Pneumonia: The 'forgotten killer'

LUSAKA, Zambia – I touched down at Lusaka International Airport on Thursday, just shy of midnight, via layovers in Amsterdam and Harare, Zimbabwe. The long, but otherwise unremarkable 24-hour journey was made suddenly poignant by back-to-back rounds of fumigation upon our descent into each African airport – “international health requirements,” the flight attendant announced over the loudspeaker. Within seconds, another flight attendant charged down one aisle, and then the other, wielding a small yellow-and-red bottle, filling the cabin with an over-fragranced aerosol reminiscent of commercial bathroom spray. It’s to kill insects, the first attendant clarifies, as I pull him aside to ask him why this spray is used. “I cannot say,” he says, when I press for more.

A child behind me coughs, has been coughing for most of the trip, and even though it’s coincidence, likely triggered by tiny scented particles in the air, it focuses my jet-lagged brain on the reason I’m landing here in the first place: pneumonia.

Coughs, fever, phlegm, shortness of breath. All symptoms of pneumonia, all ailments more associated in the US with long hospital stays, the chronically infirmed, or the elderly. But here, the infectious disease takes away thousands of lives of the youngest Zambians each year.

Data cited in a 2012 report by Countdown to 2015, a coalition organization tracking progress towards the Millennium Development Goals around child and maternal health show pneumonia to be the leading single cause of death for children under five in Zambia, as it is for children globally, according to a recent study in the Lancet.

And yet, in the many conversations with child and pneumonia health experts, doctors, and researchers I had before I left for Lusaka, it became clear to me that pneumonia is not just the top cause of death among young children. It is also one of the most overlooked. 

It's “last in queue” in child health, I was told, despite the fact that in 2010 there were an estimated 120 million cases of pneumonia among children under five. It’s an “orphan” illness without sufficient funding or attention – despite well-intentioned and aggressive global plans outlining steps for reductions. The most recent of these plans, an integrated map for eliminating deaths from pneumonia and diarrhea, referred to pneumonia as one of the two “forgotten killers” of children – despite the fact that it is causing the deaths of 1.3 million children every year.

“Proven interventions exist,” reads the document, with more than a hint of exasperation. “Children are dying because services are provided piecemeal and those most at risk are not being reached.”

For me, pneumonia’s role as a fatal but seriously under-recognized problem was crystallized by a question I’ve often had to rebuff in my trip-planning: Aren’t you looking at anything else besides pneumonia?

At first glance, Zambia may seem an unusual place to prioritize reporting on pneumonia; the country has a remarkably high rate of HIV (estimated at 13.5 percent of the population). Nearly half of its children suffer from stunted growth as a result of malnutrition. Most child deaths occur during the neonatal period, which is an area of increasing concern. Certainly there are other important health issues to cover.

But quietly, this week, as I was flying the first leg of my journey, the Zambian government officially launched a vaccine to prevent pneumococcus, the leading bacterial cause of pneumonia. For several years, along with Save the Children, Boston University, and other partners, the Zambian Ministry of Health has been working in a remote part of northern Zambia, near the mining areas of the Copperbelt province, to train volunteer community health workers in part how to diagnose and treat pneumonia.

Now seems as critical a time as any to take a closer look at efforts to prevent and treat this “forgotten killer,” and give pneumonia a home front and center in the news.