Rising cholera deaths worldwide highlight prevention challenges

Despite cholera being a preventable and low-cost treatable disease, recent data from the World Health Organization indicate a worrying increase in death rates, outpacing the increase in infection rates. Last year saw a 71% increase in cholera-related deaths worldwide, compared to a 13% increase in new cases. Factors such as climate-related disasters and ongoing conflict are exacerbating outbreaks, particularly in regions where there have been no recent cases.

Philippe Barboza, head of the cholera programme at the WHO’s health emergencies department, expressed dismay at the rapidly rising death rates, highlighting the global disdain for a disease that predominantly affects the poorest populations, without access to clean water.

In 2023, more than 4,000 cholera deaths were officially reported, but WHO estimates suggest the actual number could exceed 100,000. The disease, characterized by severe dehydration due to severe diarrhea and vomiting, can be fatal within hours if left untreated. Simple remedies such as oral rehydration salts, which cost just a few cents, are often enough to save lives.

The disease’s footprint expanded last year, with 45 countries reporting cases, a sharp increase from 35 the previous year. Africa in particular saw a 125% increase in cases, driven by extreme weather conditions that compromised water quality and sanitation.

Despite robust efforts in countries like Zambia and Malawi, health systems are struggling under the weight of major outbreaks. For example, Zambia had to convert a stadium in Lusaka into a cholera treatment facility to handle the crisis.

In conflict zones such as Sudan, despite severe difficulties, health workers have managed to keep epidemics under control, although the situation remains precarious due to the recent resurgence of the disease.

The global response to cholera is also hampered by vaccine shortages. In 2022, the organization managing the global cholera vaccine reserve recommended administering a single dose of the vaccine in regions affected by the outbreak to extend limited supplies. This single-dose strategy provides short-term protection compared to the standard two-dose regimen.

As demand for vaccines continues to outstrip supply, countries grappling with outbreaks are desperate for more doses to prevent further spread. The only manufacturer currently able to meet global demand, EuBiologics, plans to ramp up production, but even then, supply will barely meet the growing need.

With new vaccine developments on the horizon, there is hope for better management of cholera outbreaks globally. However, the immediate challenges of vaccine availability and the need for stronger health infrastructure remain critical obstacles in the fight against this ancient but preventable disease.