Pakistan and the New Typhoid VaccineTyphoid is a disease caused by Salmonella Typhi that spreads through contaminated food and water, disproportionately affecting children. There were nearly 11 million typhoid cases and more than 116,000 deaths worldwide. In Pakistan, children younger than 15 years old made up 70 percent of deaths from typhoid in 2017. Treatment with antibiotics is essential in controlling and preventing the spread. Further, vaccination helps to protect people from contracting typhoid disease.

There are several ways of preventing and treating typhoid. Preventative measures include improved sanitation, hygiene and water supply. Additionally, treatments include the use of effective antibiotics and vaccines. However, with the rising drug-resistant typhoid outbreak, the antibiotics have become ineffective.

Pakistan and the New Typhoid Vaccine

Pakistan is facing an extensively drug-resistant typhoid outbreak. However, the opportunity arose to revamp its vaccine strategy. This strategy now includes a typhoid conjugate vaccine as part of the routine immunization program. Pakistan in the first country to pilot the new typhoid conjugate vaccine. It hopes that the vaccine will be a breakthrough in the face of drug-resistant antibiotics.

The country’s drug-resistant outbreak “has infected more than 10,000 people.” This is the first-ever reported outbreak to be resistant to the drug ceftriaxone and to all but one oral antibiotic for typhoid. These challenges make the disease costly to treat. However, the new vaccine has been proven successful and safe to use as part of the outbreak response since April 2019. This vaccine establishes Pakistan as the first country in the world to introduce a vaccine set to protect 10 million children within its first two weeks.

The Importance of the Vaccine in Pakistan

Historically, Pakistan makes up one of three countries bearing the burden of the high prevalence of typhoid, along with Bangladesh and India. Typhoid is often referred to as a disease of the poor. It has been neglected by many organizations in terms of investment in vaccines. Dr. Samir Saha, Executive Director of the Child Health Research Foundation at Dhaka Shishu Hospital, states, “vaccination is not the end of the story…we need to continue surveillance to measure the impact of TCV introduction on typhoid burden and the improvement of the overall health system.”

The World Health Organization has recommended and approved this new vaccine. Additionally, the Global Alliance for Vaccines and Immunizations (GAVI) will provide the vaccine to Pakistan at no cost. The government of Pakistan is launching the vaccine introduction with the central focus and campaign beginning in Sindh Province. This location is the center of an ongoing drug-resistant (XDR) typhoid outbreak that began in November 2016. The vaccine’s improved characteristics include a stronger immune response, a longer duration of protection and usability in infants as young as 6 months.

Pakistan’s Health Authorities have reported a notable ongoing outbreak of the drug-resistant strain. Further, the resistant strains of Salmonella Typhi pose a public health concern for the country’s population. However, with the funding support from GAVI, the new typhoid vaccine introduction will initiate a two-week vaccination campaign. Once the campaign ends, Pakistan will routinize the immunization of infants. The government announced plans to introduce the vaccine in neighboring areas of Pakistan next year and then nationally in 2021.

Na’Keevia Brown
Photo: Flickr

Vaccines in Egypt On March 14, 2019, the vaccination company Pfizer, in partnership with Gavi, The Vaccine Alliance reduced the price of the pneumococcal vaccine (PCV) to $2.90 per dose for eligible countries. Gavi’s mission since 2000 has been to “improve access to new and underused vaccines for children living in the world’s poorest countries”. Public and private sectors fund the creation and distribution of important vaccines in 73 developing countries partnered with Gavi.

The Benefit of Price Drops

In 2017, the price of a single dose PCV was $3.30. However, as a result of negotiations between Pfizer and Gavi there have been three pneumococcal vaccine price drops since January 2017. It is expected to save developing countries $4.1 million this year. Dr. Seth Berkley, the CEO of Gavi says “pneumonia remains the single largest cause of death for children worldwide and [the] pneumococcal vaccine is one of our largest weapons against it”. The price drop comes at a pivotal time.

PCV is a Priority

PCV takes as long as 15 years to reach developing countries that need it the most. Whereas the vaccine is already easily accessible and widespread in industrialized nations. Vaccines have not been easily accessible in developing nations. They are expensive and difficult to distribute effectively in nations lacking funds and resources. The focus is on different areas. For example, the proportion of developing countries’ exports that is needed to service their overseas debt rose from 11 percent in 1970 to 18 percent in 1996, while overseas aid from the U.S. plummeted $14 billion. With the drop in PCV pricing, developing countries can invest in their public health.

