The perfect storm: cholera, climate change and poor water and sanitation

As the dust of Hurricane Matthew settles in Haiti, increases in cholera cases are taking centre stage. The country already faces one of the highest rates of cholera in the world, so the impact of the hurricane on cholera shows that not investing enough in water and sanitation undermines disease control efforts following a disaster. And it’s always the poorest populations who are most at risk of disease.

A relatively neglected condition on the global health agenda, cholera has been steadily rising since the beginning of the millennium, re-emerging in many countries in epidemic proportions. Frequent and protracted outbreaks, emerging drug-resistant strains, climate change and a lack of progress in improving people’s access to water and sanitation are creating the perfect storm for cholera to flourish.

It is not a new or surprising fact that safe water and good sanitation and hygiene are central to the prevention and control of cholera. Rewind to 1854 when British physician John Snow famously traced the source of a cholera outbreak in London to the Broad Street water pump. This proved that the disease was transmitted through water. Over a century and a half later, inadequate progress in improving access to safe water, improved sanitation and hygiene continues to hinder efforts to prevent and control cholera in the poorest regions of the world.

To date, efforts have focused mainly on providing medical interventions in response to outbreaks. Much less attention has been directed towards investing in the long-term prevention of disease through improvements in water and sanitation infrastructure, and changing people’s hygiene behaviour. As a result, countries and populations vulnerable to cholera face the same challenges year after year, which can be exacerbated by extreme weather events – as seen in Haiti. Compounded by growing evidence that climate change is playing an ever-increasing role in the global resurgence and redistribution of cholera, the need to build long-term resilience by investing in universal access to water, sanitation and hygiene is more urgent than ever.

A new WaterAid brief highlights why investments in water and sanitation must be at the centre of a multi-faceted approach to overcoming cholera. It outlines the short-, medium- and long-term actions necessary for us to prepare for, respond to and control cholera. These include:

1. Strengthen the cholera response in the short term by: ensuring hygiene promotion forms a central component of the response to the disease. For example, by promoting good hygiene practices to communities at the same time as administering oral cholera vaccines. 
2. Adequately prepare for cholera over the medium term by: strengthening health systems, through improving water, sanitation and hygiene in healthcare facilities; and enhancing disease surveillance. In addition, ensure water, sanitation, hygiene and health considerations related to cholera are integrated into national climate policy, and identify opportunities where climate finance could be used for cholera control.
3. Improve cholera control over the long term by: investing in water, sanitation and hygiene infrastructure; encouraging communities to adopt more hygienic behaviour; and identifying opportunities to ensure health considerations such as cholera inform the prioritisation of urban planning and other large-scale WASH projects.

Megan Wilson-Jones tweets as @MegsWJ