The global stockpile of cholera vaccine has run out – just as 16 countries battle outbreaks of the deadly bacterial illness that is infecting millions of people, including across Africa.
“The world’s oral cholera vaccine stocks have dried up,” Daniela Garone, MD, international medical coordinator of the humanitarian organisation Medecins Sans Frontieres (MSF) told Reuters.
“This directly affects MSF teams as we are trying to respond to an extraordinary number of cholera outbreaks, including in Ethiopia, Sudan, Zambia, and Zimbabwe.”
Currently, as country requests for cholera vaccines mount, the ability to manufacture more is limited to the sole approved cholera vaccine maker, EuBiologics Co. of South Korea, leaving MSF “extremely concerned”.
“All doses in production until mid-March have already been allocated, and the demand for doses keeps growing,” Garone said. “We are desperate for more manufacturers to … urgently produce oral cholera vaccines, and it’s essential that more technical support be provided for them, to speed up regulatory processes and scale up production capacity.”
A Unicef official said that a deficit of at least 50m oral cholera vaccine (OCV) doses will persist throughout 2024.
CIDRAP reports that untreated cholera, which spreads through water and food contaminated with Vibrio cholerae bacteria, can be fatal within hours but may cause no or mild symptoms. The disease poses the greatest risk to children under five. It is treated using an oral rehydration solution for most patients, while intravenous fluids and antibiotics are used for those with severe infections.
Warnings stretch back years
Earlier this month, the World Health Organisation (WHO) highlighted the dire situation in a cholera update. “From January 2023 to January 2024, urgent requests for OCV surged, with 76m OCV doses requested by 14 countries – while only 38m doses were available during that time period,” the agency wrote.
In January 2023, it classified the worldwide resurgence as a grade 3 emergency – its highest internal emergency level. Cholera cases were reported in 30 countries across five WHO regions, including nine countries that documented more than 10 000 infections in 2023, a year in which 14 countries requested 76m cholera vaccine doses, but only 38m were available.
Gavi, the Vaccine Alliance, warned in August last year that the world was not ready for future cholera surges. Earlier that year, it noted, officials in Malawi responding to an outbreak asked for more vaccine doses, only to receive fewer than a quarter of the number requested from the International Coordinating Group (ICG), an expert committee that manages emergency supplies of different vaccines.
By then, 1 700 Malawians had died.
As far back as October 2022, the ICG, whose membership includes MSF, decided to stretch limited cholera vaccine supplies by temporarily reducing the number of doses per person from two to one. Nearly 18 months later, the vaccine situation is even worse, MSF noted.
Vaccines part of multipronged approach
And the threat is growing. In January 2024 alone, 17 countries in WHO's Africa, Eastern Mediterranean, Americas, and Southeast Asia regions reported 40 900 cholera cases and 775 deaths. The most prominent surges were reported by Zambia and Zimbabwe.
“Vaccines are just one of the prevention tools,” Garone said. “The control of cholera also depends on providing safe water and sanitation, enhancing disease surveillance and diagnosis, and – more importantly – ensuring early access to treatment and care when an outbreak does occur.”
MSF said its teams are also running cholera units to treat patients in medical facilities and have set up bigger, separate cholera centres that can admit hundreds of patients at once.
The rise in cholera has been fuelled by factors like climate change–related floods and droughts, war, and forced displacement, as access to clean water is often limited in refugee and displacement camps.
No panic in SA: Phaahla
Despite South Africa having recorded 46 suspected cholera cases and five laboratory-confirmed cases between 1 January and 1 February, Health Minister Joe Phaahla said last week there was no need to panic.
Three of these cases were imported from Zimbabwe, and the other two – siblings aged 11 and 13 – had no travel history to cholera outbreak areas, “suggesting the risk of contact with a known cholera case”.
Four of these cases were detected in Limpopo hospitals (Musina and Helene Frans Hospitals), and the other one was confirmed in Helen Joseph Hospital in Gauteng, reports IOL.
“A cluster of 24 diarrhoeal disease cases was also identified during outbreak response activities at a primary and high school in the Blouberg Local Municipality in Limpopo,” Phaahla added, and test results are pending.
Local outbreak response teams had been activated to strengthen the investigation to conduct active case finding and contact tracing, and the country remains on high alert for possible surges at community level, he said.
Cholera vaccine stocks ‘empty’ as cases surge (Open access)
See more from MedicalBrief archives:
SA confirms cholera cases amid global resurgence
Zimbabwe declares state of emergency over cholera outbreak
Africa battles triple burden of malaria/cholera/measles