Coalition against Typhoid (CaT)/Take on Typhoid

Efforts to prevent and control typhoid emerged more than a century ago, yet attention and prioritisation of the disease have since diminished. One global strategy that has been employed to redirect funds and research efforts to overlooked health problems facing low- and middle-income countries (LMICs) is the creation of coalitions. Coalitions act as conveners of a specific health issue by providing a forum to the many sectors that have a stake in the issue to take a stand together by advocating for funding, mobilising resources for research, sharing knowledge, fostering capacity development, and conveying viewpoints to global health and development decision makers.

CaT is made up of more than 1,000 individual members across different sectors including health; engineering; water, sanitation, and hygiene (WASH); and human rights. Prior to 2016, CaT consisted of organisational members. However, by broadening membership to individuals, CaT was able to garner multiple champions from within one organisation, as well as individual members from organisations without a specific mandate for typhoid control. This membership base enables CaT to raise awareness among members of the global health and development community not previously active in typhoid prevention.

According to CaT personnel, an important factor in CaT's success is that the membership reflects the population that typhoid impacts most. Thirty-five percent of CaT members are based in South or Southeast Asia, and 23% are based in Africa. CaT ensures it is responsive to this diverse membership through a multistakeholder steering committee. In addition, CaT receives member feedback through the CaT website and in-person side events, and by making outreach calls to members to tailor activities to benefit its membership.

Both in person and digitally, CaT has engaged and mobilised researchers, scientists, and advocates to coordinate efforts in the fight against typhoid, ultimately hoping to raise the profile of typhoid by:

• Convening the community with a biennial international conference - Participants attend with the aim of disseminating new data, sharing and promoting best practices for prevention and control, fostering partnerships across sectors and regions, and equipping colleagues with tools to contribute to national, regional, and global advocacy efforts. For example, the 10th International Conference on Typhoid and Other Invasive Salmonelloses took place in Kampala, Uganda, in April 2017; attendees included an audience of more than 250 participants from 38 countries, primarily from Africa and Asia.
• Disseminating data and news through the CaT website and newsletter - The website serves as a continuing resource for advocates, researchers, and policymakers, with fact sheets, infographics, and message maps, many of which are tailored by country or region. Also, together, CaT and TyVAC implemented the "Take on Typhoid" campaign to disseminate evidence to global and national decision makers. Take on Typhoid has focused attention on typhoid as the new TCV was prequalified and recommended by the World Health Organization (WHO), and Gavi, the Vaccine Alliance opened a funding window for eligible countries to receive support for TCV introduction. The CaT/Take on Typhoid website consolidates several resources for use by advocates when meeting with decision makers, including news on outbreaks and the increasing danger of antimicrobial resistance, information on the TCV, and the latest research. The website is also a tool to disseminate policy decisions: When the first TCV (Typbar-TCV) achieved WHO prequalification and the WHO recommended its use, CaT issued press releases on the website. The press releases facilitated the placement of stories about these policy decisions in more than 40 news outlets.
• Advocating through a blog and social media reaching a diverse audience - As with many diseases, the challenge in typhoid advocacy has been less about accumulating evidence than it has been about communicating that evidence in a clear and impactful way. Thus:
  • CaT and TyVAC publish the Take on Typhoid blog to communicate about issues such as drug resistance, integrated approaches to prevention and control, and the new TCV vaccine to a broad audience. To shine a light on the human face of typhoid, CaT launched the "Stories of Typhoid" blog series in May 2016. This series has profiled families touched by typhoid in endemic countries including India, Bangladesh, Kenya, Malawi, Uganda, Pakistan, and Nepal. These stories explore the linkages between socioeconomic status, environment, and disease, illustrating how typhoid is interconnected with poverty, education, access to information, and natural disasters. The series has inspired CaT members to submit their own stories, as well as some they have come across in the field. The geographic diversity of readership illustrates the wide dissemination of messaging about typhoid that helps raise visibility of the disease.
  • Take on Typhoid is active on digital social media platforms to interact with a broader audience across sectors and rapidly share information and resources. When TCV prequalification was announced by the WHO, the Take on Typhoid social media plan received more than 16,000 Twitter impressions (@PreventTyphoid). According to organisers, the participation of thought leaders from the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance lent credibility to the fight against typhoid, and signaled high-level support for TCV introduction through their social media support. Social media allows Take on Typhoid a far-reaching platform to stay connected and engaged, drive followers to resources on the website, and encourage participation and action across communities.

Health, Immunisation and Vaccines

Despite resulting in 12 million cases and more than 128,000 deaths globally each year, typhoid, a bacterial infection, has remained low on the global public health agenda since the 1940s, when the disease became a rarity in developed countries. Economically poor communities in South Asia and sub-Saharan Africa bear the brunt of the morbidity and mortality of typhoid.