A new programme aiming at providing 1.2 million rapid cholera diagnostic tests has been launched in 14 African and Asian countries. 

“Routine use of diagnostics will bolster cholera surveillance in impacted countries, and must be leveraged to better target vaccination efforts, which play a critical role in multisectoral cholera prevention and control programmes,” said Aurélia Nguyen, Chief Programme Officer at Gavi, the vaccine alliance.

Cholera is an acute diarrhoeal disease with a potentially severe and rapid trajectory when left uncured, WHO warns. The intestinal infection spreads through food and water contaminated with faeces with the bacterium Vibrio cholerae.

It has surged globally since 2021, with high case fatality rates despite the availability of simple, effective and affordable treatment. According to the WHO, there are 1,3 to four million cases of cholera annually, with a death toll of between 21,000 and 143,000 worldwide.

Existing triggers for cholera outbreaks – lack of access to clean water and sanitation – are exacerbated by climate change, WHO highlights. 

It occurs in situations of poor sanitation and little access to clean water, for instance in humanitarian crises or in migration camps. Once an outbreak has occurred, the infection can spreads quickly if authorities fail to detect it and limit its spread.

A 25% increase in countries reporting cholera cases was noted in 2022, reaching 44 countries, and recent outbreaks recorded the highest fatality rate in over a decade.

Rapid testing

Even though the vaccine supply has increased 18-fold between 2013 and 2023, it still fails to meet the demand, especially as emergency doses need to be stocked in case of a sudden rise in cases. In effect, preventive vaccination campaigns have generally been too slow to stop the disease spread.

Last year, WHO’s Global Task Force on Cholera Control (GTFCC) updated its recommendations to favour strategic, routine and systematic testing of suspected cholera cases to strengthen cholera surveillance. They also launched a strategy for cholera control, aiming to reduce cholera deaths by 90% by 2030.

Responding to the challenge, Gavi has directed funds to cholera rapid testing and vaccination. 

“We are experiencing an unprecedented multi-year upsurge in cholera cases worldwide,” said said Nguyen. “The rise in infections is being driven by continued gaps in access to safe water and sanitation, and our inability to reach vulnerable communities that are being put further at risk by climate change, conflict and displacement.”

Gavi is working with UNICEF, WHO and FIND, the diagnostics organisation, to develop and deliver the rapid tests.

Leila Pakkala, of UNICEF’s Supply Division highlighted that “surveillance diagnostics help pinpoint hotspots with great precision. This allows partners to target cholera vaccines to exactly the time and place where the limited supply will save the most lives.”

The long-term sustainability of the programme depends on successful fundraising for Gavi’s next strategic period, from 2026 to 2030.

Image Credits: UNICEF.