Cholera has now broken out in 29 nations, with three times the fatalities in 2022, as in any of the last five years. Victims suffer from muscle cramps, extreme stomach pain, diarrhea, vomiting, often leading to severe dehydration. It is a horrible way to die. It is both totally preventable and, if contracted, readily treatable—but society is failing at both.
The inability of poorer areas of the world to keep up the maintenance and functioning of their water systems—including pumping stations and sewage treatment—is the key factor. More recently the disruption of the energy supply chain has thrown, for example, Syria’s war-damaged system over the edge. Haiti and Malawi are noted as two other nations suffering the most from the cholera breakout. However, the extensive flooding in Pakistan may well push that country to the top of the list.
Three weeks ago, Philippe Barboza, the WHO’s team lead for cholera and epidemic diarrheal diseases, said at a press briefing in Geneva: “After years of declining numbers, we are seeing a very worrying upsurge of cholera outbreaks around the globe over the past year” and “the outbreaks themselves are larger and more deadly.” His call for nations “to find ways to engage more manufacturers” in the production of the disappearing cholera vaccine apparently has fallen on deaf ears.
On Oct. 19, the World Health Organization announced that the shortage of vaccine supply has caused them to suspend their standard two-dose vaccine regimen against cholera, reporting that the stockpile is in a “grave state.” Their “pivot in strategy will allow for the doses to be used in more countries” at a time of “unprecedented rise in cholera” worldwide and an “extremely limited” vaccine supply. “The benefit of supplying one dose still outweighs no doses, although the temporary interruption of the two-dose strategy will lead to a reduction and shortening of immunity, this decision will allow more people to be vaccinated and provide them protection in the near term, should the global cholera situation continue deteriorating.”
The action is short-term and risky—and now depends upon “urgent action ... to increase global vaccine production.” WHO reports that only 36 million cholera vaccine doses are expected to be produced in 2022, making for a “dire” shortage.
