The Resurgence of Cholera, "The Forgotten Pandemic", Amid Vaccine Shortages

Newsletter Edition #254 [The Files In-Depth]

Hi,

In today’s edition we take a deep dive on the resurgence of Cholera - the number of cases worldwide surged in 2024 to more than 800,000 — an increase of more than 50 per cent compared to the year before.

We look at not only the multi-faceted causes of such events, but also the structural shortcomings in the response including vaccine shortages.

The challenges faced in addressing in Cholera are illustrative of the very goals of a proposed new Pandemic Agreement current under negotiation, highlighting the importance of not only investments for prevention of outbreaks, but also diversifying manufacturing capacities in different parts of the world to meet unpredictable demand.

We are grateful to Heather Rilkoff, a journalist and an epidemiologist who brings for our readers, this comprehensively reported story that fluently connects the dots. Rilkoff is also a fellow affiliated with the Journalism and Health Impact program at the Dalla Lana School of Public Health, University of Toronto, Canada.

Thank you for reading.

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Illustration Credit: Amy Clarke, Chembe Collaborative

I. STORY OF THE WEEK

The Resurgence of Cholera, "The Forgotten Pandemic", Amid Vaccine Shortages

By Heather Rilkoff

Rilkoff is a journalist and epidemiologist, and a fellow in the Journalism and Health Impact program at the Dalla Lana School of Public Health. You can reach her at rilkoffh@mail.utoronto.ca.

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Cholera has been called “the forgotten pandemic” with a massive impact on global health, although it has often been overshadowed by other infectious diseases. Its forgotten status has now put it in an unprecedented territory: rapidly rising case numbers and deaths, and a global vaccine manufacturing industry that does not have the ability to scale up as needed.

The number of cholera cases worldwide surged in 2024 to more than 800,000 — an increase of more than 50 per cent from one year prior. The demand for cholera vaccines has skyrocketed, pushing an ongoing shortage of cholera vaccines to drastic levels.

“It needs to be taken with more urgency,” says Firdausi Qadri, infectious disease specialist and Senior Scientist of the International Centre for Diarrhoeal Disease Research in Dhaka, Bangladesh in a phone interview.

A Vaccine Shortage Amid a Surge of Cases

Cholera cases and deaths have increased each year since 2021. The reasons for the increase are multifaceted, and many factors are likely to blame. Climate emergencies like natural disasters and flooding, water shortages, overburdened or inaccessible healthcare systems, conflict, displacement and increased urbanization are all contributors. Afghanistan, Yemen, Sudan and the Democratic Republic of Congo — all areas struggling with conflict, mass displacement, climate emergencies and multiple other disease outbreaks — are among the highest afflicted of the 33 countries reporting cholera cases in 2024.

A significant number of people who lose their lives to cholera, die without ever receiving medical care for the condition. In 2023, four countries reported that over 40 per cent of deaths were “community deaths” — meaning they occurred outside of healthcare facilities.

Cholera is also likely to be substantially under-reported, with researchers estimating that anywhere from 1.3 million to 4 million cases and 21,000 to 143,000 deaths occur each year.

The best prevention strategy is a combined approach: water, sanitation and hygiene (WASH), along with vaccines, disease surveillance, community engagement and prompt treatment of those infected. But in areas where the population faces conflict, displacement or other complexities, WASH improvements can be difficult to implement. In these cases, vaccines take on more importance. While vaccines are not a standalone solution to cholera, they play a critical role in slowing outbreaks by reducing the number of people at risk.

“In terms of outbreak control, where the risk of disease is very high… it’s an excellent tool,” Andrew Azman, an associate scientist in the Department of Epidemiology at Johns Hopkins University in Baltimore, Maryland, United States, said in a phone interview.

But vaccines are not a sustainable solution, he adds. “It can give you some years of protection, but it’s not actually stopping the underlying causes of disease.”

Image Credit: Photo by Idan Canfi, Pexels