Zambia’s cholera response is a model for collaboration

Last year, Zambia experienced a major cholera outbreak centered in Lusaka that resulted in more than 20,000 recorded cases. As challenging as it was, it also became a powerful example of what’s possible when we work together and center communities in the response. From ministries to international agencies, from health workers to local volunteers, everyone played a role in limiting the impact and laying the groundwork for future resilience.

Putting communities at the heart of the response

One of the biggest lessons was this: outbreaks are best managed not just in hospitals or stadiums, but in communities, early and fast. Community-based volunteers were at the front lines, distributing hygiene kits and oral rehydration salts (ORS), disinfecting latrines, and offering basic health education door-to-door. These actions didn’t just help reduce spread, they built trust and brought care closer to people’s homes.

Responding to Zambia’s largest cholera outbreak

The Ministry of Health led the initial response to the outbreak, quickly joined by the Ministries of Water Development and Sanitation (MWDS), the Ministry of Local Government and Rural Development (MLGRD), the Disaster Management and Mitigation Unit (DMMU), and key partners including WHO, UNICEF, and the Red Cross. Together, we expanded WASH efforts, ramped up water quality surveillance, and mobilized emergency supplies across Lusaka and other hotspots. This involved chlorine distribution, working with community-based volunteers to distribute hygiene kits and ORS, and disinfect latrines, among other community engagement activities.

Lusaka is a densely populated city: the settlement of Kanyama, for example, has nearly half a million people, and 95 percent rely on onsite sanitation, shallow wells, pit latrines, or other sanitation services that are more vulnerable to the spread of waterborne diseases. But thanks to coordinated efforts with the Ministry of Water and DMMU, we were able to scale up access to clean water, sanitation facilities, and health education, reducing exposure in even the most vulnerable areas.

Oral cholera vaccines were another component of our outbreak response. Vaccines can help buy time to get other WASH interventions in place, and in Lusaka, we managed to vaccinate close to 2 million people—nearly two-thirds of the city’s population. Looking at the data from last year, it’s impressive how quickly the case numbers dropped after the vaccination campaign concluded. The drop in cases following the campaign was dramatic. But it was the sustained effort in surveillance and community care that prevented resurgence.

Photo: Christina Kaluba (center), a community volunteer who trained to become a vaccinator for Zambia’s oral cholera vaccination campaign. Credit: WHO Zambia

Collecting accurate data on cholera cases has also proved critical. By mapping where cholera cases and deaths occurred, we could place oral rehydration points in areas where they were needed most. We also mapped cholera hotspots across the country over the past 10 years, an exercise that is helping guide domestic resource mobilization at the community level and show how case trajectories have changed along with investments in WASH.

Working in communities to control cholera

Community-based volunteers are the unsung heroes of Zambia’s outbreak response. Often patients would postpone going to health care facilities, whether due to stigma around cholera or safety concerns at night. Recognizing delays in health-seeking behaviour, WHO and partners helped establish more than 70 community oral rehydration points and temporary care centers in affected areas. These proved to be lifesaving, especially at night or in hard-to-reach neighbourhoods, by offering hydration, triage, and referral support before conditions worsened.

Sustaining momentum beyond the emergency

Even now, after the outbreak, many of these volunteers are continuing to look after patients and conduct community engagement work around child health and water safety monitoring. We are also engaging with communities to facilitate stronger relationships with local utilities and mobilize greater investment in WASH—something that will help prevent outbreaks over the long run.

A new plan for cholera prevention

We are drawing on the lessons from the past year to develop Zambia’s next national cholera control plan. As we look ahead, our focus is on mobilizing resources to invest in water, sanitation, and hygiene (WASH) and other interventions like proper solid waste management, which will position us on strong footing against future outbreaks.

Investments in WASH, vaccines, and community engagement work are not only components of outbreak response—they are critical outbreak prevention strategies. Since last year, we have maintained close coordination among the DMMU, Ministry of Health, Ministry of Water, and other partners as we develop Zambia’s new national cholera control plan. The lessons learned from last year’s outbreak have laid a strong foundation—not only for Zambia, but also for other countries working to prevent and control the disease.

Cover photo: Distributing emergency supplies in Zambia during the 2024 cholera outbreak. Credit: WHO Zambia