Leading the way: Pakistan introduces typhoid conjugate vaccine

Today, Pakistan made history as the first country to introduce typhoid conjugate vaccine (TCV) into its routine childhood immunization program. This is a monumental moment for Pakistan and global typhoid control efforts, and a major step forward in protecting the most vulnerable children from typhoid. Today’s launch kicked off a vaccination campaign in urban areas of Sindh Province, where children 9 months to younger than 15 years of age will be offered the vaccine. Following the campaign, Sindh Province will transition to routine TCV immunization for all children when they are 9 months old. While Sindh is the first province to receive TCV, the vaccine will be rolled out province by province throughout 2020 and 2021 in an effort to protect all children at risk of contracting typhoid in Pakistan.

Typhoid, while mostly eliminated from high-income countries, continues to be a major cause of illness in low- and middle-income countries, especially in places where water and sanitation (WASH) infrastructure is lacking. Unfortunately, in Pakistan, I have seen just how much the WASH infrastructure has deteriorated since I was a child. For example, as a kid I remember brushing my teeth with water from the faucet, whereas now when I visit, even in the nicest hotels, you’re told not to drink the water from the tap. Additionally, Sindh Province, and increasingly in other parts of the country, we are battling an extensively drug-resistant (XDR) typhoid outbreak, which continues to infect children. Children who fall ill with XDR typhoid strains, which are resistant to all but one oral antibiotic, have limited treatment options and the cost of such treatment can place further economic burdens on their families. Pakistan, with XDR typhoid and limited WASH, is particularly susceptible to an increased typhoid burden, which is why the introduction of TCV is especially exciting for me, both professionally and personally.

It took a lot of hard work, coordination, determination, and collaboration to get to this point. As part of TyVAC, our team at PATH worked to support Pakistan throughout the vaccine introduction process, beginning by ensuring that the Federal EPI had the latest information on vaccine efficacy, cost-effectiveness, and safety, as well as the burden data needed to make informed decisions about vaccine introduction. Once the decision was made to introduce TCV, we supported the government with the application to Gavi, the Vaccine Alliance all the way through to vaccine implementation planning, working with the different partners—from the World Health Organization to Gavi, to UNICEF, to local partners—to provide the Federal and provincial government the support that it needed and wanted for a successful TCV launch.

I’m glad I was able to play a part in Pakistan introducing this lifesaving vaccine to the children who need it the most. When I was a teenager, one of my first cousins died from typhoid when she was just two years old. Over the years, many more of my family members have suffered from high fevers that, while we don’t know for sure due to challenges with typhoid diagnostics, could have been from typhoid. I have experienced firsthand the devastation that typhoid can bring to families. A lot of my family still lives in Pakistan, and when I think about the introduction of this vaccine I think about my family. My cousins’ children, who are like my own nieces and nephews, will now be protected from typhoid thanks to this vaccine. It means I won’t worry about losing them to typhoid. This introduction is peace of mind that they will be protected, that families like mine won’t have the stress of having a child who is sick, or worrying about whether they can afford treatment, especially with the ever-present threat of XDR typhoid. And finally, it means that children like those in my family, who are constantly exposed to typhoid, will have the same opportunities to grow, thrive, and live up to their full potential as children like my nieces and nephews in the United States, who are given typhoid vaccines routinely when traveling to the region. And while we pause to celebrate the major achievement of today’s launch of TCV in Pakistan, it is just the beginning. We still have work to do to ensure that every child at risk of typhoid is able to access the lifesaving protection of TCVs. Because typhoid is preventable. And we have the tools and knowledge to prevent it.

Photo courtesy of PHC Global/Imran Khan