Cholera is surging in Africa. A new generation of vaccines could slow it

Cholera is caused by the bacterium Vibrio cholerae, which spreads through contaminated water or food. 

Infected individuals can develop sudden, severe diarrhoea and vomiting, leading to rapid dehydration and electrolyte loss. Without prompt treatment, cholera can cause shock and kill.

Endemic cholera refers to areas where the disease is constantly present at a baseline level, while epidemic cholera occurs when there is a sudden, sharp increase in cases above what is normally expected in a particular area.

Cholera has been a global killer for hundreds of years, but a “perfect storm” of circumstances has caused a surge in infections since late 2022.

“I think the recent surge is really multifactorial,” explained Dr Natalie Fischer, an Assistant Professor in Epidemiology with the London School of Hygiene and Tropical Medicine. 

“It often occurs in places affected by conflict. There’s also internal displacement, with refugees moving across borders, as well as areas that have suffered climate catastrophes – flooding, cyclones, and droughts – which we’ve seen increasingly in recent years, especially on the African continent.”

Extreme weather events, such as floods, cyclones, and droughts, create conditions that allow the bacteria that cause cholera to thrive by contaminating water sources and overwhelming sanitation systems.

In countries like Sudan, the Democratic Republic of the Congo, and Yemen, conflict-driven displacement has also caused overcrowding and poor sanitation, further allowing infections to spread.

High infection rates in Somalia and Yemen highlight how deeply cholera has become entrenched in fragile and crisis-affected settings.

In recent years cholera control has been hindered by a limited global vaccine supply. The situation deteriorated in 2020 when the manufacturer of the Shanchol vaccine ceased production, putting additional strain on stockpiles amid ongoing outbreaks.

Cholera vaccines are normally given in two doses, spaced weeks apart, but due to these shortages, the WHO temporarily recommended a single-dose strategy in 2022 to extend limited supplies and protect more people during outbreaks.

“The single-dose approach has been shown to be effective in curbing outbreaks and serves as an important first step in control during emergencies,” said Dr Fischer. “But it’s not a sustainable long-term strategy to rely on single-dose, reactive campaigns alone.”

The three new vaccinations could offer a solution. 

In South Korea, EuBiologics has developed Euvichol-S, a simplified version of its original Euvichol vaccine that contains just two inactivated Vibrio cholerae strains while still targeting the main pandemic subtypes. 

It simplifies production by removing a complex heating and inactivation step, which is traditionally used to kill the bacteria while preserving the components that train the immune system to recognise and fight the disease.

Euvichol-S was pre-qualified by the WHO in early 2024 and is already helping to replenish the global stockpile, with EuBiologics expanding manufacturing capacity through a new facility.

In India, Bharat Biotech has developed Hillchol, a vaccine that protects against the two main types of cholera. 

It is already licenced for use in India and is now seeking approval from the WHO so it can be used globally.

In South Africa, Biovac, supported by the International Vaccine Institute, is also developing a simplified cholera vaccine with full local manufacturing. 

Clinical trials are underway, with approval possible by 2028, which could allow Africa to produce its own vaccines.

“The big shift now is the focus on local manufacturing in affected countries – having Africa make their own vaccines, India make their own vaccines, and then hopefully make them available globally,” said Dr Griffin. 

“If vaccines are manufactured locally, it reduces vulnerability to supply chain disruptions, geographical pressures, international market competition, and vaccine hoarding. It’s really about making things more equitable and fair, especially for the countries that need these vaccines the most.”

Experts hope that the production of Euvichol-S, Hillchol, and Biovac’s vaccine will support a shift toward preventive cholera control, rather than simply reacting to outbreaks after they occur.

While these vaccines alone will not eliminate cholera, experts agree they are a crucial part of a broader toolkit. 

Safe water, improved sanitation, and rapid access to treatment remain at the core of getting outbreaks under control. 

Dr Griffin said: “With the combination of better vaccines, local manufacturing, and strengthened public health measures, there’s real hope for turning the tide against cholera.”

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