India has shown the largest positive change— 7-point increase in Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) scoreÂin the 2017, according to the latest Pneumonia and Diarrhea Report.

This is largely due to changes in vaccine coverage of measles vaccine (MCV1), Haemophilus influenzae type B vaccine (Hib), three doses of diphtheria tetanus and pertussis vaccine (DTP3), and rotavirus vaccine (RVV). In India, these percentages translate to a substantial increase in the number of vaccinated children.

The report,” 2017 Pneumonia and Diarrhea Progress Report: Driving Progress through Equitable Investment and ActionÂÂ says India could save over US$ 1 billion each year in economic benefits and avert more than 90,000 needless child deaths each year by introducing and scaling up coverage of vaccination programs targeting pneumonia and diarrhea.

Pointing out that India had the highest percent of children less than five years old with suspected pneumonia taken to an appropriate health care provider (77%), the report says this despite children less than five with diarrhea receiving Oral Rehydration Salts (ORS) treatment was low (34%).

The report further says that India had the highest percent of children less than 6 months of age exclusively breastfeeding (65%). Exclusive breastfeeding protects infants from pneumonia and diarrhea.

India recently began phased introductions of rotavirus vaccine in 2016 (9 states introduced so far) and pneumococcal conjugate vaccine (PCV) in 2017 (3 states introduced so far). Following India, the neighbouring country of Bangladesh (+5) experienced the largest GAPPD score change and fared well with over 90% coverage of PCV.

In 2016, pneumonia and diarrhea were responsible for one of every four deaths in children under 5 years of age.Figures released by UNICEF earlier this month show thatprogress against these illnesses has been stubbornly slow, despite these deaths being largely preventable with strategic investments in interventions such as vaccines, antibiotics, oxygen, breast feeding and hand washing.Released today, the some light on the factors slowing progress against the worldÂs two biggest killers of young children.

The Progress Report is issued by the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health, and provides an update on efforts to prevent and treat pneumonia and diarrhea in the most heavily burdened countries. This scorecard, released annually to mark World Pneumonia Day in November, finds countries are making progress in increasing coverage of vaccines and breastfeeding goals, but treatment targets seem still far out of reach for most.Efforts to work and invest more strategically in all three areas  immunization, nutrition and treatment  are critical to meaningfully reducing the nearly 1.5 million childhood deaths that still occur each year as a result of pneumonia and diarrhea.

ÂThe good news is that when we invest in child health, we save lives, Â says Kate OÂBrien, MD, MPH, a professor in the Bloomberg SchoolÂs Department of International Health and IVACÂs executive director. ÂSadly, there are significant gaps in reaching global targets to make sure that medicines, food and care get to that last child, living in the inner city or on a small rural farm. The success of investments in these countries demonstrates the potential to vastly improve equity, prioritizing the most vulnerable and catalyzing action to close those gaps.Â

In the report, IVAC identifies the 15 countries with the greatest number of deaths from pneumonia and diarrhea among children under 5 years of age. IVAC then uses a scoring method based on the integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD) developed by the World Health Organization and UNICEF. A countryÂs ÂGAPPD score measures the use of interventions that protect against, prevent and treat pneumonia and diarrhea. The higher the score, the more interventions are being used.

These interventions include vaccination; exclusive breastfeeding; access to care; and use of antibiotics, oral rehydration solution and zinc to treat the illnesses. These measures are known to prevent childhood deaths due to pneumonia and diarrhea and could help achieve the United Nations Sustainable Development Goal target of reducing under-5 mortality to at least 25 per 1,000 live births by 2030.

GAPPD scores in 2017 varied widely from a low of 19 percent (Somalia) to a high of 69 percent (Tanzania), with all 15 focus countries falling below the 86 percent target for the overall GAPPD score. In 2016, the scores varied from 20 percent (Somalia) to 74 percent (Tanzania), virtually unchanged compared to this yearÂs scores.

Rotavirus vaccine coverage:Sudan and Tanzania achieved or exceeded the 90 percent target for rotavirus vaccine coverage. Ten of 15 countries failed to meet a threshold of 45 percent for this vaccine which prevents a substantial portion of diarrhea deaths and hospitalizations. This includes nine countries (Afghanistan, Chad, China, DRC, Ethiopia, Nigeria, Pakistan, and Somalia) who had not yet introduced the vaccine and India, who began a phased introduction in 2016.

Pneumococcal conjugate vaccine coverage:Three of the 15 countries achieved or exceeded the 90 percent target (Sudan, Tanzania, and Bangladesh) for pneumococcal conjugate vaccine coverage. Six countries failed to meet a threshold of 45 percent, all of which had not yet introduced the vaccine in 2016 (Chad, China, India, Indonesia, Nigeria and Somalia).

Antibiotic treatment (suspected pneumonia): In the 11 of 15 countries with available data, antibiotic treatment ranged from 7 percent (Ethiopia) to 59 percent (Sudan). Two countries met or exceeded 45 percent of children with suspected pneumonia treated (Afghanistan and Sudan); nine countries did not, and data was not available for four countries. All countries were low-performing on this indicator (covering less than 70 percent children with suspected pneumonia).

ORS treatment (diarrhea): In the 14 of 15 countries with available data, ORS treatment ranged from 20 percent (Chad and Sudan) to 77 percent (Bangladesh). Four countries met or exceeded 45 percent of children with diarrhea receiving ORS (Afghanistan, Bangladesh, Somalia, and Tanzania); 10 did not, and no data was available for China. All countries, except Bangladesh, were low-performing on this indicator (covering less than 70 percent children with diarrhea).

Breastfeeding:There is strong evidence demonstrating that about half of all diarrhea episodes and about one third of respiratory infections could be averted by breastfeeding. The GAPPD target for exclusive breastfeeding within the first six months of a childÂs life is 50 percent coverage. Based on 2015 data, the report finds five countries met or exceeded the target (Bangladesh, Ethiopia, India, Sudan, and Tanzania). Nine of the 15 countries did not meet the target; of these, five countries met a threshold of 25 percent, half the target (Afghanistan, China, DRC, Indonesia, and Pakistan) and three did not (Chad, Niger, and Nigeria).

The report also captures the economic cost of the illnesses and sheds light on the complex relationship between childhood illnesses and poverty. Children in low-resource settings are at higher risk for illness; at the same time, pneumonia and diarrhea can contribute to the cycle of poverty. Costs of illness can include: lost wages for families caring for sick children; the cost of health care, a large portion of which is often paid by families; and the long-term consequences of illnesses on children, including lost schooling and the longer-term effects of repeated or severe illness.