Cholera, the WHO alert: «Over 700 thousand cases in 2023. A global effort is needed to accelerate the production of vaccines and adopt other life-saving measures»

Cholera, the WHO alert: «Over 700 thousand cases in 2023. A global effort is needed to accelerate the production of vaccines and adopt other life-saving measures»


OfRuggiero Corcella

The International Coordination Group (ICG) on Vaccine Supply calls for immediate action to stem an unprecedented multi-year surge in cholera cases around the world

A month after the alarm raised by Unicef ​​about the new, powerful, wave of cholera that hit 13 countries in Eastern and Southern Africanot counting the most recent cases in Haiti, the World Health Organization is also sounding the alarm again: according to the International Coordination Group (ICG) on vaccine supplyimmediate action is needed to stem an unprecedented multi-year surge in cholera cases around the world.

Even in Italy, last yeara 71-year-old pensioner from Arbus (Sassari) was fortunately affected without serious consequences.

What do the ICG experts ask? Investments in access to drinking water and sanitationtesting and rapid detection of epidemics, improving the quality and access to healthcare and accelerating the additional production of oral vaccine doses against cholera (OCV) at affordable prices to better prevent cases.

In 2017, WHO launched a suggestively named global strategy for cholera control: «Ending Cholera: a global roadmap to 2030», with the aim of reducing cholera deaths by 90%. At this rate, however, it risks becoming a mirage rather than an objective.

Vaccine supplies

The ICG manages global stocks of cholera vaccines. The group includes the International Federation of Red Cross and Red Crescent Societies, Doctors Without Borders, UNICEF and WHO. Gavi, the Vaccine Alliance, finances vaccine supply and OCV delivery.

ICG members are calling on governments, donors, vaccine manufacturers, partners and communities to unite in an urgent effort to stop and reverse the rise of cholera.

Cases on the rise

Cholera has been on the rise globally since 2021, with 473 thousand cases reported to WHO in 2022, more than double those reported in 2021. Preliminary data for 2023 reveals further increases, with over 700,000 cases reported.
Many epidemics have high mortality ratesabove the 1% threshold used as an indicator for the early and adequate treatment of cholera patients.
This rise in numbers is even more dramatic when you consider that Cholera is a preventable and treatable disease and that cases had been declining in previous years.

That is how cholera is transmitted

Cholera is an acute intestinal infection fecal-oral transmission that spreads through food and water contaminated with feces containing the bacterium Vibrio cholerae.

The foods most at risk for transmitting the disease are raw or undercooked foods and, in particular, seafood. However, other foods can also act as a vehicle.

The increase in cholera is caused by persistent gaps in access to drinking water and sanitation.

While efforts are being made to close this gap in some places, in many others disparities are growing, driven by factors related to climate, economic insecurity, conflicts and population displacement. Safely managed water and sanitation are prerequisites for stopping the transmission of cholera.

Diseases endemic in many states

Researchers have estimated that there are 1.3 to 4 million cases of cholera and 21,000 to 143,000 deaths worldwide each year. due to cholera. The seventh pandemic is still ongoing: it began in 1961 in South Asia, reaching Africa in 1971 and America in 1991. Today the disease is considered endemic in many countries and the bacterium that causes it has not yet been eliminated from the environment.

The countries most seriously affected

Currently, the most seriously affected countries they include the Democratic Republic of Congo, Ethiopia, Haiti, Somalia, Sudan, Syria, Zambia and Zimbabwe.

According to the WHO, now more than ever, a multisectoral response must be adopted to fight cholera. ICG members ask currently and potentially affected countries to take urgent measures to ensure their populations have access to clean water, sanitation and hygiene and essential information to prevent the spread of cholera.

Creating these services requires political will and investment at the national level. This includes the creation of timely detection and response capabilitiesimproved disease detection, rapid access to treatment and care, and close collaboration with communities, including on risk communication and community engagement.

Shortages in global vaccine supplies

The severe gap in the number of available vaccine doses, compared to the current level of need, puts unprecedented pressure on global vaccine supplies. More doses were requested for the epidemic response between 2021 and 2023 than in the entire previous decade.

In October 2022, the ongoing vaccine shortage made it necessary for the ICG to recommend a single dose of vaccine, compared to a previous long-standing two-dose regimen. About 36 million doses were produced last year, while 14 affected countries recorded the need for 72 million doses for a single-dose reactive strategy. These requests underestimate the true need.

The effects: delayed vaccination campaigns

Preventive vaccination campaigns had to be delayed to preserve doses for emergency epidemic control efforts, creating a vicious cycle. The change in strategy has allowed available vaccines to protect more people and respond to more cholera outbreaks amid supply shortages, but a return to the two-dose regimen and resumption of preventive vaccination would provide longer protection.

In 2024, 37-50 million doses will be produced

It is expected that global production capacity in 2024 will be 37-50 million doses, but will likely continue to be inadequate to meet the needs of millions of people directly affected by cholera. According to the ICG report «only EuBiologics (a biopharmaceutical company from Seoul, South Korea) currently produces the vaccine; while the company is doing everything it can to maximize production, more doses are needed. Currently no new manufacturers are expected to enter the market before 2025; they must be accelerated. The same urgency and innovation we saw for Covid-19 must be applied to cholera.”

The appeal

«Other manufacturers intending to enter the market must accelerate their efforts and make doses available at affordable prices.
We appeal to vaccine manufacturers, governments, donors and partners to prioritize urgently scaling up vaccine production and invest in all efforts necessary to prevent and control cholera.”

March 20, 2024

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