A Second Wind? A Comparison of the TB and Pneumonia Policy Networks

TB and pneumonia are the two leading causes of death globally among communicable diseases of the respiratory system. Despite pneumonia killing more people per year, TB has received greater funding and policy attention. In the 1980's, pneumonia appeared to occupy a similar position to TB, with dedicated programs at the global and national levels; however, the formation of a coherent policy network stalled while the institutionalization of a partnership to stop TB gained momentum. In this case study we take an historical, comparative approach to consider the characteristics of the diseases, the policy networks, and the environment that have shaped these diverging results. We use a process-tracing methodology with data from interviews of approximately fifty key informants in the global TB and pneumonia policy communities, as well as several hundred reports and published documents. Findings on the policy networks indicate that the TB community successfully grafted their issue to AIDS, while the pneumonia community stood still as the issue was absorbed by an integrated approach to childhood illness. Additionally, the TB community institutionalized the policy network in the Global Partnership to Stop TB and created an organizing, consensus-based framework in its Global Plan, almost a decade before similar development of a plan for pneumonia. Comparison of the strategies, structure and environment of the two issue networks not only explains some of the divergent outcomes, but also provides lessons for other global health issues.