Accra — Climate change and conflict are fuelling a resurgence of cholera in Africa, with progress toward elimination undermined by chronic underfunding, according to new analysis.
In 2024, more than 175,000 cases of cholera and 2,700 deaths were reported in Southern and Eastern African countries, making it the deadliest cholera outbreak in that region in the past decade, according to a UN brief released this week (17 February).
Case numbers were highest in the Democratic Republic of the Congo (DRC), Ethiopia, Somalia, Zambia and Zimbabwe, driven by water scarcity, infrastructure issues, recurrent flooding and conflict, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) said.
“Cholera control is rarely prioritised outside emergency responses, making long-term elimination difficult.”Philippe Barboza, team lead, WHO cholera programme
So far this year, 14 countries have reported active cholera outbreaks, including a new outbreak in Angola and a resurgence of cases in Uganda and Zambia.
Improving water, sanitation and hygiene (WASH) infrastructure is crucial to stem cholera, which is mostly spread through contaminated water and poor sanitation practices. But progress on this critical issue has been insufficient, according to another study.
The study published in the BMJ Global Health journal last month (22 January) assessed the implementation of the 2018-2030 regional framework for cholera prevention and control by the World Health Organization’s Africa office (WHO-AFRO).
It found that five years into the initiative, overall regional progress stood at just 53 per cent–far below what is needed to meet the UN target of eliminating cholera by 2030.
Philippe Barboza, team lead of the WHO’s cholera programme and a co-author of the study, says cholera persists in Africa due to several interconnected challenges.
“Insufficient WASH infrastructure development, persistent funding gaps, and weak health systems have hampered efforts,” he explains.
“Cholera control is rarely prioritised outside emergency responses, making long-term elimination difficult.”
To change this, Barboza and his team recommend establishing an African Cholera Fund under the African Union and WHO-AFRO to finance sustainable cholera prevention and response initiatives.
Cholera resurgence
According to the study, 29 out of 47 countries in the WHO African region are classified as cholera-endemic and are the primary targets for elimination.
However, the recent resurgence of cholera outbreaks has spread beyond these traditional hotspots, exposing weaknesses in non-endemic countries as well.
Slow progress to implement the regional framework for cholera prevention could explain the recurrence of outbreaks in both endemic and non-endemic countries, the study suggests,
Ethiopia has demonstrated the most progress (76 per cent) in implementing the framework, while countries such as Mauritania and South Africa lag significantly behind (19 per cent).
Some areas have seen improvements, such as hotspot mapping, surveillance, and rapid response capacity.
But progress remains slow in critical areas like WASH infrastructure and sustainable funding for cholera control, the study found.
Jackson Musembi, project manager at Amref Health Africa’s Global Health Security Programme, tells SciDev.Net: “Only 31 per cent of African countries have implemented water quality interventions, leaving millions vulnerable to unsafe water sources.
“Meanwhile, only 16 per cent of countries have fully funded their National Cholera Plans, with most relying on donor support.”
Climate and conflict
These interventions are all the more vital as climate change leads to extreme weather events, such as floods, contaminating water supplies. In a number of countries, conflicts are also increasing the spread of cholera, forcing people into overcrowded camps with poor sanitation.
“Climate change does not directly cause cholera, but it worsens outbreaks by disrupting water sources and limiting access to clean water,” Barboza explains.
The study calls for cholera control to be integrated into long-term programmes such as those for polio and malaria eradication.
Expansion of vaccination programmes and support for local vaccine production are also part of the solution, along with investment in WASH infrastructure, the researchers say.
In Ghana, only a quarter of households have access to exclusive-use toilet facilities, according to Yaw Attah Arhin, a water, sanitation and hygiene specialist at World Vision Ghana.
“Poor sanitation and hygiene must be tackled at the community level to break the cycle of cholera transmission,” he said.
This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk
