The last cholera outbreak in Britain occurred in 1866; There hasn't been an outbreak in the US since 1911.
And yet today people suffer from this ancient disease in 32 countriesAt the same time, more than 6,800 deaths have been registered this year, which already exceeds all of last year’s mortality figures. 6,000 deaths, which itself is 50% more than in 2023..
The most serious outbreaks are occurring in Africa, where conflict is accelerating spread and hampering control efforts in some countries. Cholera is the ultimate disease of deprivation. It persists not because of a lack of science or solutions, but because leaders have failed to act with the urgency and commitment that the crisis requires.
A consortium of more than 50 partners, led by the World Health Organization (WHO), is responding to these outbreaks through Global Cholera Task Force– a partnership established in 1992 to provide access to essential commodities and work to detect, prevent and treat cholera and set global priorities for sustainable control of the disease.
In addition to the work of the task force in August, WHO and Africa The Centers for Disease Control and Prevention has launched a continental cholera emergency response plan.
Cholera is caused by bacteria in food or water contaminated by the feces of an infected person, and the only way to prevent it is to provide access to safe water and sanitation. This is why it is now virtually unheard of in countries where such opportunities exist, but it thrives in communities suffering from inequality, poverty, conflict, displacement and climate-related disasters.
The disease can be prevented with effective vaccines. The injectable vaccine was first developed in the late 19th century and was replaced by oral vaccines in the 1980s.
But because the disease affects almost exclusively the poorest countries and communities, the vaccine has failed to attract investment from developers for whom it offers little market opportunity. There is currently only one manufacturer producing cholera vaccines at the scale needed for mass vaccination campaigns: EUBiologics, based in South Korea.
To combat cholera outbreaks, WHO and other partners have created a global Cholera vaccine supplies outbreaks in 2013 under the auspices of the International Vaccine Coordination Group (ICG) to ensure rapid, equitable and effective access to vaccines in emergency situations, especially in resource-limited settings. Since then, nearly 255 million vaccine doses have been distributed from the stockpile to 34 countries.
Almost 75% of these doses have been distributed since 2021 in response to the global resurgence of cholera. More than 49 million vaccine doses have been distributed from the stockpile this year, already surpassing the previous single-year record.
Given the increasing frequency and severity of outbreaks, stockpiled vaccines should only be used to bring outbreaks under control rather than for prevention campaigns in areas at risk of cholera.
Inventories are replenished every week, but production cannot keep up with demand and regularly falls below normal. recommended threshold have 5 million doses ready to respond to an outbreak at any time.
To further increase supplies, the ICG has suspended the standard two-dose vaccination regimen in 2022 in favor of a single dose.
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This was based on evidence showing that a single dose provided protection, but that it waned more quickly than with a two-dose regimen. Thus, a single vaccination is only a temporary solution to the problem of vaccine shortages.
Demand shows no signs of slowing down, meaning supply is set to increase.
In October 2024 Zambia signed a memorandum of understanding with the Chinese company Jijia Medical Technology Company to establish a cholera vaccine production facility in Lusaka. The planned production will still require stringent quality assurance and clinical trials to confirm safety and effectiveness before any locally produced doses can be approved by the WHO and used in mass vaccination campaigns.
While expanding vaccine production in Africa is essential to preventing and responding to outbreaks of this historic disease, the only long-term solution is for governments to invest in safe drinking water and sanitation.
There are some diseases that cannot be completely prevented, such as Alzheimer's disease and most types of cancer. But cholera is not one of them – it can be stopped. Cholera persists because poverty, inequality, conflict and displacement persist.
Therefore, stopping it is not a scientific, medical or technical task; this is essentially a political issue.
