Cholera cases are surging globally, the result of conflicts and climate change that are leaving people without access to clean drinking water and proper sanitation. On top of that, the production of the oral cholera vaccine, or OCV, is not keeping pace with the growing demand, leading to stockouts and forcing officials to halt preventive campaigns. That puts even more people at risk of dying from the disease.
The problem starts at the beginning of the OCV pipeline. Only one company, South Korea’s EuBiologics, has preapproval from the World Health Organization to replenish the agency’s OCV stockpile, which is then distributed to countries based on need.
WHO aims to have 5 million doses in its stockpile at any given time. But even with a surge in production last year, EuBiologics has struggled to meet that target. Cholera is simply spreading too fast.
The waterborne virus was responsible for more than 4,000 deaths in 2023. In 2024, that grim milestone had already been reached by October. And WHO reported more than 730,000 cholera cases last year through November, which was up from 535,321 in 2023.
The obvious solution is to identify additional OCV manufacturers. That’s easier said than done, though. While other companies appear to be capable of producing OCV, they must still go through the WHO prequalification process. And many manufacturers are wary of getting into OCV production unless they are guaranteed consistent orders — which will only come with sustained vaccination campaigns.
Until this situation is resolved, WHO has warned that it will continue to use the OCV it does have available “sparingly and strategically.”
Read: Countries grapple with global shortage of oral cholera vaccine
In the global health space, the only prediction for 2025 that seems reasonable is that the year will be unpredictable. And that’s thanks to one man: incoming U.S. President Donald Trump.
There are, of course, seemingly obvious changes ahead. Washington is all but assured to reimpose the so-called global gag rule and cut funding to the United Nations Population Fund. U.S. withdrawal from WHO also seems likely. Unpredictability comes in when considering how — or whether — organizations and donors will react to what is coming.
Then, there are the unknown unknowns: the possible changes and disruptions that no one can even begin to predict. But that doesn’t mean players can’t lay the groundwork to be better able to respond to whatever happens next.
In an opinion piece for Devex, Peter Singer, former special adviser to the director-general at WHO, offers a host of proposals to meet the coming moment. These include identifying scalable innovations that the incoming U.S. administration might be interested in adopting, mobilizing innovative finance that is not dependent on the U.S. government, and encouraging greater self-reliance around the world.
Opinion: The Trump effect on global health and development in 2025
Global health security expert Lawrence Gostin thinks alert levels for the international spread of mpox should be “sky high.”
The response in the Democratic Republic of Congo — the epicenter of the emergency — has been slow, inefficient, and grinding, he told my colleague Sara Jerving. The main problem is the DRC has a weak health system, with limited capacity for surveillance, testing, and contact tracing. There’s also civil unrest and public distrust of health authorities and the government.
Beyond that, he said, there’s “plenty of blame to go around.”
He applauded the Africa Centres for Disease Control and Prevention for its leadership on this and says its senior staff members are taking this outbreak “very seriously.” But he added that both WHO and Africa CDC have also lacked the resources and haven’t been well coordinated, and they’ve been delayed in creating and implementing a strategic plan to distribute available vaccines.
In response, a WHO spokesperson tells Sara that “a large and growing response is underway, although challenges remain owing to the scale and complexity of the task, as well as competing health priorities in the affected countries.”
The spokesperson says the organization is “closely coordinating” with Africa CDC — this is the first time WHO and Africa CDC have responded to a public health emergency under a unified team with one budget and plan.
While challenges remain, this new way of working “offers a promising blueprint for future responses,” an Africa CDC spokesperson says.
As of early December, less than 30% of pledged resources for this response had been disbursed to Africa CDC and its partners, which has delayed operations and vaccine rollouts. However, the Africa CDC spokesperson says they’re expecting this to increase. They have also established a committee for vaccine rollouts, working to direct them to the most at-risk populations.
“We need a real surge [of] investment in health infrastructure, the health system, and the health workers to actually get those vaccines delivered and protecting people,” the spokesperson says.
Regulatory failures have also been a major roadblock, Gostin said. While the U.S. has been trying to donate mpox vaccines for years, the DRC only recently OK’d the vaccines, which the U.S. Food and Drug Administration and the European Medicines Agency have long approved. WHO also failed until recently to act on prequalification of the vaccine, he said.
“In fact, the obstacles have been numerous and frankly inexcusable,” he told Sara.
Background reading: More point of care tests needed in mpox outbreak, expert says
Plus: What you need to know about mpox vaccines (Pro)
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Are we already staring down the barrel of the first major disease outbreak of 2025?
There have been reports from northern China of a surge in cases of human metapneumovirus, a disease that causes flu-like symptoms but can lead to more serious complications, such as pneumonia.
Experts at WHO are urging people not to overreact to the reports, though. They say that the increase in cases is likely following seasonal trends, with influenza-like illnesses on the upswing across the Northern Hemisphere as cold weather sets in. They also point to an increase in surveillance, which might be uncovering cases that would previously have gone unreported.
While it’s certainly better to be safe than sorry, experts suggest right now there is no serious cause for alarm.
Former U.S. President Jimmy Carter, who is being laid to rest today in Plains, Georgia, leaves an outsized legacy in global health. Through the Carter Center, which he founded with his wife, Rosalynn, in 1982, Carter brought unprecedented attention to a host of neglected tropical diseases.
That includes Guinea worm disease, a parasitic infection that comes from drinking contaminated water. When the Center began focusing on eradicating Guinea worm in 1986, there were an estimated 3.5 million cases annually. By last year, that number had dropped to 14.
Sara joined Devex Managing Editor Anna Gawel on a recent podcast to discuss this and other aspects of Carter’s impact on global health.
Listen: Jimmy Carter’s legacy on global health
Prosper Africa, a U.S. government initiative connecting American and African businesses, is testing a new AI-powered platform to improve visibility in Africa's drug supply chain. [Africa.com]
Despite cutting aid to some of the world's most vulnerable countries, the United Kindom has been recruiting thousands of their nurses, a new report reveals. [The Guardian]
A study of over 54 million people living in poverty in Brazil found that tuberculosis rates dropped significantly when people received cash payments. [NPR]
Sara Jerving contributed to this edition of Devex Checkup.