Climate change and conflict are driving a resurgence of cholera in Africa, with progress toward elimination hindered by chronic underfunding.
In 2024, more than 175,000 cholera cases and 2,700 deaths were reported across Southern and Eastern African nations, making it the deadliest outbreak in the past decade. Countries most affected include the Democratic Republic of the Congo, Ethiopia, Somalia, Zambia, and Zimbabwe, where water scarcity, weak infrastructure, flooding, and conflict have exacerbated the situation.
This year, 14 countries have reported active cholera outbreaks, including Angola, Uganda, and Zambia. Without urgent intervention, the crisis is likely to worsen.
A Critical Need for Water, Sanitation, and Hygiene Infrastructure
Improving water, sanitation, and hygiene (WASH) infrastructure is essential to controlling cholera, which spreads through contaminated water and poor sanitation. However, progress has been slow. A recent study assessing efforts to implement a regional cholera prevention and control framework found that five years into the initiative, overall progress stands at only 53 percent far from the level needed to meet the goal of eliminating cholera by 2030.
Several challenges have hindered progress, including insufficient infrastructure, funding gaps, and weak health systems. Long-term cholera control is often neglected outside of emergency responses, making sustained elimination difficult.
To address these issues, experts recommend the creation of an African Cholera Fund under the African Union and the World Health Organization’s Africa office. This fund would provide consistent financing for cholera prevention and response efforts, ensuring that interventions are not just reactive but also proactive and sustainable.
The Worsening Cholera Resurgence
Of the 47 countries in the World Health Organization’s African region, 29 are classified as cholera-endemic, making them the primary focus for elimination. However, recent outbreaks have extended beyond these traditional hotspots, highlighting vulnerabilities in countries previously considered low-risk.
The slow implementation of cholera prevention strategies could explain why outbreaks continue to occur in both endemic and non-endemic regions. Some progress has been made, such as improved hotspot mapping, disease surveillance, and rapid response capacity. However, advancements in crucial areas like WASH infrastructure and sustainable funding have lagged behind.
Ethiopia has demonstrated the most progress in implementing cholera prevention strategies, achieving 76 percent of the recommended measures, while countries such as Mauritania and South Africa lag significantly, with implementation levels below 20 percent.
Only 31 percent of African nations have put water quality interventions in place, leaving millions vulnerable to unsafe water sources. Even more concerning, only 16 percent of countries have fully funded their national cholera response plans, with most relying on inconsistent donor support.
Climate Change and Conflict Worsen the Crisis
Extreme weather events linked to climate change, such as floods, are further complicating efforts to control cholera. Flooding contaminates water supplies, making outbreaks more severe. Additionally, conflicts in several regions are displacing large populations, forcing people into overcrowded camps where sanitation is poor and access to clean water is limited.
While climate change does not directly cause cholera, it significantly worsens outbreaks by disrupting water sources and limiting access to safe drinking water.
The study calls for integrating cholera prevention into broader public health initiatives, such as polio and malaria eradication programs. Expanding vaccination efforts and supporting local vaccine production are also key strategies to combat cholera.
In many African countries, poor sanitation remains a major driver of cholera transmission. For example, in Ghana, only a quarter of households have access to private toilet facilities. Strengthening sanitation and hygiene at the community level is essential to breaking the cycle of cholera transmission.
The Path Forward
To effectively combat cholera in Africa, a long-term, sustainable approach is required. Investment in WASH infrastructure, increased domestic funding for cholera control programs, and the integration of cholera prevention into broader public health strategies are all critical steps.
Without urgent action, cholera outbreaks will continue to threaten lives, particularly in vulnerable communities already facing the challenges of climate change, conflict, and poverty. Addressing these underlying issues is the only way to achieve the goal of eliminating cholera by 2030.
