The Every Breath Counts coalition has today released a new report into the way in which pneumonia is treated and controlled.

Titled The Missing Piece: Why the global pandemic is an inflection point for pneumonia control, the report makes the case for a total reboot in the way governments and global health agencies invest in pneumonia.

Many have already begun to do so in response to the pandemic and shouldn’t stop once it is over, the coalition says.

Covid-19 has exposed how ineffective health systems everywhere have been in the face of a respiratory pandemic. To date, there have been 4.8 million official deaths and unofficially, estimates suggest that figure could be 5-10 times more.

Despite the existence of effective vaccines emerging with impressive speed early in the pandemic, governments are still scrambling to reduce the death toll.

Most entered the pandemic ill-equipped to deal with waves of patients needing respiratory care, especially oxygen.

Read more: Oxygen now part of the public health architecture

Unprecedented medical oxygen agreements were revealed in June (2021) with Air Liquide and Linde, respectively, the aim of which is to create a pathway of increased access to medical oxygen in low and middle-income countries (LMICs).

The agreements came after months intense engagement with the world’s major oxygen suppliers by the Covid-19 Oxygen Emergency Taskforce, a group of partners led by Unitaid and Wellcome under the ACT-Accelerator Therapeutics pillar.

The taskforce includes the WHO and the biomedical consortium it coordinates, as well as Unicef, The Global Fund, the World Bank, UNOPS, Every Breath Counts, CHAI, PATH, Save the Children, The Bill and Melinda Gates Foundation, and Access to Medicine Foundation.

Both the taskforce and those subsequent agreements came in response to the ongoing Covid-19 pandemic, though it is acknowledged that even before Covid-19, pneumonia was the world’s biggest infectious killer of adults and children, claiming the lives of 2.5 million people in 2019.

The pandemic exacerbated this problem, particularly in so-called ‘double-burden’ countries which are contending with high levels of pneumonia and Covid-19. As well as meeting the immediate needs of the pandemic, the Covid-19 Oxygen Emergency Taskforce looks to ‘leverage gains in this area’ to help with long-term pneumonia control.


‘It shouldn’t have been this way’

Every Breath Counts is clear in its belief that this double-burden simply should not have existed, and that the Covid-19 pandemic must be an inflection point for pneumonia control in every country.

“It shouldn’t have been this way. Pneumonia has been the leading infectious cause of death in the world for a long time,” the coalition said in a statement. “Prior to the pandemic, an estimated 2.5 million adults and children died from it each year, according to the Global Burden of Disease (GBD) – far more than HIV/AIDS, tuberculosis, or malaria. All countries were affected.”

“In high-income countries pneumonia deaths concentrated among older adults, while in low-income countries it was children who shouldered the burden. Many middle-income countries struggled with both.”

“But pneumonia has been the single biggest ‘missing piece’ on the global health agenda for decades. There is still no global goal for reducing pneumonia deaths and no global health agency responsible for supporting countries to prevent, diagnose, and treat pneumonia. Even with Gavi’s mandate to vaccinate the world’s most vulnerable children, half did not receive all of the pneumonia-fighting vaccines in 2019.”


“What is clear is that the Covid-19 pandemic must be an inflection point for pneumonia control in every country. Nations must never again be blindsided by another respiratory pandemic and suffer mass fatalities as a result. And they must address the massive burdens of pneumonia from other causes among children and adults.”

The new Every Breath Counts report, The Missing Piece, makes the case for a total reboot of the way governments and global health agencies invest in pneumonia.

It questions why health systems everywhere been so ineffective in the face of a respiratory pandemic and, if pneumonia was truly a ‘global health’ issue, why weren’t we better prepared for Covid-19?

The report also argues that if the burdens of pneumonia aren’t addressed as required, nations will remain ‘dangerously exposed’ to another respiratory pandemic and at risk of failing to achieve many of the Sustainable Development Goals (SDGs) for health – especially reducing maternal, newborn and child deaths (SDGs 3.1, 3.2), and communicable and non-communicable disease burdens (SDGs 3.3, 3.4).

Every Breath Counts levels that national governments should turn their reactive pandemic response plans into proactive pneumonia control strategies to drive declines in deaths from all-cause respiratory infections over the next decade, and reduce the risk of another respiratory pandemic.

It argues that global health and development agencies like the Global Fund, the World Bank, Unitaid, WHO and UNICEF should turn their Covid-19 support to LMICs into effective pneumonia control programmes, while private philanthropies should continue to support non-government organisations to strengthen respiratory care services across LMICs.

Report: Covid-19 and oxygen supply

Covid-19 (coronavirus) has left a painful, indelible mark on society the world over and continues to have a grip on our way of living, working and interacting even today.

It also continues to ravage a number of countries in the southern hemisphere that lack both the vaccination programmes and the one key treatment required to deal with it – oxygen. 

Our response to this once-in-a-century global pandemic that so unexpectedly and irrevocably change the world poses a number of questions, not least how prepared our healthcare systems and supply chains were for such an event.


An extended special report from gasworld charts a 10-point playbook of political, social, scientific and economic constructs that underpinned one of the most devastating public health emergencies in a century and critical oxygen supply chain shortages is explored.

Read Parts 1-3 online now, exclusively to gasworld: