This story, by Leon Ochiai and Mohamed Imran Khan, of the International Vaccine Institute (IVI)’s VIVA Initiative, originally appeared in the May 2011 issue of the Global Immunization Newsletters. It describes the progress of pilot programs to introduce a typhoid Vi conjugate vaccine in Pakistan and Nepal. The story is part of a series written by Coalition against Typhoid members.

IVI’s Vi-based Vaccines for Asia (VIVA) Initiative is engaged in a range of activities across Asia including pilot introduction projects, a Vi conjugate vaccine program, and an investment case program. VIVA is currently assisting withtyphoid vaccine pilot introduction programs in Pakistan and Nepal.

In Pakistan, more than 95,000 students of two Karachi townships have been vaccinated as of April 2011. The vaccination campaign is scheduled to continue until the end of May. In an evaluation of a school-based cross-subsidization scheme, children in public schools are provided Vi vaccine free of charge whereas a nominal fee is charged to students in private schools. The campaign also includes a communication strategy that uses print and electronic material for typhoid fever related information dissemination.

In Nepal, the Ministry of Health and Population reviewed the extent of the typhoid fever problem and decided to implement a pilot introduction program as part of the process of deciding to include typhoid vaccination in its national public health program. The VIVA Initiative in Nepal is piloting an alternative cross-subsidization scheme with vaccine being offered free of charge to school children in Lalitpur district while a nominal fee is charged to tourism industry workers in Kathmandu Valley. The pilot program will provide valuable information to assist the government of Nepal with selecting a national or regional vaccination strategy.

In collaboration with various stakeholders including ministries of health, non-governmental organizations, professional medical associations, academic institutions, and collaborative groups including the Coalition against Typhoid, VIVA is working to increase demand for the typhoid vaccine by increasing awareness of preventive measures against the disease. Pakistan and Nepal are among the South Asian countries with the highest burden of typhoid fever, particularly among children, with incidence estimates exceeding 300 per 100,000 persons per year.