In January, Malawi’s rainy season created the perfect conditions for a cholera outbreak. While cholera is endemic in Malawi, extensive flooding throughout in some parts of the country heightened the potential for cholera cases to increase.
Malawi’s Nsanje district was the hardest hit, experiencing the worst flooding the country has ever seen. 100 people were killed in the flood, 70,000 people were displaced, and critical infrastructure like roads and personal property like houses were destroyed.
To house the growing population of internally displaced persons (IDPs) within the district, Malawi created 21 IDP camps in Nsanje. The crowded camps are extremely high-risk areas for cholera infections because of poor sewage systems and a lack of clean water.
Recognizing the potential for outbreak in the new camps, Malawi’s Ministry of Health asked JSI to implement an oral cholera vaccine (OCV) campaign in April 2015 with funding from the International Vaccine Institute (IVI) and the World Health Organization (WHO).
Initially, the JSI team and I had been working in Malawi through the Maternal and Child Survival (MCSP) project, where we were developing a nationwide immunization strategy to introduce pneumococcal and rotavirus vaccines and strengthen routine immunization. With a potential cholera outbreak on the horizon, however, we shifted our focus to try to prevent an outbreak in Nsanje. In collaboration with local and international partners, we built an immunization strategy around the OCV.
When we began the project in April, Nsanje had recorded 176 cholera cases and three deaths. Because cases already existed in the district, our team focused on identifying target areas: When attempting to stem an outbreak, the most effective treatment strategy starts by vaccinating in areas where the disease is mostly likely to spread.
Our mantra was: “Don’t shoot where it is, but where it’s going to be.”
This strategy led us target a group of 160,000 people, age one year and older, who lived in the IDP camps, as well as surrounding areas. Our hope was to prevent infections in the most vulnerable areas within the district.
Cholera can be effectively treated with two doses of oral vaccine, which helps the body to develop antibodies needed to fight off bacteria that leads to cholera. The vaccines are designed for emergency situations, and are intended to compliment existing preventative strategies for cholera.
Implementing an OCV campaign in a country for the first time presented many challenges. From the beginning, we knew that we would be building much of the foundation for the program, including developing materials, training health workers, and implementing social mobilization strategies.
Because of the careful coordination between JSI and its partners throughout the planning, training, and implementation phases, 65% of our targeted population received both doses of the oral cholera vaccine.
In part because of the OCV campaign, there have been no cholera cases reported in Nsanje since mid-May — evidence that JSI’s strategy, combined with the program’s flexibility and support from dedicated partners, has been an effective means of stemming a potential crisis.
While the rainy season in Malawi continues, around 104,000 individuals are now fully vaccinated in one of the country’s most at risk districts — protected for the rest of this season and those to come.