SWITZERLAND — The World Health Organization (WHO) and its partners have recommended that countries temporarily switch to using a single dose of the cholera vaccine instead of two due to a supply shortage as outbreaks of the water-borne disease surge globally.
In a statement, the U.N. agency and partners that include UNICEF and the International Federation of Red Cross and Red Crescent Societies said one dose of vaccine has proven effective in stopping outbreaks “even though evidence on the exact duration of protection is limited” and appears to be lower in children.
WHO and partner agencies manage a stockpile of cholera vaccines that are dispensed free to countries that need them.
“This last-resort decision is a way to avoid making the impossible choice of sending doses to one country over another,” said Dr. Daniela Garone, international medical coordinator at Doctors Without Borders, one of WHO’s partners in managing the global cholera vaccine stockpile.
Speaking in Geneva the director general of the WHO, Tedros Adhanom Ghebreyesus, said the move was “clearly less than ideal.”
“Rationing must only be a temporary solution,” Tedros said. “In the long term, we need a plan to scale up vaccine production as part of a holistic strategy to prevent and stop cholera outbreaks.”
The world has been hit by more cholera outbreaks this year than in the previous five years combined. Since January, 29 countries have reported cholera cases, including Haiti, Malawi, and Syria, which are facing serious outbreaks.
The total represents a significant increase over the previous five years when fewer than 20 countries reported outbreaks on average.
Cholera is known as a “disease of chaos”, and the WHO blamed the “more numerous, more widespread and more severe outbreaks” on flooding, droughts, conflict, and displacement.
WHO said countries such as Haiti, Malawi, and Syria were struggling to stop large outbreaks of the disease and that climate change could make epidemics more common, as the bacteria that causes the disease can reproduce more quickly in warmer water.
In 2010, cholera killed nearly 10,000 people in Haiti after the disease was imported there by U.N. peacekeepers.
The WHO has expressed particular concern about the fatality rate, which this year was nearly three times that of the previous five years.
Cholera is a waterborne disease that is easily treatable if treated promptly, but can kill within hours if not.
According to WHO, 24 million of the 36 million vaccine doses expected for 2022 have already been shipped for immunization campaigns. It stated that there was no short-term solution to increase output.
A global cholera task force estimates that the world will require approximately 250 million cholera vaccines by 2025, both to stop outbreaks and for preventive immunization campaigns.
Shantha Biotechnics, an Indian subsidiary of French pharmaceutical company Sanofi, previously announced that it would cease production of cholera vaccines by the end of this year, leaving the world with only one manufacturer of the simple-to-manufacture oral vaccine: South Korean company EuBiologics.
Dr. Michael Ryan, WHO’s emergency director, stated that it was impossible to predict when countries would be able to resume using two doses of the cholera vaccine.
“As vaccine manufacturers are producing at their maximum current capacity, there is no short-term solution to increase production,” the WHO said.
“The temporary suspension of the two-dose strategy will allow the remaining doses to be redirected for any needs for the rest of the year.”
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