image: School children receive oral cholera vaccine in the Cuamba District of Mozambique during a vaccination campaign in 2018. view more
Credit: IVI
The International Vaccine Institute (IVI) and the Republic of Korea's Global Disease Eradication Fund (GDEF) have agreed to conduct joint projects to fight cholera, which include vaccination for a total of approximately 540,000 people at risk of cholera in Nepal and Mozambique. KOICA GDEF is providing a grant of US$8.05 million to support the project entitled 'Enhancing Cholera Control' (ECHO).
IVI Director General Dr. Jerome Kim expressed gratitude for Korea's contributions, saying "IVI is very pleased to work with GDEF once again, and the Governments of Mozambique and Nepal in the fight against cholera. While COVID-19 is a global threat, for developing countries, cholera remains an additional significant endemic and epidemic burden. Our collaboration through ECHO will enable us to accelerate efforts to eradicate cholera through the use of Oral Cholera Vaccine (OCV) according to the WHO Ending Cholera Roadmap and contributing to the realization of United Nations Sustainable Development Goals, particularly Goal 3: Good Health and Well-being."
ECHO, which runs from February 2020 to January 2024, is aimed at preventing and controlling cholera outbreaks through vaccination combined with Water Sanitation and Hygiene (WaSH) promotion, disease surveillance, and other interventions. The ECHO-Nepal project involves an OCV vaccination campaign, which targets about 210,000 residents in Kathmandu Valley and 80,000 residents in the Kailali District of Nepal.
"The ECHO-Nepal project, in collaboration with Johns Hopkins University (JHU), Group for Technical Assistance (GTA), and Epidemiology and Disease Control Division (EDCD) of MoHP, Nepal, will deliver OCV campaigns using an innovative approach called case area-targeted intervention (CATI), which integrates a rapid WaSH response with case area-targeted ring vaccination in the densely populated areas of the Kathmandu Valley," said Dr. Jacqueline Lim, project lead for Nepal.
In addition to CATI, there are mass vaccination campaigns planned for both Kathmandu Valley and Kailali. Apart from the overall enhancement of laboratory diagnostic and surveillance capacity, about 1,160,000 residents will benefit from enhanced disease surveillance. Ultimately, the data generated from ECHO-Nepal will support the development of a national cholera control plan in collaboration with in-country stakeholders in Nepal. The ECHO-N kick-off meeting will take place on Dec. 2 virtually for partners outside Nepal and with a small in-person gathering in Kathmandu for government partners and key stakeholders. The meeting will discuss planned activities, with updated timelines and challenges, especially in light of the local COVID-19 situation.
The ECHO-Mozambique project aims to contribute to cholera prevention and control in Mozambique in partnership with the Mozambican government. This project includes a preemptive OCV introduction, targeting approximately 250,000 individuals living in cholera hotspots. The project will also strengthen and implement enhanced systematic cholera and diarrheal disease surveillance and assess new cholera cases, transmission, site-specific cholera risk factors, cholera associated health-seeking behavior, and cost of illness in cholera outbreaks. The impact and vaccine effectiveness of the OCV (Euvichol-Plus®) will also be evaluated, and the government's rapid response and preparedness for cholera outbreaks strengthened. Over 1,370,000 residents in selected cholera priority areas will benefit from these activities, and ultimately the larger population at increased risk of cholera in the country.
"Cholera remains an equally important public health issue that may be neglected during this COVID-19 pandemic. In close partnership with the Instituto Nacional de Saude (National Institute of Health) and the Ministry of Health of Mozambique, and in liaison with the World Health Organization Global Task Force for Cholera Control (WHO GTFCC), we will also provide support for the government's ongoing efforts to develop a national cholera control and prevention plan through a policy dialogue platform that will be set-up under this ECHO-M project," said Dr. Se Eun Park, project lead and study principal investigator for Mozambique." ECHO-M was officially launched November 25 with a virtual kick-off meeting, bringing together key stakeholders in a joint effort to fight cholera.
The campaigns will use the low-cost OCV Euvichol-Plus® developed by IVI and produced by EuBiologics of Korea. OCV is one of the key tools for 'Ending Cholera--A Global Roadmap to 2030,' an ambitious strategy launched by the World Health Organization in 2017 to reduce annual cholera deaths by 90 percent by 2030.
GDEF is raised by levying 1,000 Korean won on international flight tickets leaving Korea. The Ministry of Foreign Affairs entrusts Korea International Cooperation Agency (KOICA) to operate and manage the GDEF. In support of its ongoing commitment to the Ending Cholera initiative, GDEF has already supported the Mozambique Cholera Prevention and Surveillance (MOCA) project which provided vaccination, WaSH, and other interventions to more than 190,000 individuals living in communities at risk of cholera in the Cuamba District of Mozambique in 2018-2019.
"Building upon the MOCA project, ECHO will help prevent cholera through vaccination campaigns and training of health professionals. It will enhance surveillance capacity for the early detection and prevention of cholera through strengthened rapid response capacity. Information gathered during this effort will allow development of evidence-based policy for cholera prevention and control in the two countries," said Dr. Julia Lynch, director of IVI's Cholera program. "Through these efforts, we will seek to establish a model for the Ending Cholera 2030 initiative in endemic countries."
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About cholera
Cholera is an acute watery diarrheal disease that can be potentially life-threatening. The disease is caused by ingesting food or water contaminated with the bacterium Vibrio cholerae, and often strikes vulnerable populations in humanitarian crises or countries with poor water, sanitation, and hygiene. Approximately 1.3 million to 4 million cholera cases and 21,000 - 143,000 deaths are estimated to occur every year around the world. Cholera remains endemic in over 40 countries worldwide. The disease is treatable but can kill the patient within hours if left untreated. Currently, there are three WHO-prequalified oral cholera vaccines: Dukoral®, Shanchol™, and Euvichol® (including Euvichol-Plus®), with the latter two developed via a technology transfer from IVI. Each of these vaccines requires two doses for full protection. The WHO recommends a combination of surveillance, water sanitation and hygiene, social mobilization, treatment, and vaccination to prevent and control cholera.
About GDEF
The Global Disease Eradication Fund of the Government of the Republic of Korea is based on the Air-ticket solidarity levy system which imposes a donation of KRW 1,000 on passengers departing from airports in Korea for the purpose of preventing and controlling infectious diseases in developing countries. The GDEF is partnering with diverse actors to develop, test and deliver a range of innovative products to combat global infectious diseases. The Ministry of Foreign Affairs entrusts Korea International Cooperation Agency (KOICA) to operate and manage the GDEF.
About KOICA
The Korea International Cooperation Agency (KOICA) under the Ministry of Foreign Affairs (MOFA), was established as a government agency in April 1991 and is dedicated to providing grant aid programs of the Government of the Republic of Korea. KOICA endeavors to combat poverty and support the sustainable socioeconomic growth of partner countries.
About the International Vaccine Institute (IVI)
The International Vaccine Institute (IVI) is a nonprofit inter-governmental organization established in 1997 at the initiative of the United Nations Development Programme (UNDP). Headquartered in Seoul, South Korea, IVI was the first international organization hosted by Korea. IVI has 36 signatory countries and the World Health Organization (WHO) on its treaty, including Korea, Sweden, India, and Finland as state funders.
Our mandate is to make vaccines available and accessible for the world's most vulnerable people. We focus on infectious diseases of global health importance such as cholera, typhoid, shigella, salmonella, schistosomiasis, Group A Strep, Hepatitis A, HPV, TB, HIV, MERS, COVID-19, as well as antimicrobial resistance. For more information, please visit https://www.ivi.int