Vaccinating the future against cholera

One morning in October 2024, 23-year-old Loveness Jackson from Kaudzu Village in Traditional Authority Sitola, Machinga District, woke up feeling extremely weak. She began vomiting and experiencing acute diarrhoea.

“It was a very strange experience in our family. I didn’t know what was happening,” she recalled.

Her mother gave her salty water in an attempt to help, but the situation worsened.

Loveness grew dizzy and weak, unable to walk. Each time she drifted off to sleep, her mother would wake her up to give her more salty water.

Soon, her younger sister also began vomiting and became just as weak. Shortly after, their younger brother fell ill as well. Their mother, overwhelmed and frightened, feared the worst.

“We thought the disease would wipe us all out. It was terrifying,” said Loveness, the eldest of seven siblings. The family lives without their father, who passed away years ago.

The three siblings were rushed to Machinga District Hospital, where they were diagnosed with cholera. They were treated with Thanzi Oral Rehydration Therapy (ORS).

“I was admitted for two days and discharged, but my siblings stayed longer,” said Loveness, a graduate of Liwonde Secondary School in the district.

She was among 20 people affected in the village during a severe cholera outbreak, prompting urgent action from health workers and local leaders.

Another member of the community, Alinafe Wasili, contracted cholera while caring for her mother, who was hospitalised with the same illness.

St Theresa Primary School, with 3,040 pupils, was also affected. According to Headteacher Anastazio Sululu, one pupil died from cholera late last year, and 23 others fell ill.

“Our school is close to the main road that goes to the hospital. Patients would vomit or defecate along the way while on bicycles. This exposed our pupils to contamination,” said Sululu.

At the height of the outbreak, more than 60 pupils dropped out of school for fear of infection. In response, health workers engaged the school to help spread preventive messages.

“As a school, we held sessions to educate pupils and teachers on hygiene such as handwashing with soap, avoiding raw or cold food, and not accepting food from unknown sources,” said Sululu.

“Most importantly, we encouraged them to be vaccinated with the Oral Cholera Vaccine (OCV).”

The same information was shared with parents, urging them to seek immediate medical care if symptoms appeared, practise hygiene, build toilets and support vaccination.

A turning point came in February 2025 when UNICEF, in collaboration with the Ministry of Health and with support from GAVI through the COVAX Delivery Support (CDS3), launched a cholera vaccination campaign in Machinga.

UNICEF helped integrate cholera vaccination with human papillomavirus (HPV) vaccinations and other related health initiatives. HPV vaccine protects against cervical cancer and other diseases.

In Kaudzu Village, community members responded positively, thanks to vigorous door-to-door sensitisations.

“It was easy to convince people because they had seen how widespread and deadly the disease was. I led by example, and others followed,” said Senior Group Headman Kaudzu.

At St Theresa Primary School, Headteacher Sululu also took the vaccine first to dispel myths among students. As a result, 1,993 of the school’s 3,040 students were vaccinated.

Among those vaccinated was 12-year-old Desire Sam, a Standard Six pupil.

“I thought I’d die if I took it, but I saw our headteacher take it and he was fine,” said Desire.

Health worker Ethel Zagwa Muhama said the community’s positive response stemmed from successful experiences during the Covid-19, polio, and HPV vaccination campaigns.

“People saw how cholera was affecting their neighbours. That encouraged many to accept the vaccine. The number of cases dropped significantly,” she said, praising the cooperation between health workers, teachers, and parents.

Fraser Gareta, Coordinator for the Expanded Programme on Immunisation at Machinga District Hospital, said the district often records high cholera rates, especially in lakeshore communities of Lake Chilwa and Chiuta where open defecation is common.

In the 2025 cholera campaign, the district aimed to vaccinate 70 per cent of its population aged over one year, about 280,000 people. By the end of the campaign, they exceeded the target, vaccinating 81.2 per cent of the population (more than 224,000 people).

“We applied a combination of approaches such as community meetings, mobile vans, schools as vaccination centres, use of UNICEF volunteers, and door-to-door outreach. Above all, UNICEF’s technical support was also very vital,” said Gareta.

Some religious communities initially resisted vaccination, but private home visits helped change their minds.

“Some refused to be vaccinated publicly but agreed to it in private. They asked us not to tell others out of fear,” Gareta revealed.

In Kaudzu Village, post-cholera vaccination campaign life and health-seeking behaviour has visibly improved.

According to Loveness, households have now adopted preventive measures such as building toilets, regular handwashing, boiling food, chlorinating drinking water, using rubbish pits and practising general hygiene.