Zim braces for cholera fight
FOR 30-year-old Simphiwe Mhlanga, news of a new cholera outbreak brings back a flood of memories she would rather forget.
In September 2018, 69 people in her suburb, Glen View, and neighbouring Budiriro in Harare lost their lives to the waterborne disease.
Back then, the two populous high-density suburbs, blighted by years of erratic water supplies and illegal garbage dumpsites, were declared epicentres of the outbreak. Simphiwe lost her three-year-old son and her 60-year-old mother. The two died only days apart after contracting the highly contagious disease.
“The last time we had an outbreak, it robbed me of my mother and son,” she told The Sunday Mail recently.
“I hope the outbreak is contained soon.”
Zimbabwe is one of the six countries in Southern Africa — including Malawi, Mozambique, Zambia, Tanzania and South Africa — battling recent outbreaks.
UNICEF estimates that about 28 million people in East and Southern Africa have been affected so far.
The last 10 years have seen two major cholera outbreaks in Zimbabwe — one in 2008, which resulted in 4 000 deaths from over 100 000 cases, as well as another one in 2018, where there were 10 000 cases and 69 deaths across the 21 cholera hotspot districts across the country.
In both cases, the capital, Harare — which is home to close to 2,5 million people — was the worst affected.
This time, however, the outbreak has been concentrated outside the capital. As of May 9, 2023, Zimbabwe had recorded five deaths, 722 cases and 669 recoveries. Cholera, which is an acute diarrhoeal illness caused by infection of the intestine with vibrio cholerae bacteria, is contracted when one ingests food or water contaminated with the bacteria.
The infection is often mild or without symptoms, but can sometimes be severe and life-threatening, according to experts.
In most cities and towns across the country, uncollected garbage, burst sewer pipes and lack of potable water have been cited as factors that are causing the disease to thrive. Harare City Council health services director Dr Prosper Chonzi says the oral cholera vaccines (OCV) that were administered in the capital in 2018 have played a major role in preventing deadly cholera outbreaks in Harare over the past four years.
The OCVs were administered to adults in 16 targeted high-burden suburbs in Harare.
The two doses of the vaccine provide protection against cholera for three years, while a single dose provides short-term protection.
According to statistics from the Ministry of Health and Child Care, two campaigns were conducted over the past four years, with 1,3 million doses administered in Harare, Epworth and Chitungwiza.
An additional 300 000 OCVs were received by inmates and prison officers.
“The cholera outbreak has severely affected some parts of the country more than others,” Dr Chonzi said.
“When the OCVs were rolled out in 2018, Harare and two surrounding towns received the vaccines; that is why these three have recorded the lowest number of cases.”
OVCs administered to Harare residents last for three to five years.
According to vaccines consultant at the World Health Organisation (WHO), Dr Marc Porcin, vaccines provide a temporary shield that gives authorities time to address water and sanitation issues.
“The OCVs protection lasts for three to five years,” he said.
“This reduces person-to-person transmission. as well as suburb-to-suburb transmission.
“This gives Government time to rectify sanitation issues in the country.”
One of the measures that will ensure eradication of cholera, Dr Porcin said, is improvement of sanitation.
Mashonaland West provincial medical director Dr Celestino Dhege said the recent outbreak has been mainly due to lack of proper sanitation.
“In 2020, about 50 000 of Chegutu’s population were vaccinated; however, due to poor sanitation, waterborne diseases have continued to ravage this area,” he said.
“Areas such as the Chegutu bus terminus, and Chinengundu and Pfupajena high-density areas have been experiencing poor sanitation for years now.”
National, provincial and district rapid response teams have since been activated.
In addition, Government will upgrade and review the Cholera Outbreak Emergency Preparedness and Response Plan for 2023-2024.
According to the response plan, Government seeks to disburse US$9 million to procure OCVs for 81 hotspots in the country.
The stock will cover two rounds of vaccination.
Information, Publicity and Broadcasting Services Minister Monica Mutsvangwa told a recent post-Cabinet media briefing that a cholera vaccination programme will soon be rolled out across the country.
“Cabinet wishes to assure the nation that the cholera risk assessment, which should guide the application of the oral cholera vaccination, has been completed across all the 10 provinces,” she said.
“Active surveillance of points of entry and exit is continuing as part of a multi-sectoral approach in response to the cholera outbreak. Government is providing funds in order to bolster the country’s response.”
Government has also started reviewing the budgets, as well as policy documents on cholera elimination.
According to the Africa Centres for Disease Control and Prevention (CDC), 86 486 suspected cholera cases have been reported in Africa to date, with 1 213 deaths, reflecting a case fatality rate of 1,4 percent.
Over 40 000 cases have been recorded in Southern Africa. Africa CDC also says the World Health Organisation (WHO) and Gavi — a public-private global health partnership that seeks to increase access to immunisation in poor countries — have been mandated to distribute OCVs.
Responding to questions from The Sunday Mail, Africa CDC acting director Dr Ahmed Ogwell said:
“WHO and Gavi have been mandated to order vaccinations for the affected countries.
“However, I understand that the vaccines are in short supply and Africa is mulling to start producing its own vaccines.”
Dr Ogwell said the way forward will be announced in due course.
This article was supported by the International Women’s Media Foundation’s Global Health Reporting Initiative: Vaccines and Immunisation in Africa.