In a new warning, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) said that more countries are now facing outbreaks, an increasing number of cases are being reported and the outcome for patients is worse than 10 years ago.

Killing the poor in plain sight

“The the pandemic is killing the poor right in front of ussays Jérôme Pfaffmann Zambruni, Director of UNICEF’s public health emergency.

that echoes the gloomy view, WHO data indicates that last May 15 countries had reported cases, but by mid-May this year “we already have 24 countries reporting and we anticipate more with the seasonal change in cholera cases,” said Henry Gray, WHO’s incident manager for the global cholera response.

“Despite progress in disease control made in previous decades we risk going backwards.”

The UN’s health authority estimates that one billion people in 43 countries are at risk of contracting cholera, with children under the age of five particularly vulnerable. Cholera’s extraordinarily high mortality rate is also alarming. Malawi and Nigeria recorded deaths as high as three percent this year, well above the acceptable percentage.

Cholera cases are increasing

South-East Africa is particularly hard hit, with infections spreading in Malawi, Mozambique, South Africa, Tanzania, Zambia and Zimbabwe. The development follows the destructive passage of Cyclone Freddy in February and March this year, leaving 800,000 people in Malawi and Mozambique internally displaced and disrupting healthcare.

These vulnerable communities are at high risk of cholera, a preventable disease that thrives in areas affected by heavy rains and floods.

A deadly combination of climate change, underinvestment in water, sanitation and hygiene services – and in some cases armed conflict – have led to the spread of the disease, the two UN agencies agreed.

Vaccines: a tool, but not a total solution

Although vaccines exist to protect against cholera, the supply is insufficient to meet the increasing demand. According to the WHO, 18 million doses of vaccine have been requested globally, but only eight million have been made available.

Increasing production is not an overnight solutionsaid Mr. Gray. “The plan is to double the production of doses by 2025, but we will not have enough if the current trend continues. Vaccines are a tool, but not a comprehensive solution. Long-term investments in water sanitation are a priority,” he added.

WHO’s wake-up call was echoed by UNICEF. “Notonly (we need) long-term investment, but immediate investment in the water system to ensure access to clean water, sanitation and dignity,” Zambruni said.

Quick measures require water investments

To respond to the growing cholera threat, the WHO is launching a 12 month strategic plan for preparedness, response and preparednesswhich calls for $160 million, along with UNICEF’s Call to Action for $480 million.

The Combined Cholera Response Plan will cover 40 countries in acute crisis. It will include coordination, infection control and prevention, vaccination, treatment and water, sanitation and hygiene.

The two UN agencies work closely together. “We need the money to do what we need to do,” Mr. Grey.