Category Archives: WHO

Experimental vaccine to be used against Ebola outbreak in the DRC

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campaign to vaccinate people at risk of developing Ebola in the latest outbreak in the Democratic Republic of the Congo could begin by the end of this week, Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, said Sunday.

Tedros said the government of the DRC has formally asked to use an experimental vaccine being developed by Merck. The WHO has a stockpile of 4,300 doses of the vaccine in Geneva; the company also has 300,000 doses of the vaccine stockpiled in the United States. Merck has given its permission for the vaccine to be used in this outbreak.

“Everything is ready for the vaccine. They want it,”  Tedros, who goes by his first name, told STAT in an interview from Kinshasa.

The WHO and its partners are responding quickly, concerned that this outbreak has the potential to spread because of its location. The epicenter, a town called Bikoro, is difficult to reach by vehicle because of poor roads between it and the regional capital, Mbandaka. Tedros and his party traveled there by helicopter.

But the town is a port, on Lake Tumba. And it feeds into the Congo and Ubangi rivers — major waterways that connect to several large centers.

To the south is the DRC capital, Kinshasa (population 11.5 million), as well as Brazzaville (population 1.9 million), the capital of the neighboring Republic of the Congo. To the north is Bangui (population 800,000), the capital of the Central African Republic. Mbandaka, with a population of about 1 million people, is also reachable from Bikoro by water.

The World Food Program has established an air bridge, a costly undertaking but one that is essential for moving people and materiel into Bikoro.

The equipment needed to keep the vaccine at subzero temperatures — the so-called cold chain — was arriving in the DRC on Sunday and would be set up in the next couple of days, he said. By Wednesday or Thursday, the vaccines in Geneva will be sent to the DRC, said Tedros. After that, vaccination of health care workers and people who have been in contact with cases will begin.

“That’s our plan. And so far things are going as planned,” he said, expressing hope that the quick response will speed containment of the outbreak. “We have better weapons this time.”

The outbreak, which is believed to have started at least five weeks ago, was officially declared on May 8 after the DRC health ministry confirmed two positive tests from among a number of suspected Ebola cases in Bikoro and a village called Ikoko-Impenge, about 40 miles away.

The WHO said on Saturday the case estimate is up to 39 — two confirmed, 20 probable cases, and 17 suspected. At least 18 of those people have died. Three health care workers are among the cases and one has died.

The plan is to employ a ring vaccination approach, vaccinating anyone who has been in contact with a case to prevent continuing spread of the virus. Contact tracing efforts are already underway. To date, 382 contacts have been identified, Tedros said.


Largest clinical trial ever conducted in postpartum haemorrhage completed

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Ferring Pharmaceuticals and MSD, through its MSD for Mothersinitiative, has announced the completion of CHAMPION (Carbetocin Haemorrhage Prevention), a global clinical trial conducted by the Human Reproduction Program (HRP) at the World Health Organization (WHO).

CHAMPION is investigating whether Ferring’s proprietary and heat-stable carbetocin could offer a new solution to prevent excessive bleeding after childbirth (postpartum haemorrhage or PPH).2,3Involving nearly 30,000 women in 10 countries, it is the largest clinical trial ever conducted in PPH.2,3

Each year, 14 million mothers are affected by PPH.1 As the leading direct cause of maternal mortality, 480,000 mothers died from PPH between 2003-09.1 Even when women survive, PPH can result in the need for serious medical interventions, including surgical removal of the uterus (hysterectomy) as well as blood transfusions to address severe anaemia.2 By preventing PPH from ever occurring, heat-stable carbetocin has the potential to both save lives and avoid severe, dangerous and costly long-term side effects.

Despite progress towards the UN Sustainable Development Goal of reducing maternal mortality, every single day women across the world are dying unnecessarily from childbirth complications such as PPH. Timely administration of effective medicines can avoid the maternal deaths that occur due to excessive bleeding after childbirth,”3 said Mariana Widmer, Technical Officer, Maternal and Perinatal Health, WHO. “If the results of the trial for heat-stable carbetocin are favourable, this collaboration between private life sciences and the global public health community could help save women’s lives worldwide.”

