A cholera emergency can be avoided

The world is facing an increase in cholera, even in countries that have been free of the disease for decades. Years of progress against this age-old disease are gone. Although the situation is unprecedented, the lesson to be learned is not new: safe drinking water, sanitation and hygiene are the only long-term and sustainable solutions to end this cholera threat and prevent future ones.

The global cholera situation is worrying, but as we mark World Water Day today and the historic United Nations Water Conference begins in New York, the Global Task Force on Cholera Control (GTFCC) is calling on countries and the international community to channel that concern into concrete action.

First, to prevent future outbreaks, countries need strong public health surveillance systems to quickly identify and confirm cholera cases, allowing for immediate action. Countries with widespread and ongoing epidemics need urgent support to monitor and address the current crisis. We can’t solve a problem we can’t see.

Other, stop the cycle that takes us from emergency to emergency by investing in water, sanitation and hygiene (WASH). When a cholera outbreak occurs, emergency services rush in with soap and chlorine tablets, truck in clean water and build temporary latrines to prevent the outbreak from spreading. While these actions undoubtedly save lives, longer-term investments in WASH infrastructure can prevent outbreaks. Wherever cholera has been eliminated in the world, it has been thanks to improvements in basic water, sanitation and hygiene – access to which is an internationally recognized human right.

The transition from immediate response to long-term improvements is more effective, because although cholera is a health problem, it is first and foremost a development problem.

the third, focus efforts on cholera hotspots. The fight against cholera requires a targeted approach aimed at hotspots – health zones or districts – where cholera cases are concentrated. Focusing on cholera hotspots more than doubles the return on investment in safe water, sanitation and hygiene: from $4.30 to $10 for every $1 invested.

fourth, support the development and implementation of national cholera plans, including the budget allocated to WASH. These national plans set out the multisectoral actions needed for sustainable cholera prevention and control, including the use of oral cholera vaccines, putting communities at the center.

Poverty, conflict and disaster continue to fuel cholera, now exacerbated by climate change. The future presents multiple challenges, but at least for cholera we have an answer: access to safe water, sanitation and hygiene in cholera hotspots. Urgent, targeted investments will get us there.

Note to editors

In recent months, the world has witnessed a renewed outbreak of cholera. As many as 30 countries experienced outbreaks last year, and we continue to see a worrying geographic spread in 2023. Countries like Lebanon, South Africa and Syria are seeing their first outbreaks in decades. It is not only the number and spread of epidemics that is worrying, but also the severity with which they strike. The average fatality rate in current outbreaks is twice the target threshold of less than 1%.

Many of these outbreaks have clear links to extreme climate events, which sometimes bring too much and sometimes too little water, both of which are potent fuels for cholera as access to water supplies is disrupted and people may be forced to move from their homes to more temporary — and sometimes overcrowded — settlements. Looking ahead, we can expect more frequent floods, droughts, storms and displacement. In addition to climate change, modeling exercises show that population growth and urbanization alone could lead to a doubling of cholera cases in the next 20 years if we don’t act now.

For more information on a full multisectoral approach to cholera control and elimination, see Statement of the GTFCC Board of Directors about the current cholera situation.

Signed by the Steering Committee of the Global Task Force on Cholera Control (GTFCC)

His Excellency Mr. Hakainda Hichilema, President of the Republic of Zambia and World Cholera Control Champion

dr. Frew Benson, Chairman of the GTFCC Board of Directors

dr. Christopher J. Elias, President, Global Development, Bill & Melinda Gates Foundation

dr. Howard Zucker, Deputy Director for Global Health, Centers for Disease Control and Prevention (CDC)

dr. Seth Berkley, CEO, Gavi, Vaccine Alliance

dr. Tahmeed Ahmed, CEO, icddr, b

Jagan Chapagain, Secretary General of the International Federation of Red Cross and Red Crescent Societies (IFRC)

dr. Christos Christou, International President, Doctors Without Borders

Catherine Russell, Executive Director of UNICEF

Dr. Tedros Adhanom Ghebreyesus, Director General of the World Health Organization