An oral cholera vaccination (OCV) campaign was launched to protect at-risk populations in cholera-affected woredas (districts) across eight regions: Afar, Amhara, Oromia, Central Ethiopia, South Ethiopia, Sidma and Somali. Covering 89 woredas, including Internally Displaced People (IDPs) and refugee camps (Sudan), the campaign achieved 98.4% coverage, vaccinating over 10,196,575 people.

“With the leadership of the EPHI and collaboration of partners, the campaign was conducted successfully despite challenges posed by conflict and other emergencies,” said Dr. Patrick Abok, WHO Ethiopia Emergency Preparedness and Response Lead. “Both the public and the vaccinators displayed commendable commitment to the campaign’s success,” he added.

Two years after the cholera outbreak began in August 2022, the country has continued to battle the disease, with a recent increase in the number of cases. The re-emergence of the outbreak in the Amhara region, particularly in areas affected by armed conflict and new displacements, poses a dual burden.

Under the leadership of the Ethiopian Public Health Institute (EPHI), multi-sectoral stakeholders have implemented response measures to interrupt transmission. These measures include house-to-house disinfection, water testing and treatment, and latrine construction. Risk communication and community engagement efforts were also undertaken to promote healthy behaviours and eliminate risky practices like open defecation. Active case search and case management were continuing.

Despite these efforts, lack of funding is severely impeding the response, including for the STOP CHOLERA NOW! campaign launched by the EPHI. It is critical that ongoing multi-sectoral interventions be combined with extensive investments in safe water supply and sanitation systems to combat the outbreak effectively.

WHO surveillance teams worked with government public health emergency management (PHEM) teams to identify the outbreak and launch a timely response in August 2022.WHO was part of the rapid response teams (RRT), and the Ethiopian National African Volunteer Health Corps initiative Strengthening & Utilizing Response Groups for Emergencies (AVoHC-SURGE) was deployed to respond to the outbreak. WHO teams provided technical support in coordination, water sanitation and hygiene, risk communication, case management, vaccination campaigns, and medical supplies, including the construction of cholera treatment facilities in the affected regions. WHO also supported capacity building and training in response intervention.

The teams trained vaccinators according to WHO OCV guidelines and provided supportive supervision to ensure quality campaign implementation. WHO also facilitated the country’s vaccine request to the International Coordination Group on Vaccine Provision (ICG) through the GAVI Vaccine Alliance and provided logistical support for the campaign.

In line with the Global Roadmap to Eliminate Cholera by 2030 and as part of the national cholera elimination strategy, OCV campaigns are conducted in affected and surrounding woredas following cholera outbreaks. This helps stop disease transmission while intersectoral response teams work to improve water safety and educate the public on good sanitary and hygiene practices.

Cholera is an acute diarrheal infection caused by consuming food or water contaminated with the bacterium Vibrio cholerae. It results in severe acute watery diarrhoea and severe dehydration. Symptoms can appear between 12 hours and 5 days after consumption of contaminated food or water. Cholera affects both children and adults and can be fatal within hours if untreated, but early detection and fluid replacement with oral rehydration solutions or intravenous fluids can save lives.

In addition to Cholera, the worrying expansion of measles outbreaks is causing increased vulnerability due to delayed emergency vaccination campaigns caused by a shortage of vaccines.

WHO and health cluster members collaborated with the EPHI and regional health bureaus in the OCV campaign. Ethiopia utilized one-third of the global stockpile for the OCV campaign, underscoring the urgency and magnitude of the situation. The country urges continued support from international partners to address ongoing funding shortages and key transmission drivers like overcrowding and inadequate water treatment chemicals.