MALAWI—An integrated vaccination campaign has been launched in Malawi that will introduce typhoid conjugate vaccines (TCV) into the immunization system that targets 9 million children.

This TCV campaign in Malawi also serves as an opportunity to administer polio vaccines, measles-rubella vaccines, and vitamin A supplementation to eligible children.

The Ministry of Health in Malawi is collaborating with Partners in Health (PATH), the Global Alliance for Vaccine and Immunization (GAVI), and UNICEF to execute this campaign.

Over the course of seven days, the vaccination campaign will focus on children of various ages, ranging from newborns to 14-year-olds.

The Ministry of Health has assured citizens that any children who may have been inadvertently missed will be reached through a mop-up exercise later in the year.

Malawi is taking advantage of this TCV campaign to also provide polio vaccines, measles-rubella vaccines, and vitamin A supplementation to age-eligible children.

Vaccines will be available at mobile and non-mobile sites, including clinics, via mobile outreach teams, and schools.

After the campaign, Malawi will transition to routine immunization, where TCVs will be available at 9 months of age. 

New vaccine introductions offer an opportunity to strengthen routine immunization services.

The mass mobilization of resources required to reach millions of children quickly throughout the country is an ideal time to reach hard-to-reach populations or identify children who may have missed other routine vaccinations.

Anticipated hesitancy and resistance

However, some fear the campaign will encounter hesitancy and resistance from people, as was the case with COVID-19 vaccines, which led to the burning of about 20,000 expired doses in Malawi in 2021.

George Jobe, chairperson of the Universal Health Coverage Coalition in Malawi said that efforts were made to educate people on the importance of the campaign with the training of community healthcare workers, community leaders as well as teachers who would advocate the vaccines to their constituents.

Malawi’s national integrated vaccination campaign will also work with partners on a communication strategy such as developing and testing messages and materials to ensure they are clear, understandable, and culturally appropriate.

According to the World Health Organisation, Typhoid has long been a health threat in Malawi and across sub-Saharan Africa, with an estimated 1.2 million cases and 19,000 deaths each year.

Through the Typhoid Vaccine Accelerated Consortium, in 2018, Malawi became the first country to use TCV to fight typhoid infections in children under clinical trials.

Over 20,000 children from 9 months to 12 years of age took part in a clinical trial that was then led by the Malawi Liverpool Wellcome program, and the trial found the vaccine was safe and was more than 80% effective.

Alarming Typhoid burden in Malawi

Malawi has a staggering typhoid burden, with surveillance data from the coalition against Typhoid showing 444 cases per 100,000 people per year.

Most of these cases occur in children younger than 15 years old with an increase in cases being attributed to rising drug resistance trends and impacts from climate change both raise the risks of increased typhoid transmission and the urgency for preventative measures.

Various partner organizations such as PATH, which are part of the Typhoid Vaccine Acceleration Consortium, has been a key partner to Malawi’s Ministry of Health and Expanded Programme on Immunization to support these critical activities.

Through their offices in Malawi, PATH provides local support to plan and prepare, which was particularly useful as new challenges arose, including Cyclone Freddy.

Emmanuel Mugisha, PATH’s Typhoid Vaccine Acceleration Consortium Project Director said, “Cyclone Freddy was one of the worst storms to hit Malawi, and its aftermath has increased the risks of waterborne diseases, including typhoid.”

25 million children miss routine vaccinations in 2021

According to the UNICEF 2023 State of the World Children report, the COVID-19 pandemic had a significant impact on routine immunization services worldwide, resulting in an estimated 25 million children missing out on routine vaccinations in 2021.

This disruption has led to a global increase in measles cases, and in 2022, Malawi reported its first polio case in 30 years.

The use of typhoid conjugate vaccines (TCV) has proven to be safe and effective in outbreak response efforts.

Examples of its successful implementation include Pakistan, where TCV was used to control an extensively drug-resistant typhoid outbreak that began in 2016, as well as in Zimbabwe.

Following Pakistan’s TCV campaign during the outbreak response, it became the first country to introduce TCVs into its routine childhood immunization program.

The phased introduction began in Sindh Province in November 2019, followed by Punjab Province and Islamabad in 2021.

Liberia was the first African country to incorporate TCV into its national routine immunization schedule in April 2021.

This was followed by Zimbabwe in May 2021, Samoa in August 2021, and Nepal in April 2022.

In April 2018, the World Health Organization’s Strategic Advisory Group of Experts (SAGE) on Immunization concluded that the typhoid conjugate vaccine (TCV) met all requirements.

As a result, WHO has recommended the introduction of TCV for infants and children over six months of age in countries where typhoid is endemic.

This new policy aims to ensure that communities most affected by the disease, which causes nearly 12 million infections and between 128,000 and 161,000 deaths globally each year, have access to typhoid vaccination.

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