Last year, American and Nepali public health specialists successfully tested a new intramuscular typhoid vaccine. The epidemiologists reported in the New England Journal of Medicine that the prevalence of disease among those vaccinated was one fourth that of those who had not been vaccinated. It might well be (and one hopes) that this new vaccine will prove itself by saving lives and health of thousands of Nepalis.
The intramuscular vaccine tested in the study requires only one dose, has few side effects and is 75 per cent effective. An oral vaccine tested in Chile and other countries requires three doses and also has no side effects. However, its effectiveness is 60 to 70 per cent.
Since the preliminary reports point to a major breakthrough, it is important to ask a few questions in the context of Nepali public health. If the research was done for the sole purpose of testing the vaccine, then the project was successful. But if the purpose was to initiate a programme of intramuscular typhoid vaccine in Nepal, then the matter needs to be discussed.
The intramuscular method of vaccination requires an adequate number of trained personnel for country-wide coverage, plus syringes, vials and special facilities for distribution and storage. Given the scarcity of health professionals and equipment, the best one could do would be to run ad hoc immunization campaigns.