Cholera remains a deadly threat for the world’s poor as progress towards elimination lags

9 June 2020
Image: WaterAid/ Joey Lawrence

Download photos

The countries worst impacted by cholera outbreaks are struggling to effectively tackle the disease, a new report released by WaterAid has found, with a lack of access to clean water and proper sanitation acting as a key barrier to progress. As the world battles to contain COVID-19, public health crises which threaten the world’s most vulnerable are at risk of falling further down the agenda. 

Cholera is a disease of inequality and outbreaks mostly occur in some of the world’s poorest countries where poor sanitation and living conditions cause the disease to spread widely. Estimates suggest there are around 2.9 million cases of cholera and 100,000 deaths every year. These numbers have the potential to climb dramatically as mass vaccination campaigns are disrupted due to COVID-19 lockdowns and resources are directed to pandemic response

The Global Roadmap to 2030 – which was published by the Global Task Force on Cholera Control in October 2017 – aims to reduce cholera deaths by 90% as well as completely eliminate the disease in up to 20 countries, but the report from WaterAid suggests that progress towards these targets are currently way off track, and were not on target even before the COVID 19 crisis hit. 

The research found that while many countries have implemented short-term and emergency response plans, they are not employing the long-term improvements which will prevent the disease from taking hold and can save more lives and livelihoods in the long run. 

Communities that lack clean water, decent toilets and good hygiene are most affected by cholera, but countries with the lowest levels of access to these basic services were the least likely to have comprehensive cholera plans, including details of how they would be implemented.  

In several of the countries studied, those at greatest risk from the disease in hotspots where cholera reoccurs on an annual basis, are not being identified or targeted with preventative measures. Protecting these vulnerable communities will not only save lives, it will help to eliminate a disease which has long been overcome elsewhere. 

Julie Truelove, Senior Policy Analyst, Health & Hygiene at WaterAid says:

 “The evidence shows strong rationale for hygiene and vaccinations to go hand in hand when it comes to disease prevention - but water and sanitation measures are not being prioritised within cholera plans.

“Hand hygiene has not only been recognised in WHO guidance as a first line of defence against COVID-19, it has always been a critical prevention measure against cholera. And yet, soap and clean water are still missing from households, workplaces and even healthcare centres across the globe. 

“It has never been more important to focus on long-term solutions to protect those most vulnerable. 

“At this crucial time, WaterAid is calling on all governments to put water, sanitation and hygiene measures in place – a ‘no regrets’ action for public health - in order to prevent thousands of unnecessary deaths each year.”

The international charity assessed cholera plans in 13 countries where they work, all of which have faced regular and repeated cholera outbreaks for many years. The report also found that: 

  • Only four countries - Bangladesh, Nigeria, Zambia and Zanzibar - had cholera plans in place which were in line with recommendations to eliminate the disease. 
  • Only three countries - Bangladesh, Nigeria and Zambia - have defined how their oral cholera vaccine programme would include and integrate hygiene and clean water programmes. 
  • Countries with the lowest levels of access to decent toilets are the least likely to have plans which align with global recommendations.  For example Ghana, where only 18% have access to basic sanitation, Niger (14%), Sierra Leone (16%) and Uganda (18%).

According to the report – which was launched today alongside the Global Task Force on Cholera Control's virtual event – only a more integrated approach, focusing on long-term improvements will protect the lives of the poorest and most vulnerable communities.

Read the report: Old disease, new threat: driving an end to cholera


For more information, please contact:
Maya Verber, Senior Media Officer on:
[email protected] or
+44 (0)207 793 4965.

Or call our after-hours press line on:
+44 (0)7887 521 552 or
email [email protected]

Notes to Editors:

Report Methodology

  • The study referenced in ‘Old disease, new threat: driving an end to cholera’ analysed national plans in cholera-affected countries where WaterAid works, to assess the extent to which Water, Sanitation and Hygiene (WASH) is integrated and coordinated alongside other cholera control interventions. 
  • The plans were analysed against nine WASH-related criteria and four criteria relating to the broader enabling environment and leadership required to support and drive a multi-sectoral response. 
  • A total of 13 national plans were analysed as available and accessible through the Global Task Force on Cholera Control (GTFCC) secretariat and other sources. 
  • The plans were graded using a traffic light analysis against each of the 13 criteria, whereby green indicated yes/well integrated; yellow for partially; and red to show more progress is needed.


WaterAid is working to make clean water, decent toilets and good hygiene normal for everyone, everywhere within a generation. The international not-for-profit organisation works in 28 countries to change the lives of the poorest and most marginalised people. Since 1981, WaterAid has reached 26.4 million people with clean water and 26.3 million people with decent toilets. For more information, visit, follow @WaterAid or @WaterAidPress on Twitter, or find WaterAid UK on Facebook at

  • 785 million people in the world – one in ten – do not have clean water close to home.[1]
  • 2 billion people in the world – almost one in four – do not have a decent toilet of their own.[2]
  • Around 310,000 children under five die every year from diarrhoeal diseases caused by poor water and sanitation. That's almost 800 children a day, or one child every two minutes.[3]
  • Every £1 invested in water and toilets returns an average of £4 in increased productivity.[4]
  • Just £15 can provide one person with clean water.[5]

[1] WHO/UNICEF Joint Monitoring Programme (JMP) Progress on drinking water, sanitation and hygiene: 2017 update and SDG Baselines

[2] WHO/UNICEF Joint Monitoring Programme (JMP) Progress on drinking water, sanitation and hygiene: 2017 update and SDG Baselines

[3] Prüss-Ustün et al. (2014) and The Institute for Health Metrics and Evaluation (2018)

[4] World Health organization (2012) Global costs and benefits of drinking-water supply and sanitation interventions to reach the MDG target and universal coverage