T

he world has run out of cholera vaccines—just when the deadly disease is on a rampage not seen in many years. Fifteen countries are currently reporting active outbreaks, with more than 40,900 cases and 775 deaths reported in January alone. But all available doses of oral cholera vaccines in the global stockpile have been allocated until mid-March, Philippe Barboza, cholera team lead at the World Health Organization (WHO), said on 23 February. He said there is now “no buffer for unforeseen outbreaks or preventive campaigns.” The catastrophic shortage is a result not just of a surge in cases, but also of an overdependence on a single vaccine manufacturer, EuBiologics in Seoul, South Korea, whose production capacity is limited. “Unfortunately, there is no short-term solution to increase vaccine production,” says Daniela Garone, international medical coordinator at Doctors Without Borders (MSF). But hope is on the horizon. EuBiologics is working to ramp up production of a simplified vaccine, and companies in South Africa and India are preparing to enter the market as well. The shortage “will lessen in 2024 and should be substantially addressed by 2025,” says Julia Lynch, director of the cholera program at the International Vaccine Institute (IVI), also in Seoul; by 2026 or 2027, it could even be a “crowded market,” she predicts. Cholera, caused by the Vibrio cholerae bacterium, causes terrible diarrhea, with the body flushing out as much as 1 liter of fluid per hour. Left untreated, it can kill in less than a day. Many public health experts attribute the current surge, which began in late 2022, at least partially to climate change. Extreme weather events in Pakistan, Malawi, and Mozambique have destroyed health and sanitation infrastructure, allowing the bacterium to thrive. Armed conflict and displacement of people in the Democratic Republic of the Congo and Yemen have also led to outbreaks. The two-dose oral cholera vaccine, developed by IVI based on earlier research in Vietnam, contains several strains of inactivated V. cholerae bacteria, along with a part of the toxin secreted by the bacterium, which boosts the immune response. Two doses given 2 weeks apart can offer robust protection for at least 3 years, and, when deployed early enough, can prevent outbreaks from ballooning. The global stockpile of the vaccine, established in 2012, is managed by an International Coordinating Group on Vaccine Provision made up of experts from WHO, UNICEF, MSF, and the International Federation of Red Cross and Red Crescent Societies. It can rapidly send vaccine to countries in need. The number of doses available for shipment reached 36 million in 2023 (see graphic, below) and could be close to 50 million this year.