The value of vaccines as a long-term investment for developing countries is leading to pneumococcal vaccine price drops. Vaccinating the youth population of developing countries, according to Gavi, creates a “virtuous cycle”.

The Cycle Follows This Order of Cause and Effect

  • Children have vaccines before the age of two
  • These children are likely to be healthier and live longer
  • Children have fewer and less serious illnesses
  • This leads to lower care costs for health systems and family
  • Which means more family money available to spend or save
  • Children will attend school more, fueling better outcomes
  • A family’s economic outlook will strengthen based on these outcomes
  • Birth rates drop and mother’s health improves
  • A community becomes more economically stable and productive
  • Contributing to politically and economically stable countries

By looking at the cost-benefit analyses for vaccinations, scientists are able to see this “virtuous cycle” in action. A study, conducted by the Cebu Longitudinal Health and Nutrition Survey in 1975, took data from a sample of Filipino children. Researchers compared test scores of children who received six vaccines in their first two years versus those that did not. The study reveals the association of immunization with improved IQ scores, language and mathematics tests. Untreated childhood illness can impair cognitive development.

Developing countries often have large obstacles to face such as food scarcity, a lack of widespread education and low GDPs. Investing in vaccines is a long-term solution that will benefit the economic, health, societal and governmental sectors of these nations. With the pneumococcal vaccine price drops, this seems to be an attainable reality for developing countries.

– Meredith Breda
Photo: Flickr

The recent breakout of yellow fever in Africa highlights the urgent need to continue routine immunizations.

Yellow fever is an acute viral hemorrhagic disease transmitted by mosquitoes. “Yellow” refers to jaundice that occurs as a side effect of the disease. According to the WHO, there are an estimated 200,000 cases of yellow fever, causing 30,000 deaths, worldwide each year, with 90 percent occurring in Africa.

The first “acute” phase of the disease usually causes fever and muscle pain with a backache, headache, shivers, loss of appetite and nausea or vomiting. However, the second “toxic” phase, which affects 15 percent of patients, is deadly.

The patient develops jaundice (a yellowish discoloration of the skin) and abdominal pain with vomiting. Bleeding occurs from the mouth, nose, eyes or stomach and kidney function deteriorates. Half of the patients who enter the toxic phase die within 10 to 14 days.

Yellow fever is difficult to diagnose and there is no specific treatment. The only thing that can be done after contracting the disease is treating the symptoms. That is why vaccines are the only means of protection against the disease.

Past success in combating yellow fever was due to vaccines. According to Gavi, a global Vaccine Alliance created in 2000, mass yellow fever vaccine campaigns in 14 African countries have lowered risk of outbreaks by up to 82 percent and over 30 million doses from the emergency stockpile have been administered.

However, there has been an increase in yellow fever cases in the past few years. Some blame complacency and lack of awareness for the disease’s comeback.Yellow_Fever_in_Africa

“The resurgence of yellow fever in Africa is a classic tale of complacency: not only the routine immunizations aren’t kept up with the required levels, but the vaccine supply doesn’t match the world’s requirements. According to UNICEF, the world needs about 64 million yellow fever vaccine doses, but only 35 million are produced—42 percent under the required quantity.”

Aid is crucial for problems like this. What’s more, the size of this problem is not too big to handle through aid alone. This disease could be wiped out with something as simple as routine vaccinations.

The U.S. has plenty of resources to knock this problem out but has not utilized enough of its budget for the benefit of suffering countries. 51 percent of U.S. discretionary spending in 2015 went to national defense. Five percent went to international affairs, which accounts for more than just foreign aid.

The private sector tends to do more in terms of aid than the government. In response to the spike in yellow fever cases, the Gates Foundation has stepped in to help with a $1.6 million investment in Senegal’s manufacturer of the vaccine, says Quartz.

While this investment will help hundreds of thousands of at-risk people, it won’t last forever. That is why a long-term solution calls for awareness. Gavi’s business challenge puts awareness at the forefront as the foundation of its sustainable solution. Getting vaccines on countries’ agendas is the first step of its co-financing model.

Although it seems like diseases are something that we just have to live with, we have to realize all that we are capable of. Organizations like Gavi and the WHO have made so much progress already. Knowledge and prevention lead to solutions, and with a collective effort, humans can win against diseases. We can defeat yellow fever.

Ashley Tressel

Sources: QZ, GAVI, WHO, InsideGov
Photo: Flickr, Wikipedia