2 November 2022 – Good afternoon and welcome to today’s press briefing on the latest updates on cholera outbreaks in the Eastern Mediterranean Region.
After decades without a single case of cholera, the outbreaks that have been recently declared in Lebanon and Syria mark an unwelcome comeback in those countries. In fact, this is part of a worsening pattern across the Region, and the globe, as 8 of the 22 countries in our Region are grappling with outbreaks of cholera and acute watery diarrhoea.
Moreover, there are now 29 cholera outbreaks worldwide – the highest number on record. We know that cholera can cross borders, placing neighbouring countries at increased risk and heightening the need for urgent control. This is a wake-up call for all of us.
Cholera can spread rapidly in our Region, driven by the multiple complex humanitarian and health emergencies, prolonged conflict, poor water and sanitation infrastructure and deteriorating economic conditions.
Additionally, climate change has contributed to the resurgence of cholera, and we see this evidence in several countries hit by extreme climate events like floods, droughts and cyclones. Droughts, which are increasingly common across our Region, reduce access to clean water and create the ideal environment for cholera to spread.
We should not have outbreaks of cholera in our Region in the 21st century, and definitely, people should not be dying from it. Access to clean water and appropriate sanitation facilities should be available to all and is a basic human right.
Most of the countries affected by the cholera outbreak in the Region are those with poor water and sanitation infrastructure with no major investment in recent years. Water scarcity – again, driven by drought – is another contributing factor.
A timely and well-coordinated response among all stakeholders is urgently needed to quickly control the outbreaks and curb the further spread of cases and deaths within the affected countries and in neighbouring countries.
This response must be focused on improving access to clean water and appropriate sanitation and hygiene, intensive awareness-raising, community engagement and strengthening early warning surveillance to detect cases quickly and respond effectively.
Good quality clinical management of patients is essential to minimize mortality – cholera is both a highly preventable and treatable disease. WHO is working with ministries of health and partners in all of these areas.
The upsurge of cholera outbreaks in the Region and around the globe has led to an acute cholera vaccine shortage. As a result, the International Coordinating Group on Vaccine Provision – which manages the global stockpile of cholera vaccine – is temporarily suspending the standard 2-dose vaccination regimen for cholera outbreak response campaigns, adopting a single-dose approach instead.
Using a one-dose strategy allows more people to be vaccinated and provides them protection in the near term.
Oral cholera vaccination campaigns are planned for both Lebanon and Syria in the coming weeks, while Pakistan has recently undertaken campaigns both prior to, and since, the recent floods.
While vaccines are a critical tool, they are not the main intervention to control cholera. Cholera is mainly prevented with access to safe water and sanitation and can be treated easily with oral rehydration solution. Most patients do not require hospitalization. Antibiotics are reserved for more severe cases.
Cholera can kill, but it is preventable. Let us not allow the hard-won public health gains of the last decades vanish due to people lacking access to simple interventions.
To conclude, let me stress the critical importance of solidarity and action among all stakeholders. Our response to cholera requires us to join efforts and work together to ensure Health for All by All – so that no one has to die from this disease.
Note to editors
WHO works closely with ministries of health in affected countries, providing much needed technical guidance to ensure proper clinical management practices, infection prevention, control, and cholera testing protocols are in place.
WHO's response has been also extended to include supplying life-saving treatment kits and medicines and raising awareness among health care workers and populations on prevention protocols.
Additionally, WHO has supported several oral cholera vaccination campaigns in affected countries and is now working to secure more vaccine doses within the temporary frame of a one-dose strategy.
In Lebanon, we supported the Ministry of Public Health to secure 600 000 doses of cholera vaccine for the most vulnerable populations, including frontline workers, prisoners, refugees and their host communities. Also, WHO provided 2 reference laboratories, 3 prisons and 12 hospitals designated for cholera treatment with laboratory reagents, treatment kits and rapid diagnostic tests, and deployed nurses and doctors to surge capacity in hospitals in the most affected areas.
In Syria, WHO is working with the Ministry of Health to implement a multisectoral approach to control the outbreak, including scaling up surveillance and testing capacity, training health care workers, promoting awareness among the population, and continuing to monitor water quality in high-risk areas. WHO provided supplies and cholera kits to treat more than 2000 severe cases and 190 000 mild cases and distributed more than 5 million chlorine tables in high-risk areas. Moreover, WHO supported the Ministry of Health in submitting a request for 2 million doses of cholera vaccine that will target all of the population above the age of 1 year in prioritized sub-districts in 4 governorates (Hassakeh, Deir-ez-Zor, Ar-Raqqa and Aleppo), except for Jebel Saman sub-district in Aleppo.
In Pakistan, WHO just completed a 5-day cholera vaccination campaign in Khyber Pakhtunkhwa province in close coordination with health authorities. WHO provided technical support in identifying the hot spots, micro-planning, training, monitoring, analysis, and reporting and also deployed surveillance and immunization experts and emergency professionals at national and provincial levels to analyse the situation and respond promptly.
In Somalia, With WHO's support, 888 092 people aged one year and above received the second dose of oral cholera vaccine compared to 897 086 people who received the first dose, and overall vaccination coverage was 888 092 (99% compared to the first round). In addition, WHO supports the state-based health teams to conduct water quality testing and analysis in Kismayo, Jubaland, as part of the acute watery diarrhoea/cholera response.
In Iraq, a WHO team recently visited the water quality laboratories and treatment plants of the Ministry of Construction, Housing, and Municipalities in Baghdad to collect data and assess the epidemiological situation of cholera in Iraq.
In Yemen, WHO has been supporting health authorities in setting up 28 emergency operations centres in long-lasting response efforts since cholera erupted across the country in 2017. WHO has also supported incorporating oral rehydration and diarrhoea treatment centres inside existing health facilities structures, training 1344 health care workers in case management and ensuring incentive support to health care workers in the centres.
In Afghanistan, WHO is working with the Ministry of Public Health to respond to cases of acute watery diarrhoea ensuring proper technical guidance is provided, and surveillance, outbreak investigation, case-finding, sample collection and shipment are implemented in 34 provinces. WHO has also distributed laboratory and other treatment kits, including rapid diagnostic kits, to all outbreak-affected areas as of 15 October 2022.
In Islamic Republic of Iran, WHO supports enhancing the diagnostic capacity of the laboratory network through the provision of 10 000 rapid diagnostic kits for cholera detection, production of risk communication and community engagement materials in Farsi on cholera, including social media cards for the public, web content and posters for travellers, food handlers, health care workers and dubbing an animation on prevention and treatment of cholera. The WHO Regional Office is collaborating with the WHO country offices in Afghanistan and Iraq to share information and produce awareness-raising materials for refugee communities in Islamic Republic of Iran in local languages.