Blog

KEY POINTS:

• Malawi faces the deadliest Cholera outbreak in decades.
• Medical supply shortage prompted closure of multiple health centres.
• Vaccine manufacturers halt production due to inability to meet high demand.

The world seems to be steadily regaining a sense of normality post-COVID, but, unfortunately, some parts of Africa aren’t in the clear just yet. Ebola reared its head once more in Uganda last year. From September to January 2023, the virus infected over 160 people, with 77 of them dying. In Equatorial Guinea, the first case of the Marburg virus was reported on February 7, and by the 25th, nine deaths were confirmed. It has been a year since Malawi began experiencing its deadliest Cholera outbreak in decades, and the virus seems to be picking up steam rapidly. What do we know about the outbreak so far?

Over 50 000 Malawians have been infected, 1 500 have succumbed to the waterborne disease, and the rate at which it ravages the country is rising. Cholera is a bacterial disease. Statistics report 1.3 to 4.0 million cases yearly and 21 000 to 143 000 deaths globally. The virus spreads through ingesting contaminated water or food, and those infected initially present mild to no symptoms. However, it takes 12 to 5 days to cause the primary sign of infection – diarrhoea. It can be treated with intravenous fluids and antibiotics in severe cases and kills within hours if left untreated.

This specific outbreak in Malawi is like nothing the country has experienced before. Cholera has been endemic in the country since the 1990s, yet, unlike usual, where the virus starts in its rainy season, this time, it began during its dry season. Warnings of heavy rains due to the looming Cyclone Freddy have everyone on high alert.

“Malawi is experiencing the deadliest cholera outbreak in its recorded history,” stated country representative for the UN children’s fund, Unicef, Rudolf Schwenk. The country is also struggling to respond to a polio outbreak and ongoing Covid-19 cases across the nation.”

Cholera is a significant indicator of socioeconomic disparities. Issues such as overcrowded habitats and unsanitary water sources primarily affect poorer communities which are, unsurprisingly, the biggest victims of this virus that thrives in these conditions. Unfortunately, poor communities are neglected in water and sanitation infrastructure funding.

 “Typical at-risk areas include peri-urban slums, and camps for internally displaced persons or refugees, where minimum requirements of clean water and sanitation are not been met,” The World Health Organisation reported in March 2022 – at the genesis of Malawi’s outbreak.

Malawi’s medical supply shortage is another major issue and caused a number of health centres to close. In December, health workers claimed that the government blatantly ignored the lack of supplies. “Patients are being told to buy syringes when they go to the health centres,” a worker revealed. The government, however, places the blame on the pandemic and economic instability, claiming that there aren’t sufficient funds to procure more meds and equipment.

The Cholera virus can be prevented via a vaccine, yet, around October last year, the only other manufacturer of cholera vaccines decided to halt production. Shantha Biotechnics manufactures the Shanchol vaccine, one of only two oral vaccines suitable for emergency distribution. A representative from Sanofi, Shantha’s parent company, cites the reason for the decision to stop production as the inability to keep up with demand. Unfortunately, Malawi is not the only country experiencing a cholera outbreak. Haiti, Syria, Lebanon, Nigeria, and Ethiopia face the same problem, and Shantha is buckling under pressure.

Not all hope is lost, though, as Malawi managed to procure 2.9 million doses from the Gavi-supported Global Oral Cholera Vaccine Stockpile in November. Gavi provides support to countries experiencing outbreaks and funds the stockpile. Since 2014, the reserve has been accessed 87 times by 22 countries and counting.

“Demand for the oral cholera vaccine has increased over the past years: in the 15 years between 1997 and 2012, just 1.5 million doses of cholera vaccine were used worldwide; in 2021, approximately 27 million doses were shipped worldwide – a testament to Gavi’s role in increasing supply to meet growing demand,” the Gavi website shares.