Despite some notable progress in recent years, global health efforts are too frequently failing the youngest children. Setting targets for improvement is crucial.
To that end, the Millennium Development Goals aimed to reduce the number of children around the world who die before their fifth birthday. But despite valiant efforts, the target was missed. In 2015, a new target was set in the Sustainable Development Goals to end, by 2030, preventable deaths of newborns and children under five years of age. Again, the right aim.
To achieve it, identifying which infectious diseases to prioritise and to tackle is crucial in a world of limited resources. Malaria, AIDS, measles and tetanus are always and rightly identified as global health priorities for good reason.
But meningitis and sepsis is missing from this priority list despite this being the second biggest infectious killer of children aged under five. Why? I believe there are three main reasons.
Firstly, the categories of data used to help inform priority setting can be confusing. For example, the United Nations 2017 ‘Levels and Trends in Child Mortality’ report uses figures with two separate categories that include meningitis: ‘meningitis’ in children 1-59 months old and ‘sepsis or meningitis’ in neonates (the first four weeks of a child’s life). This is because meningitis and sepsis are often caused by the same infections and the two clinical presentations are practically indistinguishable at such a young age. When you combine these two categories, it is clear that meningitis and sepsis combined is the second biggest infectious killer of children aged under five, responsible for more deaths than malaria, AIDS, measles and tetanus put together. Meningitis and sepsis is also ranked the leading killer of newborns. Despite this, in the text of the report, every other infectious killer is mentioned by name, but the word ‘meningitis’ does not appear once.
Secondly, the various different causes of meningitis are often reported as though they are quite separate to meningitis, for example, Group B Streptococcus (GBS) infection. The first comprehensive study of GBS infection estimates that it is responsible for 150,000 stillbirths and infant deaths globally every year. What is harder to see from the headlines associated with this work is that GBS is a leading cause of meningitis and sepsis in newborn babies in the UK and USA. Additionally, an excellent new report from Save the Children this week highlighted that tragically one million children each year are dying from pneumonia. Pneumococcal disease is the most common cause of pneumonia but also of bacterial meningitis across the globe. A plan to tackle all causes of meningitis globally would also help to defeat pneumonia and GBS as well as the huge burden of neonatal sepsis.
Thirdly, those working in the meningitis field - if there is such a thing - have been incredibly successful in recent years whilst also being comparatively quiet about the next set of enormous challenges. The vaccination of 270 million people in the meningitis belt in Africa over the past decade has saved millions of lives from a type of meningitis called MenA. As this was happening, representatives for malaria, AIDS, measles and tetanus fields, as well as some neglected tropical diseases, have been brilliant at championing their cause to gather momentum. This is not so for meningitis on a global scale. The successes we have seen in meningitis need to be built on and we need a sustainable solution.
At Meningitis Research Foundation, we think it’s time to create a plan to defeat meningitis as a matter of urgency. It’s time to use the evidence to ensure meningitis and sepsis is a global health priority. You can help make that happen by demanding their inclusion as a named priority in the WHO’s 13th programme of work before the consultation closes this week (15th November). See our website for more information: https://www.meningitis.org/news/urgent-call-to-stop-meningitis-being-missed