Cholera past and future in Nigeria: Are the Global Task Force on Cholera Control’s 2030 targets achievable?

Background: Understanding and continually assessing the achievability of global health targets is key to reducing disease burden and mortality. The Global Task Force on Cholera Control (GTFCC) Roadmap aims to reduce cholera deaths by 90% and eliminate the disease in twenty countries by 2030. The Roadmap has three axes focusing on reporting, response and coordination. Here, we assess the achievability of the GTFCC targets in Nigeria and identify where the three axes could be strengthened to reach and exceed these goals. Methodology/Principal findings: Using cholera surveillance data from Nigeria, cholera incidence was calculated and used to model time-varying reproduction number (R). A best fit random forest model was identified using R as the outcome variable and several environmental and social covariates were considered in the model, using random forest variable importance and correlation clustering. Future scenarios were created (based on varying degrees of socioeconomic development and emissions reductions) and used to project future cholera transmission, nationally and sub-nationally to 2070. The projections suggest that significant reductions in cholera cases could be achieved by 2030, particularly in the more developed southern states, but increases in cases remain a possibility. Meeting the 2030 target, nationally, currently looks unlikely and we propose a new 2050 target focusing on reducing regional inequities, while still advocating for cholera elimination being achieved as soon as possible. Conclusion/Significance: The 2030 targets could potentially be reached by 2030 in some parts of Nigeria, but more effort is needed to reach these targets at a national level, particularly through access and incentives to cholera testing, sanitation expansion, poverty alleviation and urban planning. The results highlight the importance of and how modelling studies can be used to inform cholera policy and the potential for this to be applied in other contexts. Author summary: Using a random forest model and future scenarios to project cholera risk, we assessed the achievability of the Global Task Force for Cholera Control 2030 Roadmap in Nigeria, based on sustainable development and environmental protection. The results highlighted how regional inequities within Nigeria will likely prevent the 2030 targets being reached. The northern states in Nigeria are more rural, less developed and have greater levels of insecurity and conflict. Reaching the levels of peace and development achieved in the south at a national level, along with improving urban planning and access and incentives to cholera testing, will be fundamental in reaching the Roadmap targets in Nigeria. Cholera predictions and projections are understudied and here we present the most in-depth projections currently produced for Nigeria. Projections provide a snapshot of potential future conditions and show what is needed going forward to meet and exceed health targets and reduce disease burden. We highlight how quantitative research can be used to inform policy and the relevance of doing so. Quantitative research should fundamentally aim to improve global health and by presenting our work with a strong policy focus, we highlight the relevance and importance of doing so.