When tropical storm Ana hit southern Malawi in January 2022, teams from Doctors Without Borders/Médecins Sans Frontières (MSF) went to the Nsanje district to respond to the emergency. “Following the floods and considering the very poor water and sanitation conditions, we immediately knew that there was a risk of cholera to spread,” explained Marion Pechayre, MSF’s head of mission in Malawi.
These concerns proved well-founded. Since March 3, 2022, more than 33,600 confirmed cases of the waterborne disease have been reported, and more than 1,093 people have died as a result. While access to water, sanitation, and hygiene remain key factors in sustainably preventing the spread of the disease, this crisis also underscores the importance of vaccine access in countries where cholera is endemic, such as Malawi, to prevent and limit outbreaks. There has not been a massive vaccination campaign against cholera in Malawi in the last five years, and the vaccine only offers immunity for a few years, leaving most people vulnerable to infection.
Since last spring, MSF has supported Malawi’s Ministry of Health in 13 cholera treatment units, managing more than 6,000 cases of severe and moderate cholera. We also led an oral cholera vaccination campaign for 42,000 people in the Mangochi district in December, and just started a vaccination campaign in the Blantyre district.
In addition, MSF teams also conducted water, sanitation, and hygiene (WASH) activities; donated supplies like cholera beds, buckets, and water purification tablets; and ran health promotion activities around safe hygiene practices for over 25,000 people.
Vaccines are crucial
“We expressed our concerns to the Ministry of Health and advised on the need for a preventive vaccination campaign in the area to avoid an outbreak. In the future, regular targeted preventive vaccinations should be put in place to avoid that,” said Pechayre.
Over the last year, cholera outbreaks worldwide have increased by 50 percent compared to previous years , depleting the existing vaccine stockpile. Malawi, which declared the cholera outbreak in March, 2022, was only able to start its vaccination campaign in May, reaching only 24.5 percent of the people in eight targeted districts.
“We believe that the epidemic would not be what it is today if Malawi had access to more vaccines, sooner,” said Pechayre.
This is the biggest cholera outbreak the country has seen in its history, even though Malawi had made progress in the last several years to reduce the cholera burden through vaccination and improved water and sanitation. While these improvements are key cholera-prevention measures over the long-term, 30 percent of people living in Malawi still don’t have access to drinking water services, and only 26 percent have access to basic sanitation services, which makes it challenging to adopt basic hygiene measures in some areas. In the Mangochi district, where cases of the disease have increased tenfold since last November, many people living in rural areas depend on lake Malawi for washing, fishing, and cleaning food as well as their hygiene needs.
An MSF medic tends to a patient at one of the cholera treatment centers. Malawi 2023 © MSF/Yahya Kalilah
MSF is donating medical supplies including cholera beds, in response to the country's worst cholera outbreak in history. Malawi 2023 © MSF/Yahya Kalilah
“The lack of safe water . . . and low latrine coverage and usage remain unaddressed at the community level,” said Bérengère Guais, MSF’s deputy head of emergency. “With the current rainfall throughout the country, there is a risk of further spread of cholera. To stop this outbreak, but also to be better prepared for the future, strong efforts need to be made in this area as well.”
Currently, the epidemic trends keep rising across the country, with around 600 new cases per day. While Malawi usually counts a few hundred cholera patients per year, the huge number of cases has already eclipsed the 33,546 recorded in 2002 during during an epidemic that until now was the country’s worst. And while the mortality rate for cholera is usually below 1 percent, the current 3 percent mortality rate is extremely worrisome.
MSF will continue to respond to the outbreak based on the needs expressed by health authorities and assessments conducted by our teams.
