Malawi launches cholera vaccine drive in Blantyre as rains raise fears of renewed outbreak

The line for cholera vaccines formed quickly outside a small clinic in Blantyre’s Chilomoni township, snaking past roadside vendors and toward a brown, slow-moving stream below.

At the top of the hill, health workers in reflective vests lifted the caps off tiny plastic vials and urged residents to swallow the sweet oral dose. A few minutes’ walk away, other residents knelt at the Muluda stream, washing dishes, scrubbing clothes and filling jerrycans with water authorities say is helping fuel Malawi’s latest cholera outbreak.

“I have seen that there is an outbreak of cholera in our area, and I decided to come with my children to get vaccinated,” said 24-year-old Harriet George, holding her toddler’s hand as they waited for their turn. “Nine people from this area are in the hospital, and the news was not welcome because the end result is death.”

Targeted vaccination in Blantyre

Malawi this week began a focused cholera vaccination drive in Blantyre, its commercial hub, as rising case numbers and heavy rains raised fears of another major epidemic in a country still recovering from its deadliest outbreak on record.

Health officials launched a three-day oral cholera vaccine rollout on Thursday in high-risk neighborhoods, starting with Chilomoni, a densely populated township that has recorded at least one cholera death and nearly half of Blantyre’s recent cases. Authorities say they hope to administer about 24,000 doses in this initial phase, targeting crowded, flood-affected areas with poor access to safe water and sanitation.

“We’re focusing on the most vulnerable populations,” said Dr. Gift Kawalazira, director of health and social services for the Blantyre District Health Office. Gesturing toward the Muluda stream, he added, “You can see others bring their kitchen utensils and wash them right here and also wash their clothes. This is the water that is causing cholera.”

The Public Health Institute of Malawi reported 355 suspected cholera cases, 74 confirmed cases and two deaths nationwide as of Jan. 23. Two days later, the tally had risen to 394 suspected cases, 83 confirmed and three deaths across 13 districts. About half of the confirmed cases have been classified as imported, reflecting infections linked to travel or exposure outside the immediate community.

The numbers are small compared with the country’s last cholera crisis, but the trajectory has alarmed health officials. The rainy season is just beginning, and prolonged downpours have already triggered flooding in parts of southern Africa, conditions that can quickly contaminate water sources.

“Once cholera is established in a community with poor sanitation and unsafe water, cases can increase very rapidly,” Kawalazira said. “Getting ahead of the outbreak is critical.”

Water access and the arithmetic of risk

For many families in Chilomoni, getting ahead of the disease is complicated by simple arithmetic. Residents say they typically pay 200 Malawian kwacha — about 5 to 10 U.S. cents — for a 20-liter bucket of water from private taps or community kiosks. When money runs short, they turn to the stream.

“We know it is not safe, but the taps are few and expensive,” said resident Alinafe Khamula, who lives with her children in a one-room brick house near the valley. “When there is no cholera, we are forgotten. They only bring chlorine and talk to us when people are already sick.”

Those frustrations echo across the township. Some who came for the vaccine said they welcomed the campaign but wanted to see more consistent efforts to improve water access and hygiene.

“The health department should not only come when there is an outbreak,” said Chilomoni resident Noel Kanjere, who walked alone from his five-person household to receive the vaccine. “They need to continuously give sensitization messages to the community.”

A country still recovering from its worst outbreak

Malawi’s Ministry of Health declared an end to its previous cholera outbreak in July 2024, after more than two years of intense transmission. That epidemic, first announced in March 2022 and later elevated to a national public health emergency, infected 59,376 people and killed 1,772, according to government and World Health Organization figures. It was the worst cholera outbreak in the country’s history.

The earlier crisis overlapped with Cyclone Freddy, which struck in 2023 and devastated much of southern Malawi. Floods and landslides destroyed homes, latrines and water systems, especially in low-income urban and peri-urban areas. Health officials and aid groups say those climate shocks left lasting scars on already fragile water, sanitation and hygiene infrastructure.

Although the 2022–24 outbreak was eventually contained through a combination of treatment centers, surveillance, public-awareness campaigns and vaccination, it exposed deep vulnerabilities that remain, particularly in fast-growing settlements like Chilomoni.

What cholera is—and what the vaccine can do

Cholera is an acute diarrheal disease caused by ingesting food or water contaminated with the bacterium Vibrio cholerae. It can kill within hours if untreated, but most cases are easily managed with prompt rehydration. The oral cholera vaccine now being used in Blantyre provides short-term protection and is typically deployed alongside efforts to improve water and sanitation.

Authorities say they are better prepared this time. The Public Health Institute of Malawi reports that more than nine in 10 health facilities are submitting timely surveillance data, giving officials a clearer view of where cases are emerging. The vaccine is also being used earlier and more surgically, focused on hotspots rather than nationwide once the disease has already spread widely.

Yet the campaign is unfolding against a difficult regional and global backdrop.

Regional surge, extreme weather, and vaccine shortages

Africa is facing its worst cholera outbreak in 25 years, with more than 300,000 cases and 7,000 deaths reported on the continent in 2025, according to Africa’s public health agency. The World Health Organization says that globally, at least 565,000 cholera cases and over 7,000 deaths were recorded in 32 countries last year, continuing an upsurge that began in 2021.

Southern Africa has been hit particularly hard by extreme weather. Heavy rains and flooding in neighboring Mozambique have displaced hundreds of thousands of people in recent weeks, raising alarms about potential spikes in waterborne diseases. Past cyclones, including one in late 2024, have repeatedly damaged water and sanitation systems in Malawi and nearby countries.

At the same time, the global stockpile of oral cholera vaccines remains under strain. Surging demand led international agencies to temporarily switch from a standard two-dose regimen to a single-dose approach in 2022 to stretch limited supplies. Stockpile levels dropped below their emergency threshold at several points last year before rebounding, leaving many poorer countries uncertain how many doses they could secure and when.

Malawi struggled to obtain enough vaccine during its last outbreak, and officials now describe the 24,000 doses allocated for Blantyre as a start rather than a solution.

“Twenty-four thousand doses is a good number to start with,” Kawalazira said. “But with the rainy season and the spread to other districts, more doses will be needed.”

To reduce reliance on overseas manufacturers, a South African pharmaceutical company last year began trials for what could become the first oral cholera vaccine produced on the African continent. Public health experts say regional production could eventually help close the gap between where cholera hits hardest and where vaccines are made, though any new product is still several years away.

Beyond emergency response

For residents of Chilomoni, those long-term shifts feel distant. The immediate priorities are more tangible: enough clean water points, affordable prices, and regular chlorination and hygiene campaigns that do not disappear when case numbers fall.

Health advocacy groups in Malawi have urged the government and its partners to use the current flare-up as a spur for permanent improvements, arguing that repeated emergency responses are more costly than sustained investment in basic services.

“Without affordable, reliable, clean water in high-density urban areas, cholera will continue to recur,” said health rights advocate Maziko Matemba in a recent interview on state television.

As the sun climbed higher over Chilomoni, the vaccine line thinned, and health workers began packing away their coolers. Down by the Muluda stream, the washing continued. Children splashed in the shallows while adults scrubbed clothes and pots, the same way they did before the outbreak was declared and likely will after the vaccination teams move on.

Whether the three-day campaign is enough to blunt this season’s cholera threat will become clear in the coming weeks, as case counts are updated and the rains intensify. For now, families like Harriet George’s are seizing the protection that is available — a small vial of vaccine — while they wait for a more distant promise: a tap that brings safe water to their door.