WHO EMRO Weekly Epidemiological Monitor: Volume 16; Issue no 04; 22 January 2023

Current major event

Cholera: a global grade 3 emergency

On 26 January 2023, the cholera outbreaks (event) was graded as a multi-region Grade 3 Public Health Emergency after considering the current scale, the potential for further international spread, the high urgency, complexity factors, current low to moderate capacity, and the very high reputational risk.

Editorial note

Cholera is preventable and can be treated successfully through prompt administration of oral rehydration solution. Failures in social development, conflicts, population movements, poor water infrastructure, inadequate sanitation, heavy seasonal rains, floods, droughts, and climate change have all contributed to increasing outbreaks of cholera.

Increasing humanitarian crises due to conflicts, the effects of climate change (drought and flooding), political instability and lack of development are leaving an increasing number of people at risk for cholera across WHO’s six regions. Of the countries that are reporting active outbreaks, many are experiencing conflict or political violence in affected areas (Afghanistan, Cameroon, Democratic Republic of the Congo (DRC), Ethiopia, Haiti, Nigeria, Somalia, Syria and others) (See table in the PDF).

In two of these countries, the current outbreak is not affecting conflict areas, but there is a high risk of spreading into areas of ongoing conflict (Ethiopia and Cameroon). Other countries are experiencing the effects of climate change with widespread floods or drought (Ethiopia, Kenya, Nigeria, Pakistan, and Somalia). These factors, along with others, including financial crises, mass migration of internally displaced persons and refugees, and a long-term lack of development have left large populations across all continents without access to clean water and sanitation, and healthcare, thus, at risk for cholera. In 2022, three countries reported cholera outbreaks which had not reported cholera for more than three years (Syria, Haiti and Lebanon), all countries with complex humanitarian crises. Their populations have limited access to clean water and sanitation, they have fragile health systems and are at the risk of further cholera spread in 2023.

The large number of outbreaks in 2022 coupled with major political crises requiring significant health response (Afghanistan, Horn of Africa and Ukraine), put a strain on the global medical kit supplies, including for cholera. The increasing number of outbreaks is compounding this effect. The current cholera kit supply is unlikely to meet the demand without coordinating with potential suppliers and partners responding to outbreaks and advocating to produce more cholera kits. WHO is consulting with major supply partners (UNICEF, MSF), but further work and a mechanism to coordinate with countries requesting cholera kits and other supplies will be necessary.

The global stockpile of Oral Cholera Vaccine (OCV) continues to be insufficient to meet all requests for the two-dose preventive vaccination. Therefore, the International Coordinating Group members’ decision (IFRC, MSF, UNICEF, and WHO) to limit all reactive OCV campaigns to one single dose remains active in 2023 for the foreseeable future.

The global roadmap targets 47 high-priority countries, including countries that are endemic for cholera and others with infrequent outbreaks. In 2021, 23 countries reported cholera outbreaks to WHO. In 2022, 30 countries (including 14 countries that did not report cholera in 2021) reported new or ongoing outbreaks, including Lebanon and Syria, which were not considered priorities when the roadmap was launched.

WHO is working closely with ministries of health and health partners to achieve effective prevention and cholera control. Among WHO’s key areas of intervention are promoting access to safe water and sanitation, health and hygiene in affected communities, ensuring quality health care and rebuilding strong health systems. In addition to the immunization of at-risk populations with the oral cholera vaccine as a proven, safe and effective public health intervention.

Source: World Health Organization