Statement by the Steering Committee of the Global Task Force on Cholera Control (GTFCC)

April 30, 2020

The GTFCC Steering Committee urges countries to continue reactive vaccination campaigns and to resume preventative immunization with Oral Cholera Vaccine (OCV) in cholera hotspots during the COVID-19 response as soon as it can be done safely.

The novel corona virus pandemic has caused a worldwide strain on health systems that is unprecedented in modern times. This is a global crisis that calls for solidarity among all peoples as the world seeks solutions at community, subnational, national, and global levels. As part of our collective efforts to minimize the loss of human life from COVID-19, we must work to maintain essential health services and systems – including immunization – wherever possible.

To this end, the World Health Organization (WHO) has issued a statement, endorsed by the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE), outlining Guiding principles for immunization activities during the COVID-19 pandemic. While the need for social distancing requires the temporary suspension of preventive mass vaccination campaigns, the WHO guidance calls for these lifesaving campaigns to be resumed as soon as possible. In resuming vaccination campaigns, countries must conduct careful risk assessments and apply appropriate protective measures to avoid transmission of the COVID-19. It is imperative that immunization services be maintained and resumed—particularly for epidemic-prone diseases like cholera—as a highest priority.

As an oral vaccine administered using a single-dose vial, OCV is well-suited for innovative delivery approaches. It does not require skilled personnel for administration and can be provided through directly observed no-contact self-administration, a known practice limiting contact between vaccinators and recipients.

The GTFCC Steering Committee strongly endorses these innovative delivery approaches. Both preventive and reactive cholera campaigns have now been suspended in several countries, resulting in a high risk of cholera outbreaks. Cholera is a deadly disease with high outbreak potential and a significant case fatality rate – up to five percent in the most vulnerable settings. A cholera outbreak causes severe strain on health systems and would severely compromise—and be compromised by—the COVID-19 response. It is therefore critical to avert cholera outbreaks through immunization, now more than ever.

To this end, in alignment with the guidance from WHO and SAGE, the GTFCC Steering Committee calls on countries and partner organizations to safely maintain reactive vaccination during cholera outbreaks and to reinstate cholera preventive vaccination campaigns as soon as possible. We call on health system leaders to:

• Assess current conditions, the local dynamics of COVID-19 transmission, and the epidemiology of cholera in their specific settings, determining a way forward for cholera vaccination that is responsive to local conditions.
• Recognize that immunization delivery strategies may need to be adapted and adjust cholera campaign strategies accordingly so that physical distancing can be maintained. The cholera vaccine is an oral formulation, which allows for self-administration and safe delivery outside of health settings.
• Maintain and reinforce cholera surveillance to enable early detection and rapid response to cholera outbreaks. Oral cholera vaccine (OCV) is highly effective for prevention of cholera, but reactive campaigns are significantly less effective if implemented after the peak of the outbreak has passed.
• Ensure the provision of water, sanitation and hygiene services (WASH). Access to safe WASH is a necessity to limit the spread of cholera. Good hygiene practices will also significantly reduce the spread of COVID-19.
• Protect frontline health workers. Continued investment in and safeguarding of the health workforce is among the most critical health system investments. Ensure that health workers have adequate protective equipment, sufficient support, and are compensated in a fair and timely manner.
• Ensure demand for vaccination remains strong, through robust community consultation, education and information, and high-quality immunization services.

Like cholera, COVID-19 is likely to affect the world’s poorest and most vulnerable communities most severely. Our best support to these communities during this crisis must include a strong primary health care system, including immunization against deadly diseases like cholera.

For more information follow the GTFCC Secretariat on Twitter @SecGTFCC