Amid an “unprecedented multi-year upsurge” in global cholera cases, the International Coordinating Group (ICG) on Vaccine Provision is appealing for “immediate action” from the global community. This could include investments in access to safe water, sanitation, and hygiene, testing and detecting outbreaks quickly, improving quality of and access to healthcare, and fast-tracking additional production of the affordable oral cholera vaccine (OCV). The ICG is responsible for managing the global cholera vaccine stockpile, comprising the International Federation of Red Cross and Red Crescent Societies, Mèdecins Sans Frontières, UNICEF and WHO. The stockpile and delivery of vaccines is financed by Gavi.
A global increase
The current increase in cholera cases has been observed since 2021; 473,000 cases were reported to WHO in 2022, which is “more than double those reported in 2021”. Preliminary data for 2023 “reveal further increases”, with over 700,000 cases reported. Some of the outbreaks have high case fatality rates that exceed the 1% threshold used as an indicator for “early and adequate treatment” of patients with cholera.
“These trends are tragic given that cholera is a preventable and treatable disease and that cases had been declining in previous years.”
Countries that are currently the most affected include the Democratic Republic of the Congo, Ethiopia, Haiti, Somalia, Sudan, Syria, Zambia, and Zimbabwe.
Factors behind the increase
Cholera is an acute intestinal infection spread through food and water contaminated with faeces that contains the Vibrio cholerae bacterium. WHO states that the rise in cholera cases is “being driven by persistent gaps in access to safe water and sanitation”.
“Although efforts are being made to close these gaps in places, in many others the gaps are growing, driven by climate-related factors, economic insecurity, conflict, and population displacement.”
What can be done?
“Now more than ever, countries must adopt a multisectoral response to fight cholera.”
The ICG Members call on “currently and potentially affected countries” to take “urgent steps” to ensure that all populations have access to clean water, hygiene, and sanitation services, as well as the information required to prevent any cholera spread. This “requires political will and investment” at country level.
“This includes creating capacity for early detection and response, enhanced disease detection, rapid access to treatment and care, and working closely with communities, including on risk communication and community engagement.”
Pressure on the stockpile
Alongside water and sanitation requirements there is a “severe gap in the number of available vaccine doses” in comparison with the current need. Between 2021 and 2023 more doses were requested for outbreak response than had been needed for the “entire previous decade”. Indeed, in October 2022, the shortage necessitated the ICG to recommend a single vaccine dose rather than the “previous, long-standing two-dose regimen”.
Around 36 million doses were produced last year, but 14 affected countries registered a need for 72 million doses within a one-dose reactive strategy.
“These requests understate the true need.”
Preventative vaccination campaigns have been delayed to save doses for emergency outbreak control efforts. This creates a “vicious cycle”.
Global production capacity in 2024 is forecast to be 37-50 million doses but will “likely continue to be inadequate”. There is only one manufacturer that currently produces the vaccine: EuBioligics. Although the company is “doing its utmost to maximise output”, the ICG requires more doses. No new manufacturers are expected to join the market before 2025.
“The same urgency and innovation that we saw for COVID-19 must be applied to cholera.”
The ICG appeals to the vaccine and health community to “prioritise an urgent scale-up of vaccine production” and to “invest in all the efforts needed to prevent and control cholera”.
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