The CHAMPION trial compares the effectiveness and safety of Ferring’s heat-stable carbetocin versus the current standard of care, oxytocin, for preventing PPH after vaginal birth.2,3 Heat-stable carbetocin could  address a significant limitation associated with oxytocin – the need for refrigeration during shipping and storage to prevent degradation in temperatures above 8°C.3,4 Heat-stable carbetocin may remain active long-term in hot and humid climates,3and could potentially reduce the incidence of PPH in areas where cold storage is difficult to achieve and maintain,3,4 and where 99% of maternal deaths due to PPH currently occur.4

Using our established expertise in Reproductive Medicine and Women’s Health, we strive to find innovative treatments that will help to dramatically reduce the number of mothers dying as a result of childbirth,” said Professor Klaus Dugi, Chief Medical Officer, Ferring Pharmaceuticals. “Our heat-stable carbetocin is just one example of this research effort and forms part of our ongoing commitment to safeguarding the health of families worldwide. We are looking forward to seeing the results from the CHAMPION trial and hope that the learnings will usher in a new era in the prevention of PPH.”

If the results of the CHAMPION trial are favourable, Ferring will seek registration of heat-stable carbetocin on a broad basis around the world. If approved, Ferring would manufacture the product and it would be provided to the public sector of low- and lower-middle-income countries at an affordable and sustainable access price. Results from the trial are expected to be presented and published during the second half of 2018.

The CHAMPION trial has the potential to change the paradigm in how we save more mothers from dying during childbirth,” said Julie L Gerberding, MD, MPH, Executive Vice President & Chief Patient Officer, Strategic Communications, Global Public Policy and Population Health at MSD. “Along with our partners, we recognized that heat-stable carbetocin could be a transformative solution to preventing PPH, which is the number one cause of maternal mortality.  Through MSD for Mothers, we provided our company’s scientific expertise and financial resources to prove the concept and ultimately make a sustainable impact on the health of mothers, families and communities.”


  1. Say L. et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun;2(6):e323-33.
  2. Australian New Zealand Clinical Trial Registry. Available at: Last accessed: January 2018.
  3. Widmer M. et al. Room temperature stable carbetocin for the prevention of postpartum haemorrhage during the third stage of labour in women delivering vaginally: study protocol for a randomized controlled trial. Trials. 2016;17(1):143. doi: 10.1186/s13063-016-1271-y.
  4. World Health Organization. Priority diseases and reasons for inclusion. Postpartum haemorrhage. Available at: accessed: January 2018.


TB vaccine trial results offer potential for BCG revaccination

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Study is the first ‘prevention of infection’ trial conducted for tuberculosis, the world’s leading infectious disease killer.

Aeras, a nonprofit organisation dedicated to developing vaccines against tuberculosis (TB), has announced results from an innovative clinical trial that provides encouraging new evidence that TBvaccines could prevent sustained infections in high-risk adolescents.

In a prevention-of-infection Phase 2 trial conducted in South Africa, revaccination with the Bacille Calmette-Guerin (BCG) vaccine significantly reduced sustained TB infections in adolescents. An experimental vaccine candidate, H4:IC31, also reduced sustained infections, although not at statistically significant levels. However, the trend observed for H4:IC31 is the first time a subunit vaccine has shown any indication of ability to protect against TB infection or disease in humans.

TB infections that developed during the study were determined using a QuantiFERON-TB Gold in Tube (QFT-GIT) test, a commercially available blood test that helps diagnose TB infections. In the trial, individuals who tested negative for QFT-GIT were considered to not have a TB infection. The trial measured the rate by which individuals converted to QFT-GIT positive, implying evidence of TB infection. Those individuals who tested QFT-GIT positive consecutively over 6 months were considered to have a sustained infection.

According to the World Health Organization (WHO), about one-third of the world’s population has what is called a latent TB infection, which means people have been infected by TB bacteria but are not (yet) ill with the disease and cannot transmit the disease. People infected with TB bacteria have a lifetime risk of falling ill with TB of 10 percent. People ill with TB can infect 10-15 other people through close contact over the course of a year. Without proper treatment, 45% of HIV-negative people with TB on average and nearly all HIV-positive people with TB will die.

