Yes, cholera is still a thing

Cholera is surging in developing countries around the world. (Photo: Johnson Sabin via EPA-EFE)

Remember cholera? For those who weren’t around in the 18th century—and I don’t expect anyone reading this to have been—it’s a bacterial disease that spreads through contaminated food or water. While it’s not contagious from person-to-person, it can spread rapidly in areas with inadequate treatment of sewage and drinking water. When left untreated, it can cause severe acute watery diarrhea and dehydration, which could lead to kidney failure and death within hours.

It was first recorded in 1817 in India, though it could be traced back to as early as 1563. In the 19th century, it spread across the world from its source, India’s Ganges river.The local cholera epidemic killed over 100,000 people from 1902 to 1904, at the height of the Filipino-American war. 

By now I could probably tell what you’re thinking: Cholera sounds like something I can only read from the historical records of ye olde, maybe even alongside terms like “bubonic plague” and “Mesopotamia.” 

So what does it have to do with us in the time of predominantly online warfare and robot waiters serving food at ultra-sanitized restaurants, and why should we care?

Cholera’s 2022 comeback

At the start of October, Lebanon reported its first case of cholera bacteria. Last Friday, Israel detected it in a reservoir north of the country as well, likely the result of an outbreak in neighboring country Syria. Syria has declared a cholera outbreak way back in September, following 15 confirmed laboratory cases which included one death. Other adjacent countries like Afghanistan and Iraq were already suffering from the spread of the disease prior.

Since the start of November, the WHO has declared cholera outbreaks in 29 countries around the world—an all-time high. This has resulted in an average case fatality rate that’s “almost three times the rate of the past five years,” according to Director-General Tedros Ghebreyesus.

It’s not just the Mediterranean region that’s been hit by one outbreak after the other. In the Philippines, cases rose by 4,102, up 254% from the Department of Health’s count last year. This is another alarming jump from a drop in cases in 2018.

Something in the water, the war, and the weather

As much as we’d like to pin all the blame on COVID like we normally do (and for good reason), we can’t neglect the problems of ye olde which were never resolved in the first place.

The WHO states that it’s a global public health threat that indicates “inequity and lack of social development” in a country. Daniela Garone, a Médecins Sans Frontières (MSF; Doctors Without Borders) international medical coordinator, says outbreaks generally occur in the most vulnerable places in the world—usually areas with excessive flooding or refugee settlements due to natural and man-made calamities. Both notably lack proper sanitation and safe water supply.

In the recently concluded 27th Conference of the Parties climate summit, experts stressed how climate change can poison our food. Flooding from heavy rains and poor urban planning could spread waterborne diseases like cholera—something Eastern Visayas, the region with the most local cholera cases in 2022, is no stranger to.

Haiti’s worst ever outbreak occurred in 2010 after the big earthquake which displaced over a million people. Though cases declined by 2016, this year they reported 7,569 suspected cases and 712 confirmed cases across the country after three years of no cases. 

But perhaps just as surprising as its comeback is the fact that in some parts of the world, it never left. In war-torn Yemen, an acute cholera outbreak has caused over 2.5 million cases and over 4,000 deaths since 2016. 

Where is the love—and the vaccines?

Getting dizzy from all the numbers yet? Sorry about that. While this isn’t the Data Journalism newsletter, we thought it was important to lay the numbers out in one place to give you a sense of the scale and intensity of these outbreaks. 

If there’s one thing history has made clear, it’s that cholera spreads through contaminated water brought about by the weather, war, poverty, or all of the above. An ongoing vaccine shortage—this time due, in part, to a lack of interest among global manufacturers to produce it—makes it clear that cholera is yet another third-world problem. 

"Cholera vaccines have never been a priority for manufacturers and in many cases governments have not engaged as acknowledging cholera can have implications for commerce," said Gordon Dougan, a professor in the department of medicine at the University of Cambridge.

"The oral cholera vaccine is cheap and requires bulk sales to generate profit, something off the agenda for most companies in higher income countries," Dougan said.

Other companies, like India-based Hilleman Laboratories and Bharat Biotech, are collaborating on a cholera vaccine, but it would take four to five years to produce and distribute.

Two doses of the cholera vaccine creates immunity against infection for at least three years. Due to the shortage, they’ve been cut down to one dose. Organizations like MSF say the shortage makes it impossible to follow through with preventing and eradicating cholera, but that’s like saying we’re out of Band-Aids in the middle of an open surgery. 

Old problems call for new solutions

So does love truly persist in the time of cholera and COVID-19? The more I read up on it, the less I believe in it. But contrary to that popular Tame Impala song, the less we know isn’t always better.

In the time of Evian baths and universal healthcare, it’s easy to get complacent with certain public health measures, like producing cholera vaccines, when it’s no longer your country’s problem. What we have now is too little, too late. Anyway, what good are vaccines if two billion people worldwide still lack access to safe water services? 

Plumbing is admittedly easier to fix than conflict, but we all have to start somewhere. 

Roadmap 2030 is the “new global strategy to reduce cholera deaths and stop cholera transmission.” It focuses on three key areas: early detection and response, targeted prevention using vaccines, and support from the Global Task Force for Cholera Control. In doing so, it tackles three United Nations Development Goals that aim to ensure good health and well-being at all ages, access to clean water and sanitation for all, and equality within and among countries. 

And don’t just get the doctors in on this—rope in the urban planners, wastewater experts, humanitarian workers, and government officials, too. In the same vein that natural disasters are public health matters, multisectoral problems must be addressed to keep a nation healthy too.