Picture this: a deadly illness that vanished from the shores of the United Kingdom over a century and a half ago in 1866, and from the United States since 1911, is now wreaking havoc across the globe. Cholera isn't just a relic of the past—it's a raging epidemic in 32 countries, with over 6,800 lives lost already this year, surpassing last year's grim total of 6,000 deaths, which was a 50% jump from 2023. And here's where it gets controversial: while science has armed us with tools to defeat it, the real culprits keeping it alive are leadership failures and systemic neglect. But don't stop reading yet—there's a deeper story here about why the world's wealthiest nations have conquered cholera, while poorer ones still battle it daily.
The hardest-hit areas are in Africa, where ongoing conflicts often fuel the spread and cripple efforts to contain it. Think of it like this: in war-torn regions, displaced populations cluster in overcrowded camps without clean water sources, turning a manageable health threat into a catastrophe. Cholera isn't defeated by a lack of knowledge or remedies, but because decision-makers haven't mustered the swift action and dedication this crisis urgently requires. To illustrate, imagine a community where basic infrastructure fails—sewage mixes with drinking water, and suddenly, an outbreak spirals out of control.
That's where global collaborations step in. A coalition of over 50 partners, spearheaded by the World Health Organization (WHO), is tackling these outbreaks via the Global Task Force on Cholera Control. Established back in 1992, this group provides crucial supplies, aids in spotting and treating cases, educates communities on self-protection, and outlines worldwide strategies for lasting control. Building on this, in August, WHO teamed up with the Africa Centres for Disease Control and Prevention to roll out a continental plan for cholera emergency readiness and response. It's like having a rapid-response team on standby, ready to deploy experts and resources wherever needed.
Now, for beginners diving into this, let's clarify: Cholera is fundamentally a disease born from lack. It stems from a bacterium called Vibrio cholerae, which sneaks into your system through contaminated food or water laced with feces from someone already infected. The most effective, enduring shield against it? Reliable access to clean water and proper sanitation. That's why cholera has become a distant memory in places with strong infrastructure—like many Western countries—but flourishes in areas plagued by inequality, poverty, war, displacement, and disasters worsened by climate change. For instance, in a drought-stricken village, people might resort to sharing a single polluted well, unknowingly passing the infection from one family to the next.
In spots where safe water and sanitation are out of reach, affordable and reliable vaccines offer a lifeline. The journey started with injectable shots in the late 1800s, evolving to oral options by the 1980s. But here's the part most people miss: cholera mainly strikes the world's poorest, so vaccine makers see little profit in investing heavily. Currently, just one producer—EuBiologics in South Korea—is churning out vaccines at the scale needed for widespread use.
To bridge this gap, WHO and allies set up a global cholera vaccine stockpile in 2013 through the International Coordinating Group (ICG) on Vaccine Provision. This ensures quick, fair access to vaccines during emergencies, particularly in resource-scarce areas. Since its launch, they've delivered over 250 million doses to 34 nations. And get this: nearly 75% of those went out since 2021, amid cholera's worldwide comeback. This year alone, the stockpile has handed out more than 49 million doses, breaking all prior yearly records. It's a testament to the stockpile's vital role in firefighting outbreaks.
Yet, with outbreaks growing more frequent and intense, these vaccines are stretched thin. They're best for curbing active flare-ups, not for blanket prevention in high-risk zones. The stockpile gets topped up weekly, but production lags behind demand, often dipping below the advised 5 million-dose threshold for constant readiness. In a bold move in 2022, the ICG switched to a single-dose schedule instead of the usual two, to make supplies last longer. Why? Research backs that one dose offers solid protection against cholera, though it fades quicker than the full regimen. This single-dose approach is a stopgap— a smart hack to amplify the impact of limited stocks during crises, not a long-term fix.
The need keeps rising, so we must boost supply. A promising development: in October 2024, Zambia inked a deal with China's Jijia International Medical Technology Company to build a cholera vaccine plant in Lusaka. This could make Zambia Africa's pioneer in producing these vaccines locally. Still, the road ahead involves strict checks: quality tests, clinical studies to verify safety and effectiveness, and WHO approval before any homegrown doses hit the ground in mass campaigns.
Expanding vaccine production across Africa is crucial for dodging and managing this age-old scourge. But—and this is where opinions might clash— the true, lasting antidote lies in governments pouring resources into water and sanitation systems. Forget quick fixes; it's about building resilient infrastructure that eradicates the root causes. Think about it: no amount of vaccines can replace clean taps and toilets.
Some ailments, like Alzheimer's or most cancers, defy total prevention because our bodies just age or mutate unpredictably. Cholera? Not so. It's entirely stoppable. The reason it endures isn't science failing us—it's the persistence of poverty, inequality, conflict, and displacement. Tackling cholera isn't really a medical puzzle; it's a political one, demanding leaders to prioritize equity and peace over short-term gains.
What do you think? Is it fair that profit-driven vaccine markets leave the vulnerable unprotected? Or should governments worldwide shoulder more responsibility for global health? Do you agree cholera is a 'disease of deprivation' that reflects our societal choices? Share your views in the comments—let's spark a conversation on turning political will into real change. After all, as Zambia's President Hakainde Hichilema and WHO Director-General Tedros Adhanom Ghebreyesus argue, the tools are there; we just need the commitment.
Hakainde Hichilema serves as Zambia's president and a leading advocate for cholera control through the Global Task Force on Cholera Control. Tedros Adhanom Ghebreyesus is the director-general of the World Health Organization.
The opinions expressed here do not necessarily reflect those of China Daily.
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