Why an Integrated Approach—Not just a Vaccine—will Defeat Pneumonia


For children around the world under age five, pneumococcal infections remain one of the “Big Killers.” While all pneumococcal infections are dangerous, pneumonia, an acute respiratory infection that affects the lungs, is particularly deadlykilling an estimated 935,000 children under age five in 2013 alone, according to the World Health Organization (WHO).

In 2008, the magnitude of pneumococcal infection rates around the world prompted the WHO to recommend that poor countries with high mortality rates among children under five, of 50 deaths per 1,000 births and above, introduce the new pneumococcal conjugate vaccine (PCV). Many African countries, including Rwanda, Benin, Kenya, Malawi, Niger, Tanzania, and Zimbabwe, among others, took the recommendation seriously and with JSI technical support introduced the vaccine into their routine immunization system.

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Inspecting a vaccine in Niger

While the introduction of PCV has helped to prevent one cause of pneumonia within these countries, it is not sufficient to eliminate the risk of all pneumonias for children under five. Instead, vaccine introduction should occur as part of an integrated approach, where strategies to prevent, protect, and treat all pneumonia infections provide a more comprehensive approach to saving those at risk.

In support of other USAID partners’ efforts to lower preventable deaths among under-five children, JSI has provided extensive technical support under two projects, the Maternal and Child Health Integrated Program (MCHIP) and the Maternal and Child Survival Program (MCSP). Both projects include elements to help prepare low and middle income countries to introduce PCV as a lifesaving vaccine to reduce under five mortality.

Most recently, JSI has worked on introducing PCV in Niger, which, in 2012, reported an under-five mortality rate of 80 per 1,000 live births in urban areas and of 163 per 1,000 live births in rural areas. Pneumonia and diarrhoea were the leading causes of these deaths, at 27% and 21% respectively. This grave situation prompted Niger to introduce PCV in 2014 with technical support from JSI under a contract with Gavi, the Vaccine Alliance. However, more support is still needed to strengthen the routine immunization system so that more children can be immunized.

Through the process of introducing PCV in Niger and other countries, JSI has seen positive results in the reduction of pneumococcal infection rates. Yet, JSI has learned that just introducing PCV in a routine immunization system is not enough to reduce deaths due to pneumonia. As a result, JSI is an advocate of an integrated approach, which highlights the importance of disease prevention through training and education, protection through vaccines and healthy lifestyles, and treatment through health sector development in order to help a country comprehensively fight pneumococcal infections.

PCV Vaccine Storage in Niger

Key elements of this approach include:

  1. Identifying and immunizing all eligible children with PCV by planning and implementing an equity-oriented approach like the Reaching Every District / Reaching Every Community (RED/REC) approach to address issues related to access to and utilization of immunization services by the population.
  2. Utilizing interventions like ensuring adequate nutrition and addressing environmental factors to protect children from pneumonia, in addition to immunization with PCV.
  3. Treating pneumonia with low-cost, low-tech medication and care.

While JSI’s technical support for introducing the PCV will help decrease the mortality rate of children under five, we must reach all children to truly defeat pneumonia. Launching a vaccine, while a significant intervention, will never be a comprehensive solution.

To learn more about JSI’s work on immunization, including our role in introducing new vaccines in countries around the world, visit the Immunization page on our website.