Growing Cholera Crisis in Africa: Underfunded Control Plans Struggle to Contain Outbreaks

Climate change and conflict are fueling a resurgence of cholera in Africa, according to new analysis that highlights progress toward elimination being undermined by chronic underfunding.

In 2024, more than 175,000 cases of cholera and 2,700 deaths were reported in Southern and Eastern African countries. This makes it the deadliest cholera outbreak in that region since at least a decade, as stated in a UN brief released this week (February 17).

Case numbers were highest in the Democratic Republic of Congo (DRC), Ethiopia, Somalia, Zambia, and Zimbabwe. These cases are driven by factors such as water scarcity, infrastructure issues, recurrent flooding, and conflict.

“Cholera control is rarely prioritised outside emergency responses,” says Philippe Barboza, team lead for WHO’s cholera programme. “This makes long-term elimination difficult.”

So far this year (2024), 14 countries have reported active cholera outbreaks. These include a new outbreak in Angola and resurgences of cases in Uganda and Zambia.

To stem the spread of cholera, improving water, sanitation, and hygiene (WASH) infrastructure is crucial. The disease is primarily transmitted through contaminated water and poor sanitation practices. However, according to another study released last month (January 22), progress on this critical issue has been insufficient.

The BMJ Global Health journal assessed the implementation of the 2018-2030 regional framework for cholera prevention and control by WHO’s Africa office (WHO-AFRO). Five years into the initiative, overall regional progress stood at just 53%—far below what is needed to meet the UN target of eliminating cholera by 2030.

Philippe Barboza explains that several interconnected challenges have caused cholera to persist in Africa. These include insufficient WASH infrastructure development, persistent funding gaps, and weak health systems. “These factors have hampered efforts,” he says.

To address these issues, Barboza and his team recommend establishing an African Cholera Fund under the African Union and WHO-AFRO. This fund would finance sustainable cholera prevention and response initiatives.

According to the study, 29 out of 47 countries in the WHO’s African region are classified as cholera-endemic and are primary targets for elimination. However, recent resurgence has spread beyond these traditional hotspots, exposing weaknesses in non-endemic countries as well.

The slow progress to implement the regional framework for cholera prevention could explain the recurrence of outbreaks in both endemic and non-endemic countries. Ethiopia demonstrated the most progress (76%), while Mauritania and South Africa lag significantly behind (19%).

While some areas have seen improvements, such as hotspot mapping, surveillance, and rapid response capacity, critical areas like WASH infrastructure and sustainable funding for cholera control still face challenges.

Jackson Musembi from Amref Health Africa’s Global Health Security Programme tells SciDev.Net: “Only 31% of African countries have implemented water quality interventions. This leaves millions vulnerable to unsafe water sources.” Meanwhile, only 16% of countries have fully funded their National Cholera Plans, relying mostly on donor support.

As climate change leads to extreme weather events like floods and contaminates water supplies, these interventions are even more vital. Conflicts also increase the spread of cholera by forcing people into overcrowded camps with poor sanitation.

“Climate change does not directly cause cholera,” Barboza explains. “But it worsens outbreaks by disrupting water sources and limiting access to clean water.”

The study calls for cholera control to be integrated into long-term programmes like those for polio and malaria eradication. This includes the expansion of vaccination programs, support for local vaccine production, and investment in WASH infrastructure.

In Ghana, only a quarter of households have access to exclusive-use toilet facilities. Yaw Attah Arhin from World Vision Ghana emphasizes that poor sanitation and hygiene must be tackled at the community level to break the cycle of cholera transmission.