After a three-year pause, preventive cholera vaccination campaigns are resuming globally, thanks to a significant increase in vaccine supply. The World Health Organization (WHO), Gavi, the Vaccine Alliance, and UNICEF jointly announced the milestone, with Mozambique becoming the first country to restart these crucial preventative measures. This comes as a relief after a global surge in cholera cases led to vaccine shortages beginning in 2022.
The resumption of preventive vaccination in Mozambique is particularly timely, coinciding with an ongoing cholera outbreak and the aftermath of devastating floods that impacted over 700,000 people. These floods have disrupted healthcare systems and compromised water infrastructure, creating ideal conditions for the spread of waterborne diseases like cholera.
Addressing a Critical Shortage
The global shortage of oral cholera vaccine (OCV) forced a shift towards reactive outbreak response rather than proactive prevention. “Global vaccine shortages forced us into a cycle of reacting to cholera outbreaks instead of preventing them,” stated Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “We are now in a stronger position to break that cycle.” The increased supply is largely due to the efforts of EUBiologics, currently the primary manufacturer producing OCV at the scale needed for mass vaccination campaigns. Dr. Tedros urged other manufacturers to enter this critical field to further bolster supply.
An initial allocation of 20 million doses is being deployed for preventive campaigns. Mozambique has received 3.6 million doses, while the Democratic Republic of the Congo, also grappling with significant outbreaks, will receive 6.1 million. An additional 10.3 million doses are planned for delivery to Bangladesh.
Doubled Production Capacity
Global OCV supply has doubled from 35 million doses in 2022 to nearly 70 million doses projected for 2025, a result of sustained efforts by global agencies, manufacturers, and partner organizations. These doses are financed by Gavi, the Vaccine Alliance, and procured and delivered by UNICEF.
Dr. Sania Nishtar, CEO of Gavi, the Vaccine Alliance, emphasized the importance of a sustainable vaccine supply. “The multi-year surge in cholera cases and resulting unprecedented demand for vaccines were stark reminders that sustainable, accessible vaccine supply is a global public good – and the world cannot afford complacency,” she said. She expressed gratitude to partners and manufacturers, particularly EUBiologics, and acknowledged the crucial support from Gavi’s donors.
UNICEF Executive Director Catherine Russell highlighted the potential impact of increased vaccine availability. “For the first time in years, this increase in vaccines will allow us to better prevent large-scale cholera emergencies,” she stated. “Resuming preventive cholera vaccination will protect children and help stop this highly contagious disease in its tracks.” However, she stressed that vaccination must be coupled with improvements in access to safe water and sanitation.
Equitable Distribution of Vaccines
The selection of Mozambique, the Democratic Republic of the Congo, and Bangladesh for these initial campaigns was based on allocation criteria established by the Global Task Force for Cholera Control (GTFCC). This framework ensures a systematic, equitable, and transparent distribution of vaccines for preventive campaigns.
Dr. Ilesh Jani, chair of the GTFCC Steering Committee, underscored the importance of collaborative efforts. “This milestone shows the power of bringing together diverse partners to build a more reliable response to cholera. Preventive vaccination helps shield communities and buys critical time. However, lasting progress will depend on long‑term investment in infrastructure, for which political commitment is indispensable,” he explained.
A Multi-faceted Approach to Cholera Control
The restoration of preventive vaccination is the result of years of sustained collaboration aimed at meeting high demand, expanding production capacity, and streamlining vaccine allocation. While the vaccine supply is improving, the one-dose strategy will remain the standard for outbreak responses, with two doses considered on a case-by-case basis.
Understanding Cholera and its Spread
Cholera is a highly contagious disease spread through contaminated food and water, causing severe diarrhea and dehydration. Without prompt treatment, it can be fatal. The disease is prevalent in areas lacking safe water and sanitation, particularly those affected by conflict and poverty.
In 2024, over 600,000 cases of cholera or acute watery diarrhea and nearly 7,600 deaths were reported to the WHO from 33 countries, though these figures are likely underestimates due to underreporting. While global cholera cases have shown a decline in 2025, deaths have continued to rise over the same period.
It’s important to remember that vaccination is just one component of cholera prevention and control. Long-term investments in safe water, sanitation, and hygiene infrastructure, alongside robust disease surveillance, rapid treatment, and community engagement, are essential to prevent outbreaks and reduce mortality.
The OCV 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, while two doses offer longer-lasting protection – up to three years.
