Milestones :: Perspectives
GENEVA/ NEW YORK, 30 October 2018 – This month, partners of the Global Task Force on Cholera Control (GTFCC) mark one year since the launch of Ending Cholera: A Global Roadmap to 2030, which targets a 90% reduction in cholera deaths by 2030 and the elimination of cholera in at least 20 countries out of the 47 currently affected.
At the 4 October 2017 launch of the Global Roadmap in Annecy, France, 35 global health and WASH organizations leading the fight against cholera signed the Declaration on Ending Cholera, committing their financial and human resources in support of its implementation in countries.
One year later, the movement to end cholera has made exceptional progress. At least 10 countries are now taking active measures towards cholera control plans in alignment with the Global Roadmap: Bangladesh, Haiti, Kenya, Malawi, Nigeria, South Sudan, Uganda, Zambia, the United Republic of Tanzania, and Zimbabwe. In addition, 47 African countries adopted the Regional Framework for the Implementation of the Global Strategy for Cholera Prevention and Control on 28 August at the 68th session of the WHO Regional Committee for Africa.
In May 2018, at the 71st World Health Assembly (WHA), WHO Member States took the extraordinary step of passing a resolution—introduced by the Governments of Zambia and Haiti—committing to implementation of the Global Roadmap, calling for the resources and policy changes necessary to meet the goal.
In line with the Global Roadmap, the Africa Regional Framework and the WHA resolution commit countries to implement evidence-based measures including:
:: mapping of cholera hotspots
:: significant investment in safe water, sanitation, and hygiene (WASH)
:: use of oral cholera vaccine
:: enhanced epidemiological and laboratory surveillance
:: improving access to timely treatment
:: promoting community engagement.
Cholera-affected countries demonstrate strong leadership and determination to stop cholera outbreaks
:: The end of the longest cholera outbreak in South Sudan in February 2018 shows it is possible to stop persistent cholera outbreaks in endemic settings, achieving high vaccine coverage even in the context of conflict and instability. The outbreak, which started in June 2016, resulted in 20,000 cases and 436 deaths. South Sudan conducted 38 vaccination campaigns, using a flexible data-driven approach to allocate 2.8 million doses to people living in hotspots as conditions made it possible to reach them.
:: Yemen, the location of the world’s most severe cholera outbreak, saw its first use of Oral Cholera Vaccine in 2018 – a critical step in fighting cholera there. Nearly 700,000 people have already been vaccinated and, another 1.4 million people are expected to receive vaccines in the coming weeks. However, widespread malnutrition, and destruction of water and sanitation infrastructure will require additional efforts to bring cholera under control in Yemen.
Cholera-affected countries plan a future without cholera by developing multi-sectoral cholera control plans .
:: The Government of Zanzibar, a semi-autonomous part of the United Republic of Tanzania, is ready to the Zanzibar Comprehensive Cholera Elimination Plan (ZACCEP), a costed multi-sectoral cholera elimination plan in alignment with the Global Roadmap, which aims to end cholera by 2027.
The Government of Bangladesh revised its National Program on Diarrheal Diseases Prevention, Management & Control to align it with the Global Roadmap, working with national WASH partners to collectively implement a plan to target elimination by 2030. Introduction of a phased large scale OCV campaign is planned to start in 2019. Professor Abul Kalam Azad, Director General of Health Services, Ministry of Health & Family Welfare, noted that cholera has no place in a country like Bangladesh, which is striving toward middle-income status: “Bangladesh has made huge strides in health outcomes in recent years. It is now time to commit the resources to ensure cholera will no longer be a threat to the people of Bangladesh.”
The Government of Zambia is launching a national multi-sectoral plan, aligned with the Global Roadmap strategy, targeting elimination of cholera by 2025. The response to the October 2017 outbreak triggered strong political engagement. Honorable Chitalu Chilufya, Minister of Health, observed “the government of Zambia has provided exemplary leadership in halting last year’s outbreak, bringing together a well-resourced, multi-sectoral response. With this strong political will and a sound national plan, I am confident that Zambia will be free from cholera by 2025.”
Unprecedented use of Oral Cholera Vaccine in 2018, including the largest cholera vaccination drive in history
As countries voted to pass the WHA resolution, five countries were already preparing for the largest cholera vaccination drive in history. The oral cholera vaccines were sourced from the global stockpile, funded by Gavi, the Vaccine Alliance, for five major campaigns in Zambia, Uganda, Malawi, South Sudan and Nigeria. The campaign protected over two million people from the threat of cholera. UNICEF procured 15.2 million doses to 12 countries to date, on top of nearly 10 million doses delivered in 2017. This compares to just 200,000 doses delivered in 2013, when the stockpile was created. OCV is just one tool in a much larger toolbox that includes sustainable safe water, sanitation, and hygiene (WASH), but it serves as a critical bridge to these longer-term efforts.
An energized GTFCC partnership supports countries in the fight to #EndCholera
GTFCC partners are taking action on their commitment from October 2017, by aligning their programs with the Global Roadmap and by increasing resources to concretely support cholera control efforts. In partnership with WHO, UNICEF brings strong leadership to the GTFCC working group on Water Sanitation and Hygiene (WASH). In 2018, the International Federation of Red Cross and Red Crescent Societies (IFRC) launched the One WASH program, an integrated approach that will support more than 20 cholera-affected countries. Projects are already in start-up phase in Uganda, Ghana, Malawi and Rwanda with an initial commitment of US$2.5 million. The Wellcome Trust and the UK Department for International Development (DFID) issued a call for proposals to support the cholera research agenda. The US Centers for Disease Control and Prevention (CDC) is providing technical experts in-country upon request, which is a critical allocation of human and other resources in the fight against cholera.