Cholera kills more people for second consecutive year, while prevention and treatment available – World Health Organization (WHO)

Global Cholera Resurgence in 2024: A Setback for Sustainable Development Goals

Executive Summary

A 2024 report from the World Health Organization (WHO) reveals a significant escalation in the global cholera crisis, posing a direct threat to the achievement of multiple Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 6 (Clean Water and Sanitation). The data indicates a substantial increase in morbidity and mortality, driven by systemic failures in infrastructure, climate-related pressures, and conflict, underscoring the urgent need for a renewed, SDG-focused global response.

Statistical Analysis: A Direct Challenge to SDG 3

The global statistics for 2024 demonstrate a clear regression from the targets set forth in SDG 3 (Good Health and Well-being), specifically Target 3.3, which aims to end the epidemics of communicable diseases. The reported figures, considered underestimates of the true burden, are as follows:

• Reported cholera cases increased by 5% compared to 2023.
• Reported deaths rose by 50%, with over 6000 fatalities from a preventable and treatable disease.
• The Case Fatality Ratio (CFR) in Africa increased from 1.4% in 2023 to 1.9% in 2024, far exceeding the acceptable threshold and indicating severe gaps in healthcare access and quality.
• One-quarter of all deaths occurred outside of health facilities, highlighting a critical failure in community access to basic health services.

Underlying Drivers and Their Impact on Interconnected SDGs

The report identifies several core drivers fueling the cholera pandemic, each linked to failures in achieving specific SDGs:

• SDG 6 (Clean Water and Sanitation): Long-term deficiencies in water, sanitation, and hygiene (WASH) infrastructure remain the primary cause of cholera transmission. The spread of the bacterium Vibrio cholerae through contaminated water is a direct consequence of inadequate progress on SDG 6 targets.
• SDG 13 (Climate Action): Climate change is cited as a significant contributing factor, likely through extreme weather events that disrupt water systems and displace populations, creating conditions ripe for outbreaks.
• SDG 16 (Peace, Justice and Strong Institutions): Conflict and population displacement destabilize communities, destroy infrastructure, and collapse health systems, severely hampering any public health response and undermining peace and stability.

Geographic Expansion and Global Health Security

The geographic scope of the cholera crisis expanded in 2024, threatening global health security, a cornerstone of SDG 3. Key trends include:

• The number of countries reporting cases increased from 45 in 2023 to 60 in 2024.
• The disease burden remains concentrated in Africa, the Middle East, and Asia, which accounted for 98% of all cases.
• Twelve countries reported over 10,000 cases each, with seven of these nations experiencing large-scale outbreaks for the first time in the year.
• The resurgence of cholera in Comoros after a 15-year absence exemplifies the persistent threat of global transmission.

Strategic Interventions for SDG Attainment

To reverse the current trend and make progress towards the SDGs, a multi-sectoral approach is imperative. The report underscores the need for the following actions:

1. Ensure Access to Safe Water and Hygiene (SDG 6): Governments and partners must prioritize investment in robust and resilient WASH infrastructure.
2. Strengthen Health Systems (SDG 3): Rapid access to treatment, strong public health surveillance, and effective diagnostics are essential to reduce mortality and control outbreaks.
3. Improve Vaccine Access and Production (SDG 3): Further investment is required to close the gap between the supply of and demand for Oral Cholera Vaccines (OCV).
4. Enhance Community Engagement: Providing communities with accurate information and involving them in prevention strategies is critical for an effective response.

Oral Cholera Vaccine (OCV) Stockpile and Management

The global OCV stockpile remains a critical but strained resource in the fight against cholera. While the prequalification of a new vaccine, Euvichol-S®, provided some relief, significant challenges persist.

• Demand continues to outstrip supply, with 61 million OCV doses requested in 2024.
• A record 40 million doses were approved for emergency use in 16 countries.
• Due to high demand, the temporary shift from a standard two-dose to a single-dose vaccination strategy remained in effect throughout 2024 and into 2025.

2025 Outlook and Conclusion

Preliminary data indicates the global cholera crisis is continuing unabated into 2025, with 31 countries reporting outbreaks since the beginning of the year. The WHO assesses the global risk from cholera as “very high.” Containing these outbreaks and preventing future ones is not merely a public health objective but a developmental imperative. A failure to control cholera represents a failure to deliver on the fundamental promises of the Sustainable Development Goals, particularly the rights to health, clean water, and a safe environment.

