In early 2022, nearly 200,000 Malawians were displaced after two tropical storms struck the southeastern part of Africa barely a month apart. Fifty-three people died.
“It’s difficult to say that caused the cholera outbreak,” UNICEF public health emergency specialist Raoul Kamadjeu said. “What we can say is they were risk multipliers.” Flash floods spread sewage into lakes and boreholes, washed away pipelines and sanitation infrastructure, and ruined roads integral to the delivery of supplies. By one government estimate, Ana alone destroyed 54,000 latrines and about 340 wells. People displaced from their homes turned to whatever water sources were available, often ones that were highly contaminated, and transmitted the disease as they moved to new areas.
“With a severe shortage of water, the remaining sources become easily contaminated, because everyone is using them for everything,” Ramadan said. “We have seen that in the greater Horn of Africa.” “While the storms may have created good conditions for transmission, the outbreak happened after a few years of relative calm in terms of exposures,” Azman said. “Immunologically, you had a much more naive population.”
Malawi’s outbreak came at a time of economic crisis, with its currency devalued in May 2022. Limited health resources were also stretched thin by COVID-19 and a polio outbreak, the first in 30 years. Kamadjeu said this strategy made sense given the low number of current cases. But Maritz says that capacity challenges and delays in testing with the new protocol have led to underreporting of cases.“We are still seeing people arriving at clinics with cholera symptoms that are not being reported in the national dashboards,” said Mira Khadka, an emergency health specialist leading cholera response for UNICEF in Malawi’s Blantyre district.
Amid an already-heavy rainy season, the storms Ana and Gombe caused devastation across southern Malawi to homes, crops, and infrastructure. “It’s difficult to say that caused the cholera outbreak,” UNICEF public health emergency specialist Raoul Kamadjeu said. “What we can say is they were risk multipliers.”
The global cholera surge drove a vaccine shortage right when countries needed it most. Malawi in the past used the cholera vaccine for prevention, but “now if you don’t have an outbreak, you don’t get the vaccine,” said Patrick Otim Ramadan, WHO incident manager for regional cholera response in Africa.