In 2019, the Malawi Expanded Program on Immunization announced that 75% of children aged 12 to 23 months had received all eight basic vaccinations. However, the COVID-19 pandemic, which put a halt to progress in many areas of life, also affected vaccine delivery. Disruptions in the health system, diverted funding and focus, as well as misinformation around vaccines have threatened existing vaccine programs. But with the development of the highly effective typhoid conjugate vaccine (TCV) and the government’s plan for a huge vaccine drive, Malawi has renewed immunity hopes. And the reason for such hopes is that the cases of typhoid fever in Malawi could drop.

What is Typhoid Fever?

Typhoid fever is a life-threatening infection that spreads through contaminated food or water. In 2019, there were 9.2 million cases and 110,000 deaths worldwide due to the bacterium, Salmonella Typhi, which multiplies and spreads into the bloodstream once it has entered the body. It continues to be a public health problem in many parts of Africa, the Eastern Mediterranean, Western Pacific Regions and South-East Asia.

How Does It Affect Malawi?

Typhoid fever in Malawi is very common, with more than 440 cases per 100,000 people every year. Symptoms include stomach pain, fever, diarrhea or constipation and have severe consequences on the livelihood of the affected person. Although health care is free in Malawi, the loss of wages due to missing work means that many families go into debt and children who contract the infection miss weeks or even months of school. The treatment for typhoid also costs the government a significant amount more than other childhood illnesses.

Typhoid Conjugate Vaccine (TCV)

With the support of Gavi, the Vaccine Alliance, the World Health Organization (WHO), UNICEF, TyVAC and other organizations, Malawi has become the third African country to launch its typhoid conjugate vaccine campaign against typhoid fever in Malawi. From May 2023 onwards, the typhoid conjugate vaccine will become part of the national routine immunization program following an integrated vaccine campaign that also provides the measles-rubella (MR) vaccine. This huge, nationwide campaign comes at a critical time as the country aims to play “catch up” and give people, who may have previously missed out, access to life-changing vaccines.

During the pandemic, the government put on hold many key routine medical procedures meaning that the ambitious vaccine drive it proposed will be important in reaching underserved populations. The plan, over the course of one week, aims to vaccinate more than 9 million children (up to 15 years of age) and reduce the chance of any outbreaks of measles, rubella or typhoid fever in Malawi, according to Gavi. The typhoid conjugate vaccine is particularly effective as it only requires a single dose.

Why is This Important?

Drug-resistant strains of typhoid are often more complicated and expensive to treat and put additional strain on health systems. At a time when Malawi’s health system is already under pressure, the typhoid conjugate vaccine, which WHO approved in 2018, could transform issues surrounding typhoid fever in Malawi. It is the first typhoid vaccine that can be used for children younger than 2 years of age and may provide longer-lasting protection.

Urbanization and climate change are likely to increase the global burden of typhoid fever, according to WHO. The recent floods that have hit Malawi as part of Cyclone Freddy are just an example of this. The storms displaced over 500,000 people and the government declared a state of disaster in 14 districts. For those who have lost their homes, it is harder to access clean water, and multiple families sharing crowded spaces means that the spread of infections like typhoid fever will increase if people are not vaccinated.

The Future

Malawi has been at the forefront of promoting solutions to typhoid fever – it was the first African country to provide typhoid conjugate vaccine efficacy data and was part of a five-year global project to accelerate the introduction of the vaccine.

Malawi is only the third country in Africa to introduce the typhoid conjugate vaccine into routine immunization. A study conducted in 2021 in Blantyre, the capital of Malawi, proved the vaccine to be 84% effective and hopefully the government’s decision to include the typhoid conjugate vaccine in routine vaccinations will have similar implications around the continent. It is not only important for controlling typhoid disease itself but it could also help reduce the increasing international problem of antimicrobial resistance.

– Almaz Nerurkar
Photo: Flickr