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LONDON / NEW YORK, November 11, 2020 Severe pneumonia leaves an estimated 4.2 million children under five in 124 low- and middle-income countries with extremely low oxygen levels each year, new analysis from UNICEF, Clinton Health Access Initiative (CHAI), Save the Children and Murdoch Children’s This was revealed by the Research Institute (MCRI).[i]
Agencies say health service disruptions linked to the COVID-19 pandemic threaten to be another blow in the battle against the world’s largest infectious child killer, which already claims the lives of more than 800,000 children under the age of five each year. Pneumonia is caused by bacteria, viruses, or fungi and leaves babies struggling for their breath as their lungs fill with pus and fluid. Severe pneumonia affects more than 22 million young children in low- and middle-income countries each year and kills more than malaria, measles and diarrhea combined.
“COVID-19 has infected millions of people and made difficult global conditions for children even worse,” said Henrietta Fore, Executive Director of UNICEF. “As the world grapples with the pandemic and the serious consequences it poses for the most vulnerable, we must not lose sight of the fact that pneumonia continues to claim more than 2,000 young lives every day. Medical oxygen can help save some of these lives. “
Medical oxygen could save the lives of many children with severe antibiotic-associated pneumonia. But in many places, oxygen to cure a child with severe pneumonia for 3-4 days can cost at least £ 30-45.[ii]. For poorer families, that bill represents a huge obstacle to treatment if the child is able to reach a health facility with functioning oxygen and trained health workers, which are often scarce in poorer countries.
Poorer countries faced a huge lack of oxygen systems and supplies even before the onset of COVID-19. But the growing demands of the pandemic have highlighted these shortcomings. The good news is that oxygen can be produced locally at an affordable cost.
Kevin Watkins, CEO of Save the Children UK, said: “The pandemic has exposed a devastating lack of oxygen in the poorest countries. Millions of children reach health facilities in developing countries each year in need of oxygen. In much of Africa fewer than one in five receive the care they need. Many die from exhaustion – their fragile bodies are starved of the oxygen they need to recover.
“It doesn’t have to be that way. As the world races to increase oxygen supply, to save lives from both COVID-19 and pneumonia, it must get to the hardest to reach, be free for all, and be sustainable. If we focus only on short-term solutions, we risk missing out on a crucial opportunity to save millions of lives for generations to come. ”
Dr Iain Barton, CEO of CHAI said, “Helping countries establish resilient systems to deliver oxygen reliably and efficiently will save lives during this pandemic and treat patients sustainably in the future.”
Johns Hopkins models showed that disruption of infant care, access to antibiotics, and administration of pneumonia vaccines mean that a combination of pneumonia and neonatal sepsis could lead to the deaths of more than 25,000 more babies. every month.[iii] In many countries, analysis of routine health information systems data, carried out separately by Save the Children and UNICEF, shows that the number of children receiving vaccinations, diagnosis and treatment has decreased.
Following the onset of the pandemic, worsening shortages and rising oxygen prices have been reported in countries with some of the highest numbers of childhood pneumonia deaths, such as India.[iv], Bangladesh[v] and Nigeria[vi]. According to the World Health Organization, the poorest countries may currently only have 5 to 20% of the medical oxygen they need, overall[vii].
But the COVID-19 pandemic has sparked global efforts to improve oxygen supply systems. In just one sign of the scale of efforts to increase supply, WHO and its partners have deployed 30,000 oxygen concentrators to countries around the world. UNICEF alone has delivered over 15,000 concentrators to over 90 countries.[viii]
In a Lancet commentary on World Pneumonia Day, November 12, global health agencies, including Save the Children and UNICEF, are calling on governments and donors to leverage their investments and efforts to respond to COVID. 19 to strengthen health systems that can address childhood pneumonia[ix].
Save the Children, CHAI and UNICEF call on donors and governments to:
- Invest in oxygen systems in low- and middle-income countries, including Africa and South Asia, to provide a sustainable supply of oxygen, closer to the children who need it.
- Maintain and strengthen essential routine health services critical to children’s survival during the COVID-19 epidemic and beyond, with a free basic health care package that includes oxygen therapy, even for children.
- Generate better data to monitor the pandemic and its effects on the health system, including pulse oximetry coverage for diagnosis, oxygen and first-line antibiotics recommended for childhood pneumonia: amoxicillin dispersible tablets and injectable antibiotics for severe pneumonia.
Around the world, Save the Children, UNICEF and CHAI are stepping up programs on the ground and joining forces with partners to deliver life-saving diagnoses and care for children. For example:
- In Nigeria, Save the Children has partnered with GSK to ensure that every bed in the pediatric ward at Dutse General Hospital in Nigeria has a reliable supply of oxygen.
- In Ghana and Senegal, UNICEF procured oxygen supplies for the COVID-19 response, developing and expanding efforts to support the government to improve access to essential care for children with pneumonia. In Sierra Leone, UNICEF supported the installation of three Pressure Swing Adsorption (PSA) oxygen plants across the country and in Bangladesh, UNICEF established a liquid medical oxygen facility for the Special Assistance Unit for infants at Cox’s Bazar Sadar District Hospital to assist Rohingya refugees.
- In Ethiopia, Kenya, Nigeria, India and Uganda, five countries that account for a third of global deaths from low blood oxygen levels, CHAI has been working since 2016 to increase access to diagnosis and treatment. As finalists in the MacArthur Foundation’s 100 & Change competition, CHAI and MCRI are seeking to save tens of thousands of lives each year by sustainably increasing oxygen therapy and diagnosis in these five high-load countries. CHAI is also working in partnership with PATH and the Every Breath Counts (EBC) coalition on a COVID-19 Coordination of response to respiratory care project to support countries in developing and executing respiratory care plans to meet the demands of COVID-19.
[i] Estimate generated by Save the Children, UNICEF and CHAI with a panel of experts, based on published data on the percentage of children hospitalized with pneumonia diagnosed as hypoxemic, which we estimate on average to be 25% globally with significant variations by region.
[ii] https://blogs.worldbank.org/health/oxygen-all-during-covid-19-coronavirus-and-beyond
[iii] https://www.thelancet.com/action/showPdf?pii=S2214-109X%2820%2930229-1 – Scenario 2: 12,920 additional infant deaths due to interruption due to case management of neonatal sepsis and pneumonia; 11,760 infant deaths from discontinuation of oral antibiotics for pneumonia; 690 infant deaths due to discontinuation of pneumococcal conjugate vaccine.
[iv] https://www.bbc.com/news/world-asia-india-54139112
[v] https://apnews.com/article/df97326ec00fb7cc4abf5b3821ace984
[vi] https://qz.com/africa/1890310/why-africa-has-medical-oxygen-shortages-across-the-continent/
[vii] https://www.who.int/publications/m/item/covid-19-virtual-press-conference-transcript—23-october-2020
[viii] https://www.who.int/publications/m/item/covid-19-virtual-press-conference-transcript—23-october-2020
[ix] The comments are written by industry experts and represent their views, rather than necessarily the views of The Lancet or any Lancet trade journal. Unlike articles containing original research, this comment has not been peer reviewed externally. The Lancet commentary is embargoed until 11.30pm GMT / 6.30pm EST on Wednesday 11 November and will then be published.
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