Genomic Surveillance and Environmental risk mitigation for cholera control in Africa

**Abstract** Cholera remains a significant public health challenge in Africa, exacerbated by environmental, climatic, and genomic factors. In 2024, Africa bore the highest global burden of cholera, with over 150,000 cases and 2,853 deaths reported across 18 countries. Environmental drivers such as floods, droughts, and inadequate water, sanitation, and hygiene (WASH) infrastructure, compounded by climate change, have intensified cholera transmission. Concurrently, the lack of comprehensive genomic data on *Vibrio cholerae* strains, including virulence factors and antimicrobial resistance (AMR) patterns, has hindered effective outbreak control. Genomic surveillance has emerged as a critical tool, revealing transmission dynamics and enabling targeted interventions. Initiatives like the Cholera Genomics Consortium (CholGEN) have advanced genomic capacity in Africa, yet challenges such as infrastructural deficits, funding gaps, and siloed responses persist. Integrating genomic surveillance with environmental monitoring, particularly WASH improvements and climate risk mapping, offers a holistic approach to cholera control. Multisectoral collaboration, sustained political commitment, and investment in infrastructure and capacity building are essential to bridging these gaps. By addressing both environmental and genomic determinants, Africa can transition from reactive containment to proactive prevention, reducing cholera’s impact and building resilient health systems. This integrated strategy not only addresses the root causes of cholera but also sets a precedent for global health efforts.