BANGLADESH has recently embarked on an unprecedented public health drive — vaccinating five crore children against typhoid fever. The campaign, one of the largest ever in the country, is both ambitious and necessary. Yet it also raises crucial questions about the choice of vaccine, the process of adoption, and the broader priorities of public health investment.
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Understanding disease burden
ACCORDING to data from the Directorate General of Health Services, gastro-intestinal diseases, including typhoid but excluding diarrhoea, account for about 1.06 per cent of all deaths in Bangladesh. While this is a significant figure, it is overshadowed by other major killers, cardiovascular and respiratory diseases, pregnancy-related complications, sepsis, stroke, diabetes and cancers.
In absolute terms, around 477,500 typhoid cases and some 8,000 deaths were recorded in 2021. The roots of this burden are familiar: rapid urbanisation without matching sanitation systems, poor drainage and limited access to safe drinking water. These conditions keep the disease endemic and make preventive strategies, vaccination among them, both urgent and complex.
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Science behind vaccine
VACCINES against typhoid have evolved over time. Two main types have been prequalified by the World Health Organisation: the polysaccharide vaccine (Vi antigen) and its conjugate form. The conjugate vaccine, by linking the antigen to a protein carrier, induces a stronger and longer-lasting immune response by engaging both B and T cells, the body’s two main defenders against infection. This translates to better immunity and, importantly, immune memory that allows the body to respond rapidly if the bacteria reappear.
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Typbar and Typhibev: tale of two vaccines
THE world’s first typhoid conjugate vaccine, Typbar-TCV, was developed by Bharat Biotech and received WHO prequalification in 2018. It underwent extensive clinical trials in countries including Malawi, Nepal, Bangladesh, India and Pakistan, involving hundreds of thousands of participants.
Bangladesh, however, has chosen to deploy Typhibev-TCV, produced by another Indian manufacturer, Biological E. This vaccine, prequalified in 2020, was compared to Typbar through a process known as ‘immuno-bridging’ — essentially showing that it is not inferior in generating immunity. Although WHO accepted the results, studies suggest that Typbar may still offer slightly better efficacy and a longer duration of protection, five years compared to four for Typhibev.
Interestingly, India itself has yet to include any typhoid vaccine in its national immunisation schedule, despite its National Technical Advisory Group on Immunisation recommending so in 2022. Bangladesh’s decision, therefore, to roll out the vaccine nationwide in a single massive campaign, even before routine inclusion, appears unusually hasty.
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Side-effects and safety oversight
BOTH Typbar and Typhibev have similar side-effect profiles. Common reactions include pain, redness, or swelling at the injection site, mild fever, headache and fatigue. More serious but rare adverse events, such as allergic reactions, kidney or liver problems and blood disorders have also been reported. WHO guidelines clearly advise that adrenaline injections be kept ready at vaccination centres to manage potential anaphylaxis and that recipients remain under observation for at least 30 minutes.
In practice, however, there has been little public discussion about post-vaccination monitoring or active pharmacovigilance in Bangladesh. Given global lessons from the Covid-19 vaccine rollout, where the speed of approval sometimes outpaced scientific scrutiny, transparency in monitoring adverse events should be non-negotiable.
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Economics of immunisation
WHILE the vaccine is currently provided free of cost, future procurement will fall on the government. Typbar costs roughly ₹1,530 per dose, while Typhibev is slightly higher at ₹1,656. For an annual birth cohort of 3.4 million children, that could translate into around Tk 777 crore in expenditure each year.
Such figures merit reflection. Improvements in sanitation, drainage and access to clean water could curb not only typhoid but a range of waterborne and foodborne diseases, often at a better benefit–cost ratio. Typhoid vaccination is an important tool, but it should complement, not substitute, structural public health investments.
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Call for prudence
THERE is no denying the importance of protecting Bangladesh’s children from typhoid fever. Yet public health policy must always balance urgency with rigour. Before scaling up such a vast and costly campaign, the questions deserve clear answers: why was Typhibev chosen over the more extensively tested Typbar? Were the WHO’s safety protocols strictly ensured? And how does this single-disease approach fit within a broader framework of health priorities that target the country’s leading causes of death?
Vaccines save lives, but so do transparency, accountability and foresight in public health planning. Bangladesh’s typhoid campaign can be a milestone for preventive medicine, but only if it rests on sound science, careful monitoring and honest reflection.
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Abu Muhammad Zakir Hossaind is chairman of Community Clinic Health Support Trust and former director, Primary Health Care & Disease Control and director of IEDCR, DGHS.
