During World Immunization Week, we celebrate the lifesaving power of vaccines and the health care workers and policymakers who deliver and introduce vaccines in their communities. At TyVAC, we’ve had the opportunity to support five countries as they introduce typhoid conjugate vaccines (TCVs). This year, we’re looking back to celebrate our collaboration with ministries of health and Expanded Programme on Immunization (EPI) programs to take on typhoid.
Pakistan
Pakistan, battling an increase in extensively drug-resistant typhoid cases, was the first country to introduce TCVs in 2019. Decision-makers implemented a phased introduction strategy, beginning first in Sindh Province, followed by two campaigns in Punjab, and then the remaining provinces. Through all the campaigns, Pakistan’s EPI has vaccinated more than 35 million children 9 months to 15 years old. TCV is now in Pakistan’s routine immunization program and offered at the 9-month well-child visit. Pakistan is currently getting ready for an upcoming TCV campaign to reach previously unvaccinated children in peri-urban and rural areas of Karachi and Hyderabad (the previous campaigns were conducted in urban areas). This highlights the EPI’s commitment to reaching children with vaccines regardless of where they live.
Liberia
As EPI manager Adolphus Clarke says, Liberia is a country accustomed to firsts. They were the first in Africa to introduce TCV with a national campaign in 2021 that vaccinated more than 1.5 million children aged 9 months to younger than 15 years old. TCV is now available in the routine immunization program for children at 9 months old.
Zimbabwe
In late 2018, a large drug-resistant typhoid outbreak in Harare and surrounding suburbs led to a response campaign with TCV as part of the outbreak control strategy. Following this, in 2021, Zimbabwe introduced TCV into the routine immunization system through an integrated nationwide campaign that also offered human papillomavirus vaccine and inactivated polio vaccine to children previously unreached. Zimbabwe vaccinated more than 4 million children with TCV during the introduction campaign and now offers the vaccine at 9 months old.
Nepal
With one of the highest typhoid burdens globally, Nepal decision-makers elected to introduce TCV as part of their typhoid control strategy. In 2022, Nepal introduced TCV during a campaign that vaccinated 7.5 million children between 15 months and 15 years old. Reflecting on the campaign, Mr. Sagar Dahal, Immunization Manager with the Family Welfare Division in Nepal was proud of their efforts to keep Nepal’s children healthy and protected so they can grow up strong and follow their dreams. TCV is now available for all 15-month-old infants through the routine immunization schedule.
Malawi
Malawi introduced TCV in 2023 and used the introduction campaign as an opportunity to also reach eligible children with measles-rubella and polio vaccines as well as Vitamin A supplementation. Writing about the campaign, Dr. Mike Chisema, EPI manager for Malawi, said he was heartened by the vast benefits that TCV introduction will bring to the children of Malawi. The integrated national campaign was a testament to the fortitude and perseverance of Malawi’s health workforce. They vaccinated more than 7 million children 9 months to 15 years old. TCV is now available for all 9-month-olds.
Working together to take on typhoid
Vaccine delivery and introduction is a complex process involving multiple stakeholders and partners. It’s taken a lot of hard work, coordination, determination, and collaboration to reach so many children with TCV—more than 56 million so far! And there is no one-size fits all approach. Each country must consider the data and their unique country context to make decisions on how to introduce TCV into their immunization programs.
TyVAC has partnered with these countries throughout the vaccine introduction decision-making and implementation process. Available support has included data triangulation to better understand country typhoid burden, Gavi application support, advocacy, communication, and social mobilization activities, microplanning, and more. We look forward to continuing to work with additional countries as they make TCV introduction decisions. Because together we can take on typhoid.
Cover photo: A girl waits to receive TCV with her caregiver in Nepal. Credit: PATH/Rocky Prajapati
