GTFCC virtual event On the Road to Ending Cholera: a discussion on progress and challenges in a new era

The Global Task Force on Cholera Control (GTFCC) virtual event held on June 9 highlighted the progress made by countries affected by cholera and reinforced commitments from decision-makers and partners engaged in cholera control. The event was organized in observance of the 73rd World Health Assembly. Country presentations included Zambia, Ethiopia, Zimbabwe, Haiti and Bangladesh.

During the 2018 World Health Assembly, Zambia sponsored the resolution to end cholera around the world by 2030. The country also made an ambitious goal to eliminate cholera by 2025, as outlined in the Zambia Multi-sectoral Cholera Elimination Plan (2019-2025). During the virtual event, Dr. Fred Kapaya, National Cholera Program Coordinator, presented the progress made since the launch of the National Cholera Plan one year ago in the sectors of leadership and coordination, surveillance, case management, community engagement and risk communication, oral cholera vaccination (OCV) and water, sanitation and hygiene (WASH). To target interventions, cholera hotspots in the country have been identified. Cholera hotspots are geographically limited areas where conditions facilitate cholera transmission and outbreaks persist or regularly occur. Notably, 70% of the seven-year budget for the plan has been allocated to WASH investments. Work to increase access to clean water supply has already started in selected hotspots, and a water supply and investment plan has been developed to provide 100% service coverage for Lusaka, although this plan requires funding for implementation. Provision of sanitation facilities in low income communities of Lusaka is also in progress. Furthermore, reactive OCV campaigns have been implemented in two hotspots. Going forward, the country aims to establish Cholera Task Forces in all hotspot districts and conduct pre-emptive OCV campaigns in all hotpots by December 2020, among other objectives to fully operationalize the Cholera Elimination Plan.

The progress made towards cholera control and elimination in Ethiopia was presented by Aschalew Abayneh, Deputy Director General, Ethiopian Public Health Institute. Ethiopia committed to the Global Roadmap for the control and elimination of cholera at the World Health Assembly in 2018. Since then, an epidemiological analysis of cholera hotspots has been conducted to target multi-sectoral interventions. A total of 104 of approximately 770 woredas (the third-level administrative division of Ethiopia, which corresponds to the districts) were identified as high-priority areas based on data covering the 2015-2019 period. From 2019 to 2020, at risk populations from five regions (Oromia, Somali, Afar, SNNPR and Addis Ababa) have received OCV, with 99.5% (919,047 OCV vials) of the OCV utilized during the campaigns. Furthermore, the multi-sectoral National Cholera Elimination Plan (2020 – 2025) has been drafted and is ready for review.

The progress of cholera elimination in Zimbabwe was presented by Portia MANANGAZIRA, Director Epidemiology and Disease Control, Ministry of Health and Child Care, Zimbabwe. In May 2020, Zimbabwe received Independent Review Panel GTFCC recommendations for the National Multi-sectoral cholera Elimination Plan (2018-2028), making Zimbabwe the first country in the WHO Africa Region to reach this stage of plan review. The country has identified 81 of 1,200 wards (the administrative unit located below the district level), located in 16 districts, as cholera hotspots to target multi-sectoral interventions. According to the ambitious objectives, the country plans to reduce cholera cases by 50% during the phase 2019-2021 and by 100% during the phase 2022-2024, with nationwide cholera elimination anticipated in 2025-2028.

From Haiti, Patrick DELY, Director of Epidemiology, Laboratory and Investigation, Ministère de la Santé Publique et de la Population presented an overview of the progress to eliminate cholera in the country. Although over 820,000 suspected cases have been reported in Haiti since 2010, no cholera cases have been confirmed in Haiti since January 2019. Strong epidemic surveillance efforts to guide response measures and rapid intervention teams have been critical to controlling the cholera epidemic. To enhance preparedness efforts in case of cholera resurgence, the country has strengthened laboratory capacities. Five peripheral laboratories are being equipped to test stool samples by culture and perform antimicrobial sensitivity tests, and a new system to sample suspected acute watery diarrhea cases is being implemented. Disease surveillance capacity is also being strengthened with the establishment of an improved early warning and response system that consists of indicator- and event-based surveillance to assure the rapid detection of cholera-related events. The country aims to obtain the cholera elimination certificate in 2022.

Finally, Dr. Sanya Tahmina Jhora, the Additional Director General, Directorate General of Health Service, Bangladesh, presented the success of reactive and preventive OCV campaigns to control cholera carried out in Dhaka and Cox’s Bazar.