IT has been at least a couple of years, now, that medical associations have been pointing out the outbreak of a drug-resistant strain of typhoid fever in the country. Last year, a study by the Aga Khan University discovered over 800 cases of multidrug-resistant cases in Hyderabad between 2016 and 2017 — as compared to the period between 2009 and 2014 when a mere six cases of the illness were reported. With possibly another public health crisis on its hands, the Sindh health department, in tandem with the Aga Khan University and international donor assistance, chalked out a four-month vaccination campaign that aimed to inoculate some 250,000 children in Hyderabad’s worst-hit areas.

How far that campaign got is difficult to ascertain, but the latest reminder that the emergency has not yet been ridden out comes from the Centre for Disease Control in the US. The organisation recently released its Morbidity and Mortality report, which notes that there is an outbreak of extensively multidrug-resistant Salmonella Typhi in this country, with 5,372 cases being reported between 2016 and 2018. Most of the cases were reported from Hyderabad and Karachi; it further points out that of 29 patients diagnosed with multidrug-resistant typhoid fever in the US, all had travelled to or from Pakistan in the period between 2016 and 2018. These are alarming realities that Pakistan can simply not afford to ignore. It may be time to consider making the typhoid vaccine part of the national immunisation programme, particularly given the fact that it is available and affordable. But more than that, the authorities — especially the Sindh government where the typhoid crisis is looming — must focus on issues such as the lack of the availability of potable water, the unsanitary conditions that prevail in many neighbourhoods (including the disposal of wastewater), and the poor understanding of many citizens of the principles of adequate hygiene. Without such measures, the country cannot dig itself out of the hole it finds itself in.

Published in Dawn, January 14th, 2019