A perfect storm has been brewing in Pakistan for years. The country’s high typhoid burden, coupled with the lack of improved water and sanitation infrastructure and the widespread over-prescription of antibiotics, has led to an ongoing outbreak of extensively drug-resistant (XDR) typhoid. Since the outbreak was first identified in 2016, more than 15,000 people have fallen ill, and more than 10,000 cases were identified an XDR, meaning only one oral antibiotic remains effective to treat the bacteria that causes typhoid. Children younger than 15 years old bear the brunt of this disease burden.
At the same time, a new, effective tool to prevent typhoid became globally available: a new typhoid conjugate vaccine. After reviewing data and key recommendations, the World Health Organization prequalified and recommended the new vaccine in January 2018, calling for its introduction in typhoid-endemic countries. Gavi, the Vaccine Alliance, which provides resources to support vaccine introduction, opened a funding window to support introduction of the vaccine. For Pakistan, there was now an opportunity to potentially employ the new vaccine to protect millions of vulnerable children.
For PATH, a core member of the Typhoid Vaccine Acceleration Consortium (TyVAC), the new vaccine was the clear short-term solution to Pakistan’s typhoid outbreak and endemic burden. During the summer of 2018, the PATH TyVAC team worked with the Pakistan Ministry of Health and other health stakeholders to submit a funding application to Gavi. It was the first-ever application to fund routine introduction of a typhoid conjugate vaccine into a national childhood immunization program.
With funding in place from Gavi, it was time to plan the roll-out of the TCV. PATH, WHO, and UNICEF to identified strategic areas to support an initial vaccination campaign of at-risk children. Vaccination campaigns at this scale require enormous logistics, from vaccine procurement and supply chains, through staff training, to publicity and communications support, and more. The high population density of Pakistan meant that a phased province-by-province introduction was necessary. Planning and preparation efforts began in earnest to launch TCV in Sindh Province on November 18, 2019.
Working with PHC Global, a local partner based in Sindh, PATH supported planning and implementation in the province. Part of this work included the identification of civil society organizations to mobilize communities and generate demand for families to vaccinate their children. Activities included organizing typhoid “walks,” speaking with parents and teachers in the community, and liaising with religious leaders to help support vaccine acceptance. PATH also worked with PHC Global to support UNICEF in the development of information, education, and communication materials, including pre-testing and training.
At the global level, PATH led a group of partner organizations to ensure consistent and joint messaging ahead of the campaign, and conduct media outreach to celebrate this monumental milestone.
By day 14 of the campaign, health care workers in Pakistan have vaccinated more than 9 million children in Sindh province, and the campaign isn't over yet! This means that as of today more than 9 million children are now protected against the dangers of XDR typhoid and have a reduced chance of falling ill. As vaccinations continue, millions more children in Pakistan will be protected.
As we celebrate this initial success, more work lies ahead. Later in 2020, PATH will work with stakeholders in Pakistan to support the next phase of the introduction, in Punjab Province, as well as beginning activities to ensure the new vaccine is routinely available to all children in Pakistan at their routine 9-month doctor’s visit.