Amidst crises, Malawi showcases resilience with major vaccination push

By Gavi, the Vaccine Alliance

Amidst crises, Malawi showcases resilience with major vaccination push

With support from Gavi, the Vaccine Alliance, WHO, UNICEF, TyVAC, and other partners, the Government of Malawi today 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.

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.

“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,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa.

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.

Vaccination in a time of crisis relies on the fortitude of healthcare workers, the government and local partners. The integrated approach utilised in this national campaign seeks to make the best use of available resources to deliver a lifesaving impact – recognizing the limited capacity of healthcare 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 disasters 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 that TCV is highly effective for the country context and that there is a high prevalence of multidrug-resistant typhoid fever – making the national introduction of TCV a high priority. It is the sixth country in the world, and the 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.

“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.

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 cholera (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.