Cholera Vaccine In Short Supply as Deaths Rise

Recent months have seen a global rebound of cholera, a dreaded bacterial disease that can kill within hours. The World Health Organization (WHO) has reported a 25% increase in Cholera cases in 35 countries. Deaths have already risen 14%. Despite the rapidly increasing demand for Cholera vaccines, the global vaccine supply has dwindled to almost nothing, complicating mitigation efforts. As of May 2024, the WHO reported that it was 1.8 million vaccines short of its 5 million dose goal globally.

The cholera vaccine has been crucial in combating cholera, especially in third-world nations like South Sudan (WHO).

Causes of cholera and the recent uptick:

Cholera is caused by bacteria that spreads best in unsanitary conditions. Outbreaks are often the result of limited access to clean drinking water which is most prevalent in third world countries. As dozens of countries still lack the funds to develop proper clean water infrastructure, the age-old disease not only persists but kills over 100,000 people each year.

Cholera cases have noticeably risen over the past 2 years, partially as a result of climate change that has increased natural disasters like floods in regions vulnerable to cholera. This most acute impact has been third-world nations, destroying sanitation infrastructure like bathrooms, pipes, and wells. One government report in Malawi estimated that a hurricane and subsequent flooding destroyed around 54,000 toilets and 340 wells. Because so many developing countries do not have much clean water infrastructure, people there often share unreliable sources of drinking water, which when contaminated after a natural disaster, supercharges cholera spread.

Another climate-related driver behind recent outbreaks is drought. While droughts and cholera have no immediate link, there is speculation that they could cause people to turn to unsafe drinking water by exacerbating water scarcity. In Africa, an epicenter for cholera, droughts have become much stronger and longer. To make matters worse, droughts reduce the ability of the ground to absorb moisture, so when it does rain, it often leads to flooding, resulting in an increased chance of contracting cholera.

A record-breaking drought in Southern Africa has impacted nearly 24 million people and could exacerbate cholera spread. (CNN)

Cholera symptoms and why it matters:

Cholera has a 25-50% mortality rate if left untreated. The early symptoms are diarrhea, vomiting, leg cramps, and restlessness. If left untreated or in severe cases, it could lead to loss of elasticity in the skin, rapid heart rate, dry mucous membrane, or blood pressure. Low blood pressure from the disease often leads to dizziness or fatigue. Severe dehydration and death is common. Leaving cholera untreated leads to fatality at worst and extreme discomfort at best. Fortunately, modern medicine can bring the mortality rate of cholera down to 1%. Still, especially considering poor access to healthcare in many cholera-stricken countries, vaccination is crucial.

Why is the supply of cholera vaccines going down?

The primary cause is the decision of Shantha, an Indian pharmaceutical firm, to stop producing cholera vaccines in 2020. Before then, Shantha was responsible for producing at least 15% of the WHO’s cholera vaccine stockpile. Shantha was also one of only two major cholera vaccine producers, with the other one being the South Korean firm Eubiologics. Shantha decided to pull out because they believed that Eubiotics would increase production of the cholera vaccine and did not find it necessary or profitable enough to remain in the market. Meanwhile, Eubiologics has announced a simplified formula of their vaccine to increase production which could give some relief to combating cholera globally. There is still cause for concern, however, mainly because such a crucial global stockpile is now entirely reliant on a single manufacturer.

Eubiologics is a major vaccine producer playing in a crucial role in making cholera and COVID-19 vaccines. (International Vaccine Institute).

What are the impacts of a global cholera vaccine shortage?

Two doses of cholera vaccine are 58% effective against cholera, and widespread vaccination can significantly curb outbreaks in a manner that is cheaper and faster. However, immunity does wane and coverage is low. Without sufficient supply, combating the current outbreak has become significantly more challenging, and preventable deaths will undoubtedly occur.

In the meantime, health authorities must make do with what tools they have. For example, the WHO has had to suspend its two-dose policy for combating cholera as a result of the shortage of vaccines. However, this may not be sustainable, especially as natural disasters and climate change in Africa, the Caribbean, and Asia continue to push cholera cases upward. Until production is augmented to cover all vulnerable populations, cholera will be another sad example of how the world allows preventable diseases to continue killing.