Major gaps in childhood pneumonia research priorities remain

Pneumonia is the leading infectious cause of death in children younger than 5 years, accounting for 14% of child deaths globally, and is a major barrier to achieving the Sustainable Development Goal (SDG) for child survival (SDG 3.2). Despite the role that research can have in reducing childhood pneumonia deaths, less than 3% of infectious disease research funding was spent on pneumonia between 2000 and 2015, compared with 38% for HIV and AIDS. Furthermore, most of this funding has been directed to vaccine research, leaving other areas of prevention, as well as diagnosis and treatment, underfunded relative to vaccine research. Only 8% of funding of pneumonia-related research was spent in low-income and middle-income countries (LMICs), despite these countries bearing 99% of child pneumonia deaths. In 2011, Rudan and colleagues1Rudan I El Arifeen S Bhutta ZA et al.Setting research priorities to reduce global mortality from childhood pneumonia by 2015.PLoS Med. 2011; 8e1001099 Crossref Scopus (93) Google Scholar published a priority-setting exercise that sought to inform global funders, researchers, and policy makers on the most important research strategies to reduce childhood pneumonia deaths. 11 years later, King and colleagues2King C Baker K Richardson S et al.Paediatric pneumonia research priorities in the context of COVID-19: an eDelphi study.J Glob Health. 2022; 1209001 Crossref Google Scholar published an updated list of research priorities drawn from more than 100 global experts and found that eight of Rudan's top ten priorities were considered addressed. These priorities highlight the power of consensus building and agenda setting for stimulating focused research investment.2King C Baker K Richardson S et al.Paediatric pneumonia research priorities in the context of COVID-19: an eDelphi study.J Glob Health. 2022; 1209001 Crossref Google Scholar However, 101 priority topics for paediatric pneumonia remain unaddressed, and, crucially, there are stark differences in the research priorities of experts in LMICs compared with those in high-income countries, where most global health funding originates. To assess whether research funding is currently aligned with childhood pneumonia research priorities, we conducted a desk-based review of publicly available donor databases and research registries in March, 2023, to develop the child pneumonia research investment scorecard (figure). We found that the funding remains insufficient to address the new research priorities, with less than ten registered studies or grants related to at least 15 of the top 20 global childhood pneumonia research priorities. This was the case for 12 of the top 20 LMIC priorities. Furthermore, most ongoing studies and awarded grants focused on pneumonia innovation and discovery, such as new clinical tools and technologies (eg, vaccines) and not other areas, such as operational research and health systems capacities. This focus on new clinical tools and technologies alone will not be sufficient to reach SDG 3.2. To reduce the global burden of childhood pneumonia and ensure that research translates to meaningful effect, funders must ensure that they embrace the specific needs of LMICs, in which priorities also focused on how these tools and technologies could be effectively implemented or be used to sustainably strengthen health systems. Directing more funding towards implementation research and ensuring clear pathways for integrating discovery, development, and delivery funding will improve our understanding of how to optimise access to new and existing tools to prevent, diagnose, and treat childhood pneumonia and, ultimately, increase the effect of this funding.3Cardoso-Weinberg A Alley C Kupfer LE et al.Funders' perspectives on supporting implementation research in low- and middle-income countries.Glob Health Sci Pract. 2022; 10e2100497 Crossref PubMed Scopus (2) Google Scholar This need has previously been highlighted by the Every Breath Counts Research Group, but we are yet to see major reforms from the majority of infectious disease research funders. The Wellcome Trust is an example of one major funder currently undergoing reform; however, how this reform affects the diversity of the funding available for pneumonia research remains uncertain.4King C Baker K Bin Nisar Y et al.Paediatric pneumonia: catalysing research priorities for the next decade.Lancet Respir Med. 2022; 10: 540-541Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar Funders must invest more in LMIC research priorities, especially in the countries where childhood pneumonia deaths are concentrated. Funders also have a role in supporting and connecting LMIC-based researchers and research institutes to lead the pneumonia research investment agenda.5Charani E Abimbola S Pai M et al.Funders: the missing link in equitable global health research?.PLOS Glob Public Health. 2022; 2e0000583 Crossref PubMed Google Scholar The research community is increasingly documenting ways to achieve this support; however, these solutions need to be translated into action by funders.5Charani E Abimbola S Pai M et al.Funders: the missing link in equitable global health research?.PLOS Glob Public Health. 2022; 2e0000583 Crossref PubMed Google Scholar We are calling on infectious disease research funders to increase the amount of funding that they invest in paediatric pneumonia and to target new funding to one or more of the research priorities outlined in the scorecard, especially those prioritised by LMIC-based experts. The increase in and diversification of funding must, crucially, include research into sustainably strengthening health systems and into how tools and technologies can effectively be implemented in the LMIC context. To achieve the SDGs, urgent action is needed in the 54 countries currently off-track to achieve the child survival goal. Funders of infectious disease research can maximise their contribution to the achievement of that historic goal by investing in better ways to reduce the leading causes of death among children and by strengthening the research capacity and networks in the LMICs most affected. We declare no competing interests.