SWITZERLAND — Gavi, the Vaccine Alliance, has unveiled a roadmap that outlines critical actions required to address the current shortage of oral cholera vaccine (OCV) and meet the growing demand from countries worldwide.

Against the backdrop of recent cholera outbreaks in various parts of the world, the roadmap provides a comprehensive outlook on the short-, mid-, and long-term supply of global cholera vaccines.

Developed in collaboration with key partners such as the World Health Organization (WHO), UNICEF, the Global Taskforce for Cholera Control (GTFCC), and the Bill and Melinda Gates Foundation (BMGF), the roadmap aims to facilitate collaboration between organizations, manufacturers, and countries to ensure an adequate supply of OCV for large-scale preventive vaccination by 2026.

Dr. Derrick Sim, Managing Director for Vaccine Markets and Health Security at Gavi, emphasized the significance of the steady increase in the availability of cholera vaccines over the past decade to meet rising country demand.

However, he highlighted that each vaccine dose delivered today is the result of extensive planning, investment, and coordination.

While there are enough doses to meet emergency demand despite the surge in outbreaks, this trend underscores the growing importance of preventing cholera outbreaks before they occur.

Dr. Sim stated that sustainable OCV supply and effective cholera control rely on collective efforts to strengthen prevention programs.

Collaborative strategies to ensure adequate OCV supply

The roadmap identifies three key areas where partners will collaborate to ensure sufficient supply of OCV to support both outbreak response and long-term preventive vaccination.

In the short term, partners will focus on optimizing supply utilization and availability by providing updated guidance to countries on the best use of OCV in emergency situations.

Developing an allocation framework is crucial for ensuring consistent demand, transparency, and equitable distribution of doses.

Concurrently, Gavi is working to support new suppliers in entering the market more efficiently and at larger volumes, while also collaborating with the main current supplier, EuBiologics, to increase production capacity.

The roadmap also emphasizes the need to ensure demand for preventive vaccination. Countries and partners must engage in advance planning for preventive OCV programs, as predictable and forecastable demand will provide suppliers with accurate signals to secure future supply.

Additionally, accurate mapping of high-risk areas for cholera and the implementation of high-quality, impactful, multi-sectoral, and long-term preventive programs are essential for effective cholera control.

Supporting high-impact vaccine and delivery innovations is another crucial aspect outlined in the roadmap.

Clear communication regarding the most impactful product innovations in lower-income countries, where these vaccines are most needed, and prioritizing those innovations will facilitate their successful implementation.

The roadmap also suggests the need for clear protocols and labeling for controlled temperature chain (CTC), allowing vaccines to be stored outside the cold chain in campaign or emergency response situations. This would enhance usability in lower-income countries and improve access to those most in need.

Rising cholera outbreaks

So far this year, 24 countries have reported cholera outbreaks, compared to 15 by mid-May last year. The rise in cholera outbreaks worldwide can be attributed to climate change, conflict, and displacement.

Countries that are not usually affected by cholera are being affected and case fatality rates are far exceeding the typical one in 100.

This increasing trend, coupled with countries’ interest in using OCV for cholera control, has strained the global supply of the vaccine, particularly during emergency responses.

From 2011 to 2020, approximately 38 million doses of OCV were used globally in response to cholera outbreaks. In 2021 and 2022 alone, nearly 48 million doses were required for emergency response.

To address this surge in demand, the international coordinating body managing the Gavi-funded global stockpile of oral cholera vaccines recommended a temporary shift to a one-dose strategy aligned with WHO recommendations.

This shift ensures that the available supply can continue to meet countries’ emergency OCV needs.

While preventive vaccination efforts have been affected by the increased demand for emergency response, it has underscored the urgent need for preventive vaccination in cholera hotspots.

Vaccine shortage puts cholera prevention campaigns at risk

The battle against cholera is facing a significant hurdle due to a shortage of vaccines. Despite the production of approximately 36 million cholera vaccine doses last year, manufacturers are not incentivized to invest in its production as there is virtually no market in wealthier nations.

This year, the demand for oral cholera vaccine doses has exceeded 18 million, but only eight million doses have been made available, leading to a suspension of prevention campaigns.

To make the limited supply last longer, recipients are being issued only one dose instead of the recommended two.

Although the number of available doses may double by 2025 and then double again by 2027, the current trend of increasing cholera cases threatens to outpace the supply.

This is a concerning development as cholera cases had been steadily declining over the past decade, only to reverse course in 2021.

Among the countries hit hardest by cholera outbreaks this year are Malawi and Mozambique.

Additionally, nine other countries, including Burundi, Cameroon, the Democratic Republic of Congo, Ethiopia, Kenya, Somalia, Syria, Zambia, and Zimbabwe, are facing an “acute crisis” situation.

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