Pathways to a policy for cholera control in India

Area of Science:

• Public Health
• Vaccinology
• Infectious Diseases

Background:

• Cholera remains endemic in Southern Asia, with existing control measures proving ineffective.
• The World Health Organization (WHO) has pre-qualified oral killed cholera vaccines, and the Gavi Alliance is stockpiling them.
• Despite availability and local manufacturing in India, oral cholera vaccines are not utilized in national public health programs for endemic disease or outbreak control.

Purpose of the Study:

• To highlight the urgent need for updated cholera control policies in India.
• To emphasize the opportunity presented by the availability and affordability of oral cholera vaccines.
• To advocate for the integration of oral cholera vaccines into India's national immunization strategies.

Main Methods:

• Review of current cholera control mechanisms and their efficacy.
• Assessment of the status and accessibility of oral cholera vaccines.
• Analysis of the role and considerations of the National Technical Advisory Group on Immunization (NTAGI) in vaccine policy.
• Examination of World Health Organization (WHO) recommendations and Gavi Alliance initiatives.

Main Results:

• Existing cholera control strategies in India have been largely ineffective.
• Oral killed cholera vaccines are WHO-pre-qualified and available, but not yet implemented in Indian public health programs.
• The NTAGI is currently considering cholera vaccines, taking into account disease burden, vaccine performance, cost-effectiveness, and WHO recommendations.

Conclusions:

• The ineffectiveness of current cholera control necessitates new strategies.
• The availability of affordable, pre-qualified oral cholera vaccines presents a significant opportunity for India.
• Urgent policy development is required to incorporate oral cholera vaccines into national programs to combat this public health problem.