A simulation-based policy analysis of anticipatory action for cholera outbreaks, Democratic Republic of the Congo.

Abstract

Objective: To explore the effect of anticipatory action on outcomes during a cholera outbreak in a hypothetical health zone in the Democratic Republic of the Congo by means of a cholera response model.

Methods: Using a system dynamics approach, we developed a cholera response model for the Democratic Republic of the Congo on the basis of a published cholera response simulation model for Yemen. The model evaluated four intervention scenarios: (i) existing responses to cholera outbreaks; (ii) anticipatory action (that is, immediate interventions); (iii) anticipatory action plus one vaccine dose; and (iv) anticipatory action plus two vaccine doses.

Findings: The model showed that immediate interventions can function as an essential bridge to comprehensive vaccination, particularly in resource-constrained settings where timely coordination is crucial. Moreover, anticipatory action can reduce the total number of cholera cases. However, booster vaccinations are crucial for preventing subsequent waves of infection due to waning immunity following single-dose vaccination.

Conclusion: Anticipatory action can enhance cholera outbreak management in low-resource settings by facilitating synergy between immediate and long-term interventions. The timing and coordination of interventions and the use of booster doses to prevent disease resurgence are all important. Dynamic models are useful for simulating outbreaks and can foster proactive, evidence-based public health planning, thereby supporting the shift from reactive to anticipatory strategies in alignment with the Global Task Force on Cholera Control's 2030 cholera roadmap. Continuous refinement of the model with real-world data will enhance its global applicability and help advance effective disease control strategies.