Global uptick in cholera cases raises alarm after decades of progress

Cholera, an acute intestinal infection that can prove fatal within hours if left untreated, has seen a global uptick in cases since 2021. The number of cases has continued to increase through 2023, overwhelming both domestic health services and the global capacity to respond. 

According to the World Health Organization’s (WHO) situational report, 29 countries have reported cases since the beginning of the year. Both the size and quantity of cholera outbreaks have increased, making disease intervention and control more difficult. Africa remains the most vulnerable region with countries such as Cameroon, the Democratic Republic of the Congo, and Malawi reporting more than 10,000 confirmed cases this year.

Individuals may show symptoms anywhere from a few hours to five days after infection with the bacterium Vibrio cholerae. These symptoms include diarrhoea, dehydration, and cramps. While many individuals remain asymptomatic, the bacteria can still be present in faeces for up to ten days following infection, posing a potential risk of transmission to others. 

Cholera is spread when people consume food or water contaminated with the bacteria. Precursors to cholera outbreaks include poverty and conflict since they strain public health systems and limit access to clean water and sanitation facilities. Climate change also exacerbates the conditions through which cholera develops and spreads. Extreme weather events may destroy sanitation facilities, spread infected sewage into water sources, displace infected or at-risk populations, and contaminate seafood. 

Mild cases of cholera may pass on their own, while those who develop life-threatening symptoms must be treated quickly. The illness can lead to coma or death within hours as a result of severe dehydration. According to the WHO, more than 1 billion people in 43 countries are vulnerable to cholera outbreaks. The disease remains a global public health challenge, especially since it has high rates of mortality in at-risk groups, and requires cooperation worldwide to curtail and prevent the outbreaks.

Historically, there have been seven cholera pandemics. The seventh pandemic is still ongoing. The global cholera situation improved in the 1990s since many countries expanded efforts to maintain adequate access to clean water and sanitation. Nevertheless, cholera has remained endemic in parts of Asia and Africa, with the last two years marking a significant resurgence in cases. Numerous countries are facing a myriad of conflicts and public health emergencies that make it difficult to both prevent and respond to cholera outbreaks. The COVID-19 pandemic, violence, humanitarian crises, travel, and other factors have compounded the risk factors that may introduce cholera outbreaks. 

Domestic issues have thus made addressing cholera on the local level difficult. Global capacity to assist countries dealing with the acute public health crisis has been stretched thin. The International Coordinating Group (ICG) is a body of the WHO that manages the global supply of oral cholera vaccines. However, since October 2022, it has switched to coordinating single-dose vaccination regimens with recipient countries rather than the traditional two-dose method. The change is due to a low supply of the vaccine. 

The illness is treated through oral or intravenous hydration, but it may not be possible for individuals to get treatment easily. Fragile healthcare systems and lack of access to clean water often characterise cholera hotspots, not to mention medical personnel already overwhelmed with other public health emergencies. The demand for supplies, vaccines, and resources to control cholera exceeds the supply available.

The WHO has continued to provide outbreak control assistance through delivering medical supplies, supporting public health surveillance, and more. Additionally, since 2017, the Global Task Force on Cholera Control, a group of cholera-affected countries, global donors, and organisations, have pursued a strategy called Ending Cholera: A Global Roadmap to 2030 with the intention to reduce cholera-related deaths by 90%. Thus, many countries, organisations, and groups are continuously working to eliminate cholera but still face many challenges.

The surge in cholera cases signifies a need to produce long-term solutions such as improving access to clean water and sanitation in affected countries. If left unchecked, cholera, along with other illnesses, will continue to devastate vulnerable communities. Greater attention must be brought to global health issues before it is too late.