For decades, Nigeria has struggled with recurring cholera outbreaks. More recently, climate change has exacerbated these outbreaks. This intersection is most pronounced in Nigeria's coastal cities, where the triple threat of rising sea levels, soaring temperatures, and unpredictable rainfalls has resulted in an increase in cholera cases.
The Lagos State Government declared a cholera outbreak on Sunday, June 9, 2024, after multiple suspected cases of cholera were reported. The Nigeria Centre for Disease Control and Prevention (NCDC) reported that as of June 24, at least 1,528 suspected cases and 53 deaths had been recorded across 30 states since January. Ten of the states that account for 90% of the cases are in southern part of Nigeria, along a coastal strip of swamps bordering the Atlantic Ocean.
Previous data also highlighted a disturbing trend -- cholera cases in coastal regions have increased by over 50% in the past decade alone. There appears to be a potential linkage between the effects of climate change on cholera incidence, turning what were once manageable issues into continuous emergencies.
The seasonality of cholera outbreaks
Cholera outbreaks in Nigeria often increase during the rainy season, which lasts from April to October annually. The heavy rainfall and subsequent flooding create conditions that are ripe for the spread of Vibrio cholerae the bacterium responsible for cholera. Floods often contaminate water supplies, especially in areas with poor sanitation leading to the rapid spread of the disease.
Data from the Nigeria Centre for Disease Control and Prevention (NCDC) revealed that the bulk of cholera cases are reported annually between June and September. For instance, in 2021, Nigeria experienced one of its worst cholera outbreaks in years, with over 110,000 reported cases and more than 3,600 deaths.
According to a study, climate change exacerbates the conditions that contribute to cholera outbreaks. A rise in global temperatures is also contributing to more extreme weather patterns, including heavier and more unpredictable rainfall. Coastal erosion and rising sea levels further exacerbate the already inadequate infrastructure in Nigeria's coastal cities, making them more susceptible to flooding.
Containing the spread
The primary goal of the cholera outbreak response is to contain the spread of the disease and lower mortality rate. To achieve this, the NCDC emphasised surveillance, infection prevention and control, care, and treatment.
Poor surveillance and response have contributed to the ongoing outbreaks with high rates of morbidity and death. Drawbacks to improving surveillance have been attributed to ineffective response and management of cholera outbreaks in Nigeria. Inadequate number of healthcare workers with limited training in emergency response, and limited supply of emergency response kits add to these drawbacks. To mitigate these, there must be concerted effort geared towards a coordinated and harmonised approach involving all needed components.
The continuous outbreaks of epidemics in Nigeria are significantly impacted by the country's response strategies. Rapid population growth necessitates that these response strategies evolve accordingly. If they do not adapt to the increasing population, they become largely inadequate, failing to effectively manage and control infectious disease outbreaks.
Local production of vaccines could be game-changing
According to the outcome of a risk assessment conducted in June 2024, Nigeria was classified as being at 'high risk' of increased cholera transmission. In response, the Federal Government is collaborating with Gavi, the Vaccine Alliance, to secure emergency vaccine donations to control the spread of cholera.
Sania Nishtar, CEO of Gavi, also announced that Gavi and other health partners in Nigeria are swiftly responding to the cholera outbreak, including a request for emergency vaccine doses. "The global cholera stockpile, which is funded by Gavi, is currently fully replenished and ready to help contain outbreaks and protect those at highest risks," Nishtar mentioned.
In addition, a Public-Private Partnership Vaccination Program (PVac) is in progress and is aimed at streamlining the production and distribution of cholera vaccines, ensuring timely and efficient responses to outbreaks. Insights reports from Nigeria Health Watch's social listening revealed that there is significant interest in the availability and cost of the cholera vaccine, reflecting a need for accessible vaccination information. As a result, strategies should be put in place to deal with misinformation and disinformation about the vaccination when they arise.
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While the vaccine will go a long way to contain the spread of the virus, strengthening infrastructure, enhancing climate resilience to prevent flooding, and fostering community engagement are essential steps in addressing the recurring cholera outbreaks. As climate change continues to alter the environmental landscape, proactive and adaptive measures will be crucial in safeguarding public health and preventing future outbreaks.
Cholera is primarily caused by poor hygiene, highlighting the significant work that state health authorities must undertake to prevent deaths from this preventable disease. To mitigate cholera outbreaks, it is essential to implement a multisectoral response anchored onthe One Health approach. This involves ensuring continuous health education, fostering community engagement, and providing safe water sources. By addressing these factors comprehensively, it would be possible to significantly reduce the incidence of cholera and safeguard the health of communities.
