Five-day cholera vaccination campaign rolled out in Mandela triangle to protect over 600 000 Somalis in bordering areas of Kenya, Ethiopia

A single dose reactive cholera vaccination campaign gets under way in 5 districts of Jubaland State, bordering Kenya and Ethiopia, classified as the Mandela triangle, from 12 to 16 August, 2023. The campaign aims to vaccinate 590 803 people aged one year and above, including pregnant women in Afmadow, Belet Xaawo, Luuq, Doolow, Dhobley districts. The oral cholera vaccination campaign will be synchronized among border communities with Ethiopia and Kenya.

The 5-day house-to-house campaign will be implemented by 788 vaccination teams each composed of 2 vaccinators, data clerk and cold chain attendant. Each team will be supported by a social mobilizer. The World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) are supporting the Federal Ministry of Health and Human Services and State Ministry of Health of Jubaland State to conduct the campaign. Gavi – the Vaccine Alliance, is providing vaccines and funds to implement this life-saving intervention. As of the end of July 2023, 11 704 suspected cases of cholera, with 30 associated deaths, were reported from 28 drought-affected districts in Somalia. Around 54% of these cases were children aged under 5: 52% of them were girls.

The Minister of Health of Jubaland State H.E. Ismail Ahmed Garas expressed deep gratitude to Gavi for this timely support to stop the spread of cholera and measles in the Mandela triangle. He said, “We are thankful to both WHO and UNICEF for their continued technical and operational support in preparing health workers, social mobilizers and data collectors for this very critical and life-saving cholera vaccination campaign. Our health system might be weak and fragile but our resolve to save lives is firm and together with our trusted partners we are hopeful that this intervention will help stop the transmission of cholera and measles and save scores of precious lives.”

Since 2017, Somalia has witnessed uninterrupted cholera outbreaks. These can be attributed to a large number of people having poor access to safe water and sanitation services, and natural hazards, including drought and floods, further exacerbated by protracted conflict and large-scale population displacement. Meanwhile, the ongoing drought and other climatic shocks in the country has had a grave impact on Somalis – while displacing over 770 000 people internally. It has dried up surface water sources and led to food insecurity in communities, which increases the risk of cholera infection, as well as other waterborne diseases. An estimated 49% of the population – 7.7 million people – require some form of humanitarian or protection assistance in Somalia, of whom 6.13 million are estimated to be affected by the current drought. 

WHO Representative to Somalia Dr Mamunur Rahman Malik said, “Somalia might have averted the threat of a famine but not the threat of disease, because the prolonged drought is showing a real and life-threatening impact on the lives of the people across the country and especially in Mandela triangle. It’s a race against time to try to prevent major outbreaks of cholera and measles.”Emphasizing the need for a collective and timely response, he added, “Cholera and measles can spiral out of hand in no time because of its contagious nature, therefore, we just cannot wait and see this unfolding crisis balloon out of our hands. Our collective emergency response to the global pandemic of COVID-19 is just living proof of how timely collaborative action and delivery of a high-quality and evidence-based intervention can lead to protecting the health and well-being of populations, even if the health system is fragile.”

While cholera remains endemic in Somalia and the current drought situation may have exacerbated the risk of a major outbreak across the country, vaccination against cholera with a single dose is used as a supplementary measure to control any possible outbreak and spread across the region. To curb the transmission of cholera and other waterborne diseases, the Ministry of Health, with the support of WHO and UNICEF, will be raising awareness among the target populations on precautionary measures like maintaining good personal hygiene, improving access to safe water, practising safe sanitation, scaling up active surveillance, community engagement and sensitization. Since January 2023, over 1.4 million people in 15 drought-affected districts have received a single dose cholera vaccine.

By Usmana Kousar