Cholera has affected the world since the 19th century, killing millions of people. The current (seventh) pandemic started in south Asia in 1961 and continues today, with countries including Angola, the Democratic of Congo (DRC), Sudan and South Sudan experiencing their worst outbreaks in years. In 2025, WHO reported over 616,000 cases and more than 7,600 deaths globally, though this vastly underestimates the true burden disease.

There remain significant gaps in our understanding of cholera transmission, and predictors for this. Answering these questions is essential to designing effective interventions – but only if findings are relevant and accessible to decision makers.

About the programme

In 2018, FCDO and Wellcome jointly launched a Joint Initiative on Research in Epidemic Preparedness and Response (JIREP), establishing a cholera research portfolio worth approximately £5.7 million. Nine projects were funded across Bangladesh, Cameroon, the DRC, Ghana, Kenya and USA, covering epidemiology, water, sanitation and hygiene (WASH), oral cholera vaccines (OCV) and case management.

Cholera affects people differently depending on age, location, and socioeconomic circumstances, so there is no one-size fits all approach. Local, community-centre evidence is essential.

Key achievements

The programme published over 16 peer-reviewed papers, informed WHO guidance on WASH interventions, generated new evidence on single-dose vaccine effectiveness, and strengthened cholera surveillance capacity across multiple countries.

A central principle of the programme was ensuring findings could be acted upon. In Kenya, researchers mapped how cholera was spreading through Nairobi’s informal settlements, finding that children were infected through wastewater run-off while adults were primarily exposed through contaminated drinking water and street food. When an outbreak hit Nairobi, authorities used these findings to prioritise targeted vaccination campaigns in high-risk areas, educate communities on water safety, and build drainage systems – directly reducing the number of people presenting at health clinics with cholera.

Lessons learned
The review highlighted the need for longer application timelines to allow multi-country studies, with greater involvement of researchers from cholera-affected countries, and stronger links to policy from the outset. FCDO and Wellcome have incorporated these lessons into subsequent programmes.

To visit the Wellcome Open Research website to see the full review: Wellcome-FCDO Joint Initiative on Research in Epidemic Preparedness and Response (JIREP) Cholera Portfolio.