Dr Mark Hatherill, Director of the South African Tuberculosis Vaccine Initiative (SATVI) at the University of Cape Town, and the study’s principal investigator, said: “We are pleased to have performed the first-known randomised, placebo-controlled prevention-of-infection trial for TB and to have demonstrated that vaccination has the potential to reduce the rate of sustained TB infection in a high-transmission setting. While neither vaccine proved to be statistically significant in preventing an initial TB infection, we are extremely encouraged by the signals observed for both vaccines in preventing sustained TB infections. We believe the results from this novel trial design will provide significant scientific benefit to the field in understanding TB infection, and based on this positive signal, we look forward to testing the potential of such vaccines to prevent TB disease among uninfected adolescents in a larger, more traditional prevention-of-disease clinical trial.”

The study evaluated H4:IC31 vaccination and BCG revaccination for safety, immunogenicity and the ability to prevent initial and sustained TB infections among healthy adolescents in the Western Cape Province of South Africa. H4:IC31 is an investigative subunit vaccine candidate being developed jointly by Aeras and Sanofi Pasteur, the vaccines business of Sanofi (EURONEXT: SAN) (NYSE: SNY), and the Statens Serum Institut. BCG is the only licensed tuberculosis vaccine available globally. The clinical trial was conducted at SATVI and at the Emavundleni Research Centre (part of the Desmond Tutu HIV Centre). It was funded by Sanofi Pasteur, the United Kingdom’s Department for International Development, and Aeras. The study was approved by the Medicines Control Council of South Africa and the relevant local independent ethics committees.

Dr Linda-Gail Bekker, a lead investigator for the trial, the Chief Operating Officer at the Desmond Tutu HIV Foundation and President of the International AIDS Society, said: “We would like to thank all the study participants and their families for participating in this novel clinical trial. We believe the results are important and warrant further investigation into other subunit vaccines and a reevaluation of BCG revaccination as a potential strategy to prevent TB in high-incidence countries. An effective TB vaccine remains an urgent global goal.”

Dr Jacqui Shea, CEO of Aeras, stated: “New TB vaccines are essential to end this deadly epidemic, especially with the rise of drug-resistant strains. In this innovative study, we not only observed important results for BCG, we also saw the first early efficacy signal against infection to be shown by a subunit TB vaccine candidate (H4:IC31). Further, we established that the novel prevention-of-infection trial design has the potential to provide evidence of a biological signal earlier and at lower cost than traditionally designed TB vaccine prevention of disease efficacy studies. The data collected will inform the next series of clinical studies as well as enable the search for correlates of protection against sustained infection. Later this year, Aeras and its partners look forward to announcing primary results from a Phase 2b prevention of disease trial with M72/AS01E, another subunit vaccine candidate, and to commencing two Phase 2 clinical trials with an additional, promising subunit vaccine candidate.”

The study involved 990 HIV-negative, healthy adolescents (12 to 17 years of age) who had been vaccinated as infants with BCG. All participants were randomised evenly into three study arms: placebo, H4:IC31, or BCG revaccination. All participants were screened to ensure they were not infected with Mycobacterium tuberculosis (Mtb) prior to vaccination in the study. At the outset of this innovative proof-of-concept study, statistical significance was set at one-sided p<0.1 to favor the risk of observing a false positive efficacy signal rather than a false negative.

The data showed that both vaccines appeared to be safe and produced an immune response in the adolescents studied. No vaccine-related serious adverse events were reported in the study, and the most common vaccine-related adverse event was injection site swelling in BCG revaccinated participants, typical for BCG vaccination.

For the primary efficacy endpoint, 134 participants tested positive for an initial Mtb infection as measured by QFT-GIT conversion from negative to positive (placebo=49; BCG=41; H4:IC31=44). When compared to placebo, neither vaccine achieved statistical significance in preventing an initial QFT-GIT conversion. Observed vaccine efficacy was 20.1% (p=0.15) for BCG revaccination and 9.4% (p=0.32) for H4:IC31.

For the secondary efficacy endpoint, 82 participants exhibited a sustained QFT-GIT conversion lasting at least 6 months following initial conversion (placebo=36; BCG=21; H4:IC31=25). These participants were evaluated to see if they would revert to negative as measured by the QFT-GIT test. In the BCG revaccination arm, the vaccine efficacy for preventing a sustained infection was 45.4% (p=0.013) and in the H4:IC31 arm the vaccine efficacy was 30.5% (p=0.08).


Albendazole-antibiotic combination shortens therapy for parasitic diseases

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Researchers have found a way of reducing the treatment required for lymphatic filariasis and onchocerciasis from several weeks to seven days.

