The three-week campaign aims to reach all children between 15 months and 15 years to quickly achieve wider protection from the disease

Nepal has decided to immunize 7.5 million children against typhoid this year, a move that is drawing praise from across the world with experts saying the country has maintained its pre-pandemic routine vaccination levels.

“Nepal has maintained its pre-pandemic routine vaccination levels, 82%, while reaching 83% of COVID vaccination coverage for 12+ population. How? Investing in Primary Health Care and supporting female community volunteers,” tweeted Paloma Escudero, Director for Global Communication and Advocacy UNICEF.

On April 7, with support from Gavi, the Vaccine Alliance, WHO, UNICEF and other partners, the Government of Nepal launched Typhoid Conjugate Vaccine (TCV). GAVI, the global alliance for vaccines, has provided the typhoid vaccines free of cost. Nepal is the fourth country supported by Gavi to introduce TCV after Pakistan, Liberia and Zimbabwe.

The three-week campaign aims to reach all children between 15 months and 15 years to quickly achieve wider protection from typhoid, increase the impact of the vaccine introduction and combat the rise of antimicrobial resistance.

Over 50,000 vaccination sites have been established across rural and urban settings in the country, including schools.

Nepal is a typhoid-endemic country and is estimated to have one of the highest burdens of typhoid in the world. The Global Burden of Disease study estimated that in 2019, there were at least 82,449 typhoid cases and 919 typhoid deaths in Nepal.

The nationwide introduction means children in the country under the age of 15 years will now be able to access the vaccine free of charge.

The COVID-19 pandemic caused disruptions to routine immunisation from global to local levels, affecting every aspect of vaccine supply, access, and demand. And Nepal was no exception. Like other governments across the world, the government of Nepal imposed a nationwide lockdown on March 24, 2020 a day after the second case of Covid-19 was confirmed in the country. This lockdown came as an early response to the pandemic in Nepal and went through different phases, including the closure of internal and external transportation, businesses, and academic institutions.

The lockdown measures impacted Nepal’s decade-long substantial progress on child health, especially the routine childhood immunisation services. Nepal’s routine childhood immunisation services were suspended in different parts of the country, resulting in approximately three million children aged 9 months to 5 years missing their regular vaccination doses.

According to a Lancet study estimates of vaccination coverage in 2020 suggested that 23 million children missed out on basic vaccines worldwide through routine immunisation services, which is 3·7 million more than in 2019.

During the first wave in 2020, villages in Nepal’s Dhading and Gorkha districts suffered outbreaks of measles as families were unable to vaccinate their children.

Nepali government vaccinates over 620,000 children below the age of one against 12 diseases every year. In 2019, around 537,000 children were jabbed. In 2020, as Covid-19 spread in Nepal, the number went down to 483,000.

In March 2020, when the country imposed lockdown, only around 8,000 out of around 16,000 vaccination centres were open. Due to the closure or inability of people to move, thousands of children missed out on the immunisation drive. In 2020 the BCG vaccine coverage rate, went down 16 per cent. In 2021, however, the coverage of the vaccine went up by 79 per cent.

Under Nepal’s National Immunization Programme, children from the ages of 16 to 23 months are mandatorily vaccinated against a range of diseases including measles-rubella, pneumonia, tuberculosis, diphtheria, pertussis, tetanus, hepatitis B, rotavirus and Japanese encephalitis. These vaccines are provided free of cost from health facilities around the country.

Nepal initiated the National Immunization Programme (NIP) in 1977, originally offering BCG and Diphtheria, Pertussis, and Tetanus (DPT) vaccines to children free of charge. At present NIP includes vaccines for 11 vaccine-preventable diseases–diphtheria, hemophilus influenza B, hepatitis B, Japanese encephalitis, measles, pertussis, pneumococcal disease, polio, rubella, tetanus, and tuberculosis.

Typhoid Conjugate Vaccine is the latest addition to the vaccination programme of the country. NIP is a top priority program in Nepal and has achieved significant milestones, including being declared polio-free in 2014 and maintaining maternal and neonatal tetanus elimination status since 2005.

In 2012, Nepal began the “Reaching Every Child” program under NIP to declare full immunization across the country. By 2020, 56 out of 77 districts had achieved this goal. The country still has a long way to go to achieve its goal of 95 percent immunization coverage by 2030.

On its website, Gavi has praised the introduction of typhoid conjugate vaccine in Nepal calling it “a great step forward in keeping children healthy and protected from typhoid.”

“Once the vaccination campaign concludes, TCV will become available for all 15-month-old infants through the routine immunization schedule. The introduction of TCV in Nepal demonstrates our unwavering commitment to ensuring the health and wellbeing of our nation’s children.”