More than 1.2 million cholera rapid diagnostic tests are poised for distribution to 14 countries, marking the largest global deployment initiative of its kind. The initial consignment, scheduled for arrival today in Malawi, signifies the inaugural phase of this endeavor facilitated by Gavi, the Vaccine Alliance. This strategic allocation of diagnostic resources is set to significantly enhance the prompt identification and surveillance of outbreaks, fortify the efficacy of vaccination campaigns in response to prevailing crises, and streamline the targeting of forthcoming preventive vaccination endeavors.
Underpinned by collaboration among Gavi, the World Health Organization (WHO), UNICEF, the Foundation for Innovative New Diagnostics (FIND), and other pertinent stakeholders, the global cholera rapid diagnostic test procurement program underscores a concerted effort to combat the scourge of cholera on a worldwide scale.
The commencement of the global cholera rapid diagnostic test (RDT) program in Malawi signifies the initiation of a comprehensive initiative aimed at dispatching more than 1.2 million tests to 14 countries deemed at heightened risk of cholera transmission within the ensuing months. Notable recipients earmarked for forthcoming distributions include nations currently grappling with severe cholera outbreaks, such as Ethiopia, Somalia, Syria, and Zambia. This initiative is poised to streamline the timeliness and accuracy of outbreak detection and response mechanisms, bolster routine surveillance capabilities, and expedite the identification of potential cholera cases. Importantly, it will furnish countries with invaluable insights to monitor trends and cultivate an evidential foundation for future preventive interventions, thereby advancing national cholera control and elimination objectives.
The funding and coordination of the global cholera diagnostics program are spearheaded by Gavi, the Vaccine Alliance, with UNICEF spearheading the procurement and delivery operations to beneficiary nations. This endeavor is conducted in concert with the Global Task Force on Cholera Control (GTFCC) and WHO. Furthermore, the formulation of this program owes much to the collaborative efforts of FIND, which has been instrumental in delineating a target product profile outlining the requisite specifications of cholera RDTs, alongside other pertinent entities. These preliminary dispatches herald the outset of the program, which endeavors to extend the deployment of RDTs to additional nations expressing interest in future participation. The sustained viability of this program hinges on successful fundraising endeavors earmarked for Gavi’s forthcoming strategic period spanning from 2026 to 2030.
This concerted initiative will see the integration of rapid diagnostic tests from two manufacturers, hitherto supplied via WHO and UNICEF for outbreak response, into routine cholera surveillance protocols. Pilot studies conducted across the Democratic Republic of the Congo (DRC), Niger, and Nepal, underwritten by Gavi and steered by the United States Centers for Disease Control and Prevention (CDC), Johns Hopkins University (JHU), and Epicentre/Médecins Sans Frontières, have contributed significantly to refining effective rapid testing strategies. Preliminary insights gleaned from these ongoing studies have informed programmatic frameworks, augmenting the efficacy of large-scale test rollouts.
The resurgence of cholera on a global scale since 2021, characterized by elevated case fatality rates notwithstanding the availability of simple, efficacious, and cost-effective treatment modalities, has precipitated an unprecedented surge in vaccine demand from affected nations. Although the global stockpile of oral cholera vaccines has expanded eighteen-fold between 2013 and 2023, the sustained upsurge in demand vis-à-vis extant supply constraints has strained global reserves. Consequently, preventive vaccination initiatives have been compelled to defer in order to preserve doses for emergency outbreak response endeavors. The recurrent outbreaks in nations where emergency vaccination campaigns have already been enacted underscore the imperative of enhancing the speed and precision in identifying areas harboring nascent or persistent transmission, thereby facilitating targeted interventions during the initial phases of outbreak response operations.
In 2021, the Gavi Board ratified a US$ 55 million allocation earmarked to underwrite a diagnostics program spanning from 2022 to 2025, encompassing maladies such as cholera, yellow fever, measles, rubella, meningococcal meningitis, and typhoid, with the overarching objective of enhancing disease surveillance, outbreak detection and response capabilities, and the formulation of preventive programs. Subsequently, Gavi unveiled a cholera diagnostics application window in June 2023—a window that remains open to date—with 14 nations having thus far submitted and secured approval from an Independent Review Committee comprising expert evaluators. Moreover, in 2023, Gavi initiated a preventive cholera vaccination drive aimed at buttressing long-term cholera control efforts—a stratagem that has yielded tangible reductions in outbreaks of ailments such as yellow fever and meningitis.
Cholera, an acute intestinal infection propagated through the consumption of food and water tainted with fecal matter containing the Vibrio cholerae bacterium, has witnessed a resurgence precipitated by persistent gaps in accessing safe water and sanitation facilities, coupled with sluggish response mechanisms in curtailing outbreaks and mitigating their spread. The afflicted communities, often deprived of rudimentary healthcare services, grapple with exacerbated circumstances exacerbated by climatic variables, conflict, and population displacements. In the face of this ongoing surge, stakeholders vested in cholera control advocacy have issued impassioned appeals to nations, manufacturers, and allied partners to redouble their commitments to expeditious outbreak response and case management protocols, prompt access to treatment modalities, escalated production of affordable vaccines, and urgent ameliorations in accessing fundamental water and sanitation amenities in affected locales.
The efficacy of these multisectoral interventions to combat cholera hinges on the expeditious and reliable collation of cholera surveillance data. Surveillance not only underpins early detection and rapid response to outbreaks but also assumes a pivotal role in furnishing stakeholders across various cholera prevention and control domains with the requisite data to target, devise, implement, and appraise interventions. In 2023, the GTFCC issued updated recommendations endorsing strategic, systematic, and routine testing of suspected cholera cases and advocating for the expanded utilization of RDTs to fortify cholera surveillance endeavors. The global cholera RDT procurement program is geared towards furnishing eligible nations with the requisite support to operationalize these recommendations.
“Aurélia Nguyen, Chief Programme Officer at Gavi, the Vaccine Alliance, remarked, “We are contending with an unparalleled, protracted surge in global cholera cases, and today’s announcement represents a pivotal stride in our collective battle against this affliction. The escalation in infections is underpinned by persistent lacunae in accessing safe water and sanitation facilities, compounded by our inability to reach vulnerable communities increasingly imperiled by climate change, conflict, and displacement. Routine diagnostic utilization will fortify cholera surveillance in affected nations, thereby furnishing invaluable insights to optimize vaccination endeavors, which constitute a linchpin in the multifaceted arsenal of cholera prevention and control initiatives.”
“Despite the preventable and treatable nature of cholera, children continue to bear the brunt of this potentially fatal malady. This underscores our commitment to collaborating with partners across diverse domains to curb outbreaks,” elucidated Leila Pakkala, Director of UNICEF Supply Division. “Surveillance diagnostics serve as a precise tool in pinpointing hotspots, thereby empowering partners to judiciously deploy cholera vaccines to the exact juncture and time where their impact can be maximized in preserving lives amid constrained supplies.”
“Cholera’s relentless encroachment into regions hitherto unscathed by the malady underscores the imperative for a swift, multidimensional response to channel limited resources to
