The International Coordinating Group (ICG) on Vaccine Provision is urgently advocating for accelerated measures to address the alarming surge in cholera cases worldwide.
Immediate action is imperative to combat this unprecedented multi-year increase, as stated by the ICG. Key actions include investing in access to safe water, sanitation, and hygiene, promptly detecting and managing outbreaks, enhancing healthcare quality and accessibility, and expediting the production of affordable oral cholera vaccine (OCV) doses to bolster prevention efforts.
Responsible for managing the global cholera vaccine stockpile, the ICG comprises esteemed organizations such as the International Federation of Red Cross and Red Crescent Societies, Médecins Sans Frontières, UNICEF, and WHO. Gavi, the Vaccine Alliance, funds the vaccine stockpile and OCV delivery. The ICG members are rallying governments, donors, vaccine manufacturers, partners, and communities to join forces urgently to curb and reverse the cholera upsurge.
Cholera cases have been escalating globally since 2021, with WHO reporting 473,000 cases in 2022, more than double the 2021 figures. Preliminary data for 2023 indicate further increases, with over 700,000 cases reported. Alarmingly, several outbreaks exhibit high case fatality rates surpassing the 1% threshold, indicative of inadequate treatment. These trends are tragic considering cholera is preventable and treatable, and cases were previously declining.
Cholera, an acute intestinal infection transmitted through contaminated food and water, thrives due to persistent gaps in access to safe water and sanitation. Efforts to address these gaps exist but are hindered by climate-related factors, economic instability, conflict, and population displacement. Adequate water and sanitation are essential to halt cholera transmission.
Countries most severely affected include the Democratic Republic of the Congo, Ethiopia, Haiti, Somalia, Sudan, Syria, Zambia, and Zimbabwe. A multisectoral response is imperative, necessitating urgent steps to ensure populations have access to clean water, hygiene, sanitation services, and essential information to prevent cholera transmission. This requires political will and investment at the country level.
The severe shortage of vaccine doses compared to current needs places unprecedented strain on the global vaccine stockpile. Between 2021 and 2023, more doses were requested for outbreak response than in the entire previous decade. In response, the ICG recommended a single vaccine dose in October 2022, down from the previous two-dose regimen. While this change allowed for more widespread protection amidst the shortage, a return to a two-dose regimen and resumption of preventive vaccination would offer longer-term benefits.
Although global production capacity is forecasted to reach 37-50 million doses in 2024, it remains insufficient to meet the needs of millions affected by cholera. Only one manufacturer, EU Biologics, currently produces the vaccine, and efforts to fast-track new manufacturers are essential. Additional manufacturers planning to enter the market must accelerate their efforts and ensure affordable pricing.
Urgent action is needed to scale up vaccine production and invest in comprehensive efforts to prevent and control cholera. Collaboration among vaccine manufacturers, governments, donors, and partners is crucial in this endeavor.
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