Cholera: The Water-borne Silent Killer across Eastern and Southern Africa

Cholera is an acute diarrhoeal disease caused by ingesting food or water contaminated with the bacterium Vibrio cholerae. During the 19th century, cholera spread across the world; six subsequent pandemics killed millions of people across all continents. The current (seventh) pandemic started in South Asia in 1961 and reached Africa in 1971. A person shows symptoms from 12 hours to 5 days. The loss of body fluids occurs within hours and may result in death if untreated.

Since the beginning of 2023, over 230,000 cholera cases and 4,000 deaths have been recorded across 14 countries in Eastern and Southern Africa. This ongoing crisis underscores cholera’s status as a global public health event and an indicator of social inequities and underdevelopment. The increasing cholera cases are exacerbated by extreme weather events such as droughts, cyclones, heavy rainfall and floods, highlighting the region’s climate crisis. However, cholera is preventable and controllable through surveillance, water, sanitation and hygiene (WASH) initiatives, social mobilization, treatment and oral cholera vaccine (OCV).

Long-term cholera control hinges on economic development, universal access to safe drinking water, basic sanitation, and robust surveillance systems. Thanks to the concerted efforts of the World Health Organization (WHO), the Africa Centres for Disease Control and Prevention (Africa CDC), the United Nations Children’s Fund (UNICEF) and others, vaccine drives are changing the narrative. OCV, administered in two doses, is a critical tool for protection against cholera. The main types of OCV in use—Dukoral and Shanchol/Euvichol—have efficacy rates ranging from 65% to 85%. These vaccines play a vital role in community-wide disease control, with mass vaccination campaigns significantly reducing cholera incidence and creating herd immunity.

“According to the global standard, one case of cholera should be declared an outbreak!”

In 2023, WHO, UNICEF and Kenya’s Ministry of Health, with support from Amref, conducted an OCV drive across eight counties: Nairobi, Wajir, Mandera, Garissa, Marsabit, Machakos, Kajiado, and Homa Bay. The campaign, named #TwangaCholera, aimed to administer the first dose of the vaccine for free, providing up to six months of protection. The local campaign achieved 104.5% of its target with high community acceptance. Innovative approaches like moonlight outreaches supported by Amref’s mobile clinics further boosted the campaign’s reach.

Additionally, Amref’s Regional Laboratory Programme (RLP) is crucial in enhancing early detection of cholera capacities. Last December, the Programme staff trained nine laboratory technologists from Somalia on cholera diagnosis, with support from WHO Somalia. This initiative aligns with the Global Task Force on Cholera Control (GTFCC) efforts to enhance diagnostic and surveillance capabilities in the region. Somalia, plagued by recurrent cholera outbreaks since 2017, greatly benefits from such capacity-building measures.

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This year, our commitment to cholera control extends to Malawi and Zambia through the Health System Strengthening for Effective Cholera Response project. Funded by The David and Lucile Packard Foundation and Africa CDC, this initiative aims to bolster the Ministries of Health in both countries. By enhancing their outbreak response capabilities and promoting public health measures, we are making significant strides toward a cholera-free future.

In conclusion, addressing the state of cholera in Africa requires strategic collaboration across the continent. Global health security at the regional level can only be achieved through better coordination and cooperation between African countries. We can effectively combat cholera and other public health threats by sharing resources, knowledge, and best practices and working together to strengthen health systems. This unified approach will help control and eventually eliminate cholera and build a resilient health infrastructure capable of addressing future epidemics and pandemics. Together, we can ensure a healthier, safer future for all.

David Mitine – Communications Officer, Global Health Security Unit