Nigeria’s cholera response weakened by vaccine gaps, poor health structures

Nigeria is experiencing a cholera outbreak driven not just by the rainy season, but by deep-seated systemic failures. The recurring nature of these deadly waterborne outbreaks points directly to a double-edged crisis: critical preventive gaps and an increasingly fragile public health infrastructure, public health officials have warned.

At the heart of the country’s vulnerability is the absence of the Oral Cholera Vaccine (OCV) within the nation’s routine immunisation schedule. While universally recognised as a vital tool for outbreak containment, the vaccine remains completely unavailable in public health facilities, leaving households to seek it from private providers at high cost.

The waterborne disease has re-emerged in parts of Northern Nigeria, causing fatalities and infecting thousands, especially in Plateau and Borno States, while other states are ramping up surveillance and preparedness to prevent outbreaks.

In Borno State, it has become a serious and rapidly escalating health emergency, starting in early May in Maiduguri and quickly spreading to several areas; over 74 people have so far died, while infecting nearly 8,000 people within weeks, a Médecins Sans Frontières report (commonly known as Doctors Without Borders) revealed last week.

MSF said 7,850 suspected cases had been recorded across 14 local government areas as of June 7, citing the state ministry of health, with infections rising sharply each day.

The outbreak is straining an already fragile healthcare system in a region at the heart of a 17-year Islamist insurgency, mass displacement and poor water and sanitation, raising the risk of wider spread if containment falters.

Experts warned that the most affected state, Borno, is experiencing the highest number of cases, with health facilities overwhelmed by the continued influx of patients. Women and children are among those most impacted. Despite ongoing response efforts, the situation remains dire.

According to experts, without urgent improvements in healthcare, access to safe water, and hygiene, the outbreak could worsen and threaten more lives. Since the outbreak began, over 1,300 patients have been treated, with more than 960 discharged and a case fatality rate below 1 percent, indicating that most patients have survived.

“There is a need for additional support; urgent expansion of healthcare services and clean water interventions is crucial to contain the spread, including boosting community awareness about transmission, symptoms, early care-seeking, and increasing oral rehydration points in hotspots,” an expert stated.

The state previously experienced annual cholera outbreaks, but this year, the outbreaks are of high magnitude. The expert pointed out that recent Maiduguri floods have left the affected areas severely cholera-affected due to contamination from broken latrines, wash boreholes, and other water sources, as well as open defecation.

“After the Maiduguri flood, the state government did not rebuild contaminated boreholes, toilets, culverts, latrines, and water sources. I warned then about a potential public health crisis. Currently, many toilets and houses in Maiduguri are in disrepair. Alau Dam has yet to be reconstructed after nearly two years of collapse, and these issues require investigation,” the expert stated.

BusinessDay last week published a news report about devastating epidemics that had spread across about 14 Local Government Areas, affecting at least 7900 persons.

The report came after weeks of unexplained silence from the Borno State Ministry of Health, even as several messages from BusinessDay’s Correspondent to Baba Mallam Gana, Commissioner for Health, seeking to understand why his Ministry was dragging its feet in declaring an outbreak, went unanswered.

While state health authorities remain largely quiet about the surge in cholera infections and the need to issue an official declaration, the government’s response has now shifted to active containment measures, beginning with high-level field assessments by Local Government officials.

BusinessDay visited cholera-endemic areas, including Greenhouse, Gwange, Old Maiduguri, Budum, Limanti, Shehuri North, Kofa-Biu, Shokari, and Gamboru in Maiduguri and Jere Local Government Areas. Residents reported that many people died before they could be taken to the hospital.

Abu Daud, a resident who lost four people to cholera in Kofa-Biu, said the disease had so far killed more than 10 individuals and infected an unspecified number within the community.

“We have lost 11 persons after Sallah celebrations in Kofa-Biu; they started vomiting, then developed diarrhoea. Before we could do anything, they passed away. As I’m speaking to you, three children have died, and dozens are already infected.

“We know what happened here some years back; that’s why everyone is afraid. We pray that such a calamity should not be repeated. Many people died,” he said.

Bana Kaka, a health practitioner who usually administered first aid before taking patients to treatment centres, complained that some patients do not go to the hospital, and many self-medicate, which has worsened the outbreak.

“My problem with our people is self-medication, and I told them to stop this attitude; many have lost their lives as a result of it. I have had to force some to take their children to the hospital. More than 20 have been killed by suspected cholera cases in Shehuri and Bundum areas,” he lamented.

Hauwa Mohammed, a nurse, expressed concern, “What is disturbing is that some people still have this fear about going to the hospital. When they come, and I can stabilise them, I ask them to go to the hospital, but they refuse. Many are dying in the community.”

She added that the situation is worse where people live in conditions that facilitate disease transmission.

“There are areas where the community fetches water from the reservoir (Mother Cat Dam); once the water is contaminated, the disease will continue spreading,” she said.

Also, the Plateau State Government has intensified efforts to contain a worsening cholera outbreak in Mangu Local Government Area after the number of suspected cases rose sharply to 53, with five deaths recorded across three affected wards.

Nicholas Ba’amlong, the state commissioner for health, disclosed this during a press briefing in Jos, describing the situation as serious but manageable with sustained government intervention and community cooperation.

According to the commissioner, the outbreak, initially reported with only eight suspected cases, has spread to the Pushit, Mangu 1, and Mangu 2 wards, raising concerns about continued transmission within affected communities.

“As of June 12, 2026, we have recorded a cumulative total of 53 suspected cases, 10 Rapid Diagnostic Test-reactive cases, four laboratory-confirmed cases through culture, and sadly five deaths,” Ba’amlong said.