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In the past year, cholera has returned to the fore as a public health disease of concern, with current outbreaks being battled in 22 countries across three continents, more than half of which are African countries.

What is cholera, and how can it be avoided? Can it be treated

Cholera is an acute diarrheal infection characterized by watery diarrhea and potentially fatal dehydration. It is caused by ingesting food or water that is contaminated with the bacterium Vibrio cholerae. It has a short incubation period ranging between two hours and five days.

However, it can be avoided or treated.

Avoiding cholera means avoiding poor sanitation and hygiene, and therefore ensuring quality water infrastructure. Avoiding humanitarian crises and conflict is also key, as this complicates their containment.

Treating cholera often involves rehydration and the use of antibiotics, but there is also a vaccine (Oral Cholera Vaccine (OCV)) which is ideally offered as a two-dose therapy, and can help avoid fatalities.

How big is the current outbreak and how many countries are affected?

This is one of the largest recorded global cholera outbreaks in decades. As of February 21st 2022, the global total of suspected cases was over 1.22 million with an estimate of 3,065 recorded deaths. However, since most cases are not reported, some studies estimate that typically around 2.9 million cases and 95,000 deaths occur annually.

12 African countries are currently affected: Cameroon, DRC, Ethiopia, Kenya, Malawi, Mozambique, Niger, Nigeria, Somalia, South Sudan, Tanzania, and Zambia. These countries are registering just 7% (96,636) of the global suspected cases but over 70% (2,169) of cholera-related deaths. In other words, this outbreak has a higher case-fatality ratio of 2.04% average in Africa, compared to an estimated 1.45% average globally.

Is there adequate deployment of cholera vaccines in countries that require them?

There are currently seven types of OCVs and primarily manufactured in six countries by six companies: the Republic of Korea (Euvichol by EuBiologics Co.), France (Dukoral by Valneva), China (OraVacs by United Biotech), India (ShanChol by Shantha Biologics, a subsidiary of Sanofi-Pasteur and HillChol by Bharat BioTech), Vietnam (mORCVAX by Vabiotech) and the United States (Vaxchora by Emergent BioSolutions).

But the WHO currently only deems two of the seven vaccines good enough for distribution in its global health programs – ShanChol and Euvichol.

On the African continent, ShanChol is currently manufactured in three countries: Algeria, Egypt, and South Africa. However, a 3-year process is already in train to phase out all of its production in these countries by the end of 2023. On the other hand, additional manufacturing investments in an OCV on the continent is reportedly in train, e.g., by Biovac, a South African based pharmaceutical company, supported by Wellcome and the Bill & Melinda Gates Foundation.

Is it costly to buy these vaccines?

OCVs can cost the same or lower than COVID vaccines. Pre-COVID prices for OCV (plastic packaging) were recorded by UNICEF in 2018 at US$ 1.2–1.3 per single dose, and have since increased post-COVID to US$ 1.1–1.65 per single dose in 2023. Glass-packaged doses went up from US$ 1.85 per single dose in 2018 to US$ 3.13–4 in 2023.

In comparison, the COVID vaccine costs varied between US$ 0.3 – 5.5 for single doses across a selection of manufacturers in 2021/22.

How many vaccines are available, and how many are needed?

Eight of the affected African countries have already launched OCV vaccination campaigns  –Cameroon, DRC, Kenya, Niger, Nigeria, Malawi, Mozambique and Somalia. In addition, these affected states are engaging in measures such as establishing task forces to improve OCV spread and acceptance, healthcare staff training, and introducing new water, sanitation and hygiene campaigns and initiatives.

However, current vaccine campaigns require around 1.5 – 2 million doses per country to attempt coverage of the most at-risk populations (90-100% of persons) in hotspots. That would imply for Africa, for example, that at least 18 million doses are required asap, through purchase or distribution through WHO and others.

However, the coverage is highly inconsistent. In 2021, African countries received 15.6 million doses in total; received 16 million doses in 2022; and so far in 2023, Mozambique has received over 719,000 doses and about 4.8 million doses for Malawi.

Part of the reason for the inconsistency is that only 36 million doses were projected to be produced in 2022 globally – this is insufficient. Emergency stockpiles are only growing slowly and are projected at 6 million doses this month – African countries are at the back of the queue. On October 20th, 2022, members of the International Coordinating Group (ICG) – IFRC, MSF, UNICEF, and WHO – took the unprecedented decision to temporarily limit all reactive OCV campaigns to one single dose so that they can spread doses further, even though the protective period will be shorter. This may help but could create more inconsistencies.

What more needs to be done?

Cholera can be contained. But the higher death rate in African countries suggests treatments and vaccines are simply not getting to where they need to. Part of this is due to a lack of production on the continent, plus low levels of global vaccine production.

Addressing this will therefore require additional manufacturing pacts between African states and other OCV brands / manufacturers, such as OraVacs in China; as well the WHO working to swiftly approve more OCV types to improve global supply.

