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Recherche

The Cholera Roadmap Research Agenda identifies knowledge gaps and research questions that, when answered, will have a significant impact on achieving the 2030 Cholera Roadmap.

A cholera roadmap research agenda

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The GTFCC has established a Cholera Roadmap Research Agenda using the Child Health and Nutrition Research Initiative (CHNRI) approach. A prioritized list of cholera research questions was identified through consultations with 177 cholera experts and other stakeholders operating at global, regional and country levels.

The agenda provides a list of the 20 most pressing research questions, along with the top 5 priorities per Roadmap Pillar – oral cholera vaccine (OCV), water, sanitation and hygiene (WaSH), surveillance, and case management. In addition, it outlines the three highest priority areas for discovery research.

Top 20 questions

  • What are the barriers and enablers for integrating cholera treatment into community case management by community health workers?
  • What effect does treatment with antibiotics have on cholera transmission?
  • What is the optimal treatment schedule for antibiotic prophylaxis given to household contacts of cholera patients, and does this have an effect on the magnitude, transmission, and secondary attack rate of cholera outbreaks?
  • What are the common cholera treatment complications in vulnerable populations (for example: pregnant women, the elderly, those with severe acute malnutrition)?
  • Would rehydration solution for malnutrition (ReSoMal) formulated with higher sodium, or standard oral rehydration solution containing high potassium, result in lower mortality or morbidity compared to the standard WHO rehydration solution, in children with severe acute malnutrition?

  • What is the impact of early diagnosis of cholera using a rapid diagnostic test at the point of care in a community setting compared with testing only in health facilities?
  • How can we improve and fine-tune hotspot definition and identification at a district and sub-district level?
  • What are the optimal designs for surveillance systems (e.g., indicator-based, event-based, community-based, environmental, sentinel site surveillance) to monitor progress of the Cholera Roadmap?
  • What are the optimal surveillance tools (e.g., laboratory methods, case definitions, etc.) to monitor progress of the Cholera Roadmap?
  • How can combined epidemiological and genomic analysis of V. cholerae be used to better understand transmission dynamics and inform epidemiological models?

  • What are the optimal oral cholera vaccine schedules (number of doses and dosing intervals) to enhance immune response and clinical effectiveness in children 1 to 5 years of age?
  • What are potential delivery strategies to optimize oral cholera vaccine coverage in hard-to-reach populations (including during humanitarian emergencies and areas of insecurity)?
  • What is the optimal number of doses of oral cholera vaccine to be used for follow-up campaigns in communities previously vaccinated with a two-dose schedule?
  • Can the impact of oral cholera vaccine on disease transmission, morbidity, and mortality be maximized by targeting specific populations and/or targeted delivery strategies?
  • What impact does the timing of oral cholera vaccine use have on prevention and control of an outbreak?

  • What level of coverage for relevant water, sanitation, and hygiene interventions is required in cholera hotspots to control and ultimately eliminate the risk of cholera?
  • What are the most essential (or what is the minimum set of) infection prevention and control (IPC) interventions in cholera treatment facilities and oral rehydration points to reduce risk of transmission within these facilities?
  • Is improved access to safe water (e.g., water points and distribution networks) effective in controlling and preventing cholera outbreaks?
  • How can “design thinking” be used to improve the delivery and uptake of water, sanitation, and hygiene interventions? Design thinking focuses on understanding the needs of people who will use the intervention and working with them to improve it.
  • What are the factors and determinants that lead to sustainable investments in water, sanitation, and hygiene at the country level?

GTFCC partners

The GTFCC partners call on all stakeholders to use the Cholera Roadmap Research Agenda to advance our collective effort in ways that are suitable and beneficial to their role.

Download the full report with methodology
Download the executive summary

Researchers

Use the Research Agenda to prioritize design and execution of research activities

Donors

Fund research projects that will have the most impact on practice and policy

National Policy-Makers

Incorporate research priorities, goals and findings into National Cholera Plans (NCPs)

Programme implementers

Incorporate research priorities, goals and findings into operational plans

These efforts will provide more effective tools and strategies and a stronger evidence base to accelerate progress towards the goals of the Cholera Roadmap and, ultimately, towards a world free from the threat of cholera.

Words from cholera responders

The GTFCC is a unique platform getting together worldwide cholera experts of different backgrounds, and as such provides tremendous opportunities for networking and planning cholera research. Discussions on the platform reflect the need for research and is a useful insight in priorities, and it participated to help us design meaningful cholera research projects. It also allows meeting other researchers and national stakeholders, facilitating the partnerships and study implementations. Moreover, it is a great platform where to share results to get experts’ feedback and maximize the study impact.

Since the creation of the GTFCC research team, we have received valuable support for organizing scientific meetings that bring together all cholera researchers in the DRC. Such a platform is crucial to ensure that research findings are effectively translated into national strategies, actions, and guidelines.

These meetings have enabled the DRC to use research evidence to shape key policies. For example, we shifted from a targeted vaccination approach to covering entire health districts, integrated the use of Oral Cholera Vaccine (OCV) into the CATI intervention package, established water quality monitoring systems in several regions based on WASH assessments, and incorporated rapid diagnostic tests (RDTs) into routine cholera surveillance following study results.

In each of these cases, research has been instrumental in informing and improving national strategies, ensuring that actions are evidence-based and aligned with the latest findings.

The GTFCC has been working with Wellcome over the last 7 years to build and implement the GTFCC Cholera Roadmap Research Agenda. This was developed in consultation of 177 experts from the cholera community and has been a critical tool to elevate and prioritise evidence needs of policy makers. The agenda is also used as a starting point to co-evolve and develop research projects, such as the funding call Wellcome ran in 2023. This resulted in  six  projects funded to generate evidence on the use of OCV with all projects engaging with policy makers from the very start, to help shape the research and ensure that evidence generated is relevant for policy, practice and action. The research agenda has also helped to enable complementarity between funders and avoid duplication.

The GTFCC has provided an environment for policy makers to highlight the most pressing evidence gaps which has a direct impact on the research conducted to be more targeted to have a timely impact on cholera control.