Cholera Back? 100 Crore in 43 Countries at Risk

Cholera Coming Back? 100 Crore People in 43 Countries at Risk

Is cholera, which was on the verge of a decline for decades, staging a comeback? Yes, the deadly pandemic is making a resurgence. The World Health Organization  (WHO) and UN Children’s Fund (UNICEF) gave a new threat call on cholera. They stated the deadly pandemic is on a comeback.

The UN agencies said deadly cholera is targeting the world’s most vulnerable communities. They noted that it has put over 1.1 billion people at risk, with children under five particularly vulnerable. More countries now face outbreaks. The agencies pointed out that countries report increasing numbers of cases and the outcome for patients is worse than ten years ago.


“The pandemic is killing the poor right in front of us,” said Jérôme Pfaffmann Zambruni, Head of UNICEF’s Public Health Emergency unit.

“Despite advances in the control of the disease made in the previous decades, we risk going backwards.”

The UN health agency estimates one billion people in 43 countries are at risk of cholera with children under five particularly vulnerable. Cholera’s extraordinarily high mortality ratio is also alarming. Malawi and Nigeria registered case fatality rates as high as three per cent this year, well above the acceptable one per cent.


Echoing the bleak outlook, WHO’s Incident Manager for the global cholera response said the data indicates that 24 countries reported cholera and anticipate more with the seasonal shift. In May last year, 15 countries had reported cases. 

As of May 2023, at least 24 countries continue to report cholera cases. Moreover, outbreaks are spreading across borders, particularly in East and Southern Africa. Twenty-two additional countries around the world are at risk of declaring cholera outbreaks.

Southeastern Africa is particularly badly affected, with infections spreading in Malawi, Mozambique, South Africa, Tanzania, Zambia and Zimbabwe. The development follows the destructive passage of Cyclone Freddy in February and March this year, leaving 800,000 people in Malawi and Mozambique internally displaced and disrupting healthcare.

In 2022, 30 countries faced cholera outbreaks – an alarming 145 per cent average increase from the previous five-year average. Countries like Lebanon and Syrian Arab Republic reported cholera for the first time in decades, while others like Haiti have experienced a resurgence after more than three years with no reported cholera cases.

A deadly combination of climate change, underinvestment in water, sanitation and hygiene services — and in some cases armed conflict — has led to the spread of the disease, agreed the two UN agencies.


• Most cholera-affected countries have limited resources to respond due to the competing high burden of other infectious diseases and other ongoing emergencies.

• In non-endemic countries experiencing resurgence of cholera health-care workers have limited experience or knowledge of cholera case management.

• The increase in demand for essential cholera commodities (like rapid diagnostic kits, oral rehydration salts (ORS) rehydration IV fluids or chlorine for disinfection) and technical workforce is outstripping capacity to supply in time to address multiple public health emergencies.

• A critical shortage of oral cholera vaccine (OCV), with supply insufficient to meet the increased demand


Although vaccines exist to protect against cholera, supply is insufficient to face the increasing demand. According to the WHO, 18 million doses of vaccines have been requested globally, but only eight million have been made available.

“Increasing the production is not an overnight solution,” said Gray. “The plan is to double the production of doses by 2025, but we won’t have enough if the current trend continues. Vaccine is a tool, but not an overall solution. Long-term investment in water sanitation is the priority,” he added.

WHO’s wake-up call was echoed by UNICEF. “Not only (do) we need long-term investments, but immediate investments in the water system to ensure access to clean water, sanitation, and dignity,” said Zambruni.


To respond to the growing cholera threat, WHO is launching a 12-month Strategic Preparedness, Response and Readiness Plan.  It requires $160 million, alongside UNICEF’s Call to Action for $480 million. The combined cholera response plan will cover 40 countries in acute crisis. It will include coordination, infection surveillance and prevention, vaccination, treatment, and water, sanitation and hygiene.

The two UN agencies work closely together. “We need the funds to do what we need to do,” said Gray.


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