Aligning Health Systems and Policy Implementation to Improve Typhoid Vaccine Uptake in Low-Resource Urban Communities of Pakistan

Abstract

Despite the availability of effective typhoid conjugate vaccines (TCVs), typhoid fever remains a significant public health challenge in low-resource urban communities of Pakistan. Vaccine uptake in these settings is influenced not only by individual acceptance but also by health system capacity and the effectiveness of policy implementation. This narrative review examines how alignment between health systems and policy processes affects typhoid vaccine uptake in urban low-income settings. A literature search was conducted using Google Scholar, PubMed, and World Health Organization (WHO) reports, including peer-reviewed articles, policy documents, and program reports published within the last 10–15 years. Studies focusing on typhoid immunization, health systems, and vaccine policy in Pakistan and comparable low- and middle-income countries were included. The review identifies key determinants of vaccine uptake, including governance and policy coherence, service delivery capacity, availability of trained human resources, supply chain management, and monitoring and evaluation systems. Evidence indicates that gaps between national immunization policies and local implementation capacity contribute to sub-optimal vaccine coverage in underserved urban populations. The findings suggest that vaccine-specific interventions alone are insufficient without strengthening underlying health systems. Strengthening primary healthcare services, improving policy–implementation alignment, and integrating typhoid vaccination within routine immunization programs are essential for achieving equitable and sustainable typhoid vaccine uptake in Pakistan (Batool et al., 2023; WHO EMRO, 2019).