Health officials halve dose to eke out ‘extremely limited’ supply amid unprecedented rise in outbreaks

A “dire shortage” of cholera vaccines amid an unprecedented rise in global cases has forced health officials to halve the number of doses given to people in outbreak hotspots, the World Health Organization has said.

The “exceptional decision” to reduce the number of doses from two to one would allow for the vaccines to be eked out until the end of the year, and given to more people in more countries, the WHO said today.

The organisation conceded the move would inevitably lead to a “reduction and shortening of immunity”, adding: “The one-dose strategy has proven to be effective to respond to outbreaks, even though evidence on the exact duration of protection is limited, and protection appears to be much lower in children.”

Mike Ryan, the executive director for the WHO’s health emergencies programme, said the decision marked “a sad day”.

“We shouldn’t have to do it,” Ryan said. “And it is purely based on the availability globally of vaccines.”

Twenty-nine countries have reported cholera cases this year – including Haiti, Malawi and Syria, which are facing large-scale outbreaks. Health officials believe the true number to be higher given some countries’ reluctance to be associated with the heavily stigmatised “disease of the poor”.

The tally shows a clear uptick on the previous five years, when fewer than 20 countries on average reported outbreaks. The WHO has said it is particularly concerned about the fatality rate, which this year was almost three times the rate of the past five years.

Cholera is a waterborne disease and is easily treatable if responded to in a timely fashion, but can kill within hours if not.

The International Coordinating Group (ICG), the body that manages emergency stocks of vaccines, had taken the decision because of the “extremely limited” supply, the WHO said in a statement, reiterating previous calls for “urgent action” to boost global vaccine production.

Of the total 36m doses forecast to be produced this year, 24m have already been shipped and 8m more have been earmarked for emergency vaccination campaigns, leaving just 4m doses in the global stockpile.

Speaking in Geneva the director general of the WHO, Tedros Adhanom Ghebreyesus, said the move was “clearly less than ideal”.

“Rationing must only be a temporary solution,” Tedros said. “In the long term, we need a plan to scale up vaccine production as part of a holistic strategy to prevent and stop cholera outbreaks.”

This scarcity will only be exacerbated by a key manufacturer’s decision, revealed by the Guardian last week, to discontinue production of one of the two oral cholera vaccines used in humanitarian emergencies.

“As vaccine manufacturers are producing at their maximum current capacity, there is no short-term solution to increase production,” the WHO said. “The temporary suspension of the two-dose strategy will allow the remaining doses to be redirected for any needs for the rest of the year.”