In the long-term however, vaccines are not the panacea. Cholera will only be really addressed by higher and consistent investment in water and other infrastructure in all countries.

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Research Analyst

Edmond is a research analyst who is passionate about sustainable development, innovation, and the environment. Passionate about climate financing, he firmly believe there is a more reliable system to promote equality, growth, and welfare in societies without affecting the ecosystem. Through his skills, knowledge and experienced gained over 7 years, he wants to make an impact in the world of development. Edmond holds a Master’s Degree in Public Policy from Korea Development Institute and a BA Degree (Honors) in Business from University of Derby.


    Founder and CEO

Hannah Ryder is the Founder & CEO of Development Reimagined. A former diplomat and economist with 20 years of experience, named one of 100 most influential Africans in 2021, she is also Senior Associate for the Africa Program of the Center for Strategic International Studies (CSIS), sits on the Board of the Environmental Defence Fund, and is a member of UAE's International Advisory Council on the New Economy. Prior to her role at DR, Ms Ryder led the United Nations Development Programme (UNDP)’s work with China to help it scale up and improve its cooperation with other developing countries, including in Africa. She has also played various advisory roles for the UN and OECD and co-authored the seminal Stern Review of the Economics of Climate Change in 2006.


Deputy Director

Leah Lynch is Deputy Director of Development Reimagined (DR), and head of the China office. Leah has over 10 years of experience in development and has lived in China for over 8 years. Leah has also travelled extensively around Asia and Africa for research. Leah supports the strategic direction of the team across China, with a mission to deliver high quality research on sustainable development and poverty reduction. Leah is also Chair of the Sustainability Forum at the British Chamber of Commerce in China, providing direction on sustainability initiatives for British and Chinese business. Leah has also consulted on various evaluations on UK aid (ICAI) and is a specialist on development cooperation from the UK and China. Leah has also consulted on various UN projects, including providing support to the UN China team during the COVID-19 Pandemic. Prior to DR, Leah was at the United Nations Development Programme (UNDP) China, supporting the UN’s portfolio on communication strategies, China’s South- South Cooperation and the Belt and Road Initiative (BRI). Before UNDP, Leah lived and worked in Kenya developing sustainable water policies for the Kenyan government.


China-Africa Policy Analyst

Yike Fu is a Policy Analyst and has been responsible for leading numerous areas of work, including on debt analysis in Africa and beyond, and China-Africa trade and investment logistics and analysis. She is the co-author of “African Debt Guide”, in which she challenged the narrative that Africa is in the midst of a new debt crisis by analysing data back to the 1970s and adopting new metrics to present the real story behind the data. She also developed a benchmark to compare the financial distribution of development partners such as the UK, US, Japan, France and China in Africa. Prior to her role at DR she worked at the International Finance Corporation and African Union Representational Mission to the US. She holds a Masters in International Affairs from George Washington University.


Research Analyst

Judith is a Research and Policy Analyst, where she specialises in Africa-China relations, international development, and diplomacy. During her time at Development Reimagined, Judith has co-authored several articles published in The Diplomat on debt and China-Barbados relations and was quoted by China Daily in a piece on Women Rights in China. Previously, Judith worked as a research analyst for an Advocate and Commissioner and Oats office in Kenya.


Policy Analyst

Ovigwe specialises in geopolitics with particular reference to Africa in a changing Global Order. He is adept at critically analysing the politics of contemporary development processes and providing insight into the geopolitical interests that influence them. His work includes research, publications, tailored briefings and advising on global and regional trends, and issues at the nexus of geopolitics and development. Ovigwe appears frequently in media around the world such as Al Jazeera, TRT World, SABC, CGTN, BBC Radio, and other platforms.


Policy Analyst

Jing leads China-African health and agriculture cooperation research at Development Reimagined, having managed our FOCAC Policy Analysis and Advocacy project. She is also the co-author of “China-Africa Health Cooperation under FOCAC Umbrella”, in which she analysed China’s commitments around health cooperation since the first FOCAC summit and deepdived into four African countries’ health overview, challenges and cooperation with China as cases studies. Before DR, Jing worked at GIZ Cambodia on M&E of a disability advocacy project. She also worked as a translator with Chinese medical team in Benin.


Trade Policy Analyst

Patrick is an International Trade Policy and Trade Law Expert with over 5 years of experience. His expertise includes trade law, trade policy analysis and regional integration. He is currently engaged with Development Reimagined as a Senior Trade Analyst and was the lead author of Development Reimagined's recent Report on Africa-China Relations titled "From China-Africa to Africa- China: A Blue Print for a Green and Inclusive Continent-Wide Strategy Towards China." and “Reimaging FOCAC Going Forward.” Patrick has previously consulted for the East African Community, UNECA and for the Kenya Ministry of Trade.


Senior Policy Analyst 

Rosemary is our Senior Policy Analyst. She is a skilled policy analyst and has previously worked as a UK civil servant. She is studying Human Rights at Birkbeck, University of London with a research focus on international law in the context of health crises such as the COVID-19 pandemic.


