Summary
Typhoid is a major threat. Every year, 14.3 million people suffer from the disease and 135,000 are killed – many of whom are children. Typhoidland is an international research and engagement project that challenges the myth that typhoid is a disease of the past, raises awareness about antimicrobial resistance, and analyses past interventions to inform current efforts to control the disease.
Since 2018, Dr Kirchhelle and his co-curator, Dr Samantha Vanderslott, have devised multi-award-winning exhibitions and educational content in the UK, US, Nepal, Bangladesh, India, and Ireland. Through these efforts, their research has reached hundreds of thousands of people, raising awareness of the challenges of typhoid control. They have also co-authored high-impact academic publications on typhoid control, and have promoted their findings to international news outlets and the WHO.
Research description
Dr Kirchhelle and colleagues combined techniques from different fields – medical humanities and sciences – to analyse the long-term impact of various interventions aimed at tackling typhoid, locally and internationally. The measures they looked at were based on sanitation, vaccines and antibiotics.
To that end, between 2018 and 2020 the team analysed archival, health, and financial records from seventeen Anglo-American cities. This revealed significant differences in the way sewage and water systems had evolved during the Victorian period, and how these systems affected the incidence of waterborne diseases like typhoid. The research also showed that long-term financial credit (in the form of public bonds and government loans) is important for constructing and maintaining accessible water infrastructure, and for fostering political alliances for typhoid control.
A parallel collaboration with microbiologists looked at the links between social history (like international health priorities and the use of antibiotics) and how typhoid bacteria evolved over time. This work highlighted how international neglect and beliefs that “typhoid is a disease of the past” fostered antimicrobial resistance. This is in part due to increased use of antibiotics to compensate for inadequate access to healthcare and water, sanitation, and hygiene (WASH). The research also highlighted the inefficiency of expensive control measures that focus on stopping typhoid from crossing borders and fail to tackle underlying environmental and social drivers of the disease.
During the COVID-19 pandemic, the team’s research on human challenge studies (when volunteers are deliberately infected with pathogens for research purposes), and adverse effects resulting from early typhoid vaccination campaigns, resulted in commentaries on the need for harmonised international guidelines for COVID-19 challenge studies and bespoke compensation schemes for adverse effects resulting from COVID vaccine rollouts.
An ongoing collaboration with social scientists at St John’s Medical College in Bangalore, India, is highlighting how British imperial norms of typhoid control and water infrastructure were mis-adapted to foreign environments. These mis-adaptations live on to this day. The team is also raising awareness for the caste-based exploitation of “manual scavengers” (those who remove untreated human waste from latrines and containers) when it comes to maintaining sanitary infrastructure.
Finally, a new and ongoing project at UCD – Typhoid, Cockles, and Terrorism – is exploring the diverse and often unintended impacts of sanitary reform on typhoid incidence in revolutionary Dublin, the role of shellfish in spreading the disease, and bioterrorism allegations against Sinn Fein in 1920, for considering weaponising typhoid.