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Policy Brief: Cholera in Neighboring Countries

Policy Brief: Cholera in Neighboring Countries

Policy Brief Oct. 2025

With confirmed cases of cholera reported in a neighboring country, a state of national alert and vigilance emerges, requiring the adoption of a comprehensive, multi-level preventive strategy grounded in international guidelines. This is not merely a matter of emergency health response, but rather a coordinated institutional intervention that spans the sectors of health, agriculture, trade, water, and media. The potential threat of cross-border transmission of the cholera bacterium—whether through travelers or contaminated food products—necessitates the establishment of a protective barrier based on science, effective monitoring, and informed public awareness, as recommended in international guidance.

Import Control Policies and Supply Chains

Agricultural and food products, particularly fresh produce irrigated with potentially contaminated water, represent a possible channel for disease transmission. The World Health Organization (WHO) notes that contaminated foods, especially those consumed raw, can be a significant vehicle for cholera in the absence of safe water and sanitation. Policies should therefore focus on:

  • Strengthening mandatory inspections at entry points: All shipments from affected areas should undergo rapid and accurate microbiological testing.
  • Dynamic risk assessment: WHO and the Centers for Disease Control and Prevention (CDC) recommend risk assessments based on epidemiological data from the exporting region, with strict measures applied specifically to imports from affected areas.
  • Temporary and conditional suspension of imports: In line with the International Health Regulations (IHR 2005), states may implement additional health measures, including restrictions on goods, if based on risk assessment. Such suspensions should be time-bound and subject to review.
  • Selective targeting of high-risk products: This aligns with the principle of Pest Risk Analysis promoted by the Food and Agriculture Organization (FAO) and the International Plant Protection Convention.
  • Traceability and transparency: Shipment tracking systems should be applied in accordance with the principles of Hazard Analysis and Critical Control Points (HACCP), endorsed by FAO/WHO in the international code of practice.

Governance Structure and Institutional Coordination

The effectiveness of any policy is directly linked to the quality of coordination among stakeholders. WHO emphasizes that “cholera preparedness requires multisectoral coordination and a harmonized response.” Accordingly, the establishment of a national cross-sectoral committee is recommended, bringing together representatives from health, agriculture, water, environment, and customs. This multidisciplinary approach is a cornerstone of the Global Roadmap to End Cholera promoted by WHO and the Global Task Force on Cholera Control.

Health Preparedness and Surveillance Systems

The health system must remain on high alert to detect and contain any potential cases. This includes:

  • Activation of early warning systems: WHO recommends sensitive surveillance systems capable of detecting and investigating acute watery diarrhea cases.
  • Preparedness of isolation centers and essential supplies: The Global Cholera Response Plan highlights the need to secure oral rehydration salts (ORS), intravenous fluids, and antibiotics.
  • Diagnostic capacity building: WHO encourages the use of rapid diagnostic tests (RDTs) for initial screening, with confirmation through bacterial culture.

Water, Sanitation, and Hygiene (WASH)

Contaminated water is the primary driver of cholera outbreaks. WHO stresses that “investment in safe water and sanitation is the long-term solution to ending cholera transmission.” Measures should include:

  • Monitoring drinking water quality: WHO recommends regular monitoring of residual chlorine to ensure safe water supplies.
  • Safe irrigation water: FAO highlights the importance of using clean water for irrigation, particularly for crops consumed raw, to reduce foodborne disease risks.

Community Engagement and Risk Communication

Transparency and clear communication are essential tools to counter misinformation. Public awareness campaigns, as emphasized by WHO, should focus on risk communication and community engagement as a central pillar of cholera control. Key messages should highlight:

  • Hand hygiene.
  • Safe household water treatment (boiling or chlorination).
  • Food safety practices (washing and peeling).
  • Awareness among high-risk groups such as travelers and food sector workers.

Responding to the risk of cholera from neighboring countries is a true test of the resilience of the national health and preventive system. The optimal approach is a proactive, preventive one that relies on strong institutional coordination, science-based import controls grounded in risk assessment, strengthened health surveillance, assurance of safe water and sanitation, and effective public communication. Temporary suspension of imports is one tool among many, to be used judiciously as an exceptional and short-term measure in line with the International Health Regulations (2005), until the threat subsides. The balance between protecting public health and maintaining economic continuity must be carefully preserved.

Through these integrated policies, grounded in international evidence, the state can demonstrate its capacity to manage cross-border health crises with professionalism and effectiveness.

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