Researchers have found a way of significantly reducing the treatment required for lymphatic filariasis and onchocerciasis from several weeks to seven days.

By targeting Wolbachia, a bacterial symbiont that the filarial parasites need to live, the team has discovered a drug synergy that enables effective treatment over a shorter time.

Researchers provide proof-of-concept of a radical improvement to the targeting of Wolbachia via a drug synergy between the anthelmintic drug albendazole and antibiotics.

As part of the A*WOL programme, we have screened all registered drugs for anti-Wolbachia activity, which has allowed us to look at repurposing existing and registered drugs against these debilitating conditions.

The combination of an antibiotic and the anti-worm drug albendazole provided the greatest surprise when they acted synergistically to reduce the treatment time from weeks to days, opening up the opportunity to scale-up this approach at the community level” said Professor Mark Taylor from the Liverpool School of Tropical Medicine.

The team believe that their work is of immediate public health importance because the drugs that have been used, rifampicin and albendazole, are already registered. “These drugs can be tested in infected people as soon as possible,” continued Prof Taylor.

Dr Joe Turner, LSTM first author on the paper, added, “The discovery of drug synergy between a common anthelmintic and different classes of antibiotics is also exciting because even more, potent synergism may be evident when we combine with our next generation, ‘designer’ anti-Wolbachia drugs currently in development as part of the A*WOL programme. Potentially, we may be in a position to reduce curative treatment time frames down to five days or less for filariasis, with better acceptability and reduced costs for patients and local health systems”

What is Lymphatic filariasis?

Lymphatic filariasis (LF), which can cause elephantiasis or hydrocele, swelling of the limbs or scrotum and onchocerciasis, also known as river blindness affect millions of people in some of the world’s poorest communities. Both are caused by filarial parasites for which the bacterial symbiont Wolbachia is essential for development.

Filarial Neglected Tropical Diseases are prioritised for elimination, in line with fulfilment of the 2030 United Nations Sustainable Development Goals. A consensus of expert opinion, including the WHO, and major donors, USAID and UK DFID, considers that successful implementation of a macrofilaricidal or permanent sterilising drug would greatly accelerate the endgame elimination of lymphatic filariasis and onchocerciasis.

Traditional treatment for these conditions require repetitive, long-term mass drug administrations, and although targeting the symbiont with doxycycline has proved clinically effective, it is programmatically challenging due to the long treatment time and exclusion of pregnant women and children.


Sanofi plans summit to tackle diabetes in 5 million Nigerian citizens

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Sanofi Aventis Nigeria plans to put together a National Diabetes Summit to address crisis in the country as five million of the nation’s citizens currently live with the condition.

Health professionals gathered to discuss the situation at a press conference in Lagos to herald the first incarnation of the summit, highlighting the need for immediate action.

“According to WHO as at 2014, we have a burden of 387 million globally but in 2035, the number will increase to almost 600 million,” remarked Dr Philip Ikeme, Medical Director, Sanofi – Nigeria & Ghana. “People no longer exercise that means there is increase in obesity and when obesity sets in, the ability to manage the blood sugar becomes more difficult. Things like this push us towards the diabetic end of the spectrum.”

Ikeme blamed the growing public consumption of artificial foods and the propagation of unhealthy lifestyles, adding that as much as half of cases of the condition go undiagnosed, while half of those that do have the condition are unaware of it. Because of this, patients who, on average, have unknowingly had the disease for 15-20 years will have suffered blood sugar abnormalities a minimum of 5-10 years by the time they approach a health professional, which causes the majority of patients to experience complications by the time of diagnosis. To combat this, he called for regular screening to identify the disease.

Just three years ago, Nigeria had a lower incidence of diabetes in the region compared to South Africa and Ethiopia, but this has since risen to make the country with the highest burden of the disease in Sub Saharan Africa.

Sanofi’s summit will combat this by sharing the latest diabetes management techniques with specialist doctors, nurses, family physicians, diabetologists and other experts.

“Diabetes is not a disease you can cure but can be treated and managed. If treated well, the patients will have a normal life like anybody else. It is also a disease where patients have more responsibility than the physician,” Ikeme added.


Epidemic preparedness: Protecting the world from the next infectious disease

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Dr Richard Hatchett, CEO of the Coalition for Epidemic Preparedness, details the lessons learned from the Ebola outbreak and the urgent need to equip the world to face future epidemics.

