Typhoid Conjugate Vaccine (TCV): Importance, Benefits, and Need for Inclusion in India’s Universal Immunisation Programme

Typhoid fever continues to be a major public health concern in India and other South Asian countries. Despite improved sanitation and healthcare systems, the disease remains widespread, primarily affecting children. The Typhoid Conjugate Vaccine (TCV) offers a long-lasting, cost-effective solution to prevent typhoid infections and reduce mortality rates.

Developed by Bharat Biotech and prequalified by the World Health Organization (WHO) in 2017, Typbar TCV is the first WHO-approved conjugate vaccine against typhoid. However, India, despite being a leading global supplier, has yet to include it in its Universal Immunisation Programme (UIP).

What is Typhoid Conjugate Vaccine (TCV)?

The Typhoid Conjugate Vaccine is an advanced form of vaccine that combines the Vi polysaccharide antigen of Salmonella typhi with a carrier protein. This combination enhances the body’s immune response and provides longer protection, even in infants as young as six months.

Key Features of TCV:

• Provides long-term immunity (up to 10 years)

• Effective in infants, children, and adults

• Single-dose vaccine

• Can be administered alongside other childhood vaccines

• Highly safe and cost-effective

Global Adoption of TCV

Since its WHO prequalification, several countries have introduced TCV into their routine immunisation programmes. Bangladesh recently became the eighth country to launch a nationwide TCV drive, targeting 50 million children between 9 months and 15 years.

Other countries like Pakistan, Nepal, and Liberia have also included TCV in their national vaccination schedules with significant success in reducing infection rates.

Despite supplying the vaccine globally, India has yet to implement it domestically, highlighting a crucial policy gap.

Typhoid Situation in India

Typhoid, caused by Salmonella typhi, spreads through contaminated food and water. It disproportionately affects children, leading to lost school days, hospitalizations, and economic burden on families.

• Annual burden: ~4.5 million cases

• Deaths: ~9,000 annually (SEFI study, 2017–2020)

• Global share: India accounts for nearly 40% of the world’s typhoid cases

Urban regions report particularly high incidence due to poor sanitation, unsafe water, and antibiotic misuse.

Challenges in Diagnosis and Treatment

Typhoid symptoms—high fever, headache, weakness, and abdominal pain—often mimic malaria and dengue, leading to misdiagnosis.

Diagnostic issues:

• Blood culture is accurate but costly and unavailable in many rural areas.

• The commonly used WIDAL test is unreliable and leads to overdiagnosis.

Rising antibiotic resistance is another critical challenge. Resistance to azithromycin and ceftriaxone is increasing, and extensively drug-resistant (XDR) strains from Pakistan pose a serious cross-border threat.

Water, Sanitation, and Hygiene (WASH) Limitations

Despite government initiatives like the Swachh Bharat Mission, only 6% of urban households in India have access to safe drinking water. Poor sanitation and contaminated water sources remain key drivers of typhoid transmission.

Thus, combining vaccination with improved WASH infrastructure is essential to control typhoid effectively.

Why India Needs to Include TCV in the Universal Immunisation Programme

The inclusion of the Typhoid Conjugate Vaccine in India’s Universal Immunisation Programme (UIP) is critical for several reasons:

1. High Disease Burden: Millions of annual cases make typhoid a persistent health threat.

2. Cost-Effective Prevention: TCV is cheaper than hospitalization or long antibiotic treatment.

3. Resistance Control: Reduces dependence on antibiotics, slowing drug resistance.

4. Equitable Access: Private sector cost is high; inclusion in UIP ensures free access for all.

5. Global Commitment: Aligns India with WHO recommendations for endemic regions.

Field trials conducted in Navi Mumbai have already proven TCV’s safety, efficacy, and long-term protection.

Government and Policy Updates

The National Technical Advisory Group on Immunisation (NTAGI) has been evaluating TCV for inclusion since 2016. While India has a strategic partnership with GAVI (Global Alliance for Vaccines and Immunization), progress has been slow.

Given India’s manufacturing strength—led by Bharat Biotech, Serum Institute, and Zydus Lifesciences—the country is well-equipped for mass production and nationwide distribution.

WHO Recommendations

The World Health Organization strongly recommends introducing TCV in countries with a high typhoid burden, especially where drug-resistant strains are emerging. WHO supports integrating TCV into routine childhood immunisation programs due to its proven effectiveness and affordability.

Conclusion

India stands at a critical juncture in public health policy. With one of the world’s highest typhoid burdens, domestic vaccine production capacity, and WHO-backed evidence, the inclusion of the Typhoid Conjugate Vaccine in the Universal Immunisation Programme is both timely and necessary.

Introducing TCV will not only protect millions of children but also strengthen India’s fight against antimicrobial resistance and reinforce its global leadership in preventive healthcare.

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