Oral cholera vaccine support

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More than 18 million oral cholera vaccine doses distributed through the global stockpile

Cholera Cameroon

The oral cholera vaccine is administered at Minawao Camp, Cameroon. Credit: Gavi/2015/Athanas Makundi.

PREVENTING OUTBREAKS

In 2017, the Gavi-funded oral cholera vaccine stockpile provided 10 million doses to countries, bringing the total to over 18 million. Nine countries drew on the stockpile to prevent or control cholera outbreaks in 2017.

For example, one million Gavi-supported cholera vaccine doses were sent to Sierra Leone to prevent a widespread outbreak following devastating floods and landslides. More than 670,000 doses were deployed to Haiti for a second round of vaccinations in the wake of Hurricane Matthew.

Since its creation, the stockpile has been accessed 52 times by 18 countries.

DISTRIBUTION OF CHOLERA VACCINE IN COX’S BAZAR, BANGLADESH

In 2017, an emergency cholera vaccination campaign was conducted in Cox’s Bazar, Bangladesh, to help prevent the spread of cholera among the more than 650,000 Rohingya refugees who had fled across the border from Myanmar’s Rakhine State, as well as in the host community. While the vaccination campaign was successful in preventing a large-scale cholera outbreak, the low basic immunisation coverage among the Rohingyas caused diphtheria to sweep through the refugee community, infecting thousands. To address this, Gavi supported routine immunisation with the measles-rubella, pneumococcal, IPV and pentavalent vaccines for over 150,000 refugee children.

GROWING MARKET

Demand for the oral cholera vaccine is increasing rapidly. In the 15 years between 1997 and 2012, just 1.5 million doses of cholera vaccine were used worldwide. In 2017 alone, this figure had increased to 10 million doses.

Cholera is an acute intestinal infection caused by contaminated food or water

The disease can quickly lead to severe dehydration and, in its extreme form, can be fatal

There are an estimated 1.3 to 4 million cases and 21,000 to 143,000 deaths worldwide due to cholera each year. The majority of cases reported to WHO are outbreak-related, with 40–50 confirmed outbreaks every year. Yet many cases go unreported.

The disease affects the most vulnerable in urban slums and rural areas, where clean water is not available. Due to the quick progression of the disease, most deaths are among the poorest populations who do not have rapid access to health services.

There are three main situations where cholera thrives:1 

  • endemic conditions: where the disease is entrenched in communities. This is the case, for example, in regions of the Democratic Republic of Congo and Bangladesh. In Bangladesh there are an estimated 300,000 cases and 4,500 deaths each year. 
  • sudden outbreaks: where instant vaccination is most effective, such as in Guinea and Malawi.
  • during humanitarian crises: such as the 2017 floods and landslides in Sierra Leone and the outbreak among Rohingya refugees in Cox’s Bazar, Bangladesh.

Up to 80% of all cholera cases can be successfully treated with oral rehydration salts. Outbreaks and deaths occur because people cannot access adequate treatment.


1WHO. Cholera risks high across world, but deadly disease can be controlled. Available at: www.who.int/cholera/publications/6July2015/en/. Accessed on: 15 August 2016. Feasibility and effectiveness of oral cholera vaccine in an urban endemic setting in Bangladesh: a cluster randomised open-label trial. Lancet, 2015. Ali, M, Lopez, AL, You, Y et al. The global burden of cholera. Bull World Health Organ. 2012; 90: 209–218. 

  

Gavi has supported the global oral cholera vaccine stockpile since 2014

Oral cholera vaccine stockpile

The global oral cholera vaccine (OCV) stockpile was founded in mid-2013 by five donors.

In 2013, the Gavi Board approved support for the stockpile as part of our Vaccine Investment Strategy. Our contribution of over US$ 110 million for the 2014–2018 period aims to increase access to OCV during emergencies and in countries that regularly experience cholera outbreaks.

As the stockpile provided over 10 million vaccine doses in 2017 alone, Gavi recognises that there is continuing demand. We have already begun to explore options to extend our support past the 2014–2018 timeframe.

The global OCV stockpile is managed by the International Coordinating Group, which includes four Alliance partners: the International Federation of Red Cross and Red Crescent Societies, Médecins Sans Frontières, UNICEF and WHO.

The objectives of our investment are:

  1. breaking the current cycle of low demand–low supply of oral cholera vaccine;
  2. reducing outbreaks in Gavi-supported countries; and
  3. strengthening the evidence base for periodic, pre-emptive campaigns.

The first Gavi-supported campaign using the global stockpile began in August 2015 in Cameroon. The campaign, run by Médecins Sans Frontières, vaccinated the Minawao and Gawar refugee camps, as well as the nearby villages of Gadala and Gawar.

Nine countries accessed the stockpile in 2017.

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