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Cholera Vaccine Demand Outpaces Supply: WHO Report
Context:
The World Health Organisation (WHO) reports nearly 200,000 cases of cholera have been reported in 24 countries this year and vaccines are in short supply, posing a serious challenge to global public health efforts.
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- The world is currently battling the seventh cholera pandemic.
- From January 1, 2024, to May 26, 2024, a cumulative total of 194,897 cholera cases and 1,932 deaths were reported across 24 countries in five WHO regions.
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Cholera, a water and foodborne disease caused by Vibrio cholerae bacteria, poses severe risks in regions with inadequate water, sanitation, and hygiene (WaSH) infrastructure.
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Key Highlights
- Cholera Outbreak: The Eastern Mediterranean Region recorded the highest numbers, followed by the African Region, the Region of the Americas, the South-East Asia Region, and the European Region.
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- No outbreaks were reported in the Western Pacific Region during this time.
- Epidemiological context: The seventh cholera pandemic since the beginning of the 1960s, with cases increasing significantly since 2021.
- The WHO classified the global increase in cholera cases as a grade 3 emergency in January 2023, increasing the demand for vaccines.
- Production capacity and vaccine availability: The capacity for 2024 is estimated to be between 37-50 million doses, which is still insufficient to meet the growing demand.
Current Vaccine Supply and Demand Dynamics
- Demand for vaccines far exceeds supply, with 16 countries requesting 92 million doses since January last year, while only 49 million doses were produced during the same period.
- Oral Cholera Vaccine (OCV) Stockpile: WHO highlighted a shortfall in the global OCV stockpile, prompting a revision in vaccination protocols from a two-dose regimen to a single dose.
- As of 10 June 2024, the global cholera vaccine stockpile has reached 6.2 million doses, surpassing the previous five million doses target.
Vaccine Development and Production Challenges
- WHO has prequalified three vaccines Euvichol, Euvichol-Plus and Euvichol-S produced by EuBiologicals Co Limited, Republic of Korea, following the discontinuation of Shanchol by Sanofi Pasteur in 2023.
- Shanchol was previously a significant vaccine option, prequalified in 2011, contributing to WHO’s global stockpile efforts.
- Cholera continues to wreak havoc despite being preventable and treatable.
- According to WHO, vaccines are important to prevent and manage outbreaks in areas with inadequate access to safe water and sanitation.
- The National Institute of Cholera and Enteric Diseases (NICED) director highlighted that OCVs can serve as a preventive measure in endemic areas.
- This medicine is given when warning signs appear such as upcoming monsoon, increasing sea water temperature and rising sea levels.
Global Efforts: To address the challenges WHO, UNICEF, IFRC and partners will continue to work together.
- Ending cholera: A global roadmap to 2030, with a target to reduce cholera deaths by 90% was launched in 2017 by The Global Task Force on Cholera Control (GTFCC) partners.
- Improved Water, Sanitation & Hygiene (WaSH): Ensuring access to clean water, proper sanitation facilities, and good hygiene practices to prevent cholera transmission in the long term.
India’s Efforts: A country significantly affected by cholera outbreaks, ongoing efforts include clinical trials and vaccination programs.
- Clinical trials on OCV developed by Korea’s International Vaccine Institute, in collaboration with VABIOTECH and Shantha Biotechnics Private Limited, showed promising results (65% efficacy).
- It offers protection for up to five years that means out of 100 cholera cases in non-vaccinated individuals, only 35 cases would occur among those vaccinated
- NICED is working with the West Bengal state government and the Indian Council of Medical Research on a pilot study in Bishnupur-II Block of South 24 Parganas district.
- Aim to assess feasibility and logistics of vaccination campaigns in endemic areas.
- Under-reporting: Cholera remains an under-recognised and under-reported health issue in India, according to a 2023 paper published in the journal Lancet Regional Health.