A shortage of cholera vaccines and a number of outbreaks have prompted the World Health Organization (WHO) to advise countries to administer single doses of the vaccine instead of the usual two doses.

So far, 29 countries have reported cholera outbreaks, with Haiti, Syria and Malawi dealing with large outbreaks. 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. 

“The one-dose strategy has proven effective in previous outbreaks, although evidence on how long protection lasts is limited,” Dr Tedros Adhanom Ghebreyesus, the director-general of WHO told a media briefing on Wednesday. 

However, he stressed that “this is clearly less than ideal and rationing must only be a temporary solution”.

“In the long term, we need a plan to scale up vaccine production as part of a holistic strategy to prevent and stop cholera outbreaks. The best way to prevent cholera outbreaks is to ensure people have access to safe water and sanitation,” he stressed.

Stockpile depleted

Four organisations – WHO, UNICEF, Médecins sans Frontières and the International Federation of the Red Cross and Red Crescent Societies – have managed the global stockpile of cholera vaccines since 2013. 

Of the 36 million doses produced this year, 24 million doses have already been shipped to countries facing outbreaks. The International Coordination Group (ICG), a WHO group that manages and coordinates emergency vaccine supplies and antibiotics during major outbreaks, has approved eight million doses for the second round of emergency vaccination in four countries, leaving only four million doses for further outbreak management. 

This shortage has prompted the ICG to recommend that countries temporarily suspend the two-dose vaccination regime and instead follow a single-dose regime so that more people can be protected against the bacteria. 

“The one-dose strategy has proven effective in previous outbreaks, although evidence on how long protection lasts is limited,” Dr Ghebreyesus said, calling for a scale-up of vaccine production. “The best way to prevent cholera outbreaks is to ensure people have access to safe water and sanitation.”

Narrow window to prevent Tigray genocide

Tedros also called for international attention to the civil war in Tigray, Ethiopia, which has left around six million people “under siege for almost two years”.

“I’m running out of diplomatic language for the deliberate targeting of civilians in Tigray, Ethiopia,” said Tedros. “There is a very narrow window now to prevent genocide in Tigray.”

The WHO Chief quoted Antonio Guterres, the UN Secretary-General, who called for the immediate withdrawal of Eritrean armed forces from the region.

Tedros described the “indiscriminate attacks” on civilians as “war crimes”.

“There are no services for tuberculosis, HIV, diabetes, hypertension and more – those diseases, which are treatable elsewhere, are now a death sentence in Tigray…This is a health crisis for six million people, and the world is not paying enough attention,” added Tedros, who was a former health minister of Ethiopia.

“Banking, fuel, food, electricity and health care are being used as weapons of war. Media is also not allowed and destruction of civilians is done in darkness.”

Ebola and COVID-19

WHO expressed concerns about the Ebola outbreak in Uganda and added that there is a possibility that more transmission chains and contacts might be involved in the spread of the virus. 

As of Wednesday, there are 60 confirmed and 20 probable cases of Ebola in the country, with 25 recoveries and 44  deaths.

Two people with confirmed infection in Mubende district had travelled to Uganda’s capital city, Kampal,a for treatment, thus prompting fears of transmission in the capital. The Ugandan government issued lockdown orders in Mubende on 16 October. 

“The Ministry of Health is investigating the most recent eight cases, as initial reports indicate they were not among known contacts,” Tedros said. 

Meanwhile, COVID-19 remains a public health emergency of global concern as per the Emergency Committee meeting last week. WHO urged countries to strengthen surveillance, and not reduce testing, treatment and vaccination for their populations.

“While the global situation has obviously improved since the pandemic began, the virus continues to change, and there remain many risks and uncertainties.”