Cholera is surging, yet we know how to stop it. So what’s missing?

We are witnessing a preventable tragedy unfold across multiple continents. Cholera, a disease that should be relegated to history books, is surging to levels not seen in over a decade. This crisis is not inevitable, but rather the direct result of our collective failure to invest in proven prevention measures. We're currently experiencing the seventh cholera pandemic in 200 years. As of July 2025, over 355,800 cholera cases and 4,000 deaths have been reported globally this year —and we're barely past the halfway point of 2025. These official figures represent just the tip of the iceberg: While reporting is improving, it remains insufficient, and many countries are still reluctant to acknowledge cholera outbreaks because they can be seen as a mark of governmental failure. Some countries refer to cholera as “acute watery diarrhea” to avoid the stigma associated with a disease associated with poor sanitation. But you can't solve a problem you won't name. The Global Task Force for Cholera Control estimates that actual cases range from 1.3 million to 4 million each year. What makes cholera particularly insidious is that up to 80% of infected people are asymptomatic. They carry and transmit the bacteria without knowing it, spreading it through households and communities via shared meals, communal latrines, and water sources. For the minority who do develop symptoms, cholera can kill within hours without proper treatment. This invisible transmission, combined with rapid lethality, creates the perfect storm for explosive outbreaks. The cost of managing a cholera outbreak far exceeds the expense of preventing one, yet funding patterns show the opposite priority. This represents the most fundamental failure in global health economics. The cruel irony is that we know exactly how to prevent cholera. It's not rocket science — it's clean water, proper sanitation, and basic hygiene. Analysis shows that 97% of cholera cases between 2010 and 2021 occurred in just 31 countries with the lowest levels of water, sanitation, and hygiene, or WASH, infrastructure. The World Bank reports we need to increase WASH funding forty-two-fold in low-income countries to meet basic needs. But here's the kicker: of the WASH funding that is allocated globally, only 72% is actually spent each year. Funds get tied up in fragmented systems, overly centralized decision-making, or planning processes, or spending restrictions that don’t match how local services actually work. In turn, local authorities lack the staff, skills, or flexibility to turn budgets into real projects — making it difficult to absorb and track available funding. As a result, the WASH sector as a whole, led by national governments’ spending, is failing to invest adequately and then failing to properly spend what has been allocated. The human cost of this funding failure is playing out in real time. South Sudan currently has among the highest numbers of reported cholera cases globally, but it lost critical emergency response capacity when relevant USAID-funded programs ended in December 2024. In April, eight people — including five children — died after walking three hours in intense heat to seek cholera treatment after U.S. aid cuts forced local health facilities to close. This pattern repeats across the region. The ongoing conflict in Sudan has created a cholera crisis affecting 95,000 people across 17 of 18 states since it started in July 2024, with some refugees inadvertently carrying the disease into neighboring countries. Yemen, already devastated by conflict, faces a $20 million funding gap that has forced the closure of 47 diarrhea treatment centers. Meanwhile, our successful interventions prove what’s possible with proper investment: In Somalia, we reduced cholera case fatality rates to zero in multiple districts through targeted WASH programming, demonstrating that with adequate resources, cholera elimination is achievable. The cross-border nature of current cholera outbreaks presents an international challenge and is a regional crisis in parts of the Horn of Africa. There, violence and displacement are causing the disease to spread from South Sudan's Upper Nile state into neighboring Ethiopia's Gambella region. Cholera doesn't respect borders – it follows patterns of conflict, displacement, and inadequate infrastructure. Climate change is accelerating these challenges, particularly in rural and flood-affected areas, destroying the infrastructure needed to maintain safe water and sanitation systems. In a warming world with increasing humanitarian crises, the cholera threat will only grow. Cholera vaccines are a useful tool but not a sustainable solution. Between 2021 and 2023, more vaccine doses were requested than in the entire previous decade. But they’re expensive, last only 1 to 3 years, and have 60% efficacy at best. Despite increased production, global oral cholera vaccine stockpiles remain at around 4.3 million doses. With the World Health Organization estimating that 1 billion people worldwide are at risk, we urgently need to reverse the current pattern where prevention is chronically underfunded while emergency response — however inadequate — consumes resources that could have prevented the crisis in the first place. Countries that have invested in WASH infrastructure have eliminated cholera. But this requires sustained political will and financial commitment. With proper investment in prevention and coordinated global action, we have the tools to end cholera within a generation. The Global Task Force for Cholera Control has developed national eradication plans for over 30 countries. These road maps exist. The technical knowledge exists. What's missing is the political and financial commitments to implement these solutions before more lives are lost to a disease that could have been eradicated decades ago.