Cholera crisis presents opportunity for SADC commi...

Cholera crisis presents opportunity for SADC commitment to sustainable development

Nyashadzashe Ndoro

Prompted by the increasing statistics, on February 2 this year, the Southern Africa Development Committee governments held Extraordinary Summit to discuss how to suppress the continental cholera outbreak that has SADC in its grip.

According to Africa Centre for Disease Control, in the 13 months from January 2023 to January 2024, a total of 252,934 cases and 4,187 deaths have been reported from 19 African Union Member States with over 72.5% of the total cases being in the SADC region.

Relief Web sums up the extent of the problem as follows:

“-The cholera epidemic continued to affect multiple countries in Southern Africa in 2023, placing an additional burden on vulnerable communities and healthcare facilities. About 188,000 cholera cases, including 3,000 related deaths, have been reported in eight countries in Southern Africa since January 2023. This includes six countries currently with active cholera transmissions, namely, the Democratic Republic of Congo, Malawi, Mozambique, Tanzania, Zambia and Zimbabwe that have continued to report cases since October 2023. Malawi reported 59,000 cases, the highest in the region. Mozambique, Zambia and Zimbabwe reported between 10,000 and 50,000 cases, while Tanzania and South Africa reported less than 2,000. In Zambia, a spike in cholera cases led to the delay in the opening of schools until 12 February, affecting approximately 4.3 million learners.”

The talk is great

Post-summit, SADC announced that the regional bloc would commit to resolutions that would ensure the eradication of cholera, a recurrent headache in the region.

“The fight against cholera aligns with the African regional framework for the implementation of the global strategy for cholera prevention and control, 2018-2030.

“This framework supports the new global strategy for cholera control at the country level, providing a definitive pathway towards a world where cholera no longer poses a threat to public health,” said SADC in a statement.

The strategy hinges on developing and implementing climate-resilient water, sanitation and hygiene as well as Disaster Risk Reduction programmes to prevent future cholera outbreaks,

Key is the increase in investment in WASH infrastructure and to provide efficient waste management and sustainable supply of clean water through increased budget allocation towards WASH programmes and the strengthening of accountability tools for monitoring WASH interventions and local governments reporting on their WASH performance.

The walk has a marked limp

SADC governments have made similar pledges before. In the second quarter of 2018, a number of African health ministers committed to ending outbreaks by 2030 through the Regional Framework for the Implementation of the Global Strategy for Cholera Prevention and Control at the 68th session of WHO’s Regional Committee for Africa.

But five and half years later, the region appears to be in the same space.

Harare, Zimbabwe’s capital which was the epicentre of 2008-9 cholera pandemic in which 98,585 cases and 4,287 deaths were reported, is once again faced with another outbreak.

Recently, Government, through Health Minister Dr Douglas Mombeshora, stated during a parliament question and answer session ministries and institutions had embarked on a series of national programmes to combat the outbreak, through educating citizens, deploying vaccines, and drilling clean alternative sources of water.

“The other measures that we have taken in rural areas is that we have sunk boreholes and we have also put water tanks so that we can put water sanitisers in the tanks.

“We are working with WASH who are also sinking boreholes in the rural areas under the Presidential Scheme that states that for each village, there must be a borehole before the year 2025.

“We have now sunken close to 3000 boreholes, but we will start sinking boreholes in areas that have been affected by Cholera, said Mombeshora.

Across the border in Zambia in 2018, then Health Minister Dr. Chitalu Chilufya stated the government’s commitment to ending cholera through a host of interventions which included provision of safe water and sanitation and waste management services in the communities.

But as of January 14, the country reported that it was battling what could potentially be its worst cholera outbreak since 1977 with 351 dead and nearly 9,000 active cases registered.

While the country is implementing the standard response protocols including field hospitals and vaccinations, President Hakainde Hichilema has urged citizens to move out of congested urban areas and relocate to rural areas.

