Punjab and Islamabad made history on Monday as they achieved a big milestone and began the twelve-day typhoid introduction campaign to vaccinate children between nine months to 15 years of age in urban districts. In the prevalent pandemic conditions, the word vaccine has become synonymous with Covid-19. However, as the world focuses on Covid-19 vaccines, we cannot afford to take our eyes off the ball when it comes to other deadly diseases, such as typhoid.
Over the past few years, Hyderabad, Karachi and other parts of Sindh have experienced an unprecedented eruption of extensive drug resistant (XDR) typhoid cases. As these resistant strains grow more common, the new antibiotic treatment courses have become lengthy and more expensive. The news sent shockwaves across the world health community when reports confirmed all people diagnosed with XDR typhoid in several non-endemic countries had a travel history to Pakistan. This prompted an urgency to address the issue at its root.
Thus, in November 2019, all eyes were focused on Pakistan when it became the first country to introduce the typhoid prevention vaccine—Typhoid Conjugate Vaccine (TCV)—in its childhood immunisation programme, at the age of nine months. TCV is a one-dose vaccine, injected intramuscularly with high efficacy. It is the first typhoid vaccine that can be given to children as young as 6 months of age and confers longer term protection against typhoid. Punjab was next in line in the phased introduction, planned for early 2020, but the country was then hit by Covid-19 which resulted in a massive diversion of public health resources to tackle the new threat.
Vaccination campaigns of this scale require enormous amounts of efforts. Focus needs to be placed on logistics to vaccine procurement and supply chains, through the training of vaccinators and social mobilisers to advocacy and communications support, and more. Aiming to inoculate more than 12 million children, just in Punjab, the campaign will involve approximately 28,199 health workers at fixed and outreach sites.
Despite the efforts put together by the Expanded Programme on Immunisation, the Polio Eradication Initiative, civil society organisations, UN partners, a massive campaign during the pandemic that is mandated to ensure coverage as high as 95 percent in target areas may face many challenges.
A large number of the target children are school going. As the schools re-opened on Monday, teams were vaccinating children in both public and private schools as well as madrassas.
However, the most vulnerable and difficult to trace is the group that includes children working as domestic help in homes, at auto workshops, vendors or are on the streets. These are the non-school going children aged between five years and above that may be the hardest to reach. Punjab is home to a large number of urban slums. A profiling of urban slums identified a total of 993 slums and underserved areas just in and around Lahore. Reaching out to these children also poses a challenge for vaccinating teams.
Pakistan launched an Expanded Programme on Immunisation (EPI) in 1978 with the aim to save children from vaccine preventable diseases. Today, the programme offers 10 vaccines to be administered to a child from birth till 15 months of age. They include TB, poliomyelitis, diphtheria, whooping cough, tetanus, hepatitis B, haemophilus influenzae type B, pneumonia, rotavirus and measles. Once introduced in the EPI, the TCV will be the 11th antigen added to the list.
This second phase of the campaign, the Vaccine Alliance, comes at a cost USD 40 million. However, the vaccine, like all other antigens, will be available free of cost to children under two years of age. Oral polio vaccine will also be offered to children under five years of age as part of this campaign—helping us to move even closer to eradicating this disease from the country.
The solution to the typhoid burden is an integrated one. Improvements in water, sanitation, and hygiene are imperative. So are improved diagnostics to ensure people are diagnosed promptly and treated appropriately. Avoiding injudicious or irrational use of antibiotics, combined with self-medication due to availability of antibiotics off the shelf without a doctor’s prescription are some reasons blamed for untreatable typhoid.
It’s time we understood the importance of completing our children’s immunisation schedule and put all efforts towards increasing vaccinations. It will offer a long-term solution which could see education and sanitation efforts implemented as well, as well as a polio-free Pakistan.