Cost effectiveness is unclear for 2 reasons. First, because of the difficulty in diagnosing typhoid, public health experts in a country rarely know how much of a burden of typhoid there is. 2nd the effectiveness in the highest risk populations is suspect, especially over time.

Money is always in short supply in low income countries. Right now, vaccine proponents have been unable to present a convincing case to political leaders who control budgets in low income countries, or for that matter to donors.