The international organization that distributes oral cholera vaccines during outbreaks has temporarily suspended the standard two-dose vaccination regimen and implemented a single-dose strategy in cholera outbreak response campaigns due to a limited global supply.
In a statement, WHO said that the pivot in strategy by the International Coordinating Group (ICG) will allow for the doses to be used in more countries, at a time of the unprecedented rise in cholera outbreaks worldwide.
Cholera is an acute diarrhoeal infection in the small intestine causing sometimes fatal dehydration. It is generally contracted from food or water contaminated with vibrio cholera bacteria.
“29 countries have reported cholera outbreaks this year, including 13 countries that did not have outbreaks last year,” WHO chief Tedros Adhanom Ghebreyesus informed reporters.
Haiti, Malawi and Syria are facing large outbreaks. In comparison, in the previous 5 years, fewer than 20 countries on average reported outbreaks.
The global trend is moving towards more numerous, more widespread and more severe outbreaks, due to floods, droughts, conflict, population movements and other factors that limit access to clean water and raise the risk of cholera outbreaks.
“The one-dose strategy has proven to be effective to respond to outbreaks, even though evidence on the exact duration of protection is limited, and protection appears to be much lower in children. With a two-dose regimen, when the second dose is administrated within 6 months of the first, immunity against infection lasts for 3 years,” the WHO said.
The announcement that Shanchol, an Indian subsidiary of the French pharmaceutical giant Sanofi, will cease production by the end of the year is one factor contributing to the growing level of concern regarding the situation. Shanchol is the manufacturer of one of only two cholera vaccines that can be utilized in humanitarian situations.
“And not to a halt in vaccine production by Sanofi, because we are continuing to deliver doses of Shanchol,” however, a Sanofi spokesperson emphasized, the vaccine shortage was caused by an increase in cases.
He pointed out that the company had announced its decision to halt production back in 2020 due to the low number of doses it was producing, and because other actors had announced plans to increase capacity.
The benefit of supplying one dose still outweighs no doses: although the temporary interruption of the two-dose strategy will lead to a reduction and shortening of immunity, this decision will allow more people to be vaccinated and provide them protection in the near term, should the global cholera situation continue deteriorating, it adds.
According to WHO, the current supply of cholera vaccines is extremely limited. Its use for emergency response is coordinated by the ICG which manages the global stockpile of oral cholera vaccines.
“Of the total 36 million doses forecast to be produced in 2022, 24 million have already been shipped for preventive (17per cent) and reactive (83per cent) campaigns and an additional 8 million doses were approved by the ICG for the second round for emergency vaccination in 4 countries, illustrating the dire shortage of the vaccine,” it adds.
As vaccine manufacturers are producing at their maximum current capacity, there is no short-term solution to increase production. 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, the WHO said.
This is a short-term solution but to ease the problem in the longer term, urgent action is needed to increase global vaccine production. The ICG will continue to monitor the global epidemiological trends as well as the status of the cholera vaccine stockpile, and will review this decision regularly.
With inputs from agencies*
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