Publication of the results of the Gambian pneumococcal vaccine trial focuses international attention once again on the problem of childhood pneumonia. The lack of international attention devoted to childhood pneumonia in recent years is surprising, when the number of deaths due to the disease still exceeded the combined total of child deaths attributable to malaria, measles and tuberculosis. Despite various complications in setting up and carrying out the trial the published results were worth the wait. The efficacy of the vaccine against invasive pneumococcal disease and against the new primary endpoint of radiological pneumonia was good. Most surprising, and most encouraging, was the finding that the impact on child survival was considerable and statistically significant (although the confidence intervals were wide). Because of the major public health importance of childhood pneumonia this should open the way to the vaccine's use in developing countries, if issues of supply, price and serotype coverage can be overcome. Yet we must also acknowledge that the problem of childhood pneumonia will not be solved by vaccines alone: great improvements are needed in case management, and the potential benefits of measures to improve nutrition or reduce indoor air pollution must be evaluated. Nevertheless it is time for the international community to wake up to the importance of childhood pneumonia, the leading cause of child death throughout the world.
Mulholland, K. Editorial: The Gambian pneumococcal vaccine trial - implications for control of childhood pneumonia. Tropical Medicine and International Health (2005) 10 (6) 497-500. [DOI: 10.1111/j.1365-3156.2005.01430.x]