Standing at a distance, Ishrat is fascinated watching her two boys dancing to the beat of the drum. The dholwala is surrounded by children of various age groups from the slums in Sector E- 12 in Islamabad. With a microphone in hand, the community social mobiliser is announcing the dates of the new typhoid vaccine that will be introduced in Islamabad from February 1.

Ishrat’s two boys — two-year old Ayan and five-year old Mohammad — live with her in Mera Jaffer in a one-room house in sub-human conditions. The sector has unruly settlements made of half-built structures and even tents with no access to amenities like electricity, water supply and garbage disposal. Given the squalid conditions they live in, it is a perfect breeding ground for childhood diseases. Children falling sick is a routine here.

A responsible mother, Ishrat has had her two children vaccinated at the government’s health facility. Given the information, she is all set to get her children vaccinated against typhoid. However, living in the slums, she doubts if the vaccination will be available for her children.

“Typhoid is a highly contagious disease that spreads quickly and easily when people live in crowded neighbourhoods with weak water and sanitation infrastructure. However, we strongly believe that TCV would protect our children against the potentially fatal disease of typhoid,” says Dr Hasan Orooj, the Health Department director general at the Metropolitan Corporation of Islamabad (MCI).

Pakistan is one of the countries that suffer a huge burden of typhoid in their children and young population. Recently, a strain of typhoid that is extremely resistant to antibiotics, called extensively drug resistant (XDR) typhoid has been spreading all over the country, says Dr Anita Zaidi, the Vaccine Development director at Bill & Melinda Gates Foundation.

In November 2019, Pakistan became the first country in the world to introduce the typhoid vaccine in Sindh. Following the successful roll out of life-saving typhoid vaccines in Sindh, children across Islamabad and the Punjab will now be protected against this horrific disease, supported by GAVI, the Vaccine Alliance.

“Every child in Pakistan deserves a typhoid conjugate vaccine to protect them. We are lucky, there are new vaccines, called typhoid conjugate vaccines that are effective in young children in protecting them against typhoid,” adds Dr Zaidi.

Targeting children aged between nine months and 15 years, the two-week campaign will be followed by transition to routine immunisation for nine month-old all children in the capital.

Over the years, urban slums have lacked access to safe water sources and sanitation facilities. Such slums increase the ease and speed of typhoid transmission, says Dr Orooj, dismissing the belief that typhoid only impacts rural communities. Prevention through vaccination in urban areas is the most effective solution to control the disease among the communities most at risk.

The campaign targets to achieve 95 percent coverage. A major portion of the targeted children are school-going. The campaign teams will be vaccinating children at both public and private schools and madrassas.

Pakistan is one of the countries that suffer a huge burden of typhoid. Recently, a strain of typhoid that is extremely resistant to antibiotics, called extensively drug resistant typhoid, has been spreading all over the country.

A hard-to-reach group would be the non-school-going children aged five years and above. Most vulnerable and difficult to trace, this group includes street children as well as those working as domestic help and at workshops etc.

Speaking on the importance of communication in a new vaccine introduction, Dr Zaeemul Haq, the technical advisor at the Ministry of National Health Services Regulation and Coordination, says, “People need to know the disease (and its complications) against which a new vaccine is being introduced, the schedule and mode of administration of this vaccine, along with satisfactory responses to the additional questions that they may have.”

He says the EPI teams will make all efforts to maximise the coverage while ensuring compliance with the Covid-19 SOPs. This will mean reaching a large number of children and their families, while avoiding crowding and ensuring a 6-feet distance and face masks.

“The cooperation of parents, older children, and support from school administration will be crucial in this regard,” he adds.

“TCV is being introduced for the first time and for a big age group. Therefore, community mobilisation is extremely important to reduce vaccine hesitancy and attaining high coverage,” says Lubna Hashmat, the Civil Society Human and Institutional Development Prorgramme CEO.

Ahead of the campaign, her organisation is engaged in activities to mobilise communities and generate demand for families to vaccinate their children. “We have already held more than 500 communal awareness raising sessions,” says Imran Ahmed, who works with Hashmat.

Busting the myths around vaccination and mobilising and persuading parents to take their children to fixed EPI centres or outreach sites set during the campaign, Imran’s organisation is creating awareness of the disease – typhoid, and the advantages of getting the children vaccinated.

The activities include organising typhoid rallies, speaking with parents and school teachers in the community and liaising with religious leaders at mosques, madrassas and churches to help support vaccine acceptance.

A variety of attractive tools, such as special characters, mass-level display of visuals and monkey performances have helped get the message across in the community. Drum beaters are engaged to attract crowds in the slums.

Overall response from the influencers has been positive. It would be challenging to vaccinate out-of-school children without parental consent as a majority of them roam around accompanied and unwilling to talk.

“A majority of the madrassas have hostel-based children hailing from remote areas. The madrassa in-charge is unwilling to take responsibility for vaccination,” says Ahmed.

Typhoid is a serious and life-threatening fever, spread through contaminated food and water. It disproportionately impacts children and marginalised populations in South Asia. According to Jawed Ali Khan, the UN HABITAT country manager, poor hygiene practices and a dismal healthcare system are perfect breeding grounds for typhoid bacteria.

Contaminated water sources and inadequate sewage systems, broken-down infrastructure, dilapidated sanitation system, and more than 40 percent of the country’s population living in katchi abadis exacerbate transmission

More work lies ahead. “As the world focuses on Covid-19 vaccines, we cannot afford to take our eyes off the ball when it comes to other deadly diseases, such as typhoid,” says Alexa Reynolds, Pakistan senior country manager at GAVI.

Importantly, oral polio vaccine will also be offered as part of this campaign, helping us to move even closer to eradicating this disease from the country, she adds.