The Epidemiology and Disease Control Division, which has prepared the national cholera elimination plan, has said that mass vaccination against the disease in 22 high-risk districts is the only way to eliminate it.

Those 22 districts include three of the Kathmandu Valley—Kathmandu, Lalitpur and Bhaktapur.

In total, 48 of the 77 districts in the country are at risk of cholera outbreak, with 22 of them at the highest risk due to poor water and sanitation conditions.

“We have already presented the National Cholera Elimination Plan to the Ministry of Health and Population for deliberation,” said Dr Yadu Chandra Ghimire, the division’s director. “We will proceed with its implementation once the ministry approves the action plan and resources for the programmes are secured.”

Cholera is a highly infectious disease that causes severe diarrhoea and vomiting, leading to dehydration, and even death within a few hours if left untreated. Cholera outbreaks are not new to Nepal, as they are recorded every year, especially in the monsoon season.

Nepal witnessed a massive cholera outbreak during last year’s monsoon. At least 95 cases of cholera infection were confirmed in Kathmandu, Lalitpur, Kailali, Pyuthan, Makawanpur, Rolpa, Sindhupalchok, Achham and Rautahat districts.

Health officials said that the Vibrio cholera 01 Ogawa serotype was found in the stool samples of the infected patients. Hundreds of people suffered from the diarrheal infection that continued for months.

In 2022, too, the Kathmandu Valley witnessed a massive cholera outbreak with at least 77 confirmed cases.

Nepal has committed to eliminating cholera by 2030 and the national cholera elimination plan was prepared accordingly, officials say. In December last year, a meeting was held at the Health Ministry with representatives from the World Health Organisation’s headquarter and technical officers from WHO Nepal to discuss the current cholera situation in the country.

Public health experts say that the risk of waterborne diseases, including cholera, will not lessen until and unless the country’s water and sanitation conditions improve, and people are ensured safe drinking water. Several other factors impact the quality of water supplied to households, including the condition of supply pipes, water storage, and pollution in water sources.

Multiple studies carried out in the past show that nearly 70 percent of drinking water samples in Kathmandu Valley are contaminated with E coli and faecal coliform.

The proposed cholera elimination plan focuses on improving water, sanitation, and hygiene programmes, with support from development partners, including the World Health Organisation, Unicef, and other agencies, officials say.

“We have also proposed active cholera programmes in every district, awareness programmes, and programmes related to water and sanitation,” said Ghimire. “Multiple stakeholders, including agencies and ministries, have their roles in the cholera elimination programme. Billions of rupees are required to implement the programme.”

Nepal was declared open-defecation free in 2019. Incumbent Prime Minister KP Sharma Oli had declared the entire country open-defecation free amid much fanfare during his second tenure. However, six years later, thousands of people from across the country are getting infected with water-borne diseases, including scores from cholera.

Doctors say the only ways to save lives from water-borne diseases, including cholera, are to launch awareness drives and ensure safe drinking water. According to them, a combination of surveillance, water, sanitation and hygiene, social mobilisation, and treatment is required to contain the spread of the infection.

The World Health Organisation says cholera is a global threat to public health, and a multifaceted approach is key to controlling the disease and reducing deaths.