The cholera emergency is avoidable

The world is facing an upsurge in cholera, even touching countries that have not had the disease in decades. Years of progress against this age-old disease have disappeared. While the situation is unprecedented, the lesson to draw is not a new one: safe drinking water, sanitation and hygiene are the only long-term and sustainable solutions to ending this cholera emergency and preventing future ones.

The global cholera situation is concerning, but as we mark World Water Day today, and the historic United Nations Water Conference begins in New York, the Global Task Force for Cholera Control (GTFCC) is appealing to countries and the international community to channel that concern towards concrete action.

First, to prevent future outbreaks, countries need strong public health surveillance systems to quickly identify and confirm cholera cases, allowing for immediate action. Countries with ongoing widespread outbreaks need immediate support to track and tackle the current crisis. We can’t solve a problem we can’t see.

Second, stop the cycle that takes us from emergency to emergency by investing in water, sanitation, and hygiene (WASH). When there is a cholera outbreak, responders rush in soap and chlorine tablets, bring in safe water in trucks, and build temporary latrines to prevent the outbreak from spreading. While these actions are undoubtedly life-saving, longer-term investments in WASH infrastructure can prevent outbreaks in the first place. Wherever in the world cholera has been eliminated, it has been thanks to improvements in basic water, sanitation and hygiene – access to these is an internationally recognized human right.

Moving from an emergency response to long-term improvements is more effective, because although cholera is a health issue, first and foremost, it is a development issue.

Third, focus efforts on cholera hotspots. Fighting cholera requires a targeted approach centred on hotspots–health zones or districts–where cholera cases are concentrated. Focusing on cholera hotpots more than doubles the return on investments in safe water, sanitation and hygiene: from US$4.30 to US$10 for every US$1 invested.

Fourth, support the development and implementation of national cholera plans, including the budget allocated for WASH. These national plans lay out multisectoral actions needed for sustained cholera prevention and control, including the use of oral cholera vaccines, putting communities at the center. 

Poverty, conflict, and disasters continue to fuel cholera, now turbo-charged by climate change. The future presents multiple challenges, but at least for cholera, we have the answer: access to safe water, sanitation and hygiene in cholera hotspots. Urgent, targeted investments will get us there.

Note to editors

In the past months, the world has seen a resurgence of cholera. Last year, as many as 30 countries experienced outbreaks, and we continue to see a worrying geographic spread into 2023. Countries like Lebanon, South Africa and Syria are seeing their first outbreaks in decades. It is not just the number and spread of outbreaks which is concerning, but the severity with which they are striking. The average case fatality rate of the current outbreaks is double the target threshold of less than 1%.

Many of these outbreaks have clear links with extreme climate events, which bring at times too much and at times too little water, both potent fuel for cholera as access to water supplies are disrupted, and people may be forced to move from their homes to more temporary—and at times crowded—settlements. Looking ahead, we can expect more frequent floods, droughts, storms and displacement. Other than climate change, modelling exercises show that population growth and urbanization alone could lead to a doubling of cholera cases over the next 20 years if we do not act now.

For more information on the full multisector approach to cholera control and elimination, please see the GTFCC Steering Committee statement on the current cholera situation.

Signed by the Steering Committee of the Global Task Force for Cholera Control (GTFCC)

His Excellency Mr Hakainde Hichilema, President of the Republic of Zambia and Global Cholera Control Champion

Dr Frew Benson, Chair, GTFCC Steering Committee

Dr Christopher J. Elias, President, Global Development, Bill & Melinda Gates Foundation

Dr Howard Zucker, Deputy Director for Global Health, Centers for Disease Control and Prevention (CDC)

Dr Seth Berkley, CEO, Gavi, the Vaccine Alliance

Dr Tahmeed Ahmed, Executive Director, icddr,b

Jagan Chapagain, Secretary General, International Federation of Red Cross and Red Crescent Societies (IFRC)

Dr Christos Christou, International President, Médecins Sans Frontières

Catherine Russell, Executive Director, UNICEF

Dr Tedros Adhanom Ghebreyesus, Director-General, World Health Organization