Every year, pneumonia claims the lives of nearly one lakh children under the age of five in India—a number higher than any other single infectious disease. This happens despite the existence of life-saving vaccines, easily available antibiotics, and improved child health programs. On World Pneumonia Day, the question resurfaces as to why a preventable and treatable disease continues to kill India’s youngest citizens.
What is pneumonia?
Pneumonia, an acute respiratory infection that affects the lungs, is often called 'the forgotten killer'. It doesn’t make headlines like dengue or malaria, nor does it evoke fear like COVID-19 did. Yet, globally, it kills one child every 45 seconds, according to UNICEF and WHO data. India alone accounts for over 20 per cent of these deaths.
“Pneumonia rarely strikes out of the blue,” says Dr Ramesh Shah, a family physician based in Mumbai. “It’s the result of a chain of vulnerabilities—poor nutrition, lack of immunisation, indoor air pollution, and delayed treatment.”
Risk factors
The burden of pneumonia in India is deeply intertwined with poverty. Malnutrition remains the single biggest risk factor, weakening immunity and making children more susceptible. According to the National Family Health Survey (NFHS-5), more than one-third of Indian children under five are stunted, and 19 per cent are wasted, making them more vulnerable to respiratory infections.
Children from low-income families often live in cramped homes with poor ventilation and use solid fuels for cooking, leading to constant exposure to smoke. “The same smoke that fills their kitchens also fills their lungs,” say experts from the Indian Academy of Pediatrics. That chronic exposure is like a slow poisoning, they add.
Vaccine to the rescue
India introduced the pneumococcal conjugate vaccine (PCV) into its Universal Immunisation Programme (UIP) in 2017, and it was rolled out nationwide by 2021. The vaccine protects against Streptococcus pneumoniae, the leading bacterial cause of pneumonia. Yet, coverage remains uneven, especially in remote and rural districts.
In states such as Bihar, Madhya Pradesh, and Uttar Pradesh, where pneumonia deaths are highest, immunisation rates lag behind national averages. Many families are unaware that such a vaccine exists, and others face logistical hurdles like long travel distances to health centres or interrupted vaccine supply chains.
“Immunisation is not just about vaccines being available,” says Dr. Amol Annadate, a community health specialist based in Aurangabad. “It’s about ensuring that every mother knows why it’s important, and every health worker has the resources to deliver it.”
For many families, recognising pneumonia early is the difference between life and death. Symptoms like fast breathing, chest in-drawing, or lethargy are often mistaken for a common cold, leading to delayed medical attention. When care is finally sought, it may be too late.
Government hospitals and primary health centres frequently face shortages of oxygen, antibiotics, and trained staff, particularly in rural India. The COVID-19 pandemic also disrupted immunisation drives and diverted healthcare resources, setting back progress.
“Even now, a significant proportion of pneumonia cases go undiagnosed or untreated,” says Dr. Shah. “We need to decentralise pneumonia care and strengthen primary health systems so that frontline workers can identify and treat it early.”
Air pollution is causing a major crisis
India’s air quality crisis adds another dimension to the problem. The country has 14 of the world’s 20 most polluted cities, and exposure to fine particulate matter (PM2.5) damages young lungs. Children in Delhi, for instance, are said to have lungs comparable to those of heavy smokers by the time they turn 10.
“Air pollution doesn’t just trigger pneumonia—it worsens it,” explain researchers from AIIMS Delhi. Children exposed to polluted air are more likely to develop severe forms of the disease and take longer to recover.
Climate change is compounding the risk by altering seasonal infection patterns and extending the duration of pneumonia outbreaks in several regions.
Studies show that girls in India are more likely to die of pneumonia than boys, reflecting deep-seated gender disparities in healthcare access. Families often delay seeking care for girls or spend less on their treatment. A 2023 UNICEF analysis found that in some northern states, female under-five mortality from pneumonia was 25 per cent higher than that of males.
“The child’s gender determines how quickly treatment is sought,” says a health worker working with the government of Chhattisgarh. “In poorer households, the girl child’s illness is often neglected until it becomes critical.”
Despite these challenges, progress is being made. Initiatives like SAANS (Social Awareness and Action to Neutralize Pneumonia Successfully), launched by the Ministry of Health, focus on spreading awareness, early diagnosis, and promoting breastfeeding and vaccination. Accredited Social Health Activists (ASHAs) are being trained to identify pneumonia symptoms and provide basic care at the village level.
In Rajasthan’s Dungarpur district, for instance, local ASHAs have helped reduce pneumonia-related deaths by nearly 30 per cent in the past three years by improving community-level surveillance and timely referrals.
Road ahead
Experts agree that India needs a multi-pronged approach to end preventable child deaths due to pneumonia, such as universal vaccine coverage through sustained outreach and community engagement, nutrition programs that tackle underweight and stunting, cleaner cooking fuels and stronger action on air pollution.
India has the tools, such as vaccines, antibiotics, oxygen, and awareness campaigns to end childhood deaths from pneumonia. What it needs is consistent delivery, community trust, and a relentless political will to make pneumonia history.
Until then, pneumonia will remain an old disease with new victims, claiming young lives that could easily have been saved.