Zambia’s deadly cholera outbreak offers lessons for our warming world

In the southern African country of Zambia, a heartbreaking paradox is unfolding. While heavy rains bring relief to crop fields that have faced difficult growing conditions for months, the stagnant water left in the storm’s wake brings an even scarier reality — a cholera outbreak, the deadliest our country has ever seen. 

Since October, Zambia has faced its worst cholera outbreak on record, infecting over 20,000 and killing nearly 700 people. Contaminated water, poor sanitation and inadequate healthcare create a fertile ground for the bacterial disease typically spread via contaminated food or water. 

As public health professionals, one of whom is a Zambia country director for the global health organization ICAP at Columbia University, we are deeply concerned by the recent cholera outbreak. This is not the first time we have faced this disease; it is a stark reminder of the cyclical nature of waterborne illnesses in our region. While effective interventions have been implemented for past outbreaks, emerging infectious diseases remain a constant threat, highlighting the need for long-term, preventative measures.

Outside the National Heroes Stadium in our nation’s capital of Lusaka — once a beacon of sporting glory, but now a makeshift cholera treatment center — we met Chikoti Lungu, a retiree from Lusaka’s Bauleni township, whose story exemplifies the devastating impact of this outbreak. Lungu had recently fallen ill with cholera.  

“Everything happened so fast,” Lungu said, reflecting on his arrival at the treatment center. “There were so many of us. The ward was full, some patients vomiting, medical staff fighting to save critically ill individuals. I even witnessed deaths.” 

Cholera causes rapid dehydration, which can lead to electrolyte imbalances and organ failure within hours, so prompt treatment is critical. Left untreated, cholera can be fatal in up to half of cases. Luckily for Lungu, he sought treatment just in time, but the experience shook him. 

“Other diseases at least give you some warning,” he said. “Cholera doesn’t negotiate.” 

While cholera does not provide much warning to an infected individual, the warning signs for this outbreak have been here for a very long time, and we must start paying closer attention to them to prevent more in the future. 

Erratic rainfall patterns, rising temperatures and extreme weather events exacerbate existing health system vulnerabilities, especially the spread of waterborne diseases, and have pushed our communities to the brink. In overcrowded housing settlements common in Zambia, hygiene is a luxury. The daily fear that comes with every sip of water or bite of food is palpable. Every season, especially as our weather patterns become increasingly unpredictable, we fear the emergence of cholera and other waterborne diseases. 

Our team at ICAP was called upon to assist the Zambian Ministry of Health in combating this recent cholera outbreak. Leveraging our experience in COVID-19 preparedness, we rapidly adapted programs, training healthcare workers on cholera case management, infection control and data collection. We also collaborated with the ministry to ensure efficient supply chain management of essential resources. 

While that intervention provided critical support, it was a temporary bandage on a systemic wound.  

Long-term solutions to disease outbreaks require resilient public health systems prioritizing prevention. Collaboration between governments, international organizations and local communities is imperative to addressing the root causes of cholera outbreaks, such as insecure access to safe water, inadequate sanitation infrastructure and limited healthcare capacity. Implementing context-specific solutions and exploring diverse sanitation technologies tailored to local needs are also critical.  

Numerous countries, including Zambia, have successfully implemented community health worker programs to address various health challenges. These programs leverage the trusted role of community members to deliver essential services closer to where people live. By building on existing models like these, hygiene promotion brigades could be established to raise awareness about critical hygiene practices like handwashing and proper sanitation. This approach fosters behavior change and encourages the adoption of safe hygiene practices, ultimately contributing to the fight against waterborne diseases like cholera. 

A one-size-fits-all approach will not work for addressing cholera and other water-borne disease outbreaks. Effective solutions require tailoring interventions to the specific context of each community. Factors like varying levels of infrastructure development, cultural practices around sanitation and available water sources all influence how diseases like cholera spread and how best to prevent them. For instance, a community reliant on shallow wells might require different interventions than a peri-urban area struggling with overflowing pit latrines. 

For these gains to be won, our tendency to be reactive to outbreaks rather than proactive in our investments in long-term prevention must change. Meaningful collaboration among diverse stakeholders, involving joint ownership and decision-making between government agencies, local communities and international organizations, is crucial. Leadership and policy direction from the government, local community knowledge of needs and cultural contexts and the technical expertise, financial resources and best practices from international organizations are all essential pieces of the puzzle of ongoing waterborne disease outbreaks. 

Thankfully, this month, we have seen rains subside in Lusaka. With that comes the hope of downward trends in cholera cases, and a short respite from the relentless assault on health and wellbeing. Yet, with every drop of rain, the specter of cholera looms large.  

The onus lies on all of us — funders, governments, public health professionals and communities — to build public health systems that can weather any storm, ensuring that every drop of water brings life, not suffering. 

Tafadzwa Dzinamarira, MSc, MPH, Ph.D., is a public health leader and the country director of ICAP at Columbia University in Zambia. Dr. Chalomba Chitanika, MD, MMed, is an internist and infectious disease expert currently working as the COVID-19 clinical coordinator for ICAP at Columbia University in Zambia. Sara Hendery, communications officer for ICAP at Columbia University, contributed to this piece.