Malawi - From Outbreak Response to Long-Term Protection: Blantyre Achieves Full Coverage in Preventive Cholera Vaccination Campaign

Ending cholera requires more than responding to outbreaks. It requires protecting the communities most at risk before the next outbreak occurs. In Malawi, the successful implementation of a second-dose Oral Cholera Vaccine (OCV) campaign in Blantyre has demonstrated how strategic investment in prevention can save lives, strengthen community resilience, and accelerate progress toward cholera elimination.

The August 2026 campaign marked the third phase of Malawi's OCV response during the 2025-2026 cholera outbreak, building on earlier reactive vaccination efforts implemented in hotspot districts. While the initial phases focused on rapidly interrupting transmission during the outbreak, the Blantyre campaign was designed to provide longer-term protection to populations living in communities that continued to face the highest risk of cholera transmission.

Targeting five Priority Areas for Multisectoral Interventions (PAMIs), namely Chemusa, Chirimba, Chilobwe, Suya, and Mpemba, the campaign reached 186,108 people and achieved 100% administrative coverage, ensuring that communities previously vaccinated during the response phase received a second dose to strengthen and prolong immunity against cholera.

WHO provided technical leadership throughout the campaign, supporting operational planning, readiness assessments, microplanning, vaccine deployment, logistics coordination, supervision, monitoring, and Emergency Operations Centre coordination. WHO also mobilized USD 120,933 to support implementation and worked closely with the Ministry of Health to strengthen social mobilization, adverse events following immunization preparedness, and real-time monitoring systems.

Strong community engagement was equally critical. Traditional leaders, religious leaders, local authorities, and community volunteers worked alongside health teams to promote vaccine acceptance and encourage participation. Their involvement helped build community ownership and contributed to the exceptional coverage achieved across all target areas. Beyond vaccination, WHO supported post-campaign coverage survey data collection to generate the evidence needed to guide future cholera prevention efforts and inform long-term planning for vulnerable communities.

The impact was clear. Following the OCV interventions, cholera transmission declined steadily, with the epidemic curve showing a sustained downward trend and the disappearance of large case surges. This progress contributed to the eventual declaration of the end of the cholera outbreak by the Ministry of Health on 31 August 2026.

The Blantyre second-dose OCV campaign demonstrates the power of moving from response to prevention. Through strong government leadership, WHO technical support, and community engagement, Malawi successfully protected high-risk communities, strengthened long-term immunity, and took an important step toward a cholera-free future.