Preventive cholera vaccination restarts after three years, on doses from one manufacturer

For the first time in more than three years, oral cholera vaccine is being used to prevent outbreaks rather than chase them. Gavi, UNICEF and the World Health Organization announced on 4 February that global supply has risen enough to restart preventive campaigns, with Mozambique the first country to begin [s1].

Preventive vaccination was halted in 2022, when a global surge in cholera drove demand past supply and the available stockpile was rationed entirely to outbreak response [s1]. What has changed is production volume: annual global supply of OCV has roughly doubled, from 35 million doses in 2022 to nearly 70 million doses in 2025 [s1].

Where the first 20 million doses go

A first allocation of 20 million doses is being deployed for preventive campaigns [s1]. Of these, 3.6 million doses were delivered to Mozambique, 6.1 million to the Democratic Republic of the Congo, which is also experiencing significant outbreaks, and 10.3 million are planned for delivery to Bangladesh [s1].

Mozambique's campaign is starting under conditions that illustrate why prevention and response are hard to separate. It begins amid an ongoing cholera outbreak and in the aftermath of floods that affected more than 700,000 people and displaced many, disrupting health systems and damaging water systems [s1].

The three countries were selected using allocation criteria set by the Global Task Force for Cholera Control, a partnership of more than 50 organisations, which WHO says are intended to distribute preventive doses systematically, equitably and transparently [s1]. Gavi is financing the doses; UNICEF is procuring and delivering them [s1].

The single-supplier problem, stated plainly

The most consequential sentence in the announcement is not about volume. It is about who makes the vaccine.

"I thank EUBiologics, currently the only manufacturer producing cholera vaccines at the scale needed for mass vaccination campaigns, for its efforts, and urge others to enter this vital space," WHO Director-General Tedros Adhanom Ghebreyesus said [s1].

That is an unusually direct statement of a structural vulnerability. A doubling of supply achieved through one company's expansion is a doubling that can be undone by one company's problem — a manufacturing suspension, a regulatory hold, a facility failure. The stockpile's recovery is real, and it rests on a base narrower than the demand it now serves.

Gavi chief executive Sania Nishtar described the episode as a reminder that "sustainable, accessible vaccine supply is a global public good – and the world cannot afford complacency" [s1].

What a dose actually buys

OCV is recommended for people over one year of age [s1]. One dose provides short-term protection for at least six months and can help bring outbreaks under control; two doses provide protection against infection for longer, around three years [s1].

Even with supply improving, WHO says the one-dose strategy will remain the standard for outbreak responses, with two doses considered case by case [s1]. That is the arithmetic of scarcity carried forward into a period of relative sufficiency: one dose covers twice as many people for a quarter of the duration, and in an outbreak, coverage wins.

The epidemiology behind the restart

More than 600,000 cases of cholera or acute watery diarrhoea and nearly 7,600 deaths were reported to WHO from 33 countries last year, figures the agency describes as underestimates because cholera remains underreported [s1].

The trend is not straightforward. Since 2021, global cholera cases have risen year after year, with a decline observed in 2025 — but deaths have continued to increase over the same period [s1]. Falling case counts alongside rising deaths is a pattern consistent with worsening detection, worsening access to treatment, or both. Cholera is highly lethal untreated and rarely lethal when oral rehydration reaches people in time, so the case fatality ratio is largely a measure of health system reach rather than of the organism.

UNICEF Executive Director Catherine Russell said resuming preventive vaccination "must go hand in hand with other efforts, including better access to safe water and basic sanitation" [s1]. Ilesh Jani, who chairs the GTFCC Steering Committee, put the same point in terms of what vaccination does not do: preventive vaccination "helps shield communities and buys critical time," but lasting progress "will depend on long-term investment in infrastructure, for which political commitment is indispensable" [s1].

Cholera spreads through contaminated food and water and is found mainly in places without safe water and sanitation, particularly localities affected by conflict and poverty [s1]. That is the durable constraint. Vaccine supply is the constraint that moved.

What to watch

Three things over the coming year.

Whether a second manufacturer enters at scale. Until one does, the supply recovery is contingent on a single production line.

Whether the preventive allocations hold when the next demand surge arrives. The 2022 halt happened because outbreak response consumed everything; the same logic could suspend prevention again.

And whether the divergence between falling reported cases and rising reported deaths continues. If it does, the more urgent shortage is not vaccine but treatment access.