Vaccine gap continues

The other pillar of SADC’s move towards eradication of cholera as enunciated in the post-summit communication has been the move towards vaccine self-sufficiency through local manufacturing.

But for now SADC countries continue to rely on institutions that they have no control over.

Zimbabwe has received part of its promised 2,3 million Cholera vaccines. The authorities are dispensing single doses which are effective for six months instead of double doses which can keep recipients people safe for two years. Mombeshora says the country needs more than 7 million doses to properly vaccinate people at high risk.

“We have one problem, that there is a Cholera outbreak in a lot of countries and the problem is that the vaccines are not adequate to give enough to each and every needy country.

“WHO is working on how to distribute these vaccines so that each country gets a fair share, and we are now working together with them and UNICEF on this issue,” said Mombeshora

Zambia received three million doses. A WHO February 2024 report says Zambia and Zimbabwe have experienced the highest surges, underscoring the ongoing challenge of controlling cholera and the importance of sustained public health efforts.

Mombeshora says Zimbabwe is now considering getting vaccines that have not been certified.

“I hope that what happened during the COVID pandemic, some of the doses may be allowed to be administered even if they may not have been certified totally,” said Mombeshora.

Malawi, whose cholera outbreak officially started in Machinga district at the end of February 2022 and by February 18, 2023, had reported 1,400 deaths from more than 45,400 cases also faced vaccine shortages before managing to suppress figures by the end of 2023.

No SADC country has yet presented concrete plans for n local vaccine production.

Need for consolidated regional approach

**Table compiled by Africa CDC from stats reported by SADC countries**

President of the Medical and Dental Private Practitioners association of Zimbabwe and Public health specialist Dr Johannes Marisa believes that lack of appreciation on how all countries are interlinked is the biggest challenge to a concerted regional approach.

“The self-centredness shown by some member of SADC emanates from the fact that they have not been affected. ….. When one is not affected by something, they do not see the importance of aggressive management or aggressive management,” said Dr Marisa while speaking to Zim Now on how cholera can be suppressed permanently in the region.

THE SADC Disaster Preparedness And Response Strategy And Fund 2016-2030 clearly outlines the need to approach disasters from a regional point of view.

One of the stated objectives is creation of a fund to fight disasters.

Another is: “Early action response capability supported by knowledge, plans and capacities for timely and appropriate action by authorities and those at risk.’

By definition all SADC member states are at risk from cholera. Which begs the question why the bloc has not seen it fit to pool resources in fighting cholera. Currently eight member states out of 16 are affected.

A senior journalist from a SADC country who declined to be named told Zim Now that the cholera outbreak is more than a health issue and this might explain the lack of a consolidated regional effort.

“The economic question is at times overlooked. Consider the basis on which SADC economies are built. Many member countries rely heavily on tourism and are trying to nurture that industry back, post the Covid-19 pandemic. Since Cholera is a notifiable disease, travel alerts are issued. This has an impact on sharing numbers, and coordinating a regional approach. The first response is to protect borders, which is correct,” said the journalist.

“But SADC as a group should then go one step further and mobilise resources to fight disaster at source. For example, if all SADC countries had put in resources to fight cholera in Malawi and Mozambique, they would have greatly reduced the risk of it spreading to their own countries. But instead we have seen its slow but inexorable march,” the journalist said.

Almost two years after cholera hit Malawi and almost a year after being reported in Zimbabwe, South Africa announced its first confirmed cases in January 2024 and has recorded over 1000 cases including 47 deaths since.

The journalist said that a true multi sectorial and solid strategy would have seen SADC now at an advanced stage in creating a regional vaccine production centre with the best research and development capacity to deal with cholera and other diseases.

Dr Marisa said if all SADC countries observe their commitment to the Abuja Declaration of 2001 by dedicating at least 15% of national budgets to the health sector, cholera will be defeated.

He said that SADC should plan for its own self sufficiency and avert disaster instead of being at the mercy of organisations like WHO and UNICEF after the fact.