Abstract

Typhoid fever remains a significant public health burden in Uganda, particularly in rural and urban areas where 
poor sanitation, limited access to safe water, and overstretched healthcare systems facilitate persistent transmission. 
Despite recurrent outbreaks and high morbidity, the country has yet to fully integrate typhoid vaccination into its 
national immunization strategy. This review examines the cost-effectiveness and health system implications of 
introducing typhoid conjugate vaccines (TCVs) in Uganda, with attention to rural–urban disparities. Evidence 
indicates that vaccination not only reduces disease incidence and treatment costs but also mitigates antimicrobial 
resistance and alleviates pressure on health facilities. In urban settings, vaccination helps control outbreaks fueled 
by overcrowding and poor sanitation, while in rural areas, it addresses gaps created by weak infrastructure and 
delayed access to healthcare. Policy integration of TCVs within the Expanded Programme on Immunization, 
combined with water, sanitation, and hygiene (WASH) improvements, offers a cost-effective and sustainable 
solution. The findings underscore vaccination as a transformative strategy to strengthen Uganda’s health system, 
enhance equity, and secure long-term public health resilience.