“[E]ven when it is not covered in the news or noticed by the public, cholera occurs regularly in the developing world, and the annual number of cases reported to the World Health Organization (WHO) has increased over the past few years to more than half a million cases and 7,816 related deaths reported from all regions in 2011,” Ronald Waldman of George Washington University, Eric Mintz of the Centers for Disease Control and Prevention, and Heather Papowitz of the U.N. Children’s Fund write in a New England Journal of Medicine perspective piece, adding, “[T]hese reported numbers grossly underestimate the actual global burden of cholera: the WHO estimates that three million to five million cases and 100,000 to 200,000 deaths due to cholera occur annually.” Noting changes to cholera control recommendations, including the addition of antibiotic and zinc treatment and expanded use of the two-dose cholera vaccine, the authors state, “These developments are welcome additions to the anti-cholera armamentarium, but public health professionals know that they do not address the underlying problem.”

“The best intervention for long-term cholera control and, for that matter, for the control of the great majority of diarrheal diseases is … [t]he development and maintenance of water and sewage treatment systems,” they write. While “[t]here has been some progress, … [e]nsuring safe water and improved sanitation is a difficult proposition,” they continue. “Th[e] challenges — technological limitations, costs, behavioral customs, and lack of education and of political will — should be seen not as absolute barriers to moving forward but rather as problems to be solved,” the authors write. They add, “Cholera … is as much a symptom as a disease. It is a symptom of insufficient investment by the global development community in assuring access to safe water and improved sanitation — of providing only a Band-Aid solution to a difficult problem” (1/9).