Stockpiling oral cholera vaccine.

Editorials 714 Cholera is re-emerging as a threat on the global public health stage. The number of reported cases worldwide is back at the peak level observed two decades ago, 1 new Vibrio cholerae strains have appeared and antimicrobial resistance has increased. Weak surveillance systems and the possibility of travel and trade sanctions contribute to widespread underreporting of cholera cases, which results in great uncertainty surrounding global disease burden estimates. Such estimates suggest that about 1.4 billion people are at risk of cholera and that the risk is highest among children under five years of age. Annually 2.8 million cases and 91 000 deaths from cholera occur in endemic countries; non-endemic countries contribute another 87 000 cases and 2500 deaths. 2 Although effective preventive and therapeutic regi-mens are well established, clearly cholera remains poorly controlled in both outbreak and endemic contexts. Cholera-related morbidity and mortality are particularly high during humanitarian crises. Large cholera epi-have made the international community aware of the need to not merely control endemic disease, but also to strengthen epidemic preparedness and response capacity. In 2011, the Sixty-fourth World Health Assembly issued a resolution calling for a reinvigorated focus on cholera and defined a range of actions required of the World Health Organization (WHO) and its Member States towards creating an integrated, comprehensive strategy for cholera prevention and control. 3 As part of this strategy, WHO is facilitating a multi-partner initiative aimed at establishing a stockpile of oral cholera vaccine (OCV) for use in outbreak response as an adjunct to established prevention and control measures. This approach was endorsed in September 2011 by global cholera experts, who affirmed that such a stockpile is both necessary and feasible. 4 There are currently two stockpile candidate oral cholera vaccines, both prequalified by WHO. A WHO technical working group convened in April 2012 and defined the required characteristics of a stockpiled vaccine, the epidemiological and operational considerations for deployment, and the mechanisms for stockpile gov-ernance, replenishment and appraisal. 5 This working group agreed on an initial OCV stockpile of 2 million annual doses to be available for epidemic response in low-income countries. The International Coordinating Group (ICG) has a decade of experience as a decision-making partnership that oversees the meningococcal and yellow fever vaccine stockpiles and their deployment. The ICG is composed of experts from four organizations: Médecins sans Frontières, the International Federation of the Red Cross and Red Crescent …