What a Difference a Decade Makes

As World Pneumonia Day 2013 is celebrated around the world today, I'm struck by the difference a decade has made in the control and prevention of pneumonia - particularly how far we've come in expanding access to pneumonia vaccines.

For me, 2003 is a benchmark year. That was when we kicked off the PneumoADIP project to accelerate access to pneumococcal vaccines - which prevent pneumococcal disease, the leading cause of bacterial pneumonia in children - in developing countries.

With a $30 million grant from the GAVI Alliance, my small team at the Johns Hopkins Bloomberg School of Public Health was formed to help coordinate this effort. The challenge was daunting. At that time there was only one manufacturer of pneumococcal conjugate vaccines, they had inadequate supply of the vaccine to serve even the rich countries that were using it and the price was over $200 per course. What's more, many developing countries did not know how much preventable disease they had, the World Health Organization had not yet recommended the vaccine and there were no dedicated finances to pay for its use in poor countries.

Global health donors were also a big problem at the time. Despite the fact that pneumonia was the leading killer of children under age five, most donors didn't recognize the importance of the disease. To be sure, it was a disease in need of some respect.

In a series of interviews PneumoADIP conducted with 30 leading global health donors in 2004, none of them spontaneously identified pneumonia as the leading killer of children. In fact, when asked what diseases held this distinction, most donors answered AIDS, TB, or malaria. Wrong, wrong, and wrong. Donors also complained that the name of the disease's leading cause - pneumococcal - was hard to spell and pronounce, and suggested it needed a shorter name like TB or HIV.

As a consequence, we were told repeatedly by colleagues in global health that we'd never be able to get pneumococcal vaccine to developing countries. But we soldiered on.

So on World Pneumonia Day 2013, when I see the progress we've made with introduction of pneumonia vaccines in GAVI-eligible countries, I'm inspired by the difference that a decade can make. Today, more than 30 countries have introduced pneumococcal vaccine, and more than 50 have signed up to get it through the GAVI Alliance. And by February of next year, all GAVI countries will have introduced the pentavalent vaccine that protects against Hib pneumonia.

I'm also reminded that the drivers of these large changes is often no more complicated than a small, team of dedicated individuals. So, with the move this year to focus efforts on control and prevention of not one but two leading killers of children - pneumonia and diarrhea - I'm confident that we'll make great strides in the next decade - so long as we all dedicate ourselves to the goal, even when the skeptics might tell us it can't be done.