Malawi has appealed for more than 7 million additional doses of cholera vaccine from the World Health Organization as it struggles to control a record outbreak of the bacterial illness.

The WHO donated almost 3 million doses of the vaccine to Malawi in November but those were quickly used up. Since March of last year, almost 30,000 people have been infected and nearly 1,000 have died.

The appeal for more cholera doses comes as Malawi continues to register an increase in cases that have now affected all of its 29 districts.

The spokesperson for the health ministry, Adrian Chikumbe, said talks with the WHO are underway.

“We are expecting a consignment of 7.6 million doses for 17 districts, but we are going to also consider districts that are hard hit with the current outbreak,” Chikumbe said.

The Ministry of Health said Tuesday that there is no indication Malawi will receive the vaccine any time soon because many other countries are also pressing the WHO on the same issue.

The World Health Organization first supported Malawi with 3.9 million doses of the oral cholera vaccine last May, after the outbreak was reported in March.

The country received another consignment of 2.9 million doses in November through the WHO and the U.N. children’s agency, UNICEF.

Maziko Matemba, community health ambassador in Malawi, said the vaccine shortage shows a change in attitude toward the shots.

“We had a similar situation with COVID-19 where we had low uptake when we saw more people getting sick and more people dying,” Matemba said. “So I am hoping WHO and the government of Malawi will take it as an advantage that now we have high uptake, people are demanding the vaccine. Some of us have even received calls where people want to access the vaccine. So I am hoping this time we will utilize the demand.”

Cholera is an acute diarrheal disease that can kill within hours if left untreated.

Malawi is currently battling its worst cholera outbreak in a decade, largely blamed on poor sanitation and hygiene.

The hard-hit districts include Malawi’s capital, Lilongwe, and commercial hub Blantyre

Wongani Mbale, health promotion officer for the Blantyre District Health Office, said the main cause of cholera is the use of unsafe water.

“[In] Blantyre the population is growing due to urbanization, so the source of water is so scarce, so people are resorting into using the unsafe sources of water,” Mbale said.

The Malawian government is reconnecting water kiosks in hard-hit areas. They had been disconnected because of unpaid water bills.

As the country awaits another supply of cholera vaccine, health authorities have intensified campaigns on preventive measures, like eating boiled foods, washing hands with soap before eating and using toilets.

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