprotected communities — and particularly those that are battling multiple health, security, and economic challenges — is an urgent priority for both health equity and global security. If we can figure out how to introduce and sustainably scale up new vaccines such as PCV in the most vulnerable regions of the world, we may just unlock the pathway to protect more lives everywhere.