Mutu umodzi susenza denga – One head alone cannot hold up a roof

African proverbs convey great wisdom, truth, discovery, and life lessons in just a few words. The proverb Mutu umodzi susenza denga embodies the on-going effort and teamwork behind the fight against typhoid in Malawi. As a public health administrator and the current Director of Health and Social Services in Blantyre District, Malawi, I have seen many people get sick and die unnecessarily from typhoid. From disease prevention to behavioral modifications and infrastructure changes, it is essential to address healthcare from multiple fronts. For example, in a recent cholera outbreak, we re-opened water kiosks to provide access to clean and potable water and used the media to circulate messaging on how to prevent the disease and care for those affected.

Typhoid is a growing problem: Each year, there are nearly 12 million cases and an estimated 128,000 deaths, many of whom are children in Asia and sub-Saharan Africa. In Malawi, growing multi-drug resistance, increased outbreaks, and high mortality increase the need for a solution. We welcome the newly World Health Organization recommended typhoid conjugate vaccine (TCV), Typbar TCV®, the first typhoid vaccine approved for children under two years of age.

With the typhoid outbreaks in Rumphi and Zomba, more than 1000 people, including many children, suffered from this devastating disease. We are proud to be a part of the Typhoid Vaccine Acceleration Consortium (TyVAC) trial in Blantyre, Malawi. Long before the first child was vaccinated, the Malawi-Liverpool-Wellcome (MLW) Trust and Blantyre Malaria Project (BMP) coordinated with government officials and healthcare facilities in preparation to enroll 24,000 children in this historic trial.

Typbar TCV, has been tested in infants and children in Asia, but never before in Africa. MLW and BMP are working closely with local entities, in partnership, to improve the health and livelihood of children in Malawi. Data from this study will fill an enormous gap to support vaccine introduction in Malawi and across Africa.

Keeping the proverb in mind, this vaccine is a wonderful tool, but just one tool in the toolbox. To stop typhoid, we must put our heads together for an integrated effort that includes water, sanitation, and hygiene interventions. This is not something that can be handled by one person or fixed with a simple solution; it will take a large team to hold up the roof and protect Malawi’s young population.


Photo credit: Dr. Gift Kawalazira