Cholera is preventable and almost always treatable, yet the deaths reported to WHO in 2025 were the highest since 1999, concentrated in a few countries affected by conflict and lacking safe water and sanitation.
Updated October 15, 2026. Written from the sources listed below, not independently peer-reviewed.
Of every 100 cholera deaths reported in 2025 by countries that recorded where people died, roughly how many happened outside a health facility?
7,870
Cholera deaths reported to WHO
Reported by 47 countries, territories and areas. Up 30.6% from 6,028 in 2024 and the highest annual number reported since 1999. The real number is likely much higher.
Data year 2025. Source: World Health Organization, 2026
451,499
Cholera cases reported to WHO
Down 19.5% from 560,823 in 2024, but fewer countries reported: 81 countries reported zero cases (58 in 2024) and 77 sent no data at all.
Data year 2025. Source: World Health Organization, 2026
71 million
Oral cholera vaccine doses approved for use
Out of 116 million doses requested from the International Coordinating Group on Vaccine Provision. 20 million of the approved doses were for preventive vaccination.
Data year 2025. Source: World Health Organization, 2026
Unit: days (median)
Median number of days between confirming a cholera outbreak and starting a reactive oral vaccination campaign, as stated in WHO's 2025 cholera annual report. Only the three years given in the report are plotted; 2023 is not reported there. Faster campaigns reflect the growing vaccine supply, but they do not show whether outbreaks themselves are shrinking.
Ending Cholera: A Global Roadmap to 2030, endorsed by the World Health Assembly in 2018, aims to cut cholera deaths by 90% and to eliminate cholera transmission in up to 20 countries by 2030. Instead, reported deaths in 2025 were the highest since 1999. Haiti, which had reached the roadmap's three-year threshold for elimination, has reported cases again since a resurgence in 2022, including 3,446 cases and 65 deaths in 2025.
Seven countries, Angola, Bangladesh, the Democratic Republic of the Congo, Nigeria, South Sudan, Sudan and Yemen, accounted for around 90% of all reported cholera cases and deaths in 2025.
Source: World Health Organization, 2026The WHO African Region reported 54% of the world's cholera cases and 68% of its deaths in 2025. Compared with 2024, its cases rose by 34% and its deaths by 58%.
Source: World Health Organization, 2026Five of the seven countries with the heaviest burden were classed by the World Bank as conflict-affected in 2025. Sudan reported 73,597 cases and 2,161 deaths, more deaths than any other country.
Source: World Health Organization, 2026Cholera affects children and adults. Among countries reporting more than 1,000 cases in 2025, the share of cases in children under five ranged from 5.5% in the Democratic Republic of the Congo to 56.6% in Somalia, and cases were split almost evenly between males and females.
Source: World Health Organization, 2026Instead of one “percent solved” score, DO GOOD rates three separate dimensions. A problem can have mature solutions that still reach too few people. These ratings are an editorial reading of the sources on this page, not a measured index.
Has the situation improved in the real world?
LowReported cholera deaths rose by 30.6% in 2025 to 7,870, the highest number since 1999, and the African Region's deaths rose by 58%. The 19.5% fall in reported cases partly reflects weaker reporting rather than fewer infections.
How mature and validated are the available solutions?
HighThe tools are well established: most people recover with prompt oral rehydration, severe cases respond to intravenous fluids and antibiotics, and three WHO-prequalified oral vaccines give an adult at least three years of protection with two doses. Safe water and sanitation remain the lasting solution.
How widely are effective solutions actually used?
LowMore than one in five reported deaths occurred outside health facilities, and 12 countries exceeded the 1% facility fatality benchmark in 2025. Only 71 million of the 116 million vaccine doses requested were approved, and preventive campaigns were suspended for more than three years until 2026.
Reported figures cover only cases that reach surveillance: researchers estimate 1.3 to 4.0 million cases a year against 451,499 reported in 2025. Testing, case definitions and death recording differ between countries, and reporting cholera is not mandatory.
From January to the end of August 2026, reported cases were 43% lower and deaths 58% lower than in the same period of 2025, and vaccine supply and the speed of reactive campaigns have improved. But these monthly figures are provisional, and the conflicts and water and sanitation gaps behind the 2025 surge persist.
Cholera is an acute diarrhoeal disease caused by the bacterium Vibrio cholerae. It spreads through food and water contaminated with faeces, so it takes hold where safe water and sanitation are missing, often after conflict, displacement, floods, cyclones or drought. Most infected people have no or mild symptoms, but a minority develop severe watery diarrhoea and dehydration that can be fatal if lost fluids are not replaced quickly. Treatment is simple: most people recover with oral rehydration solution, and severe cases need intravenous fluids and antibiotics. In 2025, 47 countries reported 451,499 cases and 7,870 deaths to WHO. Cases were 19.5% lower than in 2024, but deaths rose by 30.6%, to the highest annual number reported since 1999.
