Every year, 5.9 million children die before reaching the age of five. Of these, 1.5 million lose their lives to pneumonia and diarrhoea. As shown in a revealing new report, India has more of these deaths than any other country.
On November 11, the 2016 Pneumonia and Diarrhea Progress Report was published by the International Vaccine Access Center (IVAC) at Johns Hopkins University. It served as a sobering aide-memoire to the global health community of the progress that still must be made in combating pneumonia and diarrhoea.
The Report’s findings hit India particularly close to home. It found that 296,279 children die from pneumonia and diarrhoea each year. To put that into perspective, one child in India dies every three minutes from pneumonia alone. Globally, pneumonia kills a child every 20 seconds.
Diarrhoea, meanwhile, kills 117,300 children in India yearly – 37% of global deaths. About 157 million people in India live without access to adequate sanitation. It is believed that more than 41 million people defecate in public spaces, producing enough waste to fill eight Olympic sized swimming pools daily.
One of the key contributing factors to this major public health concern is India’s delayed introduction of vaccines against rotavirus and pneumococcal disease into its universal immunisation programme (UIP).
A rotavirus vaccine was among those added to the UOP in 2014 but it is currently being piloted only in four states. It is an new Indian-developed vaccine which has yet to be tested in real-life settings anywhere in the world. As Health Issues India has written before, rotavirus is the leading cause of diarrhoeal-related deaths in the less economically developed world including India, which accounts for more than a fifth of the world’s rotavirus-related deaths. Data published by the WHO in 2012 estimated that rotavirus kills between 86,000 and 155,000 children per year. Even in an industrialised country such as the United States, introduction of rotavirus vaccination had a swift effect in reducing the number of babies who were severely ill and who required a stay in hospital.
Pneumoccocal disease kills about 350 Indian babies a day, according to a 2015 paper. The authors looked at cases in 2010 and concluded that about half a million severe episodes of pneumococcal pneumonia and 105 thousand (92–119 thousand) pneumococcal deaths occurred in India that year. Almost all of these deaths could have been prevented by a vaccine that has already been introduced in countries far less developed than India.
The press and international organisations treat India with kid gloves, apparently unwilling to hold Government accountable for hundreds of vaccine-preventable child deaths. For example, The Hindustan Times reported on December 9 that the government was adding four new vaccines to its UIP, reporting that the government
has committed to providing free vaccines against 10 life-threatening diseases to 27 million children, through more than 9 million immunisation sessions each year.
The article went on to note
India has the highest number of unvaccinated children in the world, with 89 lakh children not receiving all vaccines and 17 lakh not getting vaccinated at all. Till 2014, only 65% children were fully immunised.
It did, not, though ask why India was so late in introducing vaccines available in the public health systems of countries including Chad, Rwanda and Yemen.
More broadly speaking, India accounts for a fifth of child deaths worldwide – 1.2 million of the 5.9 million total. This, again, is the highest figure in the world. There has been a decline — the rate declined by 61 percent, from 126 deaths per 1,000 live births in 1990, to just 49 in 2013. Nonetheless, India missed its Millennium Development Goal (MDG) target of 42 deaths per 1,000 births in 2015.
It is clear that action must be taken. Addressing pneumonia and sanitation would certainly lessen the burden of child mortality India bears upon its shoulders. Steps have been taken to this end by the Indian government.
The Clean India Mission was launched on October 2, 2014 with the aim of building 66.4 million individual toilets, 2.5 million community toilets, and 2.55 million public toilets by 2019, in a bid to rid India of the problem of open defecation.
There have also been calls for children to inoculated against pneumonia from pediatricians. The Times of India has quoted Dr. R. Atchum Naidu, who belongs to the Indian Academy of Pediatrics (IAP), as saying that children should be vaccinated with pneumococcal conjugate which could provide 80 percent protection against the disease. The ToI also quotes Dr. P. Venugopal as suggesting that the high cost of the vaccine – Rs 3,500 per dose in the private sector – is why the government does not include it in its immunisation programme, despite its recommendation by the IAP for several years. However, the vaccine is available much more cheaply when purchased through UNICEF.
To this end, on the other hand, the pentavalent vaccine – which inoculates against the haemophilus influenza type B bacterium which causes diseases such as pneumonia – will be included in the UIP as reported by the Hindustan Times. The vaccine will be rolled out across five states in February 2017.