11-month old pneumonia patient in Cox's Bazaar, Bangladesh © Getty

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Pneumonia is the largest single killer of children aged up to five around the world. Responsible for more than 900,000 deaths a year, it exceeds the toll from measles, malaria and diarrhoea combined. Simple existing medical interventions could sharply reduce the burden.

That is the message in a new report from Save the Children, which warns that without further progress there will still be more than 700,000 annual deaths from the disease in 2030, causing unnecessary human tragedy and hindering efforts to reach the UN's Sustainable Development Goals. 

Alongside a swipe at drug companies for failing to cut the price of vaccines sufficiently for poorer countries, it suggests that the tight “vertical” focus on other diseases by donors including the Global Fund to fight Aids, TB and Malaria may have diverted resources and attention away from pneumonia.

It highlights the need for increased funding, with a focus on governments investing more in their own health systems, training community health workers, improving diagnosis and providing basic medical support from oxygen therapy to cheap antibiotics.

At a time of growing concerns over antimicrobial resistance, care needs to be taken in any large-scale distribution of drugs. But alongside improved prevention efforts to tackle basic hygiene problems, cut household air pollution and increase use of vaccines, the targeted use of antibiotics will be fundamental to saving lives.


Three questions

We talked to Mario Raviglione, who retires this month as director of the World Health Organization’s Global TB Programme, which has just issued its 2017 global tuberculosis report.

There were 10.4m new cases in 2016 and 1.7m TB-related deaths, the report shows.

What is the key message from the latest TB report?

The big message is that the changes we were expecting are not yet visible and, despite the World Health Assembly resolution in 2014, the pace of the response required to TB is not happening. There is progress but the decline of incidence of mortality remains very slow with no sign of acceleration. The best news is that 53m lives have been saved since 2000 thanks to modern forms of TB control. But the decline in cases is 2 per cent per year. If it continues at this pace we will never eliminate anything.

What are the most important reasons for failure to do more?

You don’t see the mobilisation one would have expected. HIV is such a political priority that no one can support cutting the budget. Malaria in 90 per cent of cases affects children, and there is demand to protect travellers to high-burden regions. But TB is a disease of the poor and marginalised including migrants, drug users and the homeless whom no one cares about and who have no voice. We need to raise TB to the highest political level: to heads of state.

What advice would you give your successor?

First, maintain scientific rigour and neutrality. We have been criticised for our norms and guidelines but we have to maintain a high standard of science. Second, advocate: build the case for TB around universal health coverage and anti-microbial resistance, and push donors to invest in poor countries. Third, develop accountability. That’s what is really missing in TB. We have pledges, then people go home and forget about them. We need to build additional political momentum and have the courage to say when things are not going well.


Chartwatch

Climate change is having a critical impact on global health, from the spread of infectious disease to rising air pollution and more frequent heatwaves. This chart shows the increasing capacity of mosquitoes to transmit dengue. At least 12.6m people die each year because of preventable environmental causes — a quarter of all global deaths. (Lancet)


FT Health event

Join us at the FT in London on November 21 for an evening of discussion, drinks and networking on HIV developments. Guests include Deborah Waterhouse, the chief executive of ViiV Healthcare, and Yusef Azad of the National Aids Trust.


News round-up

Hepatitis funding Hepatitis kills more than 1.3m people a year and affects more than 325m. Although treatment is becoming more widespread, funding remains a problem. A move by medical charity MSF is reducing the price of generic hepatitis C drugs. (World Hepatitis Summit, WHO, BMJ)

The US and global health The Kaiser Family Foundation has published an analysis of how the role of the US in the global fight against epidemics has developed since the emergence of HIV in 1981. That marked an important turning point in global consciousness about emerging diseases. (Kaiser)

Violence against children A Unicef report details the violence experienced across all stages of childhood. An adolescent is murdered every seven minutes and in the US, black boys are 19 times more likely to be murdered than white ones. (Unicef, NPR)

Deprivation and death Poorer areas of England and Wales have more deaths than richer areas from causes such as heart and chronic respiratory diseases and lung cancer, according to official data. The leading cause overall for men is heart disease and for women dementia/Alzheimer's disease. (ONS, BBC)

Rohingya refugees President Trump has been urged to speak up about the plight of the Rohingya community as the number in Bangladeshi refugee camps passed 800,000. Malnutrition is setting in and local authorities are considering voluntary sterilisation. (Washington Post, UN, ReliefWeb, Al Jazeera)

Opioid action President Trump's Commission on Combating Drug Addiction and the Opioid Crisis made more than 50 recommendations including more drug courts — but there was little mention of funding. US shareholder groups are pressing drug companies to play their part. A former drug tsar is critical of the White House approach. (White House, NYT, Huffington Post, Stat).

Pharma and patents Charges of hypocrisy have been levelled against US pharma companies who rail against the country's patent dispute process but use the same system to wage their own battles. (FT)

China pharma boom China is the world's second-largest pharma market with strong demand for speciality drugs for diseases such as cancer, but is lagging in terms of R&D and has a cumbersome regulatory process. (Biopharmadive)

GSK and government Former GSK chief Sir Andrew Witty will head a new panel to fast track drugs for the UK's NHS. Companies will also get financial support for development. Patrick Vallance, GSK's president of research and development, is to become the UK's chief scientific adviser. (BBC, FT)

Health inequality Non-communicable diseases are by far the most common cause of death for women yet clinical trials are conducted disproportionately on men. Governments, civil society and the private sector must push for health services and research that do more to include women. (World Economic Forum)

Drinks dilemma Big companies have provided $67m to be used in a mass study by US health authorities of the effects of alcohol, prompting accusations of conflicts of interest. (Wired)

Dental divide A report on dental health in England and Wales showed an overall improvement but big divides between north and south and rich and poor. (Nuffield Trust/Health Foundation)


Best from the journals

HIV drug resistance Although 19.5m people worldwide are living with HIV and receiving antiretroviral therapy — half of all those affected — there are fears that drug resistance is growing. (NEJM)
Join us to discuss HIV drugs and related issues at our November event.

Changing China The Healthy China initiative cannot come too soon for Chinese people with chronic diseases and households suffering impoverishment because of ill health. Plans include strengthening community-level general practitioners, improving the supply of medicines and stopping hospitals selling overpriced drugs. (Lancet)

Violence and public health Violence is not just a law and order issue. Life-long physical and mental health problems caused by violence cost the world economy an estimated $14.3tn a year — 12.6 per cent of economic activity or $5.40 per person per day. (BMJ)

Doctors and pharma Drug prescribers who received gifts from pharma wrote a higher number of more costly prescriptions, a US study shows. (PLoS) 

Evolution and mental health The creation of massive human genome databases is allowing researchers to look for connections between mental illnesses and the environmental and societal conditions that might have driven them in our ancestors. (Nature)

Stopping suicide Examining the way the brain processes certain words via an fMRI scanner can give an indication of suicidal intent. The tool could help overcome the fact that patients tend to mask their thoughts from doctors. (Nature Human Behaviour)

The final frontier Thinking ahead to that flight to Mars? Just be aware that long periods in zero gravity might cause your brain to float upwards a little inside your skull . . . (NEJM)


Podcast of the week

Can music make you sick? A discussion on the mental health problems faced by workers in the ever-precarious music industry and how the charity Help Musicians UK aims to address the issue. (FT)


In case you missed it

Previous edition: The WHO’s screeching U-turn on Mugabe

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Final thought

Health rewards Non-smokers in Japan are being offered six days’ extra annual leave — for free — to make up for colleagues who take smoking breaks. Is this example of “nudge theory” the way forward for public health? (ITV News) 

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