Analysis of SDGs, Targets, and Indicators

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: The article’s central theme is the cholera outbreak, a major public health crisis. It discusses the increase in cases and deaths, the fragility of health systems, and the need for access to treatment and vaccines, all of which are core components of SDG 3.
• SDG 6: Clean Water and Sanitation: The article explicitly identifies “long-term deficiencies in water, sanitation, and hygiene infrastructure” and the spread of the disease through “faeces-contaminated water” as primary drivers of the cholera crisis. This directly links the issue to the goal of ensuring access to clean water and sanitation.
• SDG 13: Climate Action: The text mentions “climate change” as one of the key factors fueling the rise of cholera, connecting the disease outbreak to broader environmental challenges.
• SDG 16: Peace, Justice and Strong Institutions: “Conflict” is cited as a major contributor to the cholera surge. Conflict disrupts health systems, displaces populations, and destroys infrastructure, creating conditions ripe for disease outbreaks.
• SDG 17: Partnerships for the Goals: The article highlights the role of the World Health Organization (WHO) in global surveillance, coordination with partners, and supporting countries. It also calls on “governments, donors and communities” to work together, underscoring the importance of partnerships to combat the crisis.

2. What specific targets under those SDGs can be identified based on the article’s content?

• Under SDG 3 (Good Health and Well-being):
  • Target 3.3: “By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.” The article is entirely focused on combating cholera, a water-borne disease, and containing its epidemic spread.
  • Target 3.8: “Achieve universal health coverage, including… access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” The article points to gaps in this area by mentioning the high case fatality ratio, deaths occurring outside health facilities, and the high demand versus limited supply of the oral cholera vaccine (OCV).
  • Target 3.d: “Strengthen the capacity of all countries… for early warning, risk reduction and management of national and global health risks.” The call for “strong surveillance and diagnostics” to guide responses directly relates to this target.
• Under SDG 6 (Clean Water and Sanitation):
  • Target 6.1: “By 2030, achieve universal and equitable access to safe and affordable drinking water for all.” The article’s recommendation to “ensure people have access to safe water” is a direct call to action for this target.
  • Target 6.2: “By 2030, achieve access to adequate and equitable sanitation and hygiene for all…” The article identifies deficiencies in “sanitation, and hygiene infrastructure” as a root cause of the cholera spread, linking it to this target.
• Under SDG 13 (Climate Action):
  • Target 13.1: “Strengthen resilience and adaptive capacity to climate-related hazards and natural disasters in all countries.” By identifying climate change as a driver, the article implies that a lack of resilience to its effects is exacerbating the health crisis.
• Under SDG 16 (Peace, Justice and Strong Institutions):
  • Target 16.1: “Significantly reduce all forms of violence and related death rates everywhere.” The article’s mention of “conflict” as a primary cause of the cholera rise connects the disease outbreak to the breakdown of peace and security.
• Under SDG 17 (Partnerships for the Goals):
  • Target 17.16: “Enhance the global partnership for sustainable development…” The entire response described, involving the WHO, donors, governments, and partners, exemplifies the multi-stakeholder collaboration required by this target to address a global health crisis.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article provides several quantitative and qualitative indicators that can be used to measure progress:

• For SDG 3 (Good Health and Well-being):
  • Incidence of cholera: The article reports a 5% rise in cases in 2024, providing a direct measure for Target 3.3.
  • Cholera mortality rate: The article states deaths rose by 50% in 2024, with over 6000 fatalities. The case fatality ratio in Africa (1.9% in 2024) is another specific indicator of disease severity and healthcare effectiveness.
  • Geographic spread of the disease: The number of countries reporting cases (60 in 2024) and the number of countries with large outbreaks (12) serve as indicators of the epidemic’s scope.
  • Access to healthcare services: The fact that “one quarter of deaths occurred in the community, outside of health facilities” is a stark indicator of gaps in access to treatment (Target 3.8).
  • Vaccine availability and access: The number of OCV doses requested (61 million) versus approved (40 million) is a clear indicator of the gap between demand and supply for essential vaccines (Target 3.8).
• For SDG 6 (Clean Water and Sanitation):
  • Access to safe water and sanitation infrastructure: While not providing a number, the article implies that the “proportion of the population with access to safely managed drinking water and sanitation services” is a critical indicator, as it identifies “long-term deficiencies” in this area as a root cause.

The article implies the relevance of indicators for other SDGs (e.g., prevalence of conflict for SDG 16, impact of climate-related events for SDG 13) by naming them as drivers, but it does not provide specific data points for them.

4. Summary Table of SDGs, Targets, and Indicators

Source: who.int