Since 2010, seasonal outbreaks of typhoid have occurred every year in Zimbabwe, particularly around the capital city of Harare. In 2018 alone, the Ministry of Health and Child Care’s Weekly Disease Surveillance System recorded more than 4,000 cases, with more than 25 percent occurring in children under 5 years old—but the burden is likely even higher given the challenges with diagnosing typhoid.
The disease has been endemic in Zimbabwe for so long that drug-resistance has become a major challenge, with up to 73 percent of cases in Harare resistant to first-line antibiotic treatment. Drug-resistant typhoid is more difficult and costly to treat, increasing the urgency for prevention.
In the long term, water, sanitation, and hygiene improvements are the best solution for typhoid prevention and control—the disease is caused by Salmonella typhi bacteria, which is spread through contaminated food and water and poor sanitation. However, these infrastructural advancements are costly and can take decades to implement.
Until then, typhoid conjugate vaccines (TCV) are critical for protecting populations—particularly children—and saving lives.
This week, Zimbabwe launched a large, integrated national vaccination campaign to roll out the new TCV together with immunizations against human papillomavirus and polio.
A new addition to routine immunization
This TCV vaccination campaign aims to reach approximately 6.2 million children from 9 months old to under 15 years of age across Zimbabwe’s 11 counties.
“With this campaign, the government is fulfilling its promise to protect as many children as possible from typhoid infection,” says Aziza Mwisongo, senior medical officer with PATH’s Center for Vaccine Innovation and Access and country introduction lead for the Typhoid Vaccine Acceleration Consortium.
Following completion of the campaign, TCV will be integrated into routine immunization, making it available to all 9-month-olds across the country through Zimbabwe’s Expanded Programme on Immunization.
“This is a major milestone for addressing the increasing typhoid burden in Zimbabwe,” Aziza says. “The situation was becoming more serious as drug-resistant strains continued to spread. But today, there is hope—and this has been years in the making.”
In 2018, the World Health Organization recommended that typhoid-endemic countries introduce TCVs into routine immunization programs. With support from Gavi, the Vaccine Alliance, Pakistan became the first country in the world to introduce TCV in 2019—and has now vaccinated more than 20 million children. Liberia followed in April 2021.
“This is a major milestone for addressing the increasing typhoid burden in Zimbabwe. The situation was becoming more serious as drug-resistant strains continued to spread. But today, there is hope.”— Aziza Mwisongo, senior medical officer, PATH
TCV was first used in Zimbabwe in 2019. Following a large drug-resistant typhoid outbreak in Harare and surrounding areas, the country ran the first outbreak response campaign against typhoid in Africa.
This time, the rollout is nationwide, and the vaccination campaign faced additional challenges.
Vaccine introduction during a pandemic
As COVID-19 grew into a pandemic, Zimbabwe paused TCV introduction activities while the country focused on response.
“We know that vaccine-preventable childhood diseases, such as typhoid, did not disappear during the pandemic,” says Lassane Kabore, senior program officer with PATH’s Center for Vaccine Innovation and Access in Burkina Faso. “Unimmunized children remain vulnerable to these illnesses, making routine immunization services all the more urgent.”
The public health community adapted rapidly, adjusting to new policies and procedures to continue vaccine introductions safely. PATH supported Zimbabwe’s Ministry of Health and Child Care as planning for this TCV campaign started, stopped, and restarted again throughout the pandemic.
“We worked with the Ministry of Health and Child Care to disseminate information about the importance of TCV, while dispelling misinformation about COVID-19 vaccines,” Lassane says. “The pandemic extended the planning period, but we maintained momentum in the fight against typhoid to carry out a successful campaign. PATH has decades of experience doing this work.”
PATH, as part of the Typhoid Vaccine Acceleration Consortium, supports countries throughout the entire vaccine introduction process, from facilitating initial discussions with decision-makers all the way through to post-introduction assessments.
“In Zimbabwe, we supported the decision-making process by facilitating discussions with national stakeholders and providing relevant data and analytics about typhoid and TCV including efficacy, cost-effectiveness, and prospective program costs,” Aziza explains. “Once the government decided to introduce TCV, we assisted with the development and submission of the Gavi application.”
Following Gavi’s approval of the TCV introduction application, PATH supported the necessary planning and outreach activities including technical assistance for microplanning workshops, which bring together relevant stakeholders to identify priority communities, outline potential barriers, and develop work plans with solutions.
“Vaccine-preventable childhood diseases, such as typhoid, did not disappear during the pandemic. Unimmunized children remain vulnerable to these illnesses, making routine immunization services all the more urgent.”— Lassane Kabore, senior program officer, PATH
Despite the additional challenges created by COVID-19, our work with the government of Zimbabwe and local partners brought us to this moment of celebration.
With this vaccine introduction, the Zimbabwean government has taken action to strengthen the routine immunization system and protect children from vaccine-preventable diseases including typhoid.
PATH and the government of Zimbabwe will continue collaborating on post-introduction activities to assess the successes, impact, and lessons learned during TCV introduction.