Extreme weather. Lack of life-saving vaccines. Africa’s cholera crisis is worse than ever

LILANDA, Zambia – Extreme weather events have relentlessly hit parts of Africa over the past three years, with tropical storms, floods and droughts leading to hunger crises and displacement. They leave behind another deadly threat: some of the worst cholera outbreaks on the continent.

In southern and eastern Africa, more than 6,000 people have died and almost 350,000 cases have been reported since a series of cholera outbreaks began in late 2021.

Malawi and Zambia have had the worst outbreaks on record. Zimbabwe has had multiple waves. Mozambique, Kenya, Ethiopia and Somalia have also been severely affected.

Everyone has experienced floods or drought (in some cases, both) and health authorities, scientists and aid agencies say the unprecedented rise of the waterborne bacterial infection in Africa is the latest example of how the climate extreme is playing a role in driving disease outbreaks. .

“Outbreaks are getting bigger because extreme weather events are becoming much more common,” said Tulio de Oliveira, a South Africa-based scientist who studies diseases in the developing world.

Zimbabwe and Zambia have seen cases rise as they battle severe droughts and people rely on less safe water sources in desperation, such as wells, shallow wells and rivers, which may be contaminated. Days after this month’s deadly floods in Kenya and other parts of East Africa, cases of cholera emerged.

The World Health Organization calls cholera a disease of poverty, as it thrives where there are poor sanitation conditions and a lack of clean water. Africa has had eight times as many deaths this year as the Middle East, the second most affected region.

Historically vulnerable Africa is at even greater risk as it faces the worst impacts of climate change, as well as the effect of the El Niño climate phenomenon, health experts say.

“It doesn’t affect countries with resources,” said Dr. Daniela Garone, international medical coordinator for Doctors Without Borders, also known by its French acronym MSF. “Therefore, it does not provide the resources.”

Billions of dollars have been poured into other diseases that predominantly affect the world’s most vulnerable, such as polio and tuberculosis, largely because those diseases are highly contagious and could cause outbreaks even in rich countries. But that is not the case with cholera, where epidemics remain contained.

The WHO said this month that there is a “critical shortage” of oral cholera vaccines in global stockpiles. Since the beginning of 2023, 15 countries (the desperate few) have requested a total of 82 million doses to deal with deadly outbreaks, when only 46 million doses were available.

Only 3.2 million doses remain, below the goal of having at least 5 million in reserve. While there are currently cholera epidemics in the Middle East, America and Southeast Asia, Africa is by far the most affected region.

Vaccine alliance GAVI and UNICEF said last month that approval of a new cholera vaccine would boost supplies. But the result of the shortage has already been measured in deaths.

Lilanda, a township on the outskirts of Lusaka, the capital of Zambia, is a typical cholera hotspot. Puddles of stagnant water dot the dirt roads. Clean water is like gold dust. Here, during two terrible days in January, Mildred Banda watched her 1-year-old son die of cholera and rushed to save the life of her teenage daughter.

Cholera should not be killing anyone. The disease is easily treated and prevented, and vaccines are relatively simple to produce.

That did not help Banda’s son, Ndanji.

When he fell ill with diarrhea, he was treated with oral rehydration solution at a clinic and discharged. That night at home he became dehydrated again. Banda feels terrible guilt.

“I should have realized sooner that my son wasn’t feeling well,” she said, sitting in her small cement house. “I should have acted faster and taken him back to the clinic. “I should have taken him back to save his life.”

Due to vaccine shortages, Zambia was unable to undertake a preventive vaccination campaign after the outbreak in neighboring Malawi. That should have been a warning call, de Oliveira said. Zambia only filed an emergency request when cases began to rise.

The doses that could have saved Ndanji began arriving in mid-January. He died on January 6.

In Zimbabwe, a drought worsened by El Niño has caused cholera to spread in distant rural areas as well as its traditional hotspots of crowded urban neighborhoods.

Abi Kebra Belaye, MSF representative in Zimbabwe, said the southern African nation normally has around 17 heavily affected areas, mostly urban. This year, cholera spread to 62 districts as the struggle to find water increased the risk.

“This part of Africa is paying the highest price for climate change,” said Kebra Belaye.

Augustine Chonyera, who hails from a cholera-prone area of ​​the capital, Harare, was shocked when he recently visited the sparsely populated rural district of Buhera.

He said he heard grim stories about the impact of the disease: a family that lost five members, a husband and wife who died within hours of each other and local businesses that used delivery trucks to take the sick to a clinic several miles away. kilometers of distance.

“It seems that people in rural areas are more in danger than us now. “I still wonder how it happened,” Chonyera said.

He said he returned home as soon as he could, after giving a large bottle of treated water he had brought to an elderly woman.


Mutsaka reported from Harare, Zimbabwe. Imray reported from Cape Town, South Africa.


The Associated Press receives financial support for global health and development coverage in Africa from the Bill & Melinda Gates Foundation Trust. The AP is solely responsible for all content. Find AP’s standards for working with philanthropic organizations, a list of supporters and funded coverage areas at

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