It’s the beds that often irritate visitors to a cholera ward when they first see them: narrow camp beds, covered in fabric – and with a gaping hole in the middle. People who are seriously ill with cholera have such severe diarrhea and are so weak that they often cannot make it to the toilet. Hence the hole. There is a bucket underneath. “People are shocked when they see this, but this is the reality,” said Philippe Barboza, head of the World Health Organization’s cholera program, in a video interview released by the WHO a few months ago.
Cholera is an acute intestinal infection. In most cases it is mild. But if left untreated, it can also lead to death within hours. Seriously ill people lose liters of fluid due to watery diarrhea and vomiting. In the worst case, they die of organ failure. Children under five are particularly at risk. Theoretically, this should no longer happen in 2024.
Cholera is caused by contaminated water or food, triggered by the bacterium Vibrio cholerae. This bacterium has been known to medicine for more than a hundred years. It is not a pathogen that presents doctors with insurmountable tasks. There is a vaccination against it and cheap treatment options – cholera is preventable and easy to treat. What is currently happening in many countries is all the more dramatic. Since 2021, the world has experienced an unprecedented increase in the number of cholera cases, even in countries that had previously been spared from outbreaks for decades.
Thema:
Cholera
Cholera: More than 35 million cholera vaccine doses were missing in 2023
As early as 2022, the WHO counted 473,000 cases worldwide, more than twice as many as in the previous year. Preliminary data now suggests that around 700,000 people will contract cholera in 2023. Around 4,000 died. And these are just the registered cases. Even the first few weeks of this year do not give any reason to give the all-clear. Currently, 17 countries are experiencing cholera outbreaks, including Afghanistan, Haiti, Zambia and Zimbabwe. Experts from the WHO and international aid groups issued a stark warning this week that global vaccine supplies will soon be exhausted and unable to meet demand.
Why are the numbers increasing?
Cholera is rampant where people are poor and lack access to clean water. It has always been like this. But the fact that the situation is getting so bad in many countries at the moment is also due to the current state of the world. Cholera is a marker of crises and dislocations – social, economic and climatic. War and displacement, natural disasters such as earthquakes and extreme weather events such as hurricanes, floods and droughts promote the spread of the pathogen. Because they all make it more difficult for people to access safe drinking water and destroy sanitary infrastructure. In Mozambique and Malawi, for example, the severe cholera outbreaks last year followed Cyclone Freddy, which raged longer than any tropical storm before.
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Cholera has also resurfaced in war-torn Syria and is affecting a weakened population with vulnerable children. The same applies to other conflict regions such as the Democratic Republic of Congo or Yemen. Some now fear serious outbreaks of cholera in the Gaza Strip.
Although these connections are known, the world is ill-prepared for them. Because the vaccine against cholera is far from reaching everyone who needs it now.
Why is there so little vaccine?
The global community has managed to supply more than half of the world‘s population with novel Covid vaccines within a very short space of time. The same global community is currently watching people die from intestinal infections that shouldn’t exist in 2024. An effective oral vaccination has existed for years. But the large number of outbreaks in different countries has caused demand to increase so much that the manufacturer can no longer keep up with production. Last year, affected countries ordered 76 million doses of vaccine, but only half of them could be delivered. The reason is obvious: all vaccine doses currently come from a single company, EuBiologics in South Korea.
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It had long been foreseeable that this manufacturer would have problems meeting growing demand. By the end of 2022 there was another manufacturer, an Indian branch of Sanofi. When he withdrew from the market, the vaccine was already in short supply. In October 2022, the WHO expert panel, the International Coordinating Group, even had to change its vaccination recommendation: Since then, people in affected areas have only received one dose instead of two. This means that supplies can be stretched somewhat, but the vaccination protection does not last as long. This is not a long-term solution.
Two more manufacturers in South Africa and India are expected to start producing vaccines by the end of the year at the earliest. Until then, EuBiologics is trying to increase its capacity. The company even developed a simplified version of its vaccine so it could make more of it. But experts doubt that this can avert the acute shortage.
It would be easy to treat cholera
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However, vaccinations are only part of the solution. As long as people in so many countries lack drinking water, cholera will not disappear. Hygienic living conditions, clean water and soap, sanitary facilities are needed. More suitable treatment centers for cases of infection are needed as well as systematic early detection of outbreaks. The means to control cholera and save thousands of lives every year are well known. They are not complicated and often not even expensive. You don’t need “ventilators, intensive care units or large hospitals,” says cholera expert Philippe Barboza in a WHO video interview. Simple electrolyte solutions can help counteract fluid loss. In severe cases, sufferers need infusions and antibiotics. “It’s very simple,” says Barboza.
At the same time, this is exactly what makes experts like him despair. Because often enough, even these simple resources are lacking. “People are still dying,” Barboza says, because they don’t have access to a sachet of electrolytes that costs just a few cents. This is unacceptable – when it could be prevented so easily. Humanity feared cholera for centuries. And I still fear them – just not in our part of the world anymore.
It’s the beds that often irritate visitors to a cholera ward when they first see them: narrow camp beds, covered in fabric – and with a gaping hole in the middle. People who are seriously ill with cholera have such severe diarrhea and are so weak that they often cannot make it to the toilet. Hence the hole. There is a bucket underneath. “People are shocked when they see this, but this is the reality,” said Philippe Barboza, head of the World Health Organization’s cholera program, in a video interview released by the WHO a few months ago.