Climate change and conflict are fueling a resurgence of cholera in Africa, according to new analysis that underscores the ongoing challenges in eliminating this deadly disease.
In 2024 alone, more than 175,000 cases of cholera and 2,700 deaths were reported across Southern and Eastern African countries. This marks the deadliest cholera outbreak in these regions in a decade, according to a UN brief released this week (February 17).
The Democratic Republic of Congo (DRC), Ethiopia, Somalia, Zambia, and Zimbabwe have been hit hardest by water scarcity, infrastructure issues, recurrent flooding, and conflict. These factors contribute significantly to the spread of cholera.
Philippe Barboza, team lead at WHO’s Cholera Programme, highlights that cholera control is rarely prioritized outside emergency responses. This makes long-term elimination particularly challenging.
So far this year, 14 countries have reported active cholera outbreaks. Angola has seen a new outbreak, while Uganda and Zambia are experiencing resurgences of cases.
To effectively combat cholera, improving water, sanitation, and hygiene (WASH) infrastructure is crucial. However, another study found that progress on this essential issue remains insufficient.
The BMJ Global Health journal last month assessed the implementation of WHO-AFRO’s 2018-2030 regional framework for cholera prevention and control. Five years into the initiative, overall progress stands at just 53%, far below what is needed to achieve the UN target of eliminating cholera by 2030.
According to Barboza, several interconnected challenges are responsible for the persistence of cholera in Africa: insufficient WASH infrastructure development, persistent funding gaps, and weak health systems have all hindered efforts.
To address these issues, Barboza and his team recommend establishing an African Cholera Fund under the auspices of the African Union (AU) and WHO-AFRO. This fund would be dedicated to financing sustainable cholera prevention and response initiatives.
The study identified 29 out of 47 countries in the WHO African region as cholera-endemic hotspots, which are primary targets for elimination efforts. However, recent outbreaks have spread beyond these traditional areas, revealing weaknesses even in non-endemic countries.
While some progress has been made in hotspot mapping and surveillance, critical areas like WASH infrastructure and sustainable funding continue to lag behind. For instance, only 31% of African countries have implemented water quality interventions, leaving millions vulnerable to unsafe water sources. Additionally, only 16% of countries have fully funded their National Cholera Plans.
Climate change exacerbates the situation by leading to extreme weather events such as floods that contaminate water supplies. In some regions, conflicts are also driving the spread of cholera by forcing people into overcrowded camps with poor sanitation conditions.
To combat these factors, Barboza calls for integrating cholera control into long-term health initiatives like those for polio and malaria eradication. He suggests expanding vaccination programs and supporting local vaccine production, along with significant investments in WASH infrastructure.
For example, Ghana only has access to exclusive-use toilet facilities in 25% of households. Yaw Attah Arhin, a water, sanitation, and hygiene specialist at World Vision Ghana, emphasizes that addressing poor sanitation and hygiene at the community level is crucial for breaking the cycle of cholera transmission.
These comprehensive approaches aim to not only mitigate current outbreaks but also build more resilient communities in the face of ongoing challenges posed by climate change and conflict.