How did CEPI come about?

CEPI was formally established at Davos 2017 in January, and initially with funding close to $500 million, provided by five major investors. The original investors were the Wellcome Trust and the Bill & Melina Gates Foundation, and three sovereign investors: Germany, Norway and Japan. We also received the extensive support of the World Economic Forum and the government of India as additional founding partners.

About a year’s worth of prior planning had gone into setting CEPI up; the day that it was formally established, we also issued our first call for proposals to develop vaccines against three high-priority pathogens – Mers, Lassa and Nipah. These pathogens have been identified by WHO on a shortlist that was published as part of their R&D blueprint, as part of their action against epidemic diseases.

CEPI has had a tremendously active year – we’re still very much in our initiation stage. I came on board as CEO in the middle of April and the major activities have been centred around building the organisation, developing a more structured internal organisation chart. When I was appointed at the February board meeting, the initial charge to me was to come back with some revisions to CEPI’s governance, which was specifically and explicitly an interim government structure designed for the initiation stage. The board recognised that the needs of the organisation would evolve over time and so they asked me to come back with recommendations as we move towards a steady-state phase.

How did the collaboration with sovereign investors arise and how many more countries do you hope to get on board?

Currently, the original investors all have well-established connections to global public health – both philanthropic and the sovereign investors. Norway and Germany play outside roles in supporting global public health, and Japan has major commitments in this area, having long made investments in epidemic preparedness. Norwegian scientists and public health officials were instrumental in the only clinical trial for a vaccine during the Ebola crisis that generated definitive data on efficacy – that was the trial that took place in Guinea.

There was a global consensus that things did not go well with Ebola and that we didn’t want to be in a position again where we had vaccines that were almost ready but not quite. There was a real commitment to ensuring that we could buy the world a better insurance policy.

We’ve been actively engaged in further resource mobilisation efforts, and have had three further countries sign up to the coalition: Australia, Belgium and Canada. The collective commitment of these countries is smaller than the original investors and is, initially, limited to one year of investment but we are in active discussions to further this agreement with them. We are pursuing agreements with a number of sovereign partners and hopefully will be able to make announcements in the not too distant future about additional funding.

At present, we have secured $620 million towards our initial funding goal of $1 billion dollars. With the exception of the three smaller investments mentioned, all of our investors have committed to a five year agreement. To be clear, the $620 million will be used over a five-year time horizon.

What is the driving force behind CEPI?

I think Ebola is a really good illustration of the risk epidemic diseases represent and the unpredictability of that risk. Ebola is a disease that we’ve been familiar with for forty years, with around 30 outbreaks over this period. Some of these outbreaks had been fairly large, with the most significant causing around 400 deaths. However, all of those outbreaks had been contained within several months and it’s possible that the world had become a little bit complacent over Ebola. We hadn’t realised the importance of the social milieu and context to whether the outbreak would propagate. What happened in West Africa was there was a disease, which we thought we understood and thought we could control, which got into an environment where public health systems were poor but the road networks were good and the populations were concentrated. Suddenly, a disease that we thought we understood completely exploded.

There are other diseases, like Mers, Lassa and Nipah, that have been manageable to date but have characteristics that make them scary. We’ve seen this in quite public ways, for example in the epidemic in South Korea, where an individual instance gets into the hospital environment and becomes a super-spreader – suddenly, one case becomes a hundred cases. We went through a very careful selection process looking at the diseases on the WHO R&D blueprint list, thinking about their potential for outbreaks and the impact that they might have, as well as the likelihood that vaccines could be successfully developed. We went through a comprehensive screen of all the 11 diseases on the WHO list and mapping against those two dimensions, we prioritised the three diseases we are now focused on.

Is there now a growing concern over the threat infectious diseases pose?

There is a strong sense among public health officials, and there is data to back this up, that the tempo of these disrupting epidemics is increasing and it relates to many factors: growing population, intrusion into previously remote areas, better transportation networks, and greater concentrations of populations. We’ve seen the potential for, not just potential loss of life, but also significant disruption of national economies by epidemic diseases. All of these factors converge to increase the risk to a level greater than it has been previously. There’s always the risk that there will be a diseases that hasn’t had much focus, such as Zika or a new disease, to emerge and spread rapidly.

How is CEPI helping the world to prepare for such an eventuality?

