Burden of Cholera Globally
Cholera is an acute diarrheal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. It remains a global threat to public health and an indicator of inequalities in access to clean water and sanitation. According to the World Health Organization (WHO), there are an estimated 1.3 to 4 million cases, and 21,000 to 143,000 deaths due to cholera every year worldwide. The majority of infections occur in developing countries where basic sanitation and clean water supplies are lacking. Countries in Africa, Asia and Haiti have been affected by repeated and ongoing outbreaks in recent decades. Large outbreaks have overwhelmed national health systems and displaced populations. Cholera also constitutes a huge economic burden for affected communities and countries.
Cholera Vaccines Industry as a Preventive Measure
WHO recommends oral Cholera Vaccines as an additional control and preventive measure in epidemic and endemic settings. Two vaccines are currently prequalified and recommended by WHO – Dukoral and Shanchol. Both are safe, affordable and provide protective immunity for approximately 2 years after two doses. However, global vaccine supply is still limited compared to population needs in high risk areas. Cholera vaccination programs target at-risk populations like communities with limited access to clean water and sanitation, internally displaced persons and refugees. Mass vaccination campaigns may be conducted during outbreaks to complement other control efforts like water, sanitation and hygiene interventions. Research is ongoing to develop more effective and affordable vaccine formulations.
Cholera Vaccines Industry in Bangladesh
Bangladesh is considered a global epicenter of cholera, with regular seasonal outbreaks occurring predominantly in coastal and riverine regions. Population is at chronic risk due to environmental factors like floods, cyclones and poor water/sanitation infrastructure in densely populated areas. Bangladesh was among the first countries to introduce cholera vaccination as part of comprehensive cholera control strategies. Since 2008, the nationwide oral cholera vaccination program has integrated routine vaccinations with campaigns during outbreaks or before natural disasters. Independent evaluations showed that two doses of the Shanchol vaccine provided over 60% protective efficacy in the first year, and helped reduce disease burden in highly endemic areas. Continued vaccination is credited with preventing millions of cases as water/sanitation improvements lag behind. The experience demonstrates how oral cholera vaccines can fill a crucial gap when used along with other interventions in high burden settings.
Integrated Approach in Haiti
Cholera was introduced to Haiti in October 2010, following the earthquake, and rapidly spread into the country’s largest epidemic in recent history. Over 800,000 suspected cases have occurred so far, with over 9,000 related deaths. Control proved challenging due to poor water treatment infrastructure compounded by flooding and crowding after the earthquake. In response, the Ministry of Health and partners launched a two-pronged strategy combining vaccination with strengthened water/sanitation/hygiene practices across the country. Multiple mass vaccination campaigns administered the bivalent killed whole-cell oral cholera vaccine Shanchol to over 900,000 Haitians aged 1 year and above in high-risk areas during 2012-2013 and 2017. Alongside water system rehabilitation and community education drives, this integrated approach helped reduce cholera incidence substantially according to national surveillance data. Continued immunization efforts aim to eliminate cholera from Haiti by 2022 through herd protective immunity within communities.
Challenges and Future Directions
While current evidence supports strategic use of oral Cholera Vaccines, further roll-out is hampered by several challenges. Global vaccine production remains limited due to high manufacturing costs and low prioritization. Outbreak response is also hindered by insufficient global/national stockpiles and time needed for emergency shipment. Vaccine affordability is a concern for severely resource-constrained countries depending on GAVI subsidies. Moreover, ensuring adequate cold-chain storage and synchronized delivery with wat/san activities poses logistical obstacles in remote settings.
Efforts continue towards developing more thermally-stable, easily-administrable single-dose formulations. Permanent solutions ultimately lie in achieving universal access to clean water, sanitation and hygiene for all. Still, the incremental but vital role of vaccination in protecting vulnerable populations cannot be denied – it saves lives now and every year through integrated prevention strategies. With coordinated global action, cholera can be controlled and potentially eliminated from epidemic hotspots worldwide within our lifetime.
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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
