Cholera cases doubled last year in comparison to 2021, and preliminary data suggests that 2023 is likely to be even worse, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus told a media briefing on Wednesday.

“So far 28 countries have reported cases this year, compared with 16 during the same period last year,” said Tedros.

Ethiopia, Haiti, Iraq and Sudan have “the most concerning outbreaks”, he added, but noted that “significant progress has been made in countries in southern Africa, including Malawi, Mozambique and Zimbabwe” but these countries remain at risk as the rainy season approaches.

Last week, the WHO released its 2022 cholera report, noting that there had been 472 697 reported cases in 44 countries, in comparison to 223 370 cases in 35 countries in 2021.

“The geographical pattern of outbreaks also changed, as countries that had not reported cholera in many years, including Lebanon and the Syrian Arab Republic, reported large outbreaks in 2022,” according to the report.

It also noted that seven countries reported very large outbreaks of over 10,000 cases – Afghanistan, Cameroon, Democratic Republic of the Congo (DRC), Malawi, Nigeria, Somalia, and Syria.

Tedros said that the “worst affected countries and communities are poor, without access to safe drinking water or toilets” and faced shortages of oral cholera vaccines and overstretched health workers.

We are concerned about the upsurge of #cholera cases in over 40 countries.

Safe drinking water, sanitation and hygiene are the only long-term and sustainable solutions to ending the cholera emergency, and preventing future outbreaks. #HealthForAll https://t.co/owKgNPpgQm

— Tedros Adhanom Ghebreyesus (@DrTedros) September 25, 2023

Almost a year ago, in the face of a huge shortage of oral cholera vaccines, the WHO recommended that people be given a single dose instead of the usual two doses 

The standard preventive approach to cholera is two-dose vaccination with the second dose administered within six months of the first. The immunity of a fully vaccinated person against cholera lasts for three years. While single doses have been used effectively in previous outbreaks,  there is limited evidence on how long protection lasts. The global shortage is projected to last until 2025.

“WHO is providing essential supplies, and coordinating the on-the-ground response with partners, supporting countries to detect, prevent and treat cholera and informing people how to protect themselves,” said Tedros. 

“To support this work, we have appealed for $160 million, and we have released over $16 million from the WHO contingency fund for emergencies. But the real solution to cholera lies in ensuring everyone has access to safe water and sanitation, which is an internationally recognised human right.”

Dr Mike Ryan, WHO’s head of health emergencies, added that cholera outbreaks were sensitive to climatic variability and climatic change, while conflict and resultant displacement of people were driving cases.

Rise in COVID-19 cases

The WHO also expressed concern about the rise in COVID-19 cases, particularly in Europe and the Americas.

“Among the relatively few countries that report them, both hospitalisations and ICU admissions have increased in the past 28 days, particularly in the Americas and Europe,” said Tedros. 

He added that vaccination levels among the most at-risk groups was “worryingly low”, with only a third of people having received a booster shot.

Dr Maria van Kerkhove, WHO’s technical lead on COVID-19, stressed that the vaccines currently available worked on the new variants.

More resources for cervical cancer

The WHO’s Expert Group on Cervical Cancer Elimination met this week to review progress and advise on the future direction or the initiative.

Addressing the press conference, co-chair Professor Groesbeck Parham, said the group had resolved that there should be a “heavy emphasis on country-specific support for the implementation of the three pillars”, namely HPV vaccination of young girls, cervical cancer screening of adult women, and treatment of women who were found to have pre-cancer or invasive cancer during screening.

“There should be fewer guidelines from WHO but more resources that focus on supporting field workers in the countries that have the highest burden of disease,” said Parham.

The group also felt that all three pillars should be “implemented collectively” and that  “information hubs need to be created that facilitate countries sharing their successes.”

“Rwanda has had great success in vaccinating greater than 90% of their young girls,” he added.