|International efforts to reduce cholera are bearing fruits with a 60% decrease in cases in 2018 compared with numbers from the previous year, according to a World Health Organization report / Photo by: Raman Venin via 123RF|
International efforts to reduce cholera are bearing fruits with a 60% decrease in cases in 2018 compared with numbers from the previous year, according to a World Health Organization report.
This major development indicates an "encouraging trend" in preventing the disease and controlling major hotspots in the world including Haiti, Somalia, and the Democratic Republic of the Congo (DRC).
While the results of the collective international effort highlight the importance of mass cholera vaccination campaigns, WHO Director-General Tedros Adhanom Ghebreyesus emphasized that the long-term solution for eradicating cholera "lies in increasing access to clean drinking water and providing adequate sanitation and hygiene."
Reports from 34 countries show that there were 499,447 cholera cases and 2,990 deaths due to the disease recorded in 2018. When excluding reported cases from Yemen, where reports are imprecise, the total number of cases and deaths was 128,121 and 2,485, respectively.
"While the true global disease burden is not entirely captured by annual reporting of cholera epidemiological indicators by [the] Member States to WHO, the overall number of cholera cases was 60% lower in 2018 than in 2017," the WHO reported.
It added the decrease is attributed to a significant reduction in the number of cases in key continents.
For instance, the overall cholera burden in Africa dropped by 37% in cases and 25% in deaths in 2018 compared to the year before. The WHO report stated this general reduction can be attributed to several factors like the resolution of the massive outbreaks in countries like the DRC and the wide distribution of the oral vaccine.
Over in the Middle East, Yemen represented a great improvement over the previous year despite reporting the most cholera cases (371,326 cases and 505 deaths). The country saw a 64% decrease in the number of cases and a 78% decrease in deaths, showing the efficacy of the country's efforts to improve water, sanitation, and hygiene as well as providing adequate medical care.
A strategy for an integrated rapid response in Haiti resulted in outbreaks over the previous year to its lowest number since the cholera epidemic broke out in 2010. Meanwhile, the Dominican Republic continues to report a few cases, with the number decreasing over time in parallel to that in Haiti.
The Global Roadmap Strategy
The WHO attributed the worldwide decline to the massive vaccination programs and growing adoption of the Global Roadmap to 2030 strategy in many nations' cholera action plan.
In the vaccination campaigns, the UN agency said nearly 18 million doses of Oral Cholera Vaccine (OCV) were shipped to 11 countries in 2018—bringing the total number of shipped OCVs doses from 2013 to nearly 60 million worldwide.
The importance of these vaccines is observed in the African continent, where nine countries benefited from the more than 12 million doses of OCV shipped to them during the year.
But even with the growth in providing vaccination, as well as stable funding for global vaccination drives, the WHO maintained the need to further improve accessibility to clean drinking water and adequate sanitation.
Dominique Legros, head of the WHO's cholera program in Geneva, called for continued engagement of "all cholera-endemic countries" with the Global Roadmap strategy to further eliminate the disease.
The global strategic action plan seeks to reduce cholera deaths by 90% and eliminate transmission in up to 20 countries in 2030. According to the WHO, the strategy would engage countries in detecting and rapidly responding to cases, strengthening surveillance and vaccination, effective coordination, and resource mobilization.
|The WHO attributed the worldwide decline to the massive vaccination programs and growing adoption of the Global Roadmap to 2030 strategy in many nations' cholera action plan / Photo by: Riccardo Lennart Niels Mayer via 123RF|
Declaration to End Cholera
Tedros said the Global Roadmap provides clear guidance on preventing and, ultimately, eliminating cholera using available tools, with the Global Task Force on Cholera Control (GTFCC) looking over the developments.
"Ending cholera is a moral obligation and an important achievement in its own right, and it is also critical to achieving the Sustainable Development Goals (SDGs)," the action plan stated. "If we fail to act, climate change, urbanization, and population growth will create an increased risk of cholera in the coming years."
The Global Roadmap focuses on 47 cholera-endemic countries and consists of multi-sectoral interventions, with a focus on three strategic points:
• Early detection and quick response to prevent outbreaks.
Countries take on strengthened community engagement, improved early warning surveillance and laboratory capacities, health systems, supply readiness, and rapid response team strategies that the GTFCC believes can help significantly lower the number of cholera-related deaths even in vulnerable countries.
• A targeted multi-sectoral approach to prevent cholera recurrence.
Countries focus on cholera hotspots or small areas where the disease is endemic and experience cases on an ongoing or seasonal basis.
• A mechanism of coordination for technical support, advocacy, resource mobilization, and partnership at local and global levels.
A robust framework to support countries in strengthening efforts in cholera control, founded on country-led, cross-sectoral cholera control programs, and supporting them through human, technical, and financial resources.
With all these efforts and the cooperation of citizens especially from the most-hit countries, it should be just a matter of time when the cholera is completely eradicated.