Covid-19 exposed the limitations of health systems in the world to cope with pandemics of respiratory infections. With an official death toll from covid-19 that already exceeds five million and unofficial estimates that reach five times that number, the difficulties of health systems are evident everywhere.

What is not so clear is why the world did not foresee covid-19. Respiratory diseases have long been the leading cause of death from infection in the world. Before the COVID-19 pandemic it was estimated that 2.5 million adults and children died from pneumonia each year. No other infectious disease comes close to this number of fatalities.

And there are deaths from pneumonia in every country. In those with high incomes, deaths are concentrated in the elderly; while in low-income countries, the main victims are children. Many middle-income countries suffer large numbers of deaths in both groups.

Considering these data, respiratory infections were the most significant missing piece on the global health agenda. Before the pandemic, there was never a global health campaign focused on reducing deaths from pneumonia, nor was there a global health agency responsible for supporting countries to prevent, diagnose and treat it.

Not even Gavi, the Global Alliance for Vaccines and Immunization, whose mandate is to vaccinate the world’s most vulnerable children, has been able to protect more than half of them with one of the most powerful weapons against pneumonia: the conjugate vaccine. pneumococcal (PCV). Large numbers of children – more than 350 million under five years of age – are then dangerously exposed.

Even the wake-up calls from two outbreaks of respiratory infections – severe acute respiratory syndrome (SARS-CoV) in 2002 and Middle East respiratory syndrome (MERS-CoV) in 2014 – were not enough to persuade national governments and global health agencies of the need to emphasize pneumonia control.

For this reason, health systems were not prepared on any continent when SARS-CoV-2 – the virus that causes covid-19 – appeared, which quickly became a pandemic. National health authorities were not equipped to deal with the waves of people in need of rapid diagnosis and treatment (and especially the large amounts of medical oxygen required by coronavirus patients).

Tragic stories of deaths from lack of access to healthcare first appeared in Latin America in the early summer of 2020 and soon spread to Asia, the Middle East and Africa. It is impossible to forget the suffering of patients who were struggling to breathe or the difficulties of their families and healthcare professionals as they desperately tried to get oxygen.

. Implementing a permanent and effective response to pneumonia would reduce deaths from respiratory causes of all types of infections and the risk of another respiratory pandemic

We don’t know how many deaths there were from covid-19 due to lack of diagnosis and treatment, but many of the countries with the highest death rates from this disease reported low screening rates and oxygen shortages. Now, more than 18 months after the start of the pandemic and despite the availability of effective vaccines, governments continue to struggle to reduce the number of deaths. Of the 50,000 coronavirus deaths that still occur each week, 70% are in low- and middle-income countries.

It is unacceptable. The pandemic must become a turning point for pneumonia control worldwide. Countries must never again suffer massive deaths from pandemic respiratory infections. And so many people should not continue to die each year from pneumonia not related to covid-19.

However, this will continue to occur unless national governments replace their reactive pandemic response plans with proactive strategies to control pneumonia. Implementing a permanent and effective response to pneumonia would reduce deaths from respiratory causes of all types of infections and the risk of another respiratory pandemic.

Achieving this goal will require comprehensive coverage with powerful vaccines to combat pneumonia, better diagnostic tools at all levels of health care systems, and improved access to treatment. The main risk factors for deaths from pneumonia, including environmental pollution, childhood wasting and tobacco use, will also need to be reduced.

Global health and development agencies – such as the Global Fund, the World Bank, Unitaid, the World Health Organization (WHO), and UNICEF – should convert the support they have provided to low- and middle-income countries through the covid-19 in long-term pneumonia control programs. The Covid-19 Access to Tools Accelerator Oxygen Emergency Working Group alone provided countries in need with oxygen supplies for more than $ 600 million and should receive funding from the G20 to achieve more. And private philanthropic organizations should continue to support NGO efforts to strengthen respiratory care services beyond the pandemic.

The cost of not investing the necessary resources to combat pneumonia will be measured in the loss of millions of lives each year

Without this sustained support, the world will remain exposed to the possibility of another respiratory infection pandemic and we will run the risk of failing to meet many of the Sustainable Development Goals for health, especially those related to reducing maternal, newborn and child mortality. , and the burden of contagious and non-contagious diseases.

Although COVID-19 uncovered some critical flaws in the global health architecture, it also revealed all that national governments, global health and development agencies, and donors can achieve when they are urged to invest in fighting respiratory infections. And there is still much to do.

After all, our world is going through changes that will accelerate the risk of another respiratory disease pandemic. Airborne infections – which spread when we breathe, talk, laugh, and sing – thrive in warmer, highly urbanized, and mobile environments where poor diet, chronic disease, and increased life expectancy increase vulnerability to ailments and death. The cost of not investing the necessary resources to combat pneumonia will be measured in the loss of millions of lives each year and millions more each time there is a new pandemic.

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