Cape Times

What’s behind the shortage of cholera vaccines?

- EDINA AMPONSAH-DACOSTA Dr Amponsah-Dacosta is a research officer and evidence-informed decisionma­king specialist at UCT.

LAST month the World Health Organizati­on (WHO) said southern Africa was suffering the deadliest regional outbreak of cholera in at least a decade.

At the epicentre of the disaster were Malawi, Zimbabwe and Mozambique, where cholera cases surged more than four-fold between 2022 and 2023. Over 1 600 deaths were reported in the three countries.

Already 2024 is threatenin­g to be another devastatin­g year for cholera in the region as warmer weather, and unusually heavy rains and storms have fuelled the disease’s spread. Zimbabwe, Mozambique and Malawi have reported more than 13 000 cases so far this year.

Cholera bacteria are spread by eating or drinking food or water contaminat­ed by the faeces of an infected person. Oral vaccines help contain outbreaks and limit the spread of the disease. But there is a worldwide shortage of the vaccines.

From January 2023 to January 2024, there were urgent requests for 76 million doses of the oral cholera vaccine from 14 nations. Only 38 million doses were available. Stockpiles ran dry at the beginning of the year. The world’s oral cholera vaccine stockpile has run dry. Why? The cholera vaccine is developed on a needs basis. There is limited funding to purchase cholera vaccines, and as a result there is limited production.

There is only one vaccine recommende­d for mass vaccinatio­n during cholera outbreaks, Euvichol-Plus, which is manufactur­ed by EuBiologic­s, a global biopharmac­eutical company based in Seoul in South Korea.

The company has limited manufactur­ing capacity. So when there is a spike in the need for the vaccine, demand outstrips production.

There has not been several countries experienci­ng outbreaks at the same time as is currently being seen in southern and eastern Africa, as well as in parts of the eastern Mediterran­ean, the Americas and south-east Asia.

EuBiologic­s has identified steps in the manufactur­ing process that could be refined and shortened, while ensuring that the vaccine remains safe.

A low-cost, simplified version, Euvichol-S, has been approved by the World Health Organizati­on. Over 15 million doses are expected this year.

◆ What is being done about the vaccine shortage in southern Africa? Firstly, in October 2022 the WHO temporaril­y suspended the standard two-dose vaccinatio­n in favour of a single dose to stretch supplies.

Two doses provide up to two or three years’ protection, but one dose is still safe and effective.

Secondly, countries like Zambia and Zimbabwe have taken steps to prioritise vaccine distributi­on to areas that need them the most.

Last year, cholera cases surged in Malawi and Mozambique following Cyclone Freddy. It traversed the southern Indian Ocean for more than five weeks in February and March.

◆ Is progress being made to develop more cholera vaccines?

In Africa, less than 1% of doses of all vaccines are locally manufactur­ed.

During the Covid-19 pandemic, African countries were forced to the back of the queue for life-saving vaccines. It taught us that we need to have our own local manufactur­ing capacity.

There has been a lot of investment in expanding the cholera vaccine manufactur­ing capacity. Two manufactur­ers are coming into play globally, one in South Africa and one in India.

Biovac, a biopharmac­eutical company based in Cape Town, has received investment capital to develop vaccinatio­ns for cholera and other diseases.

It has concluded a licensing and technology transfer agreement with the Internatio­nal Vaccine Institute, a non-profit internatio­nal organisati­on headquarte­red in South Korea, for the manufactur­e of the vaccine.

The first batch of vaccines will undergo clinical trials from 2024 to 2025, with licensing expected from 2026. In India, company Biological E plans to manufactur­e the simplified version of Euvichol-Plus.

But vaccinatio­n is not a replacemen­t for the provision of safe drinking water, adequate sanitation and good hygiene practices.

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