The world has run out of oral cholera vaccine in the middle of a southern African outbreak

• All oral vaccines under production until March have already been booked.
• More than 10 of the 16 countries affected by the vaccine shortages are in Africa.
• The shortage has, in the recent past, been a problem that forced the International Coordinating Group to propose a one-dose vaccination instead of two.

The world's oral cholera vaccine stockpile has run dry, while 16 countries, most of them in Africa, suffer outbreaks of the waterborne disease.

Now public health experts are pushing manufacturers to urgently speed up production.

The lack of vaccines "directly affects Médecins Sans Frontières (MSF) teams as we are trying to respond to an extraordinary number of cholera outbreaks, including in Ethiopia, Sudan, Zambia, and Zimbabwe", said MSF's international medical coordinator, Dr Daniela Garone.

Africa continues to have a larger proportion of people dying from reported cholera than any other part of the world.

According to Save the Children, cholera cases increased more than fourfold in Malawi, Zimbabwe, and Mozambique from 2022 to 2023. 

The number of cases increased from 26 250 to over 95 300, with more than 1 600 deaths in the three nations, making it one of the worst cholera epidemics in decades.

Cholera is also endemic in Somalia, the Democratic Republic of the Congo, South Sudan, Burundi, Cameroon, Somalia, Kenya, Tanzania, Mozambique and Nigeria.

The vaccines currently being manufactured have already been claimed.

"All the doses in production until mid-March have already been allocated, and the demand for doses keeps growing," Garone said.

She said:

The shortage has in the recent past been a problem that forced the International Coordinating Group (ICG) on vaccine provision suggesting a one-dose vaccination instead of two in 2022. 

This temporary measure was meant to stretch out supplies. However, the world finds itself in a similar predicament without new manufacturers approved.

Garone pictures this as a letdown for communities that are at a greater risk.

"The lack of vaccines means that people and entire communities will continue to be unprotected against cholera," she said.

She added:

"We are very worried that people are at much greater risk of getting and potentially dying from a disease that’s preventable if there's no vaccine available to respond to an outbreak in their community, nor to prevent one from starting in the first place."

The current spate of cholera outbreaks is linked to forced displacements creating humanitarian crises in countries such as DRC, Sudan and Somalia.

In countries such as Zimbabwe, Malawi and Zambia, the outbreaks are linked to factors such as draughts, floods and poor public infrastructure ,like systems for the provision of clean water made worse by failing public health systems.