The first series of cholera outbreaks in Nigeria was reported between 1970 and 1990 [9]. Major epidemics also occurred in 1992, 1995–1996, and 1997 [9]. Since then, the disease has become seasonal and occurs every year, mainly during the rainy season and in areas with poor sanitation.

Cholera is an acute diarrheal infection caused by the consumption of food or water contaminated with the bacterium Vibrio cholera. The WHO has highlighted the provision of safe water and sanitation as important preventive and control measures [10]. These are resources that many resources limited countries including Nigeria cannot afford or maintain. In an attempt to control the spread of cholera, the Nigerian government has continued to implement policies that involve the promotion of basic sanitation, provision of safe water, and promotion of personal hygiene practices. In addition, the government in partnership with the International Organization for Migration (IOM) supplied solar-powered boreholes, an initiative that has maintained 58 boreholes in Borno state including 11 new boreholes as of 2019 [11].

In Nigeria, the centerpiece of cholera prevention and control has been Water, Sanitation, and Hygiene (WASH) approaches, surveillance, risk communication, and case management. In 2018, National Cholera Hotspot Prioritization Survey and Risk Assessment led to the identification of 105 Local Government Areas (LGAs) as Cholera Hotspot Locations [12].

In addition, a 5 years National Strategic Plan of Action for Cholera Control was established to promote coordinated control and prevention of cholera in the country. An important component of the plan is to reduce cholera morbidity and mortality by 67% by the year 2023, which constitutes a commitment toward meeting the global target of eliminating cholera by 2030 [12]. Gearing towards these goals, the OCV administration was conducted in seven cholera hotspot locations across four like Borno, Bauchi, Yobe, and Adamawa.

In response to the sudden increase in the number of cholera cases in April 2021, the National Cholera Emergency Operations Center (EOC) was activated on the 22nd of June 2021. This led to the distribution of Rapid Response Teams to states affected by the outbreak [13]. Also, the WHO in partnership with Gavi (The Vaccine Alliance) supplied over 1.5 million doses of OCV to Bauchi state to mitigate the cholera outbreak. This led to the vaccination of 710,212 people across the state as of 28 July 2021 [14]. While OCV is an important step toward mitigating the impact of the outbreak, it does not offer a long-term solution to cholera. The government must strengthen investment in water, sanitation, and hygiene infrastructure.

As with other countries across the world, Nigeria is trying to revamp its health system to control the third wave of the COVID-19 pandemic. However, the sudden outbreak of cholera has further worsened the fragile health system. As of December 19, 2021, a total of 109,189 suspected cholera cases and 3,604 cholera-related deaths were reported across the 32 states and the Federal Capital Territory [15]. Children between the ages of 5 and 14 appeared to be hardest hit by the cholera outbreak with a case fatality ratio of 3.3%, which is twice that associated with COVID-19. With 14% of Nigeria’s population who have access to safe drinking water, the morbidity and mortality due to cholera have significantly increased especially in the 19 northern states that account for 98% of suspected cholera cases [16]. Thus, putting millions of lives at risk of cholera-related morbidity and mortality.

While the focus is on the COVID-19 pandemic, cholera cases are silently increasing and could become a bigger threat in a country with an underserved healthcare system. This situation coupled with the interruption of humanitarian aid, inefficient human capacity [17], ongoing armed conflicts, rapid urbanization, population growth, and traditional religious beliefs [18] is likely to further weaken the country’s health system, thereby overturning progress already attained in the fight against diseases including COVID-19 and cholera if not addressed immediately.

There is a need to adopt a well-coordinated multi-sectoral approach to cholera prevention in Nigeria. This will help to identify and strengthen the connections between government agencies, bilateral and multilateral development partners, and non-governmental organizations (NGOs) whose activities help to lower the risk of cholera and promote prevention at the local and national levels. A well-coordinated cholera prevention and control strategy should be developed and implemented by the Nigerian government, and it should include robust disease surveillance as well as free and compulsory vaccination. This will aid in the early detection of cholera outbreaks, targeted prevention strategy, and partnership with state governments and non-governmental organizations (NGOs). Furthermore, the collaboration will include ministries of environment and water boards to ensure proper sanitation, sewage management, and adequate supply of clean water. If implemented, this recommendation will assist in preventing Cholera outbreaks in Nigeria, particularly during pandemics such as COVID-19. There will, however, be challenges, including funding issues, improper implementation, and corruption across various sectors.

While stool cultures are the most popular method for confirming cholera cases in Nigeria, rapid diagnostic test kits should be promoted once an outbreak has begun to quickly identify suspected cases, select candidate samples for stool cultures, and track epidemiological data. To achieve this, the government should empower and train the health personnel that is the closest to people such as those in community pharmacies, primary healthcare centers, and patent medicine stores to carry out rapid diagnostic tests. The recommendation may be challenged by laws governing health practices but the official Gazette granting a waiver will be sufficient to solve this problem. Therefore, the government in Nigeria should be prompt to increase the number of healthcare facilities particularly, primary and comprehensive healthcare centers at least within a reach of 1 km square. This will drastically reduce the case fatality rate (the CFR) and the spreading of the cholera infection in an outbreak.

COVID-19 has highlighted the importance of WASH programs in controlling the spread of infectious diseases including cholera. Therefore, there is a need to strengthen policies and programs that promote WASH and waste management practices including the provision of public convenience toilets and latrines to combat open defecation. In addition, there should be at least one safe drinking water facility in every radius of 1 km², especially in vulnerable communities. Also, chlorination of drinking water supplies has proven to be an effective means of preventing infectious diseases. Therefore, drinking water must be treated at the source, at points of collection or at the household level. Data on cholera surveillance must be shared with the WASH, this will timely activation of rapid response techniques.

There is a need to strengthen community engagement to ensure timely reports and control of cholera outbreaks at local, state, and national levels. This can be done by increasing awareness on social media and billboards in public spaces, reorienting people through the National Orientation Agency (NOA), and educating the public about disease management and prevention in local languages through radio stations. Also, advocacy should be made to the government and policy makers to provide monitoring and evaluation units to checkmate the success of the programs and compliance with the policies on tackling and preventing cholera outbreaks across Nigeria.