Cholera has long been known as a disease of poverty, primarily affecting people who lack access to safe water and adequate sanitation and hygiene facilities. An article published by the New England Journal of Medicine (NEJM) on June 6, “Global Cholera-Control Efforts—Progress and Remaining Challenges” makes clear how this worldwide scourge could be wiped out, were the decision made to do so. Hence, cholera is now a disease of choice.
“The current cholera pandemic—the seventh in recorded history—began 65 years ago, in 1961,” the authors report, while “the number of new cases and the magnitude of outbreaks continue to increase.” The bacteria is now endemic in nearly 50 countries, and causes millions of cases and tens of thousands of deaths yearly.
A two-pronged campaign is necessary to end the pandemic, and avoid another: ensuring all people have access to safe water and adequate sanitation (known in the field as WASH: water, sanitation and hygiene), and producing sufficient vaccines, of greater effectiveness, to carry out mass vaccination campaign both in areas of outbreaks and where it is endemic.
The failure to ensure WASH conditions for everyone is scandalous. “The World Health Organization (WHO) estimates that at least 2 billion people lack access to safely managed drinking water, more than 3 billion do not have safely managed sanitation, and more than 350 million defecate in the open each day,” while the World Bank estimates that six-times the current level of investment would be required to meet WHO Sustainable Development Goals for water and sanitation by 2030. And that does not take into account the billions of new persons who will be born in the next few decades.
An oral cholera vaccine (OCV) has been developed, which is credited with having prevented an estimated 8 million cholera cases and more than 100,000 deaths since the global OCV stockpile was established in 2013. Over 65 million doses were produced in 2025, but at least 120 million doses per year is the estimated amount needed to provide for both responding to outbreaks and for preventive use in endemic areas. Because of that production shortfall, “only enough vaccine for a single dose per person is being sent to outbreak areas, rather than the recommended two-dose regimen,” NEJM reports.
Work is also ongoing on improving the vaccines, both to lengthen the duration of their preventive effect (currently for one-to-five years), and, very importantly, on developing vaccines that are more effective for the most vulnerable to the disease: children aged five years or under. At least one third of all global cholera cases and deaths occur in those children, yet only 31% of them gain any protection from a two dose-regimen of the currently existing vaccine; at one dose, it has no efficacy.
Provide human living conditions for everyone, and carry out mass vaccination campaigns in the areas where the bacteria is endemic, and this scourge could end.