Reported figures understate the real toll: researchers estimate 1.3 to 4.0 million cases and 21,000 to 143,000 deaths a year. The burden is highly concentrated. Seven countries (Angola, Bangladesh, the Democratic Republic of the Congo, Nigeria, South Sudan, Sudan and Yemen) accounted for around 90% of reported cases and deaths in 2025, and five of them were classed as conflict-affected. More than one in five reported deaths happened outside health facilities, among people who did not reach treatment in time. Between January and the end of August 2026, reported cases and deaths were well below the same months of 2025, but 28 countries were still reporting cases.
Countries report cholera cases and deaths to WHO through their surveillance systems, but testing, case definitions and the recording of deaths differ widely, and reporting cholera is no longer mandatory under the International Health Regulations (2005). The main measures are:
Reported cases
People with acute watery diarrhoea counted as cholera by national authorities, confirmed clinically, epidemiologically or in a laboratory. Many are suspected cases that were never tested, and some countries report acute watery diarrhoea instead of cholera, which is not directly comparable.
Reported deaths and place of death
Deaths among reported cases, ideally split into deaths in health facilities and deaths in the community. Many countries do not report where people died, so community deaths are likely undercounted.
Case fatality rate (CFR)
The share of reported cases that end in death. WHO's benchmark is that fewer than 1% of patients treated in health facilities should die; a higher facility rate points to late arrival or poor quality of care.
Estimated burden
Because so many cases go unreported, researchers model the true number of cases and deaths in countries where cholera is common. These estimates span a wide range, from 1.3 to 4.0 million cases a year.
What works
Oral rehydration solution replaces lost fluids and treats most patients successfully; severe cases need intravenous fluids, oral rehydration solution and antibiotics. Among patients treated in health facilities in 2025, the fatality rate was 0.9% globally, within WHO's 1% benchmark.
Limits
Treatment only helps people who reach it in time. More than one in five reported deaths in 2025 happened in the community, and 12 countries had facility fatality rates above 1%, including Chad, Kenya and Sudan.
What works
The International Coordinating Group on Vaccine Provision releases doses from the global stockpile to countries facing outbreaks. Reactive vaccination reached its highest level on record in 2025, and the median time from outbreak confirmation to campaign start fell to 45 days, from 120 days in 2022.
Limits
Requests for 116 million doses in 2025 were met with 71 million. Since October 2022 outbreak campaigns have given one dose instead of two because of the shortage; one dose gives good but shorter-term protection.
What works
Vaccinating people in places where cholera keeps returning can prevent outbreaks before they start. After more than three years of suspension, preventive campaigns resumed in February 2026 with 20 million doses: 3.6 million delivered to Mozambique, 6.1 million to the Democratic Republic of the Congo and 10.3 million planned for Bangladesh.
Limits
Twenty million doses cover only a small part of the people at risk, and vaccines protect for a limited time. Vaccination complements safe water and sanitation but cannot replace them.
What works
Access to safe water, basic sanitation and hygiene stops the faecal contamination through which cholera spreads. WHO describes universal access to these services, together with economic development, as the long-term solution.
Limits
Building and maintaining water and sanitation systems takes years and steady funding, and the places hit hardest by cholera are often those where conflict or disasters have damaged infrastructure.
What works
Rapid diagnostic tests help detect probable outbreaks early, and laboratory culture or PCR confirms them. Through the Global Task Force on Cholera Control, countries draw up multisectoral national cholera plans that start by identifying the priority areas where water, sanitation, vaccination and care should be concentrated.
Limits
WHO cannot reliably calculate what share of reported cases were tested, and in 2025 the number of countries reporting zero cases rose from 58 to 81 while 77 sent no data, which makes it harder to target action.
Promising, but not proven at scale. The stage shows how far each approach has come; it is not a recommendation.
A third WHO-prequalified oral vaccine, Euvichol-S, has joined Dukoral and Euvichol-Plus, and global production rose from around 30 million doses in 2022 to about 80 million in 2025. The added supply has allowed preventive campaigns to restart, but one-dose regimens, adopted because of the shortage, are still in use.
Since October 2022, vaccine shortages have led WHO to use one-dose regimens, which stretch each stockpile further. One dose gives good but shorter-term protection than two, and WHO expects one dose to remain the standard for outbreak response, with two doses considered case by case.
