Deadly cholera outbreak hits southern Africa – DW (English)

More than 1,000 people have succumbed to cholera, while tens of thousands across Africa have been infected in a series of deadly cholera outbreaks since the beginning of 2024.

The hardest hit nations are the Democratic Republic of the Congo, Mozambique, Zimbabwe,Zambia in southern Africa, and Ethiopia furthernorth.

Zambia is being battered by its worst outbreak ever, with more than 740 cholera deaths recorded since the onset of seasonal rains in October 2023.

The highly contagious bacterial disease can cause severe diarrhea and dehydration within hours of infection. When people are quickly treated, less than 1% die. But the death rate in Zambia, one of the world's poorest countries, is more than 3%.

Cholera outbreaks often occur in disaster-hit areas or poorer communities lacking safe drinking water and proper sanitation. Those who depend on untreated water from rivers and ponds or live in slums and refugee camps are at particular risk.

Thisis because the Vibrio cholerae bacteria that causes cholera is shed in the fecesof theinfected host, with the bacteriaspreadingrapidly if it gets into food or water supplies.

"Just imagine one household where the toilet is pretty close to the place where people fetch their water, so there is a transmission of contamination between the toilets and the water that people drink," explained epidemiologist Yap Boum, the head of the Pasteur Institute of Bangui, a non-profit research foundation in the Central African Republic.

"And then in settings like refugee camps, where you have a concentration of people, the water that is being used is highly contaminated."

There are a host ofreasons forthe rash of simultaneous cholera outbreaks across somany southern African countries, saidepidemiologist Boum.

"Cholera is a marker of inequality, mostly affecting countries that are exposed to conflict, insecurity and poverty," he said.Those factorsare all present in each of the African nations currently battling cholera outbreaks.

Another factor is climate change.

"Increasingly frequent and more severe flooding linked to climate change has an impact [on cholera outbreaks] too," wrote water management expert Anja du Plessis, an associate professor at the University of South Africa, in response to DW questions. "Cholera occurs more in the rainy season, which the region is currently experiencing."

"Flooding results in more run-off containing more pathogens, increasing the risk of contamination."

To make matters worse, stockpiles of the only available cholera vaccine are empty as demand soars.

Only one manufacturer,based in South Korea, currently makes an oral cholera vaccine. It is churning out 700,000 doses a week, but demand is four times greater than it can supply, according to Doctors Without Borders (MSF).

Thisdespite an October 2022 International Coordinating Group (ICG) on Vaccine Provision recommendation to replacethe long-standing two-dose regimen witha single dose of the cholera vaccinein an effortto preserve stocks.

Unlike routine childhood vaccinations, cholera vaccines are produced on a "needs basis," said Edina Amponsah-Dacosta, a vaccine expert with the Vaccines for Africa Initiative based at the University of Cape Town in South Africa.

"We tend to use cholera vaccines for mass vaccination programs whenever we have outbreaks to control the outbreak of the disease. Thatmeanswe tend to produce a limited amount for a limited number of countries."

The past decade has seen a massive increase in cholera vaccines produced,jumping from roughly 2 million doses in 2013 when the cholera stockpile was set up to 36 million in 2022.

But thatstill isn't enough to keep up with the current unprecedented surge in global cholera cases.

"If cholera were similarly affecting Western countries, I believe we wouldhave the highest amount of vaccine available, but that is not the case," said Boum, who previously headed MSF's researcharm, Epicentre.

At the same time, every expertinterviewed for this article warned that vaccines wouldnever be thesilver bullet that will stem the spread of cholerain southern Africa.

Rather, a vaccine is just one of many tools to help fight disease. Others include improving community health messaging about boiling water and good hygiene practices, like washing one's hands, providing safe and reliable water sources, and increasing water quality testing and monitoring.

In 2022, the South African-based company Biovac signed a licensing contract to manufacture oral cholera vaccines in a deal heralded by international health experts. But Biovac's vaccines can't be used to curbcurrent outbreaks becauseproduction isn't slated to startuntil2026.

Having a regional manufacturer is an important step in the right direction though, say both Yap Boum and Edina Amponsah-Dacosta.

"Diseases are not prioritized the same way in all parts of the world," vaccinologist Amponsah-Dacosta told DW. "With cholera, we have just one manufacturer with limited global interest in a disease such as this one. It creates the situation that we're seeing now in terms of the dwindling stockpile."

"If you increasemanufacturing capacity in parts of the world that experience the disease the worst, it just means that they are able to take ownership and rely on their own resources and better support their health programs. "Thatis critical."

Edited by: Chrispin Mwakideu

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Deadly cholera outbreak hits southern Africa - DW (English)