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The World Health Organization said Wednesday that a shortage of cholera vaccines has forced a temporary shift to a single-dose strategy, from the usual strategy, in campaigns to fight a ballooning number of outbreaks.
The UN health agency said “strained global supplies of cholera vaccines” prompted the International Coordination Group (ICG), which manages emergency supplies of the vaccines, to suspend the two-dose regimen.
“The centerpiece of the strategy will allow the doses to be used in more countries at a time of unprecedented rise in cholera outbreaks worldwide,” the WHO said in a statement.
The head of the World Health Organization, Tedros Adhanom Ghebreyesus, told reporters that “29 countries reported outbreaks this year, including 13 countries that had no outbreaks last year.”
That compares with fewer than 20 countries reporting such outbreaks in total over the past five years.
“The global trend is towards more numerous, widespread and severe disease outbreaks due to floods, droughts, conflict, population movements and other factors that limit access to clean water and increase the risk of cholera outbreaks,” said a statement on Wednesday.
Cholera is an acute diarrheal infection of the small intestine that causes sometimes fatal dehydration. It is generally transmitted from food or water contaminated with the bacteria Vibrio cholerae.
very limited
The World Health Organization and other members of the ICG – the charity Doctors Without Borders (MSF), the United Nations Children’s Agency (UNICEF) and the Red Cross – have highlighted that the single-dose strategy of cholera vaccines has proven effective in responding to the outbreak.
But they cautioned there was only limited evidence on the exact duration of protection, which appeared to be much lower in children in particular.
With two doses, when the second dose is given within six months of the first, immunity to infection lasts for three years.
“The benefit of giving a single dose still outweighs no doses,” the statement said.
The World Health Organization has warned that current supplies of cholera vaccines are “extremely limited”.
The ICG manages a global stockpile of oral cholera vaccines, but of the 36 million doses expected to be produced this year, 24 million have already been shipped for preventive and reactive campaigns.
The ICG approved an additional eight million doses for an emergency second round of vaccination in four countries.
Tedros said the shift in strategy was “clearly less than ideal and rationing should be a temporary solution”.
‘A very difficult decision’
One reason for the growing concern about the situation is that Shanchol, the maker of one of only two cholera vaccines for use in humanitarian emergencies, has said it will halt production by the end of the year.
However, a Sanofi spokesman stressed that the vaccine shortage is due to an escalation in cases, “and the non-stop production of the vaccine by Sanofi, because we continue to deliver doses of Chanchol.”
He indicated that the company announced its decision to stop production again in 2020 due to the small number of doses it was producing, and because other actors announced plans to increase capacity.
Doctors Without Borders said a serious global shortage of cholera vaccines left it and other ICG members with no choice but to support the “very difficult decision to reduce the doses people will receive from two doses to one”.
“It is very frustrating to face this situation with cholera spreading in more than 20 countries, including places already devastated by crisis such as Haiti, Nigeria and Syria,” said Daniela Garoni, international medical coordinator for MSF.
“This last-resort decision is the way to avoid the impossible choice of sending doses to one country over another.”
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