The global stockpile of cholera vaccines is empty. There are no doses in reserve. And while the vaccine manufacturer is churning out 700,000 doses a week, all those vials are going directly to active outbreaks.
"The demand is four times more than the supply," said Daniela Garone, the international medical coordinator for Doctors Without Borders. "And we don't have enough vaccines to use for the preventive programs."
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In October 2022, the international group managing the stockpile recommended giving just one dose of the vaccine – instead of the usual two doses. The protection doesn't last quite as long, but "it basically allows you to vaccinate twice as many people," said Russell.
At the same time, scientists set to work crafting a quicker, cheaper way to make the vaccine. Typically, the vaccine is made by growing five different strains of cholera bacteria, then killing them and finally mixing them together into the vaccine. But, it turns out, all five strains are not necessary, says Russell.
"There are two strains that are very critical. And so the simplified version we have seen in clinical trials produced a similar immune response to the five-strain version," she said, adding that she hopes this new formulation will start being made in the coming months.
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Between January 2023 and January 2024, 76 million vaccines were requested by 14 countries. That's far more doses than available and more than have been requested in the past.
Vaccine supply has proved challenging, with only one company – EuBiologics in South Korea – making the global cholera vaccine.
The lack of additional manufacturers is "a good indicator of the lack of interest, investment, commitment to control cholera," said Barboza.
There are companies in India and South Africa slated to start producing the vaccine in the coming years. However, he said, "this is taking time, especially for a vaccine which is cheap, which is only focused on the most poor part of the population in the poorest countries in the world. So, it does not attract big manufacturers."
The vaccine typically sells for about $1.50 a dose, leaving thin profit margins for the vaccine maker. Another deterrent is the fact that the cholera vaccine is not part of a routine vaccination campaign and, thus, the demand is bumpy and depends on whether or not there are outbreaks.
Some public health experts are hoping for the resumption of preventive cholera vaccinations, which have been placed on hold given the depleted stockpile. They say it would not only help attract vaccine manufacturers, but it would be good for public health.
From the article (published in March):
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