Cholera Vaccine Supply Rises: Preventive Campaigns Resume After 3-Year Halt

After a three-year pause triggered by global shortages, preventive cholera vaccination campaigns are resuming, with Mozambique as the first nation to roll out a new program. This marks a significant step forward in the fight against the deadly diarrheal disease, as global vaccine supply has now reached nearly 70 million doses in 2025 – double the amount available in 2022. The resumption comes at a critical time, coinciding with an ongoing cholera outbreak in Mozambique and the aftermath of devastating floods that have impacted over 700,000 people, increasing the risk of waterborne illnesses.

Cholera’s Resurgence and the Vaccine Supply Challenge

Cholera, spread through contaminated food and water, causes severe dehydration and can be fatal if left untreated. The disease disproportionately affects communities lacking access to safe water and sanitation, particularly those experiencing conflict or poverty. A surge in global cholera cases beginning in 2021 led to unprecedented demand for oral cholera vaccine (OCV), quickly depleting existing stockpiles and forcing a temporary halt to preventive campaigns in 2022. Instead, limited doses were prioritized for outbreak response – a reactive approach that proved less effective than proactive vaccination.

The current increase in supply is largely due to efforts by EUBiologics, currently the primary manufacturer producing OCV at the scale needed for mass vaccination. Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), emphasized the importance of expanding manufacturing capacity, stating, “I thank EUBiologics… and urge others to enter this vital space.” The initial allocation of 20 million doses will be distributed to countries with the greatest need, including Mozambique (3.6 million doses), the Democratic Republic of the Congo (6.1 million doses), and Bangladesh (10.3 million doses).

A Multi-Partner Effort to Restore Prevention

The restoration of preventive vaccination isn’t solely about increased production. it’s the result of sustained collaboration between global health agencies, manufacturers, and partner organizations. Gavi, the Vaccine Alliance, is financing the vaccine procurement, while UNICEF is responsible for the logistics of delivering the doses to countries. UNICEF, a founding partner of Gavi, plays a pivotal role in both implementing immunization programs and shaping the Vaccine Alliance’s policies. UNICEF’s engagement with Gavi has been described as highly synergistic, expanding the reach of vaccination efforts.

Dr. Sania Nishtar, CEO of Gavi, highlighted the importance of sustainable vaccine access, stating, “The multi-year surge in cholera cases… were stark reminders that sustainable, accessible vaccine supply is a global public good.” Gavi has helped immunize over 1.2 billion children since 2000 and prevented more than 20.6 million future deaths in 78 lower-income countries. More information about Gavi’s work can be found on their website.

Allocation Criteria and the Global Task Force for Cholera Control

The selection of Mozambique, the Democratic Republic of the Congo, and Bangladesh for the initial vaccine allocation was based on criteria established by the Global Task Force for Cholera Control (GTFCC). The GTFCC, a partnership of over 50 organizations, aims to ensure equitable and transparent distribution of OCV for preventive campaigns. The specific allocation framework considers factors such as cholera risk, vulnerability of populations, and existing infrastructure.

Dr. Ilesh Jani, chair of the GTFCC Steering Committee, emphasized that while vaccination is a crucial tool, lasting progress requires long-term investment in infrastructure and political commitment. “Preventive vaccination helps shield communities and buys critical time,” he stated, “However, lasting progress will depend on long‑term investment in infrastructure.”

Understanding Cholera Vaccine Effectiveness and Current Strategy

The oral cholera vaccine is considered safe and effective for individuals over one year of age. A single dose provides short-term protection for at least six months and can help control outbreaks. Two doses, however, offer longer-lasting protection – up to three years. Despite this, the WHO currently recommends a one-dose strategy for outbreak responses due to ongoing supply constraints, reserving the two-dose approach for specific circumstances.

Globally, more than 600,000 cases of cholera or acute watery diarrhoea and nearly 7,600 deaths were reported to the WHO in 2024, though these figures are likely underestimates due to underreporting. While global cases have shown a decline in 2025, deaths continue to rise, underscoring the need for comprehensive prevention and treatment strategies.

Beyond Vaccination: A Holistic Approach to Cholera Control

Vaccination is a vital component of cholera prevention, but it’s not a standalone solution. Effective cholera control requires a multi-faceted approach that includes improved access to safe water and sanitation, disease surveillance, rapid treatment of cases, and community engagement. Catherine Russell, UNICEF Executive Director, stressed this point, stating, “Resuming preventive cholera vaccination will protect children and help stop this highly contagious disease in its tracks. But it must go hand in hand with other efforts, including better access to safe water and basic sanitation.”

Looking ahead, continued efforts to expand vaccine production, streamline allocation processes, and strengthen health systems will be essential to protect vulnerable populations from cholera. The restoration of preventive vaccination represents a significant milestone, but sustained investment and collaboration are crucial to building a more resilient and equitable global response to this preventable disease.