The government of Pakistan has become the first country to approve the nationwide rollout of a typhoid conjugate vaccine (TCV) following new evidence of the spread of an unusual typhoid strain which is extensively resistant to antibiotics.

An outbreak of extensively drug-resistant (XDR) typhoid in Hyderabad in Pakistan’s Sindh province has already affected over 1,000 children. Research from Aga Khan University shows that the disease has now spread to other cities and rural areas in Sindh as well as parts of two other provinces, Balochistan and Khyber Pakhtunkhwa.

Researchers from AKU, who were involved in an emergency vaccination campaign in Hyderabad in January 2018, also informed the government that the TCV was safe with no adverse events being noted in 99.7 percent of children who received doses.

“Immunization is the only feasible option we have left against this superbug,” said Farah Qamar, associate professor of pediatrics at AKU. “Since this vaccine has been demonstrated to be safe, we now need to intensify our efforts to bring it to every child in Pakistan.”

Antibiotic resistance is a global problem and the shortage of medicines to treat the disease led to the World Health Organization prequalifying the typhoid conjugate vaccine in January 2018 enabling its supply to countries such as Pakistan.

GAVI, a global, public-private partnership committed to increasing access to vaccines, has already pledged US$ 85 million in funding to enable the global launch of the vaccine.

“The recent GAVI commitment to support the introduction of typhoid conjugate vaccines is a great opportunity for Pakistan,” said Dr. Syed Saqlain Ahmad Gilani, national program manager for the federal Expanded Programme for Immunization (EPI). “We have previously introduced vaccines against pneumonia, diarrhea and the injectable polio vaccine. The launch of the typhoid vaccine will be another step towards improving the immunity of our children against disease.”

Dr. Gilani noted that the Ministry of National Health Services Regulations and Coordination would now submit an application to GAVI, a global vaccine alliance, to seek funding for the vaccination.

hand holding syringe

“This vaccine will not only save lives in Pakistan but it will also be an effective weapon in the global fight against antimicrobial resistance,” said Professor Rumina Hasan from the department of pathology and microbiology at AKU.

Dr. Anita Zaidi, Director of Vaccine Development, Surveillance, and Enteric and Diarrheal Diseases at the Bill and Melinda Gates Foundation, and an AKU alumna, was also involved in global efforts to generate evidence of the efficacy for this vaccine against typhoid fever.

“For too long, typhoid, which invariably affects the world’s poorest people, has been neglected in efforts to improve global health,” said Dr Zaidi. “With this new vaccine – the first-ever to be useful for preventing typhoid in young children – countries will finally be able to protect millions of children who are most vulnerable to this deadly disease.”

The research and advocacy efforts were backed by a team at AKU including Professor Rumina Hasan, Professor Zahra Hasan and Dr. Sadia Shakoor from the department of pathology and microbiology, Dr. Farah Qamar, Dr. Tahir Yousafzai and Dr. Momin Kazi from the department of pediatrics and child health at AKU.

The control and prevention of water-borne diseases such as typhoid is a global health priority with targets under goal 3 of the Sustainable Development Goals calling for the eradication of such diseases by 2030.

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