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Feature Vaccines

Cholera makes a comeback amid calls to boost vaccine production

BMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p636 (Published 29 March 2023) Cite this as: BMJ 2023;380:p636
  1. Jane Feinmann, freelance journalist
  1. London
  1. jane{at}janefeinmann.com

Shortages of cholera vaccine and an unexpected surge in outbreaks have brought the fight against cholera to its knees. JaneFeinmann asks why the sudden danger, when a highly effective vaccine has been available for more than 20 years?

In October 2017, a global network of 50 government and non-governmental agencies announced an ambitious roadmap for “Ending Cholera by 2030.”1

The plan looked tantalisingly achievable: access to clean water and sanitation was explicitly recognised as a human right by the UN in 2010, alongside evidence that a cheap and simple treatment of clean water, salt, and sugar (oral rehydration solution) saves lives in more than 99% of cholera cases. Finally, a game changing cheap and effective oral cholera vaccine (OCV) has been available since 2001 and distributed free to countries facing cholera outbreaks since 2013. The OCV enables containment of outbreaks in an emergency and prevents transmission where the disease is endemic.

In the first four years of the roadmap, cholera rates fell steadily. The World Health Organization reported no cholera cases in Bangladesh and India in 2018,2 and emergency vaccination campaigns successfully contained outbreaks in Somalia, Yemen, and the Democratic Republic of the Congo.

But since 2022, the situation has deteriorated. Cholera mortality has been high—estimated at up to 143 000 every year. UN figures show that between 2015 and 2020, access to clean water increased from 47% to just 54% of the global population.3

In 2022, WHO reported “an acute upsurge” in the number and size of cholera outbreaks,4 with 29 countries affected in the previous 12 months, including 13 that had not reported any cases the previous year. Outbreaks were occurring in previously stable middle income countries such as Syria and Lebanon, neither of which had recorded cases of cholera for decades.

Malawi, previously …

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