While the global stockpile of oral cholera vaccines (OCV) has been empty since mid-October, vaccine doses are being produced each week and shipped directly to countries in need, according to the World Health Organization (WHO).

“As soon as adequate quantities are produced, they are shipped to countries in need. This is why the stockpile can remain at zero for long periods. It does not mean that there is no production,” a WHO spokesperson clarified to Health Policy Watch after reporting on 18 October that the stockpile was empty.

This year, 30 countries have reported cholera outbreaks involving over 430,000 people which is driving demand for the vaccines.

Pharmaceutical company EuBiologics in the Republic of Korea is the only company currently producing cholera vaccines under the brand name, Euvichol.

However, the WHO prequalified a simplified oral cholera vaccine in April, which will “nearly double the available doses from around 45 million this year to about 90 million by 2026”, according to the spokesperson.

“But the current increase will not fully address the existing vaccine gap. The demand remains exceptionally high and is still growing, despite the increase in production.”

Huge demand

The global stockpile of the oral cholera vaccine was established in 2013 with two million doses. By 2023, this had expanded to 36 million doses. 

The stockpile is overseen by the International Coordinating Group on Vaccine Provision (ICG) consisting of the International Federation of the Red Cross and Red Crescent Societies, Médecins Sans Frontières, UNICEF, and WHO. 

Gavi, the Vaccine Alliance pays for the vaccine and its distribution to all eligible countries.

“The ICG has approved 14 million cholera doses for outbreak response over the last two months, a volume that represents twice the size of the current stockpile,” according to a Gavi spokesperson.

“However, while there may be short periods where all available doses are allocated to specific country requests, the stockpile is continually replenished on a rolling basis by the manufacturer.”

Investments made by Gavi and its partners to increase the volume and speed of supply have halved the timeline needed for replenishing the global vaccine stockpile this year. 

Gavi expects close to three million new doses to be made available this week, seven million in November, and six million in December, “all ready to be shipped to countries that may request them for ongoing outbreaks”.

 “In April we welcomed the arrival of a new OCV, Euvichol-S which enabled EuBiologics, its manufacturer, to produce more volumes of vaccine, faster, and at a lower cost – a key step to expanding supply amidst the ongoing acute global upsurge of cholera outbreaks,” said the Gavi spokesperson.

“The global availability of OCV has once again shown an annual increase from 38 million doses in 2023 to approximately 50 million in 2024, and is further expected to increase again in 2025, to 70 million doses,” said Gavi.

However, creating both sustainable and predictable demand for OCV, and supporting efforts towards long-term control by launching preventive programmes in endemic countries, is vital for controlling the disease, Gavi notes.

Image Credits: WHO.