Inform, engage, vaccinate: reaching the unreachable children in Pakistan

Since an outbreak of extensively drug resistant (XDR) typhoid, Pakistan has made great progress in typhoid prevention and control. In 2019, the country introduced typhoid conjugate vaccine (TCV), a highly effective tool to prevent typhoid. More than 30 million children aged 9 months to younger than 15 years old have been vaccinated through campaigns conducted in urban areas throughout the country. Typhoid cases have been predominately identified in the urban areas; as such, campaigns have been conducted in the urban centers. Since 2019, children aged 9 months have received TCV as part of the childhood immunization program; all children at 9 months of age, regardless of their residence, are eligible for TCV.

TCV coverage rates vary across the country. In recent months, there has been an increase of XDR typhoid cases reported in cities like Karachi and Hyderabad in Sindh province. In response, the government is conducting a follow-up campaign to boost immunity and cover geographic areas, including rural communities, where children may have missed vaccination in the previous campaign.

Reaching every child

The federal directorate of immunization, the provincial immunization program, and the district health offices lead the planning and implementation of a robust vaccination campaign. Karachi and Hyderabad are two densely populated cities of Pakistan, which requires strong and coordinated planning to identify children at home and in schools.

Severe, destructive flooding in 2022 forced many families from rural areas to flee to temporary urban settlements, where many still reside. These settlements often don’t have access to safe water and sanitation infrastructure, raising typhoid risks. This campaign is an opportunity to ensure that all children are protected from typhoid.

Outreach activities in Pakistan to encourage people to bring their children for typhoid immunization. Credit: PHC Global.

Voices from the field: strategies for outreach

Myriad partners, including provincial immunization department and district health offices, and PHC Global, is to identify children eligible to receive TCV. Partners work with the health systems, schools, and communities to raise awareness of the campaign. PHC Global speaks with teachers and parents to share information about typhoid, the benefits of TCV, and when and where to bring children for vaccination. The PHC Global team includes dedicated provincial and district coordinators, field associates, and data associates.

Shoaib Ahmed Memon, the Provincial Coordinator for TCV Sindh Campaign, believes that community engagement and mobilization strategies should always be ‘responsive and participatory.’ “We cannot achieve our targets without listening to and learning about our community’s perception and understanding of the subject. Giving them time to ask questions will help address misinformation and rumors about the vaccine(s). It is all about patience.”

Syed Adil Ali, the District coordinator for Karachi West, shared that “a voice from a familiar and trusted person is the key. We have contacted pediatricians and doctors where children [younger than] 15 years old go for their checkups. We make regular visits to schools to find missed children and add them to the micro plans. We’re using our own phones [TikTok] to create awareness. This helps access to correct information.”

Field associate Mureed Jan remarked “proper preparation” ahead of the campaign is crucial: “we’ve had trainings and visits for about two months now. We have been in constant touch with community leaders and influencers to promote immunization and inform them of their role in making this campaign a success. Our team is meeting stakeholders in every Union Council of all eight districts,” he said.

Ahmed noted how media messaging can reduce the number of missed children. “Education via media is extremely important to convince the vulnerable population. We should address and remove their fears and concerns. You must win their trust, speak to them in ways they want to listen and that can be different for different families,” he said.

More vaccines, more protection

The current TCV campaign will run for eleven days, aiming to vaccinate nearly 9 million children. This is 9 million more children protected from a dangerous illness. It’s millions of school-aged children who won’t have to miss school recovering from a typhoid infection, and its millions of families who won’t have to worry about accessing and paying for medical treatment for typhoid.

Throughout this campaign, we celebrate the determination of health care workers and vaccinators to deliver these lifesaving vaccines. And we applaud Pakistan’s continued commitment to typhoid control and to protecting its children from vaccine-preventable diseases.


Cover photo: Individuals await typhoid vaccination in Pakistan. Credit: PHC Global.