We talk about our investments in terms of two categories: ‘just-in-case’ and ‘just-in-time’. Investments against Mers, Lassa and Nipeh, are ‘just-in-case’ investments, where we want to advance these vaccines to bring them much closer to being ready to deploy, either into clinical trials or emergency use authorisation.

Our investment in rapid-response platforms are part of the ‘just-in-time’ approach. The only vaccine platform that has been accepted by regulators is the influenza platform because they have to manufacture a new influenza vaccine every year. The regulators have become very comfortable if you swap in a new flu virus antigen, then they’ll accept the vaccine with a defined, but limited, amount of testing.

In 2009 in the US, it took about 26 weeks from the identification of H1N to the first doses of vaccine becoming available to the general public. At this time, there weren’t enough vaccines for the public before the late autumn wave of incidents had already come and gone. This means that even in influenza 26 weeks is not a long enough period of time to develop a vaccine and that’s on a platform that we are already familiar with.

Ebola began in late 2013 and really imprinted itself in the world’s consciousness in April/May time and then accelerated through the summer. The first large-scale clinical trials for an Ebola vaccine began in West Africa in early 2015, by that time the epidemic had basically been brought under control. The Ebola vaccines that entered clinical trials had been under development for the better part of a decade and had been developed not for epidemics but to combat the potential of bioterrorism. By the time things began to speed, there was over a decade’s worth of investment before they could be brought into clinical trials, and that was clearly too long.

That is the state of play today. CEPI wants to have these high-priority vaccines ready and sitting in stockpiles so that if there’s ever an epidemic then we can roll them right into clinical trials within weeks, not months or years.

Do we have a tendency to focus on the high-profile epidemics in high-intensity until they fade as a threat rather than being pre-prepared for emerging threats?

I think there has been a drum beat over the last 10 or 15 years, like SARS, Avian Influenza, Ebola, Mers, and Zika – you can’t predict the disease but there is a periodicity to threats emerging to global stability. There is a general awareness among global leaders across the political spectrum that infectious diseases pose global public health threats and security threats. Due to the latter risk, there is the possibility to secure sustained funding even when administrations change or political winds shift.

The concern with the general public is that infectious disease threats have a very limited hold on the public attention. When a public health threat is present or imminent they really want a vaccine but when the threat goes away, people tend to blot it out. Infectious diseases don’t knock buildings down, they just fill up graveyards. The memory of epidemics is very effervescent and that’s a problem when it comes to sustaining political will when it comes to preparedness.


Global campaign to reduce cholera deaths by 90%

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A new campaign, launched by the WHO, has begun today to reduce deaths from cholera by 90% through to 2030.

The action will be instigated by the Global Task Force on Cholera Control (GTFCC), which is a network of 50 UN and international agencies, academic institutions, and NGOs that work to help countries struggling the most with the disease.

The push comes at a time when war-torn Yemen is facing the worst recorded outbreak of cholera that the world has ever seen – with 771,945 reported cases and 2,132 deaths. Globally, there are 2.9 million cases and approximately 95,000 deaths every year from the infection.

Cholera predominantly affects areas that have poor access to clean water supplies and poor sanitation facilities, it is most common in the poorest areas of the globe (see map above). The infection is relatively simple to treat, with rehydration salts offering a quick solution, and there has also been vaccine developed that offers protection from the bacteria for three years at a time.

The oral vaccine itself is cost effective, working out at only $6 per person – a development that the WHO referred to the availability of two vaccines as a “game-changer in the battle to control cholera, bridging the gap between emergency response and longer-term control”.

Cholera itself is an acute diarrhoeal infection, caused by the bacterium Vibrio cholera. It spreads through the contamination of water or food with the bacteria, in areas with poor sanitation, it can spread rapidly.

As can be seen in the map above, the infection is isolated to a select group of countries, with 47 countries affected by cholera and in 20 of these the disease is endemic; the Roadmap put forward by the WHO aims to rid up to 20 of the infection.

“WHO is proud to be part of this new joint initiative to stop deaths from cholera. The disease takes its greatest toll on the poor and the vulnerable – this is quite unacceptable. This roadmap is the best way we have to bring this to an end,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO.

It is noted that Northern Europe and the US have managed to eliminate cholera 150 years ago. It is estimated that to provide all individuals with clean water, sanitation and hygiene the cost would amount to $40 per person.