Amid a global resurgence of cholera, the world faces a significant challenge. The global stockpile of the oral cholera vaccine, already difficult to predict and fulfill, has nearly depleted following the cessation of production by an Indian pharmaceutical company, which supplied about 15 percent of the world's supply. While other manufacturers are increasing production, the stockpile is effectively empty, with doses being immediately dispatched to current cholera hotspots upon production. This crisis underscores a broader issue: the persistent lack of political will and financial investment to substantially reduce cholera-related deaths.
Cholera thrives in environments with contaminated water, poor sanitation, and dense populations, such as Rafah, housing over a million Palestinians displaced by the Gaza conflict. While no cholera cases have been reported there yet, an outbreak could be catastrophic due to Gaza's crippled healthcare system and limited access to clean water and medicine.
The disease spreads through contaminated water sources, causing acute diarrhea and vomiting, often leading to death within a day if untreated. While affluent nations with robust sanitation systems are largely immune, cholera cases have been rising globally since 2017, with current outbreaks in several countries including Zambia, Mozambique, and Haiti, among others.
The shortage of cholera vaccines can be attributed to various factors. In 2020, Shantha (now Sanofi India), a major producer, announced its exit from the market, leaving only one other manufacturer, South Korea's EuBiologics, to fill the gap. Efforts to persuade Sanofi to continue production were unsuccessful. Despite recent WHO approval of a simplified formula by EuBiologics, vaccine doses are being rationed, with all available doses immediately allocated to active outbreak zones.
To address the supply crisis, new vaccine technologies are in development, including a temperature-stable pill form, but these won't be available for several years. Meanwhile, Gavi and other organizations are working to enhance vaccine production capacity in developing countries and increase funding for cholera vaccination efforts, which currently fall short.
The resurgence of cholera is exacerbated by factors such as the diversion of resources to combat COVID-19, increased displacement due to conflict and climate change, and deteriorating public infrastructure in many countries. Climate change, in particular, is expected to further fuel cholera outbreaks in new regions.
In conclusion, while efforts are being made to address the cholera crisis, more urgent action and funding are needed to prevent further deaths from this preventable disease.