Those interested in global infectious diseases get a lot of news from the global internet surveillance groups. It can be a bit daunting – where is H5N1 re-emerging?  Is emergence of a new bug indicate a potential epidemic? These questions often get into the press, and tracking these stories has been a proposed approach to learning what is emerging in the human population.

And we follow these stories avidly, partially because of self interest (do I travel there?  does this change what I eat?). But occasionally, a single picture can bring right into our households, and hearts, the pain of millions.

It reminds me of a story once upon a time of a little girl that fell into a well – the global press focused on each step needed to get her out.   

And I’m baffled. How do we pay real attention to the quiet epidemics?

We care about that little girl, because it’s a nightmare for any child to be trapped in a well.  But the reality is that millions of children die, every year, every HOUR, from infectious diseases that should have been prevented, and failing that, treated.  Two examples are worthy of highlighting because each of these disease syndromes kills so many children in the poorest countries that these rank among the most important causes of death among children ages 1 month to 5 years:  pneumonia (infection of the lung) and diarrhea (most of it due to infection of the gut).  And we get two opportunities to make a difference (prevent and treat), but we are only now introducing the tools to make that a reality.

Surprised?  Many people think its HIV, or malnutrition that kills children.  And while it can vary enormously, it is very clear that children in the poorest countries suffer disproportionately from infections that children in richer countries either avoid or successfully survive, and in simple rankings, these are priorities.  And while we can hear the child in the well, we cannot comprehend that millions of children who die from the slow and ongoing and often unseen epidemics of infectious diseases in children, far away. 

There are good news on the horizon.  As a result of innovation over that past 2 decades, and enormous mobilization by many over the past year, we are poised to see a difference.  Pneumococcal vaccine prevents the primary bacteria causing pneumonia, and rotavirus vaccine prevents severe disease from the most important virus causing dehydrating diarrhea in children less than 5 years.  Extending treatment for those that are missed is possible, with antibiotics, oral rehydration solution, and zinc.  If all of these are used, at least x% of the impact of pneumonia and diarrhea can be prevented.

So we need to challenge ourselves to make sure that decision makers are driving to impact that largely unseen and preventable epidemic in children, that most fragile vision of our global future.