Apply the Covid plan to cholera

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The fight against cholera requires further research. File Photo: Collected

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The fight against cholera requires further research. File Photo: Collected

While the coronavirus has posed unique challenges at a time of profound global interconnectedness, pandemics are nothing new. The Covid pandemic is not even the only one we are currently experiencing. In much of the developing world, cholera epidemics are proliferating.

While the Sars-CoV-2 virus is “new”, cholera – a waterborne diarrheal disease caused by the bacterium Vibrio cholerae – is old, as is its history of widespread devastation. The current cholera pandemic is the seventh in the world since the beginning of the 19th century.

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Despite their apparent differences, Covid and cholera have a lot in common. Both are at least partially controllable by vaccination and spread more easily in crowded and unsanitary environments. Ensuring adequate shelter and strengthening water, sanitation and hygiene (WASH) practices and infrastructure are therefore essential to limit transmission.

These commonalities explain why measures to limit Covid have led to a drop in cholera cases. But as governments around the world roll back pandemic restrictions, cholera is returning with a vengeance. At the end of 2021, there were 16 active cholera outbreaks worldwide.

However, the Covid response still holds valuable lessons to strengthen the fight against cholera. Initiatives such as the World Health Organization’s Global Covid-19 Research Roadmap have helped guide this effort, ensuring that resources are channeled to areas where knowledge and innovation were most needed.

Research is no less important in the fight against cholera. That’s why, last year, the Global Task Force on Cholera Control (GTFCC) launched the Cholera Roadmap Research Agenda. Representing the collective vision of 177 cholera experts and other stakeholders, the program identifies the highest priority research questions. Getting the answers is critical to achieving the goals set out in the GTFCC’s Ending Cholera by 2030 global roadmap.

Many questions could just as well be found in a Covid research program. For example, what is the fastest and most cost-effective way to provide a limited supply of vaccines? How can we improve the uptake and sustainability of response measures to prevent the disease from reaching epidemic or pandemic proportions? How can we meaningfully engage with at-risk communities in the design and implementation of interventions? Which disease surveillance systems are most effective, and when and where should they be deployed?

With the Covid, strong political will and massive investments have enabled researchers to quickly produce answers. Although cholera has been around for much longer, the solutions remain elusive. One of the main reasons is that, while Covid has ravaged developed and developing countries, cholera was eradicated from the global North more than 150 years ago. It is much more difficult to mobilize resources to fight a disease that affects the poorest and most marginalized people in the world.

With just a fraction of the commitment that underpins the fight against Covid-19, vital progress could be made in cholera research. Epidemiological surveillance would help map transmission patterns. New and innovative diagnostic tests could increase the speed, efficiency and quality of case detection and confirmation. And new or improved vaccines would strengthen the link between emergency response and long-term control and prevention.

Optimizing vaccine timing and dosing is key, as is learning to engage communities to ensure the needs of marginalized populations are addressed. Transforming treatment for vulnerable communities requires studying the impact of antibiotics on cholera transmission and understanding what enables – and blocks – the integration of cholera treatment into community health worker case management .

Armed with this knowledge, countries and health partners would be in a better position to choose the most effective tools and approaches in pursuit of their national cholera plans.

We have learned so much during the pandemic. We listened to our public health officials and took steps to limit the spread of the virus: wear face masks, practice social distancing, quarantine, get vaccinated, and wash your hands more regularly. We must leverage this heightened awareness and momentum to achieve new advances in public health, not just in our own communities, but around the world.

That is to say, to target other, much older scourges. We have the tools we need to beat cholera, but we still need to do the research to figure out how, when and where to use them. Only then can we protect the world’s most vulnerable populations from this disease that has too many precedents.

Dr. Firdausi Qadri is a Principal Investigator and Head of the Mucosal Immunology and Vaccinology Unit at the International Center for Diarrheal Disease Research, Bangladesh (icddr,b) in Dhaka.
Dr Md Taufiqul Islam is assistant project coordinator in the mucosal immunology and vaccinology unit of the icddr,b.

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