Addressing Cholera Outbreaks in Zambia: A Call for a Social Ecological Approach

Abstract

Cholera remains a major public health threat in Africa, accounting for the majority of global cases and deaths and disproportionately affecting vulnerable populations. Recent trends indicate a worsening trajectory, with projections showing substantial increases in cases and fatalities during upcoming rainy seasons if current control efforts remain unchanged. In response, Africa CDC and the World Health Organization have launched a continental cholera response plan, endorsed by African political leadership, to accelerate progress toward cholera elimination by 2030 through strengthened coordination, surveillance, case management, WASH interventions, vaccination, and community engagement.

Zambia’s recurrent cholera outbreaks exemplify the persistence of structural, environmental, and social drivers of transmission, particularly in urban and peri-urban settings with inadequate water and sanitation infrastructure. Drawing on Zambia’s experience, this editorial argues that cholera control cannot be achieved through biomedical or emergency responses alone. Instead, it calls for the application of the Social Ecological Model to understand and address the interconnected individual, community, institutional, and policy-level factors that sustain cholera transmission. Adopting this integrated, multi-level approach is essential for achieving sustainable cholera prevention, strengthening health system resilience, and advancing the goal of a cholera-free Africa.