World put on highest health alert after global cholera outbreak

5 min read
Cholera survivor, Mirriam, 9, chats with her mother Monica and her father Jonathan at their home in Mazyopa Compound, Chipata sub-district, Lusaka, Zambia. May 2018.
Image: WaterAid/ Chileshe Chanda

Health experts around the world have expressed alarm at the extent and gravity of recent cholera outbreaks in 30 countries. Some of the affected countries had not reported any cholera cases for years.

“Over the last year we’ve seen a staggering global cholera crisis, reversing years of declining infections,” said Arielle Nylander, WaterAid’s Senior Health Policy Analyst.

“Climate change is now recognised as a major contributing factor in the resurgence of the deadly disease.

“There are not only more outbreaks but they affect more people and are deadlier.

“In total, 13 countries which reported no cholera in 2021 experienced outbreaks in 2022. More concerning, many of these countries had been cholera-free for years. Lebanon had reported no cholera for nearly three decades, but by the end of 2022 there were cases in the majority of districts across the country.

“Among the usual contributing factors like poverty, weak infrastructure, conflict and humanitarian crises, climate shocks are increasingly driving multiple severe outbreaks and posing an enormous challenge to effectively controlling and ultimately eliminating this disease in 2023 and beyond,” she said.

The World Health Organization (WHO) has called the current outbreak in Malawi “the deadliest in the country’s history”. It began last March at the end of the cyclone season. The latest figures from Malawi’s health ministry show that there have since been more than 1300 deaths and 40,000 cases. In Mozambique, it has now spread into 18 districts where there have so far been 29 deaths and almost 3,400 cases.

WHO Director-General Dr Tedros Adhanom Ghebreyesus, told the WHO Executive Board: “We have now raised the global cholera crisis to a grade three emergency, the highest level in our internal grading system, due to the high case fatality, the potential for further spread and severe limitations in vaccine supply.”

At a media briefing today, Dr Patrick Otim Ramada, WHO’s Africa Incident Manager for Cholera Response said: “It’s really important that governments invest in long-term clean water and hygiene interventions in their countries. This is a multi-sectoral effort, not only a health issue. It requires, like we did for Covid, a whole governmental response so that governments really prioritise and invest in interventions that increase the availability of safe drinking water and hygiene facilities for populations in their countries in the region.”

Dr Otim highlighted the central role of climate change in aggravating the cholera outbreaks in drought-hit areas of Kenya and the Horn of Africa and the intense rainy season in Southern Africa.

The cyclone season, which has already hit Madagascar this year, has the potential to spread the disease further across Southern Africa.

WaterAid’s country directors Mercy Masoo, in Malawi and Adam Garley, in Mozambique, issued a joint statement: “Like the COVID-19 pandemic, the current cholera outbreak underscores the urgent need for governments to invest in water and sanitation,” they said.

“Improving access to sustainable water and sanitation services will not only serve to control cholera. It will also help stop the spread of a range of other waterborne diseases such as diarrhoea which is responsible for 20% of hospital admissions in Mozambique and is the second leading cause of death in children under five in both countries.”

“Given the clear link between climate change, water and public health we also advocate for more funds for climate adaptation to be made available by the international community to support improvements in water and sanitation in low-income countries.”

Another city which experienced its worst outbreak for 60 years in 2022 was the Bangladesh capital Dhaka. At the peak in the last March, more than 1200 people a day were being hospitalised.

Dr Nurullah Awal, Health Adviser to WaterAid Bangladesh, is the current Chair of the Water Sanitation and Hygiene (WASH) working group of the Global Task Force for Cholera Control (GTFCC). He said: “Outbreaks in Dhaka are often most severe in slums and low-income communities. Many slums lack access to safe water. Solid waste is also not collected in a systematic way from urban slums, which leads to poor sanitation. Malnourished children face higher risks from diarrhoea and cholera.

“Bangladesh in one of 20 countries in the world that are trying to eradicate cholera. It approved the National Cholera Control Plan in 2019 which clearly emphasised the role of safe water, sanitation and hygiene to eradicate the disease.

“To obtain a sustainable solution, the health ministry, together with city authorities and utility service agencies should take preventative measures at the beginning of every summer to educate the people about the risks of cholera and diarrhoea.”

Indeed, ahead of the upcoming summer season, the national technical committee on cholera, of which WaterAid Bangladesh is a member, is due to meet this week to plan how to improve the identification of cholera hotspots.

WaterAid’s ongoing work to control and prevent cholera outbreaks in the countries where we work is an integral part of delivering on the 2023 priorities of the GTFCC WASH working group: to improve the collection of WASH data for cholera surveillance; to ensure sustainable WASH is central to National Cholera Plans; and to improve water quality management.

“Water and sanitation services represent the only long-term solution for ending cholera. While oral cholera vaccines have played an important role in bridging short-term and long-term efforts, the well-documented vaccine supply issues have reiterated the need to immediately strengthen sustainable water and sanitation services,” said Nylander.

 The GTFCC and Wellcome plan an event to explore the link between the spread of cholera and climate change on 23rd Feb at which WaterAid has been invited to give evidence from its country programmes.