Cholera is a disease that, for many, seems to belong to the past, a relic of a time when public health was more rudimentary and less effective. However, in recent years, this disease has made a significant comeback, and it is doing so with increasing frequency and severity. The return of cholera is being driven by a combination of factors, including climate change, ongoing wars, and strained global health systems. In 2024 alone, there were over 804,000 cholera cases globally, with 5,805 deaths. This represents a nearly 50% increase from the previous year, indicating a worsening trend. While these figures might seem alarming, experts believe that the actual numbers could be much higher. The true toll of cholera could range between 1.3 million and 4 million cases, with death estimates ranging from 21,000 to 143,000 annually.

In early 2025, six countries—Myanmar, the Democratic Republic of the Congo, Sudan, South Sudan, Angola, and Ghana—requested doses from the global cholera vaccine stockpile, which, unfortunately, has been depleted at various points over the last year. The cholera vaccine stockpile was designed to hold 5 million doses, but the high demand caused by outbreaks around the world led to shortages. This has left health authorities struggling to control outbreaks and leaving high-risk countries without preventive vaccination campaigns for over two years. The shortage is exacerbated by the fact that only one supplier is providing the vaccines, making it difficult to keep up with the rising demand.

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Cholera’s Resurgence: A Closer Look at the Contributing Factors

Cholera is spread primarily through the consumption of contaminated water. People infected with the Vibrio cholerae bacterium can develop severe diarrhea, often leading to dehydration and death if untreated. The disease is treatable through rehydration therapies, but access to these treatments is limited in many parts of the world, especially in areas plagued by conflict and poor sanitation.

The situation is particularly dire in regions where war has devastated infrastructure, leaving civilians without access to clean water and proper sanitation. South Sudan, for example, has experienced a surge in cholera cases, with refugees fleeing conflict in Sudan exacerbating the spread of the disease. The refugee camps, often overcrowded and lacking basic sanitation, have become hotspots for cholera outbreaks. The situation is further complicated by the difficulty of reaching affected populations with vaccines, due to the logistical challenges of working in conflict zones.

In South Sudan, a cholera treatment unit (CTU) set up by Médecins Sans Frontières (MSF) in the capital, Juba, has been working tirelessly to manage the outbreak. The unit has seen hundreds of patients, successfully treating most, but the deaths continue in the wider community. Cholera is often spread through the consumption of contaminated water, as seen in the case of Guta Epulo, a nurse overseeing the treatment unit. Many of the cholera cases in South Sudan are traced back to unsafe drinking water, such as water from wells that are contaminated by animals.

Despite the best efforts of organizations like MSF, the ongoing conflict and lack of clean water make it very difficult to control the spread of cholera. In areas where the war has displaced large numbers of people, the disease spreads rapidly, especially in overcrowded camps where sanitation is poor and access to clean water is limited.

The Role of Climate Change in Cholera’s Resurgence

Climate change has exacerbated the cholera crisis by increasing the frequency and intensity of floods, which can wash contaminated water into previously safe areas. The Africa Centres for Disease Control and Prevention (Africa CDC) highlighted this issue in a January 2025 briefing, noting that the increased flooding, driven by climate change, has significantly contributed to the rise in cholera cases across the continent. Additionally, the poor state of sanitation infrastructure in many of these countries makes it even harder to contain outbreaks once they occur.

In Africa, cholera is a significant killer, and the outbreaks are often deadly because of the weak health systems and lack of basic supplies needed to provide proper care. Access to clean water is limited in many areas, and without basic sanitation and hygiene practices, diseases like cholera spread easily. Cholera treatment requires access to rehydration salts, intravenous fluids, and, in some cases, antibiotics, all of which are in short supply in conflict zones and regions affected by poverty.

Vaccination Efforts and Challenges

Vaccination is one of the most effective ways to prevent cholera, but the global stockpile of cholera vaccines is under strain. The World Health Organization (WHO) has stated that, due to the overwhelming demand, the stockpile is often depleted, and the vaccine is not available for preventive campaigns in high-risk countries. In 2024, the cholera vaccine stockpile was completely drained multiple times, and the vaccine was only made available in emergency situations. The situation has improved slightly in 2025, with the vaccine being replenished in just three to four weeks, a marked improvement over previous years, where replenishment would take up to two months.

The Africa CDC has emphasized the need for better access to cholera vaccines in Africa, where outbreaks often result in high mortality rates. Prof Ngashi Ngongo, chief of staff at the Africa CDC, stressed that the key to controlling cholera outbreaks is not only increasing the availability of vaccines but also improving water and sanitation infrastructure. In many parts of Africa, the lack of access to clean water and proper sanitation continues to fuel the cholera epidemic.

The Global Cholera Response and the Need for a Coordinated Effort

Global health organizations like WHO, MSF, and Gavi, the Vaccine Alliance, have been working tirelessly to combat the cholera outbreaks. Gavi, for instance, has played a critical role in coordinating the global cholera vaccine stockpile, but the high demand for vaccines, coupled with the complexities of conflict zones and climate change, has made it difficult to ensure adequate supply.

Allyson Russell, a senior program manager at Gavi, noted that the rise in cholera cases since 2022 has put immense pressure on health systems worldwide. The global cholera response has been further complicated by the strain on health workers, supply chains, and the lack of infrastructure in conflict areas. In many instances, the supply of vaccines is inadequate, and the priority has often been to contain outbreaks in the most affected areas rather than providing preventive vaccinations in high-risk countries.

To better control cholera outbreaks, public health experts emphasize the need for improved sanitation, better access to clean water, and more robust health systems. In addition to vaccination efforts, efforts must be made to improve the availability of essential treatments like rehydration salts, IV fluids, and antibiotics. These measures, combined with public health education and awareness campaigns, are essential in reducing the impact of cholera outbreaks and saving lives.

A Global Health Crisis

The resurgence of cholera is a clear indication that global health challenges are becoming increasingly complex and interconnected. Climate change, conflict, and vaccine shortages are just a few of the factors contributing to the rise in cholera cases worldwide. As the global community grapples with these challenges, it is clear that coordinated efforts are needed to address the root causes of the disease and ensure that those most at risk—especially in conflict zones and impoverished areas—have access to the care and resources they need to survive.

Addressing cholera outbreaks requires a multifaceted approach, one that focuses on improving sanitation, water access, and health infrastructure, while also ensuring that vaccines are available for those who need them most. Only through international collaboration, better resource allocation, and a commitment to addressing the underlying causes of cholera can we hope to stem the tide of this preventable disease and protect vulnerable populations worldwide.