Angola’s cholera outbreak has killed hundreds – but with vaccines, the country is fighting back
The worst cholera outbreak in a generation has brought together a coalition that includes medics, health leaders, international partners and young survivor-activists.
- 17 March 2025
- 6 min read
- by Gaspar Micolo
In early January this year, tragedy took hold in Joaquim Nando’s family. A resident of the Paraíso neighbourhood in the Cacuaco suburb of Luanda, the 25-year-old witnessed his nephews becoming seriously ill with cholera.
Severe vomiting and diarrhoea culminated in the deaths of the children – a brutal loss faced by many families in this part of the country since cholera resurfaced in early January.
But Nando, too, became ill enough after coming into contact with his sick nephews that he needed to be hospitalised. He overcame the disease thanks to treatment, but left the hospital with the painful premonition that many more lives might be lost before the outbreak was brought to heel.
It didn’t take long for the situation to get worse. What started in Cacuaco, an area with severe sanitation deficiencies in the Angolan capital, has now spread to 13 of the country’s 21 provinces.
Between the outbreak’s start and 11 March there have been 6,651 cases recorded countrywide and 240 deaths, with Luanda province alone reporting over half the total caseload – 3,477 cases in total.
Angola fights back
With the resurgence of the disease, Angola decided to reactivate its national multisectoral commission, charged with steering the national contingency plan to respond to the outbreak.
Measures undertaken in coordination with other institutions include disinfection of contaminated areas, identification and contact tracing of cholera patients, as well as in-depth epidemiological and laboratory investigation to confirm suspected cases. With support from the World Health Organization (WHO), health authorities are stepping up disease surveillance and other response activities in high-risk areas along the border with Zambia and the Democratic Republic of the Congo.
The National Director of Public Health, Dr Helga Freitas, assured the public that several ministerial departments, partners and communities themselves are involved in the cholera control effort. Several cholera treatment centres (CTCs) have been opened in various areas of Luanda and other provinces. These centres have been a critical line of defence in ensuring that infected patients receive the emergency treatment they need, in their locality.
Equipped with oral rehydration solution, vital medications and adequate medical equipment, CTCs have been strategically positioned in the most affected areas, including Cacuaco, to reduce mortality and facilitate access to immediate medical care.
Vaccines arrive on the front-line
Aníbal Kambundu is a doctor who works at one of three centres scattered across Luanda. He says that months into the outbreak, many cases still arrive at the hospital in critical condition. “Every patient who recovers is a victory, but we know that there is still a lot to be done. Prevention is as crucial as treatment,” he says, adding that basic sanitation is one of Angola’s major challenges.
“Initiatives such as awareness campaigns, distribution of hygiene kits and chlorination of water sources show the Government’s commitment to combating the disease, directly involving local communities in this crucial process,” Kambundu comments.
So do the vaccines, which began rolling out in Cacuaco, the outbreak’s cradle and epicentre, on 3 February. In just a few days, the immunisation campaign launched by the Angolan Government, with the support of WHO, UNICEF, Gavi and the World Bank, managed to reach and protect more than 940,000 people. Vaccines were sourced from the Gavi-funded stockpile, however, since Angola is a middle-income country, the government is responsible for repaying the value of the vaccines.
Recipients included residents of the most affected areas and health professionals on the frontline in the fight against the disease. The vaccine used, Euvichol-S, is administered orally and can be given to all people aged one year and over in a single dose.
Public health specialist Jeremias Agostinho told VaccinesWork, “[The vaccination campaign] was the most appropriate measure to contain the outbreak in the short term. In other words, to reduce the increase in the number of cases and consequent deaths. We are seeing a lot of daily deaths: between five and six deaths on average per day. It’s a high number,” he said.
More vaccines will be needed, he adds – especially for other provinces, which are beginning to see an increase in cases, and there is a risk of the outbreak crossing borders into neighbouring countries if not brought under control. “There is a slowdown [in transmission] due to vaccination, but the risk of an increase in cases in other provinces exists.”
Furthermore, he points out, the basis of the problem persists: poor basic sanitation.
Fatality rates start to flag
At the end of February, Dr Freitas revealed that the case fatality rate, the proportion between the number of deaths from a disease and the total number of patients, dropped from 9% to 4% – still well above the guideline threshold of less than 1% that WHO advises is possible to achieve with early and adequate treatment.
Dr Freitas explains the reduction in deaths on basis of the work undertaken by the Ministry of Health and partners, highlighting the creation of Cholera Treatment Centres, vaccination, distribution of hygiene material, distribution of drinking water and training of community agents.
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In Cacuaco, a survivor turns activist
Joaquim Nando, one of the first to feel the impact of this outbreak, is now an activist against the disease in his community. In Cacuaco, he joined his friends Paulo Gomes, 23, and Jovito Leonel, 25, to help distribute posters and other awareness materials.
“Basic sanitation is essential and urgent, but I feel that these awareness-raising actions help to guarantee the safety measures that we always need,” explains Leonel, who has embraced the cause since his friend survived the disease.
Gomes, in turn, says that the disease had a great impact on the municipality of Cacuaco, highlighting the suffering of many families who lost loved ones. When the vaccination campaign took place, he was one of the first to set an example in his community. “Community involvement is essential to the success of the campaign. Each person vaccinated helps to protect the community, containing the spread of the disease and saving lives,” explained the young nursing graduate.
According to WHO, Angola has struggled with cholera outbreaks through much of its history. After a period without outbreaks between 1995 and 2000, the country recorded a large outbreak in 2011, which resulted in 2,284 cases and 181 deaths, and then a larger outbreak in 2013 with over 5,600 cases and 190 deaths. The most recent outbreak, which occurred between 2016 and 2017, affected the provinces of Cabinda, Luanda and Zaire, with a total of 252 cases and 11 deaths.
As the disease resurges globally, Angola’s current outbreak dwarfs those in living memory.
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