Panic in the time of cholera: addressing issues critical to managing a resurgence 

Global cholera crisis worsened by climate change, lack of clean water, sanitation; urgent need for prevention, treatment, and vaccination.

There is no escaping the damage caused to health by climate change across the globe. But as we talk of innovation and AI-assisted vaccine platforms, there is, on the civic and local side, a stunning lack of attention to very simple issues — clean water, hygiene, and sanitation. The latter was greatly exacerbated again by climate change, resulting not only in mortality but also reduced quality of life. The recent cholera data published by the World Health Organization (WHO) falls into this category of simple issues that don’t get the attention they deserve.

Cholera is an acute diarrhoeal disease caused by the ingestion of water or food contaminated with vibrio cholerae. It can cause severe diarrhoea, vomiting, leg cramps, and weakness, and people with low immunity such as malnourished children and people living with HIV/AIDS are at greater risk of death if infected. As a paper in Nature points out: “The dynamics of the infection involve multiple interactions between the human host, the pathogen, and the environment, which contribute to both human-to-human, and environment to human transmission pathways. The most common pathways of contracting the germs are by eating food cooked by infected people, drinking contaminated water, and shaking hands with infected people. The main symptom of cholera is severe acute watery diarrhoea that lasts for three to seven days. If treatment is delayed, this can lead to excessive and fast dehydration and possibly death.”

The situation is quite dire, if we take Unicef Deputy Executive Director Ted Chaiban at his word: “2 billion people still lack access to safely managed drinking water, and 3.6 billion people lack access to safely managed sanitation.”

According to the data, the number of reported deaths from cholera increased last year by 17% compared to 2022. The number of cases increased by 13%. “Cholera killed 4000 people last year, a disease that is preventable and easily treatable... Preliminary data show that the gobal cholera crisis continues in to 2024, with 22 countries reporting active outbreaks,” said WHO director general Tedros Tedros Adhanom Ghebreyesus.

From 1 January to 28 July 2024, a total of 5,052 cholera and AWD cases were reported across four countries in the South-East Asia Region. During this period, cases were reported from India (3,805 cases), Myanmar (1,141 cases), Bangladesh (86 cases), and Nepal (20 cases), as per WHO data. 2,400 deaths have already been reported to WHO across all continents as of 22 August.

Dr. Tedros, in his message, added that conflict, climate change, unsafe water and sanitation, poverty and displacement all contributed to the rise in cholera outbreaks last year. His revelation that the geographical distribution of cholera had also changed significantly, with cases from the Middle East and Asia declining by one-third, and cases from Africa more than doubling, was worrisome, given the existing inequities in access to health care.   Not surprisingly, the global cholera crisis has caused a severe shortage of cholera vaccines. Between 2021 and 2023, more doses were requested for outbreak response than the entire previous decade, the WHO DG said. About 36 million doses were produced last year, only half the amount requested by 14 affected countries. Therefore, since October 2022, the International Coordinating Group, which manages emergency vaccine supplies, has had to suspend the standard two-dose vaccination regimen, adopting a single-dose approach to reach and protect more people with limited supplies. Dr. Tedros also emphasised that there is currently only one manufacturer of cholera vaccines, and urged other manufacturers planning to enter the market to accelerate their efforts and make doses available at affordable rates. 

His prime message though was: While vaccination is an important tool, safe drinking water, sanitation and hygiene remain the only long-term and sustainable solutions to ending cholera outbreaks and preventing future ones.