OCV Policy

Ending Cholera: A Global Roadmap to 2030

Ending Cholera: A Global Roadmap to 2030.


In October 2017, 35 GTFCC partners endorsed a call to action on ending cholera, an unprecedented engagement to fight cholera through implementation of "Ending Cholera – A Global Roadmap to 2030." Through the declaration, the GTFCC partners call for a commitment from all stakeholders to support cholera-affected countries and align our energies, efforts, and resources to end cholera transmission.

GTFCC Declaration to Ending Cholera

Global Task Force on Cholera Control Declaration to Ending Cholera 4 October 2017 - Annecy, France

Where do we stand on eliminating cholera from the globe?

Mohammad Ali, PhD

Senior Scientist | Johns Hopkins Bloomberg School of Public Health
OCV Administration in Kolkata, India by the IVI-NICED Cholera Team (2006)

OCV Administration in Kolkata India by IVI-NICED Cholera Team (2006)

Cholera is one of the most feared diseases and many people die of the disease each year. The disease was first noted by British troops near Jessore, India in 1817. By 1832, it had spread across Russia and Germany to England. [1] During this time, cholera was recognized as a European disease, [2] but with improvements in sanitation and the provision of safe drinking water, the disease was eliminated from  Europe.

The effectiveness of improved sanitation in stopping transmission of cholera shows that these improvements in infrastructure—if they could be accomplished universally—would finally eliminate cholera’s threat. Unfortunately, provision of modern sanitation has not been feasible for many countries, and cholera has continued its spread from Asia to Africa, Latin America, and recently to Haiti.

It is not necessary to wait for improved sanitation to control transmission of cholera; one additional, effective, and currently available intervention is vaccination.

A study conducted in Kolkata, India showed that the oral cholera vaccine (OCV) Shanchol offers 65 percent protection for at least 5 years [3], with significant herd protection [4].  This is noteworthy because sustained protection for 5 years by an OCV had not been previously shown. Moreover, the vaccine shows similar benefits for both children and adults. This tells us that by combining both direct and indirect effects of the vaccine, and achieving reasonably high coverage, we could reduce the risk of chorea for at least five years, even in areas where sanitation conditions are poor. 

Given our current understanding and available solutions to control cholera with vaccine, why does cholera continue to be a threat in developing countries? Do health officials believe that cholera is not a major health problem?  Do they believe that oral rehydration solution (ORS), which is now commonly available, has solved the problem?  Perhaps there is a belief that the logistical support to provide two doses of vaccine to all the people in a community is too difficult to manage. Is the vaccine too expensive or too difficult to obtain?  Or is there a need to better define how often the vaccine should be given, who is to be targeted, and how the vaccination program can be integrated with water and sanitation components?

Even with the licensure of this efficacious vaccine, there is still more work to find practical solutions for eliminating cholera. Unless we find these, cholera will remain a life-threatening problem throughout the globe.

1Cholera comes to Britain: October 1831.

2Hamlin C. Cholera: The Biography. New York. Oxford University Press, 2009

3Bhattacharya et al. 5 year efficacy of a bivalent killed whole-cell oral cholera vaccine in Kolkata, India: a cluster-randomised, double-blind, placebo-controlled trial. Lancet Infect Dis 2013; 13: 1050–56

4Ali et al. Herd protection by a bivalent-killed-whole-cell oral cholera vaccine in the slums of Kolkata, India. Clinical Infectious Diseases 2013;56(8):1123-31.

Asian experts advocate for use of cholera vaccines

Anna Lena Lopez, MD

Research Associate Professor | Inst. of Child Health & Human Development, Univ. of the Philippines Manila-National Inst. of Health
IDEA Asia Image

Following a meeting of health experts from Asia, members from eight countries in South and Southeast Asia released an advocacy document highlighting the need for an integrated program for cholera control which includes the use of oral cholera vaccines (OCVs) in countries at risk.

Released by the Initiative against Diarrheal and Enteric diseases in Asia (IDEA), an independent, multi-disciplinary group of Asian health professionals working on the surveillance, control, and prevention of cholera and other enteric diseases, the document proposes three critical interventions as part of a comprehensive strategy:

1) Continuous improvement of safe water and sanitation,

2) Establishment or strengthening of effective surveillance systems, and

3) Use of vaccination as a complementary weapon in at-risk populations.

This document is intended for use by national and local health officials, policymakers, and health professionals. Download the full document to learn more.

Cholera is a disease that disproportionately affects the poor; their needs are overlooked because they lack strong advocates like those from which the more affluent can benefit. Cholera is traditionally controlled by good sanitation, access to clean water, and personal hygiene. However, these measures are not always available in slums or in far-flung areas where water supply is not assured and latrines not widely available. Moreover, there may not be enough money to buy soap for personal hygiene in these areas. 

In Asia, cholera is not routinely identified; rather, it is lumped together with other diarrheal diseases under a broad category of “severe watery diarrhea,” largely because of the stigma attached with the disease. Perceived to be a disease found only in unclean environments, government officials may hesitate in the open reporting advocated by the 2005 International Health Regulations. For emerging economies dependent on trade and tourism, fear of embargoes and travel restrictions hinder open acknowledgement of the disease.

Furthermore, cholera identification requires bacteriologic laboratories that may not be available in affected areas; thus when the disease is eventually detected, explosive outbreaks have already occurred, taxing an already overburdened weak public health infrastructure. Since cholera affects mostly the poor who seek care in public clinics and hospitals, private physicians rarely recognize the disease due to their belief that cholera is controlled in their areas.

OCVs have been available for many decades, and yet their use as an additional measure for cholera control has only been recommended recently. Surprisingly, Bangladesh, the country where the first large-scale oral cholera vaccine trial was conducted in 1986, only recently began using OCVs in their public health program. Other mass campaigns have recently been conducted in Africa , Latin America, and Asia. Perhaps this is the beginning of more widespread use of OCV in cholera-burdened countries.

The IDEA advocacy document released by a group of experts from countries that are most affected by cholera adds another voice to the growing clamor for coordinated approaches for cholera control.

Related Countries: 
Image caption: 
This map shows some of the countries with medical and scientific experts participating in IDEA.