Cholera is making a devastating comeback in Africa, driven by climate change, conflict, and chronic underfunding. Once thought to be on the path to elimination, the disease is resurging in many regions, posing a significant public health threat. According to a recent UN brief released on February 17, 2024, more than 175,000 cases and 2,700 deaths were reported in Southern and Eastern Africa. This makes it the deadliest cholera outbreak in the past decade.
The highest number of cases have been reported in the Democratic Republic of the Congo (DRC), Ethiopia, Somalia, Zambia, and Zimbabwe. The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) attributes the outbreak to a combination of water scarcity, poor sanitation infrastructure, recurrent flooding, and conflict. In total, 14 countries are currently experiencing active cholera outbreaks, including Angola, Uganda, and Zambia.
Cholera is a bacterial infection spread primarily through contaminated water and poor sanitation practices. To control its spread, experts emphasize the need for improved water, sanitation, and hygiene (WASH) infrastructure. However, progress in implementing these essential measures remains insufficient.
A recent study published in BMJ Global Health on January 22, 2024, assessed the implementation of the 2018–2030 regional framework for cholera prevention and control by the World Health Organization’s Africa office (WHO-AFRO). The findings were concerning: five years into the initiative, overall regional progress stood at only 53%. This falls far short of the UN’s goal of eliminating cholera by 2030.
Philippe Barboza, the team lead of WHO’s cholera program and a co-author of the study, pointed to several key challenges:
Insufficient WASH infrastructure development
Persistent funding gaps
Weak health systems
“Cholera control is rarely prioritized outside emergency responses, making long-term elimination difficult,” Barboza explained. To change this, he and his team recommend establishing an African Cholera Fund under the African Union and WHO-AFRO to finance sustainable cholera prevention initiatives.
According to the study, 29 out of 47 countries in the WHO African region are classified as cholera-endemic and have been prioritized for elimination efforts. However, cholera outbreaks have recently spread beyond these traditional hotspots, highlighting weaknesses in non-endemic countries as well.
One reason for this resurgence is the slow implementation of the regional framework for cholera prevention. Ethiopia has made the most progress in implementing the framework, reaching 76% completion, while Mauritania and South Africa lag significantly behind at just 19%.
Some areas have seen improvement, such as:
Hotspot mapping
Surveillance and early detection
Rapid response capacity
However, progress remains slow in critical areas such as WASH infrastructure development and sustainable funding for cholera control.
Jackson Musembi, project manager at Amref Health Africa’s Global Health Security Programme, emphasized the urgency of addressing these gaps. He noted that only 31% of African countries have implemented water quality interventions, leaving millions vulnerable to unsafe water sources. Additionally, only 16% of African countries have fully funded their National Cholera Plans, with most relying on donor support.
Climate change is exacerbating the cholera crisis in Africa. Extreme weather events such as floods and droughts are contaminating water supplies, increasing the risk of infection. At the same time, conflicts in many regions are displacing populations, forcing them into overcrowded refugee camps with poor sanitation.
Barboza explains, “Climate change does not directly cause cholera, but it worsens outbreaks by disrupting water sources and limiting access to clean water.”
In response, the study calls for integrating cholera control into long-term public health programs such as polio and malaria eradication efforts. Expanding vaccination programs and supporting local vaccine production could also be part of the solution.
The key to breaking the cycle of cholera transmission lies in improving sanitation and hygiene at the community level. In Ghana, for example, only 25% of households have access to private toilet facilities. Yaw Attah Arhin, a water, sanitation, and hygiene specialist at World Vision Ghana, stresses that investing in WASH infrastructure is critical for long-term cholera prevention.
African governments, international organizations, and donors must work together to address the root causes of cholera outbreaks. Establishing sustainable funding mechanisms, expanding vaccination programs, and improving WASH infrastructure will be essential in eliminating cholera from the continent.
If Africa is to meet the UN’s goal of cholera elimination by 2030, urgent action is needed. Without significant improvements in sanitation, water access, and healthcare funding, the continent risks continued outbreaks that will endanger millions of lives.
