Cholera is on a rampage; underdevelopment and the climate crisis are mostly to blame. 

Cases of the disease sharply rose over 2022, with 31 countries reporting outbreaks by the end of the year — 14 of which had zero cases of cholera just one year prior. Fortunately, this number decreased by 2023, with only 18 countries reporting continued epidemics — however, current outbreaks are worsening and beginning to spread. 

To make matters worse, the World Health Organization’s Dr. Tedros Adhanom Ghebreyesus announced a global shortage of the two-dose vaccine that helps to protect against cholera. This has meant that those tasked with rolling out vaccines have had to change strategy from administering two doses, to administering just one. While one dose does provide protection from the disease, there’s no telling how long that protection lasts, meaning that it is only a temporary solution. 

Meanwhile, according to the WHO, Malawi is currently experiencing its deadliest outbreak of cholera in history. Over 1,300 citizens have lost their lives to the disease, and as of February, the country is scrambling with an under-supported health care system and low access to vaccines and medical equipment to manage over 40,000 cases of infected citizens. 

What Is Cholera? 

Cholera is a waterborne disease caused by eating or drinking contaminated water or food. It is a fast acting diarrheal disease that can kill within a matter of hours. 

Imagine a fly drops into your cup of coffee and has clung to the inside of your mug. The longer it sits there, the more it contaminates your coffee. Every time you pour out a bit of your drink to push the contaminants out, you lose coffee, but the contaminants remain. 

You continue to pour out your coffee until you’re left with nothing but an empty mug, and the fly that flew into it. The way the fly acts, is somewhat how the bacteria that causes cholera acts. 

Vibrio cholerae, the bacterium in question, attaches itself to the intestines and releases a deadly toxin. In response, the body directs all of its fluids into the gut to try and flush it out. This leads to a diuretic reaction that weakens the body, and can lead to death.

4 Facts About the Global Cholera Crisis in 2023

1. 18 countries are experiencing cholera epidemics (as of February 2023). 
2. The WHO reports a global shortage of cholera vaccines. 
3. Malawi is experiencing its deadliest outbreak in history. 
4. In 2017 a roadmap to eradicating cholera globally by 2030 was launched into action by the WHO’s Global Task Force on Cholera Control (GTFCC). 

The Case of Malawi

In 2021 Malawi had just two cases of cholera. Fast forward two years, and that number is now 42,422 and (unfortunately) counting. This has happened for a handful of reasons, and the first reason is climate change. 

Last year, tropical storms Ana, Batsirai, and Gombe caused significant damage to water systems across Malawi, and demolished sanitation and hand-washing facilities in some communities. This has impacted access to clean water in some regions and — with cholera being caused by drinking contaminated water — this has contributed to the spread of the disease. 

The second reason is Malawi’s existing water and sanitation crisis. Even before the storms of 2022, a national study indicated that 33% of Malawian households do not have access to clean drinking water and sanitation. Malawi’s Nyasa Times reported in 2021 that water and sanitation had been the “least funded sector over the past decade.” 

🔴 The @WHO says Malawi is facing its worst cholera outbreak in two decades.

More than 1,200 have died and all but two of the country's 29 districts are affected.

But it isn't the only affected country - nine other African nations are also experiencing a surge in cases. pic.twitter.com/pxlzG4TaVB

— BBC News Africa (@BBCAfrica) February 11, 2023

Finally, experts believe that the COVID-19 pandemic and vaccine campaigns interrupted the campaign to vaccinate all Malawians against cholera. The New York Times further reported that skepticism surrounding the COVID-19 vaccine has also influenced citizens’ attitudes toward getting treated for, and preventing contraction of cholera. 

“Some communities have chased away health workers, accusing them of trying to trick people into taking the COVID-19 vaccine,” a health official told the New York Times. 

The global shortage of vaccines and limited support for Malawi’s health care system have also contributed to the surge in cases in the country, a surge that has since crossed borders to also impact Zambia and Mozambique. The WHO remains concerned about the potential of the spread to also reach Tanzania and Zimbabwe. 

Overall, this year alone there have been reports of outbreaks in at least 10 African countries including Malawi’s upsurge. On Feb. 13, Malawi’s President Dr. Lazarus Chakwera announced an “End Cholera” campaign with support from the WHO.

“The campaign will focus on three broad activities: increasing access to appropriate cholera prevention and treatment health care services; increasing access to safe water, sanitation, and improved food hygiene; and strengthening risk communication, community involvement, and social mobilization,” the official statement read. 

How does it impact the mission to end extreme poverty and systemic causes of extreme poverty? 

Cholera is directly linked to not having access to clean water and sanitation, which impacts the United Nations’ Global Goal 6 (for clean water and sanitation access for all). The majority of cholera outbreaks take place in underdeveloped global south countries that have limited or no access to sanitation and clean water. In 2022, some of the most concerning outbreaks were seen in Pakistan (which experienced significant flooding over the course of the year), Syria, Lebanon, Malawi, Haiti, and the Philippines — all of which are still countries to watch when it comes to the crisis. 

The disease also impacts the global mission to achieve the UN’s Global Global 3, which calls for access for good health and well-being for all people, everywhere. The UN’s Global Goals are 17 goals — like for health care, or access to clean water — all of which work together in the mission to end extreme poverty once and for all. 

What action can we all take against it? 

While work to replenish the vaccine shortage is underway, there are things we can all do as Global Citizens to help alleviate the impact of the global cholera crisis. The first is to take action with Global Citizen, calling for world leaders to step up against the climate crisis — with climate change-induced storms and flooding having contributed to outbreaks in both Pakistan and Malawi. 

You can also take action to support our campaigns calling on world leaders to do more to invest in and support the world’s health care systems; as well as taking action on ensuring access to clean water and sanitation for all. 

You can also donate to organizations working to combat the world’s biggest cholera outbreaks including Doctors without Borders, World Vision, and Save the Children.