Project Manager and Africa-China Communication Assistant

Jade is a Project Manager for Development Reimagined’s flagship project Africa Unconstrained, which focuses on financing needs and debt vulnerabilities of African countries. Her research focuses on China-Africa development finance alongside debt vulnerabilities, infrastructure needs and South-South cooperation. She has worked with a breadth of stakeholders from China, Africa and the wider international community, including governments, private sector, NGOs and civil society. Her writing has appeared in a number of publications, including The Africa Report, The China-Africa Project, The Diplomat and more. Jade holds a Master’s in China and Globalisation studies from King’s College London.


Programme Manager

Rosie is the Project Manager of Africa Reimagined (AR) at Development Reimagined (DR) where she supports high-end African brands with entering the Chinese market by operating services such as trademark protection, Chinese market research, Chinese partnership building, and Africa to China logistical support and import/export services. Rosie has worked with DR for over two years now with proven success in helping high-end African brands navigate the Chinese market. She is extremely passionate about her work because more African brands selling in the Chinese marketplace means African countries can export MORE value-added goods, create MORE jobs and foster MORE innovation in African countries.

Rosie is also alumni of the School of International Studies at Peking University in Beijing where she is also an editor at the Peking Africa Think Tank. PATT is led by a diverse group of scholars who specialise in African Studies within the context of Sino-Africa relations.



Lauren has lived in six countries from the Americas to Europe and Asia and speaks both French and Spanish proficiently. At Development Reimagined, Lauren’s research focuses on climate action both in the Asia-Pacific and in Africa, and how countries are using tools such as SDGs and Covid-19 action to build a more climate-resilient future. She holds a Masters in International Relations from Leiden University.



Etsehiwot holds a Masters’s degree in Development Studies from the London School of Economics. She has diverse experience in humanitarian and development issues by working in both multilateral organizations and international non-governmental organizations. Etsehiwot is currently a consultant focusing on the SDGs and development finance.


Economist Consultant

Dibekulu is an economist by training. He holds an MSc in International Development Studies from Palacky University Olomouc, an MSc in Development Economics from the University of Clermont Auvergne, and an MSc in Economics, Finance, and International Integration from the University of Pavia. At Development Reimagined, he works as an Economist consultant. He has strong data analysis skills, with research interests centring around development finance, impact assessment, food security, and agricultural insurance.


Project Manager

Osaru is a health professional with an MSc in Health Systems Policy and an interest in women’s health and population management. At Development Reimagined, she applies her health sector experience to global health research and collating locally applicable development insights from China.


Research Analyst

Ferdinando’s research at Development Reimagined is centred on South-South Cooperation dynamics, specifically on the analysis of Chinese investment and debt flows in Africa and their linkages to African industrialisation. He is currently a Yenching Scholar at Peking University, after having graduated from the University of Cambridge with an MPhil in Development Studies.


Research Analyst

David is a Research and data analyst at Development Reimagined. His scholarly focus is mostly on interdisciplinary research in demographic economics and development with interests in migration, economic development and policy, education, health and subjective well-being. He is currently a PhD scholar at Nelson Mandela University from which he also holds Economics and Statistics and respectively.


Research Analyst Kenya

Ivory is a Kenyan lawyer with experience in policy research and analysis. She also supports the communications team at DR. Ivory speaks English, Swahili and French.


Research And Data Analyst China 

Joy Ene is a Research and Data Analyst at DR. Joy is passionate about African/global development, poverty eradication and trade policies between underdeveloped and developing countries. She is also a fourth-year student of International Economics and Trade at the  Liaoning University, Shenyang, China. She serves as the President of the Student Union, Liaoning University, International Students chapter.


Research Analyst 

Chensi Li is a research analyst. She has previously worked for local NGOs in Nigeria and Cameroon and think-tanks in China.  Her research areas include Sino-African relations, African foreign affairs, public diplomacy, state-building and national governance.

Yixin Yu

Research Analyst 

Yixin is a Junior Research Analyst and her focus areas is on public-private partnership and entrepreneurship. She has over three years of working experience in both private and public sectors in Ethiopia. She was the China Liaison Officer for project ‘Partnership for Investment and Growth in Africa’ at International Trade Centre, where she accumulated rich experience in investment and trade promotion


Founder and CEO

Hannah Ryder is the Founder & CEO of Development Reimagined. A former diplomat and economist with 20 years of experience, named one of 100 most influential Africans in 2021, she is also Senior Associate for the Africa Program of the Center for Strategic International Studies (CSIS), sits on the Board of the Environmental Defence Fund, and is a member of UAE's International Advisory Council on the New Economy. Prior to her role at DR, Ms Ryder led the United Nations Development Programme (UNDP)’s work with China to help it scale up and improve its cooperation with other developing countries, including in Africa. She has also played various advisory roles for the UN and OECD and co-authored the seminal Stern Review of the Economics of Climate Change in 2006.