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MSF extends support to change in global cholera vaccine strategy amid unprecedented number of outbreaks

Laxmi Yadav, Mumbai
Saturday, October 29, 2022, 08:00 Hrs  [IST]

Due to the high number of countries currently experiencing cholera outbreaks and a shortage of oral cholera vaccine, Médecins Sans Frontières (MSF) has extended its support to the International Coordinating Group (ICG)’s decision to shift to a single dose of vaccine from the standard two-dose vaccination regimen administered during cholera outbreaks which will allow more people to be vaccinated.

The ICG is the international body that manages emergency supplies of vaccines and is made up of members from MSF, the World Health Organization, UNICEF, and the International Federation of Red Cross and Red Crescent Societies.
There are currently 29 countries experiencing cholera outbreaks—an unusually high number of countries—including Haiti and Syria. This unprecedented rise in cases is due to climate factors like floods and droughts, conflict, and forced displacement as there is often limited access to clean water in refugee and displacement camps, among other factors.
The Southeast Asia Region, which includes Bangladesh and India, has the largest populations at risk for cholera. According to the Integrated Disease Surveillance Program that tracks cholera outbreaks throughout India, there has been a steady increase in reported cholera outbreaks throughout the country over the last three decades. From 1997 to 2006, 68 outbreaks were reported. While the reported outbreaks rose to 559 between 2009 and 2017. However, this is only the tip of the iceberg. The disease is grossly underreported in India. In India, cholera is endemic and occurs with marked seasonal dynamics; cholera is prevalent in the hot, humid and rainy season.

A steep rise in cholera vaccine demand in the wake of more outbreaks and limited supply of vaccine have led to vaccine shortage.
Shantha Biotechnics, an Indian subsidiary of French pharmaceutical company Sanofi which contributes to about 15 per cent of the ICG's cholera vaccine stockpile, informed the ICG in 2020 that it would stop supply by the end of 2022. The bulk of the stockpile is produced by EuBiologics of South Korea.
The switch to a single-dose approach will help conserve stocks, allowing the oral vaccine to combat the potentially fatal waterborne disease in more countries, amid an “unprecedented” rise in outbreaks, said the World Health Organization (WHO) in a press release.
“Although two is optimal, 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. Immunity against infection lasts for three years under the two-dose regimen, where the second dose is administrated within six months of the first. The benefit of supplying one dose still outweighs no doses: although the temporary interruption of the two-dose strategy will lead to a reduction and shortening of immunity, this decision will allow more people to be vaccinated and provide them protection in the near term, should the global cholera situation continue deteriorating,” WHO said.
The supply of cholera vaccines right now, is extremely limited and has to be coordinated by the ICG which manages the global stockpile, it stated.
Of the total 36 million doses forecast to be produced in 2022, 24 million have already been shipped for preventive (17 per cent) and reactive (83 per cent) campaigns, and an additional eight million doses were approved by the ICG for the second round for emergency vaccination in four countries, illustrating the dire shortage of the vaccine.
With vaccine manufacturers currently producing at their maximum capacity, there is no short-term solution to increase production, said the agency.
Echoing WHO’s view, Dr. Daniela Garone, MSF’s international medical coordinator said “A single dose of vaccine, which has proven effective in the past, will be given in order to protect more people. A critical global shortage of cholera vaccines has left MSF in the position of supporting the very difficult decision of reducing the doses people will receive from two to one. The vaccine, which was developed more than 10 years ago, is a desperately needed, lifesaving, preventive tool. It is incredibly frustrating to face this situation as cholera surges in more than 20 countries, including in places already devastated by crises like Haiti, Nigeria, and Syria. This last resort decision is a way to avoid making the impossible choice of sending doses to one country over another. Single dose vaccination will provide shorter protection, but it is the fair and equitable way to try to protect as many people as possible as we face simultaneous cholera outbreaks.”


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