Pneumonia is the single largest cause of death among children under five worldwide. Pneumococcal pneumonia (Streptococcus pneumoniae) is the most common cause of severe pneumonia among children in the developing world. In India, pneumococcal disease is the leading cause of vaccine preventable death and illness among children under 5. It is a major cause of hospitalizations or even death in children under 5 years in the country. Unfortunately, even when treatment for pneumococcal pneumonia is possible, in the form of a Pneumococcal Conjugate Vaccine or PCV, the costs associated with treatment can have substantial impact on the financial stability of low-income states.
In the Indian setting, the burden of pneumococcal disease is the greatest among under privileged children and vulnerable populations who do not have access to affordable quality health care. The incidence of the ailment is particularly higher in places marked by poverty, illiteracy, lack of hygiene, poor diet and nutrition.
Common issues such as malnutrition, poor access to care, overcrowding, immune-compromising infections, low levels of parental education contribute to the fact that a child born in the poorest fraction of society has many times the risk of pneumonia and death compared to a child born in the wealthiest fraction.
The vicious cycle of poverty-associated risks are sick children get sick more often, negatively impacting their growth and development. Their weakened immune system puts them in a greater risk of pneumonia. Also, poor children, and those with less educated parents, are less likely to be immunized.
India currently accounts for nearly 20 percent of global pneumonia deaths among children under 5 years. The states with the highest pneumococcal pneumonia burden are Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh. To honour commitments to the United Nations Sustainable Development Goals, India now has a means to address this disease burden, thus enabling children to see their fifth birthday and pave the way for their healthier life.
A Pneumococcal Conjugate Vaccine (PCV) was introduced under the Universal Immunization Programme from 2017 in a phased manner in identified districts of Uttar Pradesh, Bihar and the entire state of Himachal Pradesh. It is currently being scaled up to include Madhya Pradesh, remaining districts of Bihar, six new districts of Uttar Pradesh and nine districts in Rajasthan.
PCV is the most safe and effective method for protection against pneumonia, meningitis and other diseases caused by the pneumococcus bacteria and can be administered to children at 6 weeks, 14 weeks and 9 months (booster dose) of age. This expensive vaccine has been available in the private market in India, but has not been accessible to vulnerable children who need it most. These children include low birth babies, born in remote locations and whose families who do not have access to information and many times those who are unable to afford such a vital yet expensive vaccine.
With the introduction of PCV, India is strengthening its fight against pneumonia and meningitis to help save the lives of children and contribute to the cause of a healthy nation. PCV is also helping erase the complex inequity into which children living in poverty are born. Hardships associated with everyday life for children in poor households are the risk factors for childhood pneumonia and pneumonia mortality.
Given the significantly increased risk of pneumonia – and recurrent infections – borne by children in poverty, it stands to reason that these children will benefit the most from the protective boost afforded through vaccines such as Hib, pneumococcal and measles vaccines. The disadvantaged sections of society will greatly benefit from the introduction of PCV in the UIP, in terms of out-of-pocket treatment expenditure borne by them.
The additional benefits of PCV are protection against life-threatening meningitis and sepsis, tempering the threat of antibiotic resistance and overuse and preventing life-long disabilities.
Both the Government of India and the States that are rolling out these vaccines have put in place robust monitoring mechanisms to ensure that any untoward incident is efficiently handled and that the initiative to save lives that are vaccine preventable is realised!
Dr AP Dubey is the former Director Professor of Paediatrics at Maulana Azad Medical College, and an active member of Indian Academy of Paediatrics (IAP).