Systemic barriers and strategies for typhoid conjugate vaccine introduction in Nigeria

Abstract

Typhoid fever remains a significant health challenge in Nigeria, with high child morbidity and mortality. Despite WHO recommendation and Gavi support since 2018, Nigeria has yet to introduce Typhoid Conjugate Vaccines (TCVs) nationally. This paper examines systemic barriers to TCV introduction, critically evaluates available evidence—including recent Severe Typhoid in Africa (SETA) data—and identifies strategies to accelerate adoption. As a narrative review, findings represent interpretive synthesis rather than quantitative effect estimates. We conducted a narrative review guided by the Typhoid Vaccine Acceleration Consortium (TyVAC) framework. The literature search (PubMed, Scopus, Web of Science; 2015–2025) was supplemented by grey literature. We incorporated recent Nigerian data on incidence, antimicrobial resistance, typhoid intestinal perforation, and diagnostics. Nigeria possesses substantial locally generated evidence, including SETA population-based incidence data and multiple studies documenting resistance patterns and perforation burden. However, this evidence remains fragmented. Key barriers include incomplete utilization of existing data for Gavi applications; competing health priorities; cold chain constraints; co-financing challenges, and insufficient community engagement. Available evidence suggests that policy translation and coordination challenges may have contributed substantially to delays. Recent TCV introductions in Burkina Faso and Niger demonstrate that political commitment, alongside evidence synthesis and operational readiness, may facilitate accelerated introduction. Nigeria could benefit from establishing a National TCV Task Force to synthesize existing data, develop financing roadmaps, and coordinate phased subnational introduction.