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In April 2025, the Global Task Force on Cholera Control (GTFCC) released new recommendations for cholera surveillance, an attempt to revamp global response systems and increase early detection of outbreaks. Developed by leading epidemiologists and laboratory experts at more than 50 collaborating organizations, this new system marks a breakthrough in the fight against one of the world's most recalcitrant public health challenges.

Historically, cholera surveillance has relied mostly on the reporting of acute watery diarrhea with inadequate laboratory verification. This has caused outbreak response to be slowed and precise tracking of the disease burden to be hampered. The new system of surveillance plugs these gaps by emphasizing diagnostic precision, adaptive methods, and the use of community-based data collection.

One of the merits of this new guidance is that it is flexible. Surveillance measures are now tailored to different cholera settings early outbreak detection to continuous monitoring in endemic settings. It promotes more use of rapid diagnostic tests (RDTs), more laboratory integration, and regular case level routine data collection. For instance, nations are now encouraged to implement RDTs not just for reactive testing but also for real-time surveillance during outbreaks.

Several conditions have offered rich ground for these developments: enhanced political will in affected places, lessons from the COVID-19 pandemic that pushed laboratory capability to the limit, and a growing corpus of genomic evidence suggesting that ongoing outbreaks often stem from a single epidemic lineage. These advances help to locate hotspots and micro-hotspots settings like homes or communities where risk of transmission is greatest.

To make it work on the ground, it needs implementation support. GTFCC has vowed to assist nations in shifting away from earlier forms of surveillance and toward this subtler, evidence-based method. For some systems, this will be a tremendous change, yet it is something that must occur in order for us to keep cholera in check at the source.

As with the lessons from the experiences of vaccine rollout problems in eastern DRC, where millions of doses were imported but coverage was acutely low, this advice reminds us that a tool is no stronger than its system of delivery. Good surveillance is not just a foundation for response to outbreaks, but also a spur to targeted interventions, either in water and sanitation, vaccination, or community mobilization.

This new cholera surveillance system is a timely and evidence-based route to end cholera as a global health threat by 2030 if we choose to make it so.

Published in The Lancet Infectious Diseases. April 2025 https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(25)00143-4/fulltext