IN a hospital in Hyderabad, a young girl lies feverish and weak. After weeks of inconclusive treatments, her doctors deliver a daunting diagnosis: extensively drug-resistant (XDR) typhoid. For her family, the news is overwhelming, as they navigate the emotional and financial burden of seeking treatment with the last-line antibiotics available.
Since 2016, Pakistan has been grappling with an outbreak of XDR typhoid, caused by a strain of Salmonella Typhi that is resistant to nearly all first-line antibiotics. This crisis is not just a medical challenge but a reflection of long-standing issues with public health infrastructure, including poor sanitation, unhygienic food practices and limited access to safe drinking water.
In cities like Karachi, clean water is a luxury. Many residents rely on expensive, often contaminated water provided by the tanker water mafia. The absence of functional wastewater systems exacerbates the problem, creating an environment where typhoid and other waterborne diseases spread easily.
The misuse of antibiotics has worsened the situation. Medications like azithromycin, vital for treating typhoid, have been overprescribed or used inappropriately for minor ailments, leading to rising drug resistance. This indiscriminate use has made a once-treatable infection an increasingly complex and costly disease to manage.
What makes this crisis even more alarming is its global impact. Cases of XDR typhoid linked to travelers from Pakistan have been reported in countries such as the United States, the United Kingdom and Australia. Modern travel has turned what was once a localized issue into an international public health concern.
Despite these challenges, there is hope. Vaccination efforts in Pakistan have shown promise. In 2019, the country became the first to introduce the typhoid conjugate vaccine (TCV) into its routine immunization program. This vaccine has reduced the incidence of typhoid in areas where it has been implemented effectively.
However, coverage remains inconsistent, particularly in high-risk urban slums and rural areas. Expanding vaccination campaigns and ensuring equitable access must be national priorities. Outreach programs can play a critical role in addressing vaccine hesitancy and ensuring that underserved populations receive protection.
Addressing the root causes of this crisis is equally important. Investing in clean water infrastructure, improving sanitation and enforcing food safety standards could significantly reduce the transmission of typhoid. Public awareness campaigns on the responsible use of antibiotics are also essential to curbing the rise of drug-resistant strains.
XDR typhoid is a reminder of the consequences of neglecting public health. For decades, essential issues like water and sanitation have been sidelined, creating an environment where preventable diseases can thrive. The cost of this neglect is borne not only by families who struggle to afford treatment but also by the global community, which faces the risk of antibiotic-resistant pathogens spreading across borders.
Addressing XDR typhoid requires a coordinated effort from policymakers, healthcare providers and international organizations. By prioritizing clean water, vaccination and responsible antibiotic use, Pakistan can control this outbreak and prevent future public health crises.
—The writer is Associate Professor, Health Services Academy, Islamabad.
