Malawi is battling a cholera outbreak in 10 of its 28 districts. Oral cholera vaccines are helping to stem the tide.

It is winter in Malawi, which makes the continued cholera outbreak unusual. Yet, according to Ministry of Health’s 13 July cholera update, the disease has already claimed 40 lives with 857 cumulative cases. While the outbreak started in March, towards the end of rainy season, its prolonged nature can, partly, be attributed to the damage that tropical storms have wreaked on the country.

“Tropical storm Ana destroyed water and sanitation facilities, which have not been repaired. Climate change is another contributing factor. With climate change, infectious diseases such as cholera become a problem,” says Head of Public Health at Kamuzu University of Health Sciences, Prof Adamson Muula.

Ministry of Health spokesperson Adrian Chikumbe clarifies that while cholera is associated with the rainy season, the situation does vary from district to district.

“In Nsanje, the situation is endemic due to cross-border interactions with Mozambique. Blantyre has been hit by the disease. Only 37% of the district’s population has access to safe water, meaning the majority of them use unsafe water. We always advise people to treat their water before usage,” he says. “Many areas are congested. There is no recommended space between wells and pit latrines, which makes things worse.”

Blantyre district has been the worst hit, with 351 cases and 18 deaths. The local District Environmental Health Officer (DEHO), Penjani Chunda, says that the most infected age groups are 10- to 29-year-olds followed by under-nines and incidence is rare in the elderly. Most cases are being reported in slum townships.

He adds, “Even though vaccines are a reactionary approach, in places where vaccines have been administered, we have seen cases slowing down. We had a good vaccination response in both rural and urban areas. The only challenge is how to reach certain areas due to geography, terrain, etc.”

In May 2022 Malawi, with support from WHO, Gavi and UNICEF, launched a cholera vaccination campaign targeting 1.9 million people aged one year and above. According to the Ministry of Health, Malawi has received a total of 3.9 million doses of oral cholera vaccines from the global stockpile funded by Gavi, the Vaccine Alliance.

Chikumbe says what is particularly worrisome about the cholera situation is the fatality rate. “The standard is only one person per 100 but we have close to five fatalities per 100, especially in the southern region districts.”

He adds: “The districts that received the first dose will need to receive the second dose. We are still doing an assessment on the vaccination campaign we had in May. We will announce dates for the second dose in due course.”

Chairperson for Naperi Development Committee, Fedson Kansiyamo says he used the community WhatsApp group and mobilised the youth of his area to spread cholera vaccination messages.

“I personally believe in prevention rather than curing a disease, which is why I was one of the first residents to receive the cholera vaccine during the campaign. I then convinced the other residents to do the same and it worked well,” he elaborates.

“Even though we are in the city, we still have people that use water from wells and streams, where others  dump their waste in the same places. Also, I believe the issue of diaper disposal has greatly contributed to this. All these issues are reversible,” he says.

WHO country representative, Doctor Neema Rusibamayila Kimambo says the 4.77 percent cholera national fatality rate average means more people have died than they should have.

“This can be due to several factors. It can be due to poor community knowledge or community beliefs where people come late to their health facility. So even when they come, they are already in a state where that it’s difficult to resuscitate and manage them,” she notes.

Professor Adamson Muula says that the current epidemic shows that there continues to be a large Malawian population that is underserved with drinkable water and sanitation.

“Vaccinations are good. But they don’t remove the fact that people are drinking water that is mixed with human faeces. I think it is good to understand the role of vaccines in that way. We should be working towards a country where vaccines are not needed. We need to get back to basics, ensure that our people have safe water for drinking,” he says.

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