Neglect of typhoid outside rich countries ‘threatens global health emergency’
Untreatable strains of typhoid threaten a new global health emergency that needs urgent collective action, experts warn.
The researchers from Oxford Martin School are calling for global health institutions to dedicate new resources to tackling typhoid.
They say it has become a neglected disease of poorer countries following its elimination in many high-income countries.
Scientists argue the rising antimicrobial resistance and the ongoing outbreak of extensively drug-resistant (XDR) typhoid in Pakistan should be a wake-up call to the international community.
Researchers say that while new vaccines offer hope, one intervention alone will not be enough to eliminate the disease which affects 11 million people a year.
The new typhoid conjugate vaccine (TCV) is already in use in Pakistan on a pilot basis, and is undergoing testing in Malawi.
A full roll-out is expected in the coming months.
Dr Claas Kirchhelle, of the Wellcome Unit for History of Medicine at the University of Oxford, said: "Popular notions of typhoid as a disease of the past are a myth.
"For poorer countries, the spectre of typhoid has never gone away.
"Over the last decades, international neglect, lacking sanitary infrastructures and vaccine programmes, and compensatory reliance on antibiotics have resulted in a situation where typhoid is increasingly difficult to treat.
"The current resurgence of XDR typhoid bears the biosocial footprint of more than half a century of antibiotic-intensive international neglect."
Analysing the past and present of typhoid control, in the journal Clinical Infectious Diseases, the researchers identify a range of actions key to the strategic elimination of typhoid globally.
They say typhoid is still a major global health issue but is largely unrecognised, due to factors including poor surveillance and the complex dynamics of the disease, including new drug-resistant strains.
The scientists also find the availability of cheap credit and sustainable financing schemes for affordable water and sanitary systems at the municipal level have an important role to play in typhoid control – as seen in the elimination of typhoid in the UK and US.
Another finding is that progress on typhoid control will depend on support for independent research and policy decisions within endemic countries to improve water quality.
Researchers, including historians, immunologists and social scientists, also say the recent advent of a new generation of typhoid conjugate vaccines can play an important role until clean water and sanitation are in place for those at greatest risk.
Dr Samantha Vanderslott, of the Oxford Vaccine Group, said: "The emergence of untreatable strains needs to be taken far more seriously.
"Top-down interventions such as vaccination programmes need to be combined with flexible credit to empower local communities, so that they can implement essential infrastructure such as waste disposal, sanitation and clean water systems."
Professor Andrew Pollard, who leads the Oxford Vaccine Group, said: "The escalating problem of antimicrobial resistance means we need urgently to deploy new interventions to tackle typhoid.
"The availability and funding of new effective typhoid vaccines give us a critical tool for strengthening global control of typhoid, with the potential to protect vulnerable populations from this disease."