The year cholera came roaring back

In early 2025 the maps started to fill in again. Clinics from the Sahel to the Caribbean reopened cholera beds. Buckets lined up outside crowded tents. In some cities the taps ran brown after storms. In others there was no piped water at all, only drums on rooftops and tanker trucks that skipped the alleys where the poorest live. What mattered was not a single country or headline. It was the rhythm: heavy rain, broken pipes, crowded shelters, then a quick climb in watery diarrhoea and lab confirmations that pushed health teams into emergency mode. The numbers that followed were hard to brush aside. From January through June 2025, countries reported more than 305,000 cholera cases and 3,500 deaths, with the World Health Organization warning that the surge was still concentrated in three regions and that June alone saw 62,330 new cases across twenty countries. World Health Organization

Behind the curves is a simple supply problem. The world does not keep enough oral cholera vaccine on the shelf for the size and speed of these outbreaks. In June 2025 the global emergency stockpile averaged 2.9 million doses, below the 5 million floor WHO considers necessary to respond fast. That shortfall is why the international group that manages the stockpile moved to single-dose campaigns during emergencies, a policy shift that started in late 2022 and still holds when supplies tighten. Single doses save lives quickly and buy time, but they do not protect as long as the original two-dose schedule. World Health OrganizationIFRC

Manufacturers are trying to catch up. In April 2024 WHO prequalified Euvichol-S, a simplified version of the main vaccine that is faster to make. By mid-2024 the producer reported lifting annual capacity to the tens of millions of doses, helped by process changes and larger fermenters. UNICEF and Gavi framed the new formulation as a way to grow volumes and cut costs, and there are plans to expand preventive use once supplies stabilize. The problem is timing. Outbreak demand keeps outpacing production, so the cupboard dips just when countries ask for the most. UNICEFGavi

Look at where the disease is moving. In the African region, WHO tallied active transmission in seventeen countries as of March, with the DRC, Ethiopia, Nigeria, South Sudan, and Zimbabwe accounting for most cases and deaths since 2024 began. By late March the region had logged 246,896 cases and 4,626 deaths since January 2024, and March case counts rose nearly fifty percent over February. That is not weather alone. It is displacement, weak water systems, and the cost of clean water in places where incomes are falling. Iris

Country snapshots show how the drivers vary but the outcome is the same. Zimbabwe reported a resurgence at the end of 2024 and had 740 cumulative cases and 20 deaths by April 30, 2025, with health teams leaning on chlorination, bucket stands, and targeted vaccination where doses were available. Zambia peaked in late January, with border districts reporting clusters linked to markets and transport hubs. Haiti kept detecting localized outbreaks in 2025 after nationwide spread in 2022–2023, a pattern that flares when violence traps families in neighborhoods with unsafe water and blocked clinics. UNICEFReliefWebPan American Health Organization

Zoom back to the global view and the signal is clear. WHO’s July 24 situation report counted a sustained surge from 28 countries across the Eastern Mediterranean, African, and South-East Asia regions. Deaths dipped slightly in June compared to May, but remained high, and the agency noted that the stockpile had fallen below the emergency level for the first time in six months. In plain terms, countries are asking for more doses while the shelf is getting bare. World Health Organization

This is not a story that ends at the vaccine warehouse. Cholera is a textbook WASH disease. Pipes that leak, latrines that flood, and tanker water that is not chlorinated will keep feeding outbreaks no matter how many vials move through airports. But the vaccine gap sets the tempo of the response. When there are enough doses, campaigns can ring hotspots, push two doses in stable areas, and bend the curve before rains or conflict make things worse. When there are not, teams stretch a single dose as far as it will go and hope the next shipment arrives before the lines at rehydration points get longer. WHO CDN

The path forward is unglamorous and measurable. Keep the stockpile above five million through the peak months, not just on paper but in pallets ready to ship. Use the new Euvichol-S volumes to restart preventive campaigns in known hotspots instead of waiting for explosive spread. Pair every campaign with chlorine distribution, water trucking standards, and real-time water quality checks so the gains last. And publish district-level case and death curves weekly so people can see if the line is bending after each intervention. None of this is novel. All of it can be tracked. World Health OrganizationUNICEF

Key facts to cite in your piece

• Jan–Jun 2025 global tally: 305,903 cases and 3,522 deaths from 28 countries; 62,330 new cases in June alone. OCV stockpile 2.9m in June, below the 5m floor. World Health Organization
• Feb 2025 snapshot: 70,488 cases and 808 deaths through Feb 23; stockpile averaged 5.5m but demand still exceeded supply. World Health Organization
• 2024 global total: 804,721 cases and 5,805 deaths across 33 countries. ReliefWeb
• Africa regional burden since 2024 start: 246,896 cases and 4,626 deaths to Mar 30, 2025; transmission active in 17 countries. Iris
• Zimbabwe 2025: 740 cumulative cases and 20 deaths by Apr 30, 2025. Zambia peaked late Jan 2025. Haiti continued localized outbreaks in 2025. UNICEFReliefWebPan American Health Organization
• Vaccine supply trend: single-dose emergency policy since Oct 2022; Euvichol-S prequalified Apr 2024 to speed output; producer reports capacity increases to help close the gap. IFRCUNICEFGavi

The year cholera came roaring back

The path forward is unglamorous and measurable. Keep the stockpile above five million through the peak months, not just on paper but in pallets ready to ship.