Cholera spreads quickly, but it can be stopped. Why haven’t we relegated him to history? | Hakainde Hichilema and Tedros Adhanom Ghebreyesus

The last cholera epidemic in Britain was in 1866; in the United States there has not been an epidemic since 1911.

And yet today, people are suffering from this ancient disease in 32 countries, with more than 6,800 deaths reported so far this year – already surpassing last year’s entire death toll of 6,000, which itself represented a 50% increase from 2023.

The most serious outbreaks are occurring in Africa, where conflict is accelerating its spread and hampering control efforts in some countries. Cholera is the definitive disease of deprivation. This situation persists, not for lack of science or solutions, but because leaders have failed to act with the urgency and commitment that the crisis demands.

A consortium of more than 50 partners, led by the World Health Organization (WHO), is responding to these outbreaks through the Global Cholera Control Task Force, a partnership established in 1992 to enable access to essential supplies, as well as to work on the detection, prevention and treatment of cholera and set global priorities to sustainably control the disease.

Complementing the work of the task force, WHO and the Africa Centers for Disease Control and Prevention launched a continental cholera emergency response plan in August.

Cholera is caused by bacteria ingested in food or water contaminated by the feces of an infected person, and the only way to prevent it is to ensure access to clean water and sanitation facilities. This is why it is now virtually unknown in countries with these facilities, but thrives in communities affected by inequality, poverty, conflict, displacement and climate-related disasters.

The disease can be prevented with effective vaccines. An injectable vaccine was first developed in the late 19th century and was replaced by oral vaccines in the 1980s.

But because the disease almost exclusively affects poorer countries and communities, the vaccine is not attracting investment from developers, for whom it offers few commercial opportunities. There is currently only one manufacturer producing cholera vaccines at the scale needed for mass vaccination campaigns: EUBiologics, based in South Korea.

To manage cholera outbreaks, WHO and other partners established a global stockpile of cholera vaccines in 2013 under the International Coordination Group on Vaccine Supply (ICG) to ensure rapid, equitable and effective access to vaccines in emergency situations, particularly in low-resource settings. Since then, the stockpile has distributed nearly 255 million doses of vaccine to 34 countries.

Nearly 75% of these doses have been distributed since 2021, in response to the global resurgence of cholera. So far this year, the stock has shelled out more than 49 million vaccine doses – already eclipsing the previous record for a single year.

Given the increasing frequency and severity of epidemics, vaccines from stockpiles can only be used to control epidemics, rather than to carry out prevention campaigns in areas at risk of cholera.

The stock is replenished every week, but production cannot meet demand and is regularly below the recommended threshold of having 5 million doses ready to respond to outbreaks at any time.

To further expand supply, the ICG suspended the standard two-dose vaccine schedule in 2022 in favor of a single dose.

This is based on evidence showing that a single dose provides protection, but that this wanes more quickly than it would with a two-dose regimen. Single-dose vaccination is therefore only a temporary solution to the shortage of materials.

Demand shows no signs of slowing down, which means supply needs to increase.

In October 2024, Zambia signed a memorandum of understanding with China’s Jijia Medical Technology Company to establish a cholera vaccine production facility in Lusaka. Planned production will still require rigorous quality assurance and clinical trials to confirm safety and effectiveness before locally manufactured doses can be approved by WHO and deployed in mass vaccination campaigns.

Although 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 clean water and sanitation.

Some diseases cannot be completely prevented, such as Alzheimer’s disease and most cancers. But cholera is not one of them: it can be stopped. Cholera persists because poverty, inequality, conflict and displacement persist.

Stopping it is therefore not a scientific, medical or technical challenge; fundamentally, it is a political question.