Deadliest cholera outbreak in the past decade hits southern Africa

Sandra Mwayera wailed as her older brother crouched next to her in the backseat of a car – he had died of cholera while waiting for treatment with dozens of others outside a hospital in Zimbabwe's capital, Harare.

“My brother! My brother! Why have you abandoned me?” she begged. “Please come back. Coming back!”

In neighboring Zambia, at the 60,000-seat National Heroes Stadium in the capital Lusaka, rows of gray camp beds lined the rooms of a makeshift treatment center where 24-year-old Memory Musonda had died. Her family said they were not informed until four days later: the government buried her and they have yet to find her grave.

Ms Musonda's uncle, Stanley Mwamba Kafula, said the family was “disturbed” and “heartbroken”.

Active outbreaks of cholera, a water-borne bacterial disease, are now raging in five countries in central and southern Africa, ranging from the far north to the Democratic Republic of Congo and as far as Mozambique.

The epidemic has spread over the past two years, infecting more than 220,000 people and killing more than 4,000 in seven countries. This is the deadliest regional outbreak in terms of cases and deaths that will hit Africa in at least a decade, said Dr. Patrick Otim, who oversees the cholera response for the World Health Organization in Africa. Public health workers in Africa say it is rare for so many cases to occur in so many countries at the same time.

The number of cholera cases in Africa was actually declining and reached a low point in 2020, he said. But then there was a resurgence in West Africa in 2021, followed by the current outbreak in the southern part of the continent.

Two countries – Zambia and Malawi – have reported their largest ever cholera outbreaks, while Zimbabwe has had the second highest number of cases on record. Of the 19 African Union countries that reported deaths and cases in the past year, almost three-quarters are from southern Africa. according to the Africa Centers for Disease Control and Prevention.

“The cholera situation in southern Africa – especially in Zimbabwe and Zambia – is dire,” says Dr. Mounia Amrani, the leader of Doctors Without Borders' medical team in southern Africa.

The devastation is linked to increasingly violent storms, a shortage of vaccines and poor water and sewer infrastructure, public health experts say.

Representatives of 15 countries in the Southern African Development Community have agreed to a collective mobilization that will include investments in vaccine production and distribution, cooperation on surveillance of the disease across borders and the development of reliable water and sanitation facilities included.

Zambia has been hit hardest by the disease and is experiencing its deadliest outbreak on record. Since October, more than 650 people have died and more than 18,500 have been infected, although cases and deaths have declined since they peaked in January. Five deaths were reported in the 24 hours leading up to Monday, compared to the more than 15 fatalities recorded daily last month. Schools reopened on Monday after a delay of about a month.

Yet there are worrying signals. The outbreak was initially confined to the capital Lusaka, but has since spread spread to nine other provinces. The 3.5 percent mortality rate is much higher than the 1 percent rate that health experts say is typical. Dr. Otim said about half of Zambia's deaths occurred at home and not in health centers, an indication that people were in denial or did not know they had cholera.

Doctors Without Borders has deployed 50 health workers to Zambia and 30 to Zimbabwe to help control the outbreaks.

As public health and government officials rush to combat the outbreaks, the African CDC warns of the possibility of a dire situation ahead: Above-normal rainfall is expected across much of the region this month, the kind of weather that floods communities, destroys infrastructure and increases the risk of cholera transmission.

People typically become infected with cholera when they swallow water contaminated with human waste. The surest way to prevent the disease is to keep water sources for drinking and washing separate from sewage, public health experts say.

Many communities in southern Africa are plagued by poor water and sewerage infrastructure. Residents often rely on shallow latrines as toilets and, without piped water, use streams or lakes for drinking and washing. This poses a significant risk of cross-contamination, especially when there is heavy rain and flooding.

One of the key commitments made by Southern African Development Community leaders was to increase investment in the development of resilient water and sewerage systems.

“If we do not address water, hygiene and sanitation issues, we will not be able to stop the cholera outbreak,” said Dr. Otim from the WHO.

Vaccination is also a big problem. A wave of cholera outbreaks worldwide in 2021 and 2022 has depleted vaccine supplies, Dr. Otim. one manufacturer that produces the cholera vaccine at a global level. About 37 million doses were produced last year, while demand was about 60 million, he said.

Dr. Amrani said cholera has received less attention than other diseases from the pharmaceutical industry, which has also contributed to the vaccine shortage.

While longer-term solutions such as creating better water infrastructure and increasing vaccine production may take time, organizations like Doctors Without Borders and WHO are helping countries in the region tackle the immediate problem of treating suffering patients. They provide hydration treatments, medical staff and supplies.

At a treatment center in a school in a densely populated suburb of Harare, nurses wearing latex gloves tended to patients spread out on cots. There were moans and screams, and some patients leaned uncomfortably on couches, waiting to be treated.

“I'm dying! Please, I'm dying!” a woman at school screamed as nurses tried to put intravenous tubes in her hands to give her fluids for hydration. “What will my children do? Who will take care of them?”

On a recent morning at the Sally Mugabe Central Hospital in Harare, where Ms Mwayera's brother had died in the car outside, a nurse delivered bad news to members of another family waiting in a corridor. Jethro Nguweni, 52, had lost his battle against cholera.

“What shall I do?” his wife, Melia Nguweni, cried as she took off her headscarf and threw it down. “My husband is no longer here. He left me.”

Collins Chilumba Sampa provided reporting from Lusaka, Zambia.