Cholera has re-emerged as a serious health threat in Africa, exposing critical gaps in funding and long term preventive measures. So far this year, 14 countries have reported active cholera outbreaks, including Angola, Uganda, and Zambia. While cholera control efforts ramp up during emergencies, sustained investments in water, sanitation, and hygiene (WASH) infrastructure remain inadequate, making long-term eradication a distant goal.
Cholera, a waterborne disease caused by the bacterium Vibrio cholerae, thrives in regions with poor sanitation and limited access to clean drinking water. The World Health Organization’s (WHO) 2018–2030 regional framework for cholera prevention aimed to eliminate the disease in Africa by 2030. However, a recent study published in BMJ Global Health indicates that progress has been slow, with only 53 percent of the plan’s objectives met.
Philippe Barboza, team lead for the WHO cholera programme and co author of the study, highlights the major roadblocks to elimination: “Insufficient WASH infrastructure development, persistent funding gaps, and weak health systems have hampered efforts. Cholera control is rarely prioritized outside emergency responses, making long-term elimination difficult.”
The study emphasizes the need for sustainable funding mechanisms, proposing an African Cholera Fund under the African Union and WHO-AFRO. Such a fund would ensure ongoing investments in cholera prevention rather than relying solely on emergency interventions.
Historically, cholera has been concentrated in endemic regions, but recent outbreaks have spread beyond traditional hotspots. The study found that 29 out of 47 countries in the WHO African region are classified as cholera endemic. However, cases have now been reported in non-endemic regions as well, suggesting that weak WASH infrastructure and poor preparedness are enabling the disease’s spread.
While some countries have made notable progress Ethiopia, for example, has implemented 76 percent of the WHO framework others lag behind. Mauritania and South Africa, for instance, have implemented only 19 percent of the recommended measures. The disparity in progress underscores the need for tailored interventions and increased accountability in cholera control efforts.
Cholera’s resurgence is also linked to climate change and conflict. Floods, droughts, and extreme weather events disrupt water supplies, increasing the risk of cholera outbreaks. Barboza explains, “Climate change does not directly cause cholera, but it worsens outbreaks by disrupting water sources and limiting access to clean water.”
Conflict situations further exacerbate the crisis. Displacement camps with inadequate sanitation become breeding grounds for cholera, as overcrowding and poor hygiene conditions facilitate rapid transmission. Without robust public health interventions, these vulnerable populations remain at high risk
Experts stress that integrating cholera control into broader health initiatives, such as polio and malaria eradication programs, could enhance effectiveness. Jackson Musembi of Amref Health Africa notes that only 31 percent of African countries have implemented water quality interventions, leaving millions exposed to contaminated sources. Additionally, just 16 percent of countries have fully funded their National Cholera Plans, with most relying on donor assistance.
Yaw Attah Arhin, a WASH specialist at World Vision Ghana, emphasizes that tackling cholera requires a grassroots approach: “Poor sanitation and hygiene must be addressed at the community level to break the cycle of cholera transmission.”
Vaccination also plays a crucial role in prevention. Expanding vaccine coverage and supporting local vaccine production could help mitigate future outbreaks. However, without substantial investment in WASH infrastructure, vaccination alone will not be sufficient to eliminate cholera.
Africa’s struggle with cholera is a stark reminder of the consequences of underfunding public health initiatives. While emergency responses have helped curb outbreaks temporarily, long-term solutions require sustainable funding, infrastructure development, and climate resilience. Establishing an African Cholera Fund could be a game-changer, ensuring that resources are allocated efficiently for prevention rather than reactive emergency interventions.
Unless governments, donors, and international organizations prioritize WASH infrastructure and cholera control, Africa’s dream of eliminating the disease by 2030 may remain unfulfilled.
