Action not words needed over biggest public health failure of our time: pneumonia | Larry Elliott | Business

Davos this year will be like Hamlet without the prince. Donald Trump was all set to be the star of the show for the second year running but has decided that giving a keynote address to a hall full of billionaires is politically problematical at a time when the US government is shut down.

Emmanuel Macron is giving the World Economic Forum a miss for similar reasons. If you have been dubbed the president of the rich the last place you really want to be seen is at the annual gathering of the 1%. Theresa May has decided she has better things to do with her time..

But even without Trump, Macron and May, there will be plenty for the global elite to talk about. The World Economic Forum, the body that has organised the event since 1971, says this week should all be about setting a course for Globalisation 4.0.

Without doubt, there is room for improvement on Globalisation 3.0, the model that has crashed and burned over the past decade. But it is a bit of a stretch to imagine that the Davos regulars are the ones to do the job. These are the people, after all, who lionised financial liberalisation, snaffled most of the proceeds of growth, salted their money away in tax havens and pressed for tax cuts for themselves while insisting on austerity for the poor.

It is not hard to specify the problems. This year’s Davos comes at a time when global growth is slowing and political discontent is growing; when global problems such as climate change are becoming more pressing and yet the global cooperation needed to deal with them is at its weakest since the 1930s.

The attendees at the WEF get all that. There will be plenty of talk in the conference hall and at the after-dark cocktail parties about how “something must be done” about inequality and how the economic benefits of the robot age must be shared by all. What there won’t be, at least on past form, is any action to back up the rhetoric. There is a complete disconnect between these problem solvers and the real-world challenges they consistently fail to tackle.

Let’s take one example: the battle (or, more accurately, the non-battle) against pneumonia, which is the biggest public health failure of our time.

Pneumonia attracts little attention, in large part because it is assumed to be a disease that kills old people. That’s true in the west but in the developing world pneumonia is the biggest killer of children going. In 2016 it cost the lives of almost 900,000 children – more than for malaria and diarrhoea combined. Most of them were less than two years old.

Nor is tackling pneumonia difficult or expensive. As Kevin Watkins, the chief executive of the charity Save the Children, wrote in a recent article for the Lancet: “Almost all pneumonia deaths could be prevented through vaccination or early diagnosis and treatment with antibiotics costing less than 50 US cents.”

Why is there no outrage at the idea that somewhere in the world a child is dying every two minutes from something that could be easily and cheaply treated? Where are the international initiatives? Where is the coalition of rock stars, billionaire philanthropists and politicians announcing at Davos a major drive to eradicate this disease? The answer is that it is nowhere to be seen, despite the fact that on current trends by 2030 – the target date under the UN’s sustainable development goals (SDGs) for ending preventable child deaths – 750,000 children a year will still be dying of pneumonia.

In part, the painfully slow progress in eradicating childhood pneumonia reflects the failure to make tackling inequality central to achieving the SDGs. There is no real point in setting ambitious targets for health unless health systems are designed and funded to cater for the most marginalised people in developing countries.

Poverty and pneumonia are inextricably linked. The children most at risk are invariably from the poorest families in rural regions and urban slums. They are the most likely to be malnourished and the least likely to be immunised, diagnosed and treated.

What’s more, pneumonia is confined to the poor. Unlike measles, cholera or HIV/Aids it does not readily cross social boundaries, which means that the children of those with the loudest political voices in developing countries don’t suffer from it. Health priorities are set by those with different priorities.

That goes for the international community as well. If pneumonia could be transmitted across borders like, say, Ebola, western donor countries would take it a lot more seriously than they do. “Pneumonia,” Watkins says, “is a disease that can be contained in poor communities of poor countries – and this is a prescription for policy inertia.”

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There is one final reason pneumonia remains the world’s Cinderella disease: treating it requires long-term investment in health care systems skewed towards poor communities. That means trained doctors and nurses that can spot the symptoms early and have the necessary resources to respond. Insecticide-treated bed nets have helped in the fight against malaria but no magic bullet exists in the battle against pneumonia.

Instead, what is required is action at all levels: higher spending on health in developing countries; specific action plans to tackle pneumonia and international initiatives to increase supplies of cheap drugs.

Doubtless, there will be much hand-wringing this week about the importance of international cooperation in creating a new and better globalisation. The willingness to tackle pneumonia is a test of that commitment because it requires a global partnership, the transfer of resources and an eagerness to put the interests of the poorest and most vulnerable first. Above all, it requires a willingness to act not only talk.

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