The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) is extremely concerned about a recent announcement that the global cholera vaccine stockpile has been exhausted. As a high number of countries are reporting outbreaks, more manufacturers—existing and new—must urgently help boost the global supply, said MSF.

“The world’s oral cholera vaccine stocks have dried up,” said Dr. Daniela Garone, MSF’s international medical coordinator. “This is a worrisome situation as 16 countries worldwide are reporting cholera outbreaks. This directly affects MSF teams as we are trying to respond to an extraordinary number of cholera outbreaks, including in Ethiopia, Sudan, Zambia, and Zimbabwe.”

There is also very little capacity to manufacture more cholera vaccines, said MSF. It is critical that existing manufacturers scale up vaccine production, and that the efforts of new manufacturers are supported.

“Many countries have requested or will urgently need vaccines,” Dr. Garone said. “All the doses in production until mid-March have already been allocated, and the demand for doses keeps growing. Today, we’re still desperate for more manufacturers to jump in and urgently produce oral cholera vaccines, and it’s essential that more technical support be provided for new manufacturers to speed up regulatory processes and scale up production capacity.”

In October 2022, the International Coordinating Group (ICG)—of which MSF is a member—made the unprecedented decision to temporarily reduce the number of cholera doses given to people from two to one to stretch out supplies. Nearly 18 months on, the vaccine access situation has worsened. No new manufacturers are entering the supply system, and the demand for doses is rising, leaving stockpiles empty until at least through mid-March.

What the cholera vaccine shortage means for communities

“The lack of vaccines means that people and entire communities will continue to be unprotected against cholera,” Dr. Garone said. “We’re very worried that people are at much greater risk of getting and potentially dying from a disease that’s preventable if there’s no vaccine available to respond to an outbreak in their community, nor to prevent one from starting in the first place.”

“Vaccines are just one of the prevention tools,” Dr. Garone said. “The control of cholera also depends on providing safe water and sanitation, enhancing disease surveillance and diagnosis, and—more importantly—ensuring early access to treatment and care when an outbreak does occur.”

The unprecedented rise in cholera cases in recent years is due to climate factors like floods and droughts, conflict, and forced displacement as there is often limited access to clean water in refugee and displacement camps, among other factors.