Rapid tests can flag probable cholera outbreaks at the point of care, before laboratory results are available. Test positivity among suspected cases was high in several countries in 2025, but results still need laboratory confirmation, and how widely testing is used cannot yet be measured reliably.
Implementation gap
Countries requested 116 million doses of oral cholera vaccine in 2025, and 71 million were approved. Preventive vaccination was suspended for more than three years so that scarce doses could go to outbreaks.
Technology gap
EUBiologics is currently the only manufacturer producing cholera vaccine at the scale needed for mass vaccination campaigns, which leaves global supply exposed to any disruption at one company.
Implementation gap
Among countries that recorded place of death in 2025, 22.7% of cholera deaths occurred in the community, and Angola, South Sudan and Sudan each reported more than 300 community deaths. Twelve countries had facility fatality rates above the 1% benchmark.
Coordination gap
Five of the seven countries with the heaviest burden in 2025 were conflict-affected. War disrupts water supplies, health services and vaccination campaigns, and Sudan alone reported 2,161 deaths. Responding requires humanitarian, water and health agencies to work together in insecure settings.
Coordination gap
Cholera persists wherever people lack safe water and sanitation, and WHO sees universal access as the only lasting solution. Investment in these services is slow and falls largely outside health budgets, so vaccination and treatment are often used to contain outbreaks that infrastructure could prevent.
Knowledge gap
Reporting cholera is not mandatory under the International Health Regulations, case definitions and testing differ, and in 2025 81 countries reported zero cases while 77 sent no data. The true burden, estimated at 1.3 to 4.0 million cases a year, is therefore known only roughly.
Unresolved questions, not vetted breakthroughs. Answering any of them would change what is possible.
Reported cases are a fraction of modelled estimates, which themselves span a wide range. Which mix of testing, community surveillance and modelling would give a reliable picture of where cholera occurs and how many people die?
Single-dose campaigns are now the norm. How long does protection last in young children and in places with frequent outbreaks, and when is a second dose worth the extra supply?
Twelve countries had facility fatality rates above 1% in 2025. How much is due to late arrival, how much to staffing, supplies or quality of care, and which fixes work fastest in crisis settings?
With limited budgets, which combination of water supply, sanitation and hygiene measures in priority areas reduces cholera fastest, and how should it be sequenced with vaccination?
Learn how to use oral rehydration solution and recognise severe watery diarrhoea as an emergency. If you live in or travel to an area with cholera, seek care quickly when symptoms start, and follow local advice on safe water and food.
Organisations that provide safe water, sanitation, treatment centres and vaccination in outbreak and conflict zones depend on donations. Look for groups that publish independent evaluations and report what they deliver.
Vaccine supply, water and sanitation programmes and humanitarian responses rely on public funding. Telling elected representatives that you support global health and water and sanitation aid is one way to influence it.
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World Health Organization (25 September 2026), published 2026
WHO's annual summary of cholera data reported for 2025. Source of global and regional cases and deaths, comparisons with 2024, zero reporting and missing data, facility and overall fatality rates, place of death, country figures (Sudan, South Sudan, DRC, Angola, Nigeria, Haiti), age and sex data, conflict-affected countries, vaccine requests and approvals, production, reactive campaign timing, the 2030 roadmap goals and surveillance limitations.
World Health Organization (news release, 29 September 2026), published 2026
WHO's release on the 2025 annual data. Source of the seven countries accounting for around 90% of cases and deaths, the statement that reported data understate the burden, and the share of deaths outside health facilities.
World Health Organization (29 September 2026), published 2026
WHO's overview of cholera. Source of the estimated 1.3 to 4.0 million cases and 21,000 to 143,000 deaths a year, transmission, symptoms and treatment, the 1% facility benchmark, rapid tests, drivers such as conflict, displacement and climate events, the three prequalified vaccines and their protection, the one-dose policy since October 2022, and WASH as the long-term solution.
World Health Organization, Gavi and UNICEF (news release, 4 February 2026), published 2026
Source of the resumption of preventive vaccination after more than three years, the 20 million doses allocated to Mozambique, the Democratic Republic of the Congo and Bangladesh, the single large-scale manufacturer, and the continued one-dose standard for outbreak response.
World Health Organization (2 October 2026), published 2026
WHO's monthly cholera update with data to 30 August 2026. Source of provisional 2026 figures: 275,284 cases and 2,601 deaths in 28 countries from January to August, 43% fewer cases and 58% fewer deaths than in the same period of 2025.