Mermin et al. described a massive outbreak of multidrug-resistant typhoid fever involving 10,000 clinical cases and 100 deaths that occurred in the central Asian republic of Tajikistan in 1997 [1]. The team from the Centers for Disease Control and Prevention (CDC), Atlanta, investigated the outbreak in the capital city of Dushanbe, where they determined that contaminated municipal water was the most important of perhaps multiple sources. The control programs that were recommended to local governmental and international agencies included water chlorination, water pipe repair, education programs, epidemiologic surveillance, and distribution of ciprofloxacin to local hospitals for treatment. Typhoid vaccination was entirely missing from the wide-ranging list of interventions. The authors acknowledged that safe and effective vaccines were available. Indeed, it would be very surprising if members of the CDC investigative team were not vaccinated before traveling to Tajikistan, as are millions of other travelers going to typhoid-endemic regions [2]. So why was a measure so commonly recommended and so effective for travelers not recommended for typhoid control for local inhabitants?