Strategies for achieving a healthy oral cholera vaccine market: Model-enabled scenario exploration of supply and demand dynamics

Donovan Guttieres, Carla Van Riet, Nico Vandaele and Catherine Decouttere

PLOS Neglected Tropical Diseases, 2026, vol. 20, issue 2, 1-22

Abstract: Following decades of progress, recent years have seen a resurgence of cholera. This has led to unprecedented demand for vaccines from the global emergency stockpile of oral cholera vaccines (OCVs), for outbreak and humanitarian use. As a consequence of chronic supply shortages, preventive vaccination has been suspended since 2022. Although strategic demand scenarios have been published for OCV, models that integrate OCV supply and demand across long time horizons are lacking. Therefore, a quantitative system dynamics model is presented to simulate OCV market dynamics between 2013–2035. The model considers the evolving OCV supply landscape as well as the impact of preventive efforts. Building on stakeholder-driven scenario design, simulations help identify leverage points to improve OCV market health and assess the individual and combined effect of interventions on accelerating cholera control. Specifically, country adoption of preventive vaccination programs and complementary investments in water and sanitation infrastructure are critical to reduce the risk of cholera. Although more resource-intensive, re-vaccination of at-risk populations helps sustain outbreak prevention. It also offers potential benefits such as increasing long-term demand predictability and the overall market size. These serve as important incentives to maintain supplier diversity, thus improving market health. However, since many cholera endemic countries rely on donor support to access OCV, budget constraints associated with reduced development aid can jeopardize programmatic ambitions. Interventions such as the use of rapid diagnostic tests and price competition of procurement can help meet country needs. Finally, market dynamics are influenced by the policies around when to resume preventive OCV use in endemic countries and 2-dose reactive vaccination. Specifically, inventory policies based on the current available stock level versus incoming stock in transit are compared. Aligning OCV supply with demand, both in time and quantity, will be critical to address immediate needs and support broader multi-sectoral activities towards cholera elimination.Author summary: Cholera disease is caused by ingesting food or water contaminated by the V. cholerae bacteria. Multiple, converging factors have led to a resurgence of cholera, especially in cholera endemic countries across Sub-Saharan Africa and the Eastern Mediterranean region. However, cholera has also spread to previously unaffected countries, jeopardizing containment efforts and straining health systems. The growing burden of cholera has contributed to a growing mismatch between the supply and demand of oral cholera vaccines (OCV). This is seen by recurrent stockouts of the global emergency stockpile of OCV, primarily used for outbreak response, as well as constraints on preventive vaccination campaigns despite available programmatic funding and country interest. In this work, market health, the ability to align supply and demand both in quantity and time, is used as a proxy to assess progress on cholera control efforts and reduction in disease burden. A model is presented to capture OCV market dynamics between 2013–2035 to inform strategies aimed at improving OCV market health. Adopting preventive vaccination, with complementary multisectoral interventions, helps prevent outbreaks, improve predictability of OCV demand, and increase market attractiveness for suppliers. Market shaping strategies are critical to promote alignment of OCV supply with demand, as well as fully meet programmatic ambitions of countries.

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pntd00:0013995

DOI: 10.1371/journal.pntd.0013995

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