Malawi becomes the third African country to introduce typhoid conjugate vaccine (TCV) into routine immunisation as Ministry of Health and partners collaborate to protect children across the country from typhoid fever.
Prior to TCV introduction, Malawi has today embarked on an ambitious one week push to reach more than 9 million children – nearly half the country’s population – with an integrated “catch-up” campaign providing vaccines against typhoid fever, measles, rubella, and polio, as well as a vitamin A supplement.
This large scale effort comes at a critical time as Malawi battles multiple crises, with Cyclone Freddy leaving more than half a million people displaced and increasing the risk of vaccine-preventable outbreaks.
With support from Gavi, the Vaccine Alliance, WHO, UNICEF, TyVAC, and other partners, the Government of Malawi has launched a nationwide integrated vaccine campaign to deliver measles-rubella (MR) vaccines and typhoid conjugate vaccine (TCV), which will be followed by the introduction of TCV into the national routine immunisation programme. Throughout the campaign, eligible children who are “caught up” on these vaccines will also be offered the bivalent oral polio (bOPV) vaccine, as well as a vitamin A supplement.
“We are proud to launch this integrated campaign, and introduce the TCV vaccine thereafter, that will help give our children the opportunity for a better future. With outbreaks of typhoid and the rise of anti-microbial resistant strains, primary prevention through vaccination is a game-changer.” – Dr Mike Chisema, Expanded Programme on Immunization (EPI) Manager, Ministry of Health Malawi.
Over the course of one week, more than 9 million children up to 15 years of age will be targeted in this effort aimed at preventing outbreaks of measles and other diseases, strengthening childhood immunity with vitamin A supplementation, and maximizing the impact of the TCV introduction – by reaching as many children across the age group as possible with the highly efficacious single-dose typhoid conjugate vaccine.
Vaccines will be available at various sites including health facilities and mobile outreach teams throughout the country, with special emphasis placed on reaching underserved and hard-to-reach populations to ensure equitable access. Immediately after the campaign, the typhoid vaccine will be available through routine vaccination at health centres across all districts and will be given to 9-month-old children alongside the first dose of a measles-containing vaccine.
Countries often conduct regular “catch up” campaigns to improve vaccine coverage and reach those who may have missed out, and this is particularly important following emergencies. After the COVID-19 pandemic, and the impacts of Cyclone Freddy – including outbreaks of polio and cholera – this ambitious push, which the government and partners have been planning for multiple years, comes at a critical time.
“Malawi has demonstrated remarkable resilience in the aftermath of a devastating cyclone. Not only is it introducing a new vaccine, which is never an easy task, it becomes one of the first countries in the world to make the lifesaving typhoid conjugate vaccine routinely available to children,” said Thabani Maphosa, Managing Director of Country Programme Delivery at Gavi, the Vaccine Alliance.
Vaccination in a time of crisis relies on the fortitude of health care workers, the government and local partners. The integrated approach utilised in this national campaign seeks to make best use of available resources to deliver lifesaving impact – recognizing the limited capacity of health care workers who have been stretched to the maximum to address multiple health challenges individually.
Why it matters: Tackling typhoid and other health challenges
Typhoid fever, caused by the bacterium Salmonella Typhi, is life-threatening. In 2019, over 9 million typhoid fever cases occurred globally, causing over 110,000 deaths. It is usually spread through the ingestion of contaminated food or water – meaning climate change, natural disaster and displacement increase the risk of typhoid outbreaks. Equally concerning is the rise in drug resistant strains of typhoid, which makes treatment more difficult, potentially leading to complicated cases, which are more expensive to treat and put additional strain on health systems. However, the typhoid conjugate vaccine, approved by WHO in 2018, is highly effective at preventing typhoid fever, and is the first typhoid vaccine that can be used in children 6 months and older.
Malawi has endemic typhoid transmission, and has experienced typhoid outbreaks throughout the country. Recent studies in Malawi have shown both that TCV is highly effective for the country context, and that there is a high prevalence of multidrug-resistant typhoid fever – making national introduction of TCV a high priority. It is the sixth* country in the world, and third African country, to introduce TCV into its routine immunisation programme. Pakistan, Liberia, Zimbabwe and Nepal have all introduced the vaccine, with support from Gavi and partners, including UNICEF and WHO. The Vaccine Alliance is continuing to support high-burden countries to introduce TCV – including by helping to strengthen disease diagnostic testing and surveillance, in order to assess disease burden and guide decision-making for impactful vaccine use.
Yet typhoid is not the only health risk children in Malawi face. Despite traditionally high basic vaccine coverage, the country did see a drop in routine immunisation coverage rates due to the pandemic, from 95% to 93% (3rd dose pentavalent vaccine coverage), and is overdue for a measles vaccine campaign to catch missed children and reduce the risk of outbreaks. With increasing numbers of extreme weather events due to climate change, as well as urbanisation, migration and continued gaps in access to safe water and improved sanitation, the risk of other outbreaks is also increasing.
The country is tackling this challenge through proactive immunisation efforts. Following the detection of the wild-polio case in early 2022, Malawi is conducting multiple bOPV campaign rounds as part of a regional effort, supported by the Global Polio Eradication Initiative. To guarantee the best health outcomes and ensure that millions of children receive protection against multiple diseases, the polio vaccine is included in this national campaign, targeting children under five. Since 2022, Malawi has also conducted multiple cholera outbreak response campaigns, including the launch of the “Tithetse kolera (End Cholera)” campaign in 2023 to control the current outbreak. The government, with support from partners, also conducts regular campaigns to deliver vitamin A supplements to improve immunity and health outcomes.
QDr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa said: “This is a significant step for Malawi. Children are at the highest risk of typhoid-related disease and death. Achieving high typhoid vaccination coverage as part of routine immunization services will contribute to reducing the burden of typhoid in Malawi.”
Gianfranco Rotigliano, UNICEF Representative in Malawi, has since urged all parents, caregivers, community leaders and partners to come together to support this campaign so that every child, regardless of where they are, has access to the vaccines.
“This campaign is great progress for Malawi and for the African region. As Malawi confronts drug resistant typhoid and increasing climate change events, the introduction of TCV will help to keep children protected against typhoid. By ensuring TCV is available to all children, the Government of Malawi is prioritizing better health, fewer hospital visits, and greater economic and academic productivity. Routine vaccination will help alleviate the urgent need for health services as the health system continues to recover after COVID-19” said Dr Emmanuel Mugisha, TyVAC Project Director and Senior Advisor on Vaccines and Immunizations at PATH.
Follow us on Twitter:
