Africa Turns to Monkeypox Lessons to Fight Cholera

The rapid spread of cholera across the continent has sparked discussions on joint efforts to combat the disease, which has impacted 16 countries, with four facing severe outbreaks.

The Africa Centres for Disease Control and Prevention (Africa CDC) has raised the possibility of tackling cholera in the same way as the mpox outbreak, which is showing signs of slowing down in most of the affected countries, amid an intensification of response efforts involving multiple partners.

According to UNICEF, over 178,000 cases of cholera have been confirmed in 16 countries in Eastern and Southern Africa from January 2024 until March 2025. More than 1,600 deaths have been recorded.

The affected countries are Angola, DRC, South Sudan, Sudan, Ethiopia, Ghana, Kenya, Malawi, Mozambique, Namibia, Nigeria, Rwanda, Uganda, Zambia, and Zimbabwe.

However, Angola, DRC, South Sudan, and Sudan account for over 90% of the cases, with conflict being among the drivers of the disease. South Sudan alone has reported over 22,000 cases and more than 470 deaths this year, followed by the DRC with more than 18,000 cases and 360 deaths. Over 500 deaths have been reported in Angola from more than 15,000 cases.

“Lessons learned from the mpox response, especially the need for close collaboration with other partners, will now be applied to fighting cholera,” said Dr Ngashi Ngongo, the Principal Advisor to Africa CDC’s Director General. He highlighted a new continental approach to public health emergencies, focusing on enhanced health systems, heightened surveillance, and the local manufacturing of medical products.

Mpox was declared a continental health emergency by Africa CDC and a global health emergency by the World Health Organization (WHO) in August last year. The outbreak expanded from 12 to 23 countries and is currently active in 16, 10 of which have received vaccines.

Since then, the outbreak has been managed through an Incident Management Support Team (IMST) jointly led by Africa CDC and WHO, working with 26 other partners, including UNICEF, the International Committee of the Red Cross, and Gavi, the Vaccine Alliance.

Under Dr Ngongo’s leadership as Incident Manager, the IMST has been praised as a model for managing complex outbreaks, such as mpox, which is highly transmissible across borders and shares symptoms with chickenpox and measles. The disease has multiple strains, with the latest announced in early 2025.

The IMST allows the partners to collaborate based on the “four ones” — “One Team, One Plan, One Budget, One Monitoring Framework” approach, which strengthened coordination among affected countries.

While mpox was the IMST’s initial focus, it has also incorporated concurrent outbreaks. “We’ve shifted toward an integrated strategy that also includes the care of measles and chickenpox,” said Dr Ngongo. “That’s where we are moving, so that the opportunity of the response to one outbreak also opens up to addressing other concurrent outbreaks as well.”

An additional area of focus for the IMST, now in its second phase, is the resilience of the health system as a legacy. “We are now strengthening the key pillars like surveillance and laboratory, to make sure that we have enough capacity on the continent to also address other ongoing outbreaks. A very good example is the evolution of the current IMST, which is being expanded very soon to also take care of the ongoing cholera outbreak,” he said.

However, even if cholera is jointly managed by Africa CDC, WHO, and other partners, some argue that addressing its root causes, such as improving water quality and sanitation, is essential. Just as important is the growing recognition of how insecurity and conflict exacerbate cholera outbreaks.

Equally significant is strengthening the African Pooled Procurement Mechanism so that cholera vaccines, which in recent years have been in short supply, are manufactured on the continent.

A call has also been made for Africa CDC to collaborate with the Global Task Force on Cholera Control, a collaborative network of over 50 organisations, including NGOs, academic institutions, and United Nations agencies.

Distributed by APO Group on behalf of Africa Centres for Disease Control and Prevention (Africa CDC).