‘The worst we’ve seen in 20 years’: why cholera has made a terrifying comeback around the world

Ms. Nylander agrees that the high death rate may be a result of overburdened health systems.

“Staff shortages are a chronic problem in many countries in Africa and elsewhere in the Global South, and are particularly acute post-Covid, when many health workers have been lost for a variety of reasons,” he says.

Ms. Nylander also points to the global economic crisis, which affects both governments and individuals. Governments do not invest in public services; foreign aid budgets were cut and the cost-of-living crisis means that individuals in countries at risk of cholera may be skimping on clean water and basic necessities like soap.

Much of the work on cholera is focused on emergency situations – for example, reactive mass vaccination and the delivery of clean water in tankers. This may stop a current outbreak, but does little to prevent future ones – as citizens in Haiti have found.

The Caribbean island was finally declared disease-free in 2019 after battling an outbreak that began in 2010. However, the disease re-emerged in February 2022, and since then there have been 850,000 cases.

“As with many infectious diseases, when a large proportion of the community is exposed, the bacteria no longer have susceptible people to infect and outbreaks slow or stop, at least in the short term. During previous outbreaks, there were many measures to reduce the risk of cholera in Haiti, but they were very case-focused and very short-term. The infrastructure was little improved in terms of water and sanitation, so the conditions were still ready for another outbreak,” says Dr. Azman.

In countries with poor infrastructure, there is always the risk of reimporting diseases, he says.

“If people don’t see cholera among their population, they often give in. This is understandable as they have many competing health priorities. And then all of a sudden there’s this explosion. Cholera does not stop at national borders, so if you have cholera in a region, all countries are at risk. An expedition in an individual country in the region may be impossible without the water and sanitation systems we have in Europe and North America,” he says.

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