On 2 February 2024, the government of Comoros, an archipelago off the east coast of Africa, declared an unprecedented Cholera Outbreak in Comoros.
The country has experienced several waves of epidemics since 1975. Still, this latest one has seen a significant number of Comorians affected by the disease, with more than two hundred cases a day recorded at the epidemic's peak. As of 31 July, the country has recorded 10,342 cases and 149 deaths. Many of the deaths have occurred in remote communities such as Mremani. At the government's request, Doctors Without Borders (MSF) teams have set up an emergency response on the hardest-hit island of Anjouan, and on the island of Moheli.
In Anjouan, MSF supported two cholera treatment centres (CTC) integrated into the hospitals in Hombo and Domoni, two cholera treatment units (UTC) in Pomoni and Mremani, and seven oral rehydration points (ORP) spread across the island. In Moheli, our teams have been working to improve patient management and reinforce sanitation and hygiene activities.
What can be done in practice to contain an epidemic that may seem out of control?
To efficiently treat cases of cholera, one of the pillars of the response has been prevention. In collaboration with the Ministry of Health, our teams launched a mass vaccination campaign targeting the entire Comorian population, to develop collective immunity and prevent the spread of cholera.
Building trust with community members
In any type of epidemic, the community plays a key role. It is the cornerstone of the fight against the spread of the disease. Therefore it is essential to involve them in the campaign, particularly in raising awareness. However, we had to face up to a major challenge: the population's denial of the existence of the disease", explains Frédéric Lai Manantsoa, emergency coordinator in Comoros.
A large proportion of the Comorian population did not believe that the disease even existed, and because the oral vaccine Euvichol-plus was little known, its acceptance was not without difficulties. Our teams had to deal with numerous rumours and resistance within communities. For example, some people feared its side effects, claiming that the vaccine encouraged people to contract cholera. Community involvement and mobilisation played a major role in encouraging people to be vaccinated.
In the end, our teams were able to vaccinate 79% of the population of Anjouan, i.e. 276,153 people, and 73% in Moheli.
Successful community engagement strategies
Awareness-raising relied mainly on existing infrastructures, in particular the Risk Communication and Community Engagement Committee (RCCE), which brings together community leaders, the Anjouan regional health department and various humanitarian actors (UNICEF, IFRC, Comorian Red Crescent, WHO).
Mass awareness-raising was done through local media, including TV, radio and social networks, and this was reinforced with various community approaches, such as community engagement in schools, mosques, main public places, door-to-door campaigns, and meetings with community leaders.
The involvement of influential social groups, like youth and women's associations, and the ongoing analysis of community opinions and suggestions helped our teams adapt their messages for community dissemination during the vaccination campaign.
Of all East African countries affected by cholera, such as Tanzania and Mozambique, Comoros archipelago was the only one to receive the required quantity of Euchivol-plus, the oral cholera vaccine, from the ICG (International Coordinating Group for Vaccines) for its entire population.
This is an opportunity that other countries where cholera is endemic have not been able to take advantage of, preventing an optimal medical response. The combination of high-quality care and a mass vaccination campaign has borne fruit: as of 31 July, no cases of cholera have been reported.