I am putting the final touches on my syllabus for my new class “Introduction to Global Health Policy”, which I will be teaching this fall at NYU-Wagner. One of the first readings I want my students to read is a paper entitled “Where and why are 10 million children dying every year?” by Robert Black, Saul Morris, and Jennifer Bryce in the Lancet in 2003 (361: 2226-34). It is a good, short summary of the magnitude and causes of child mortality in developing countries.

I’ve included this reading because I think it really sets the stage for discussions about global health priorities. Despite everything that has been done over the past decades of international cooperation, health system development, and the scale up of foreign assistance, approximately 10 million children still die every year, most in developing countries (the data is a little out of date, but not much). In most of these regions, at least 1 in 10 children still do not make it to their 5th birthdays and in some countries it is even higher than this.

Deaths among children are actually quite concentrated in just a few causes. Between a third to a half of deaths happen during the neonatal period (the first month of life from birth asphyxia, low birth weight, etc.) and then diarrhea and pneumonia are the next biggies, each responsible for about a fifth of total deaths. Malaria, AIDS, measles and everything else are therefore responsible for less than 15-25% of total deaths. Of course these figures are skewed towards Asian disease profiles due to numbers (India and China alone are responsible for over a quarter of childhood deaths). But at the global level, progress towards MDG4 will not be made unless we are able to make a dent into one of these biggies.

If I had to select one of these biggies where significant progress will likely be made, I would choose pneumonia. The disease causes about 2 million deaths a year and the major causative agent – streptococcus pneumoniae – is vaccine preventable. Roll out of the vaccine, for a number of reasons, has been slow, but I am really, really happy to hear that progress is being made.

Last week the vaccine was introduced in the Gambia – one of the countries with the highest proportional burden of the disease. Gambia is now the second developing country, following Rwanda, to have introduced the vaccine.

The introduction appears to be due to the successful efforts of a number of groups, most notably the GAVI alliance, UNICEF, PneumoAdip, the WHO, and the private sector – Wyeth contributed more than 3 million doses of Prevenar, the first ever blockbuster vaccine. It is hoped that a pneumococcal vaccine will be made available in as many as 60 countries by 2015. Many countries will not benefit from the existing vaccine, but instead will benefit from a newer formulation that will likely be the product of the first ever Advance Market Commitment program, wherein donors have already pledged US $1.5 billion to develop the next generation of vaccine, one which will be better tailored to developing countries.

This development makes me really excited because a clinical trial in Gambia of the older generation vaccine showed that an older vaccine reduced childhood mortality by 16 % – a huge deal and likely a lower bound when newer generation vaccines come online. It also makes me happy to see that when partners work together, big progress can be made. If only all partnerships could appear to work so well.

Update: Since I wrote this post, I saw this excellent related posting on the HuffPo by Seth Berkly from IAVI, on the topic, so I am linking to it here.

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2 Responses to “Addressing one of the biggies in child mortality”

  1. Simon says:

    Hi Karen
    What are the underlying causes of high rates of pneumonia in countries like The Gambia?

  2. Atheendar says:


    This is a great post. I'm working on respiratory illness right now and am surprised at how few people know about its importance as a cause of child death and, consequently I guess, such few funds flow towards research in this area. One big underlying cause of acute respiratory illness is exposure to pollutants and cooking smoke, which is receiving some attention now in two interesting sets of randomized trials in India and Bangladesh.

    Anyway, thanks for this post. The word needs to get out,


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