Extreme weather. A lack of lifesaving vaccines. Africa's cholera crisis is worse than ever

LILANDA, Zambia (AP) — Extreme weather events have hit parts of Africa relentlessly in the last three years, with tropical storms, floods and drought causing crises of hunger and displacement. They leave another deadly threat behind them: some of the continent's worst outbreaks of cholera.

In southern and East Africa, more than 6,000 people have died and nearly 350,000 cases have been reported since a series of cholera outbreaks began in late 2021.

Malawi and Zambia have had their worst outbreaks on record. Zimbabwe has had multiple waves. Mozambique, Kenya, Ethiopia and Somalia also have been badly affected.

All have experienced floods or drought — in some cases, both — and health authorities, scientists and aid agencies say the unprecedented surge of the water-borne bacterial infection in Africa is the newest example of how extreme weather is playing a role in driving disease outbreaks.

“The outbreaks are getting much larger because the extreme climate events are getting much more common," said Tulio de Oliveira, a South Africa-based scientist who studies diseases in the developing world.

De Oliveira, who led a team that identified new coronavirus variants during the COVID-19 pandemic, said southern Africa's latest outbreaks can be traced to the cyclones and floods that hit Malawi in late 2021 and early 2022, carrying the cholera bacteria to areas it doesn't normally reach.

Zimbabwe and Zambia have seen cases rise as they wrestle with severe droughts and people rely on less safe sources of water in their desperation like boreholes, shallow wells and rivers, which can all be contaminated. Days after the deadly flooding in Kenya and other parts of East Africa this month, cholera cases appeared.

The World Health Organization calls cholera a disease of poverty, as it thrives where there is poor sanitation and a lack of clean water. Africa has had eight times as many deaths this year as the Middle East, the second-most affected region.

Historically vulnerable, Africa is even more at risk as it faces the worst impacts of climate change as well as the effect of the El Niño weather phenomenon, health experts say.

In what's become a perfect storm, there's also a global shortage of cholera vaccines, which are needed only in poorer countries.

“It doesn’t affect countries with resources,” said Dr. Daniela Garone, the international medical coordinator for Doctors Without Borders, also known by its French acronym MSF. “So, it doesn’t bring the resources.”

Billions of dollars have been invested into other diseases that predominantly affect the world's most vulnerable, like polio and tuberculosis, largely because those diseases are highly contagious and could cause outbreaks even in rich countries. But that's not the case with cholera, where epidemics remain contained.

WHO said this month there is a “critical shortage” of oral cholera vaccines in the global stockpile. Since the start of 2023, 15 countries — the desperate few — have requested a total of 82 million doses to deal with deadly outbreaks while only 46 million doses were available.

There are just 3.2 million doses left, below the target of having at least 5 million in reserve. While there are currently cholera epidemics in the Middle East, the Americas and Southeast Asia, Africa is by far the worst-affected region.

Vaccines alliance GAVI and UNICEF said last month that the approval of a new cholera vaccine would boost stocks. But the result of the shortage has already been measured in deaths.

Lilanda, a township on the edge of the Zambian capital of Lusaka, is a typical cholera hot spot. Stagnant pools of water dot the dirt roads. Clean water is like gold dust. Here, over two awful days in January, Mildred Banda saw her 1-year-old son die from cholera and rushed to save the life of her teenage daughter.

Cholera shouldn't be killing anyone. The disease is easily treated and easily prevented — and the vaccines are relatively simple to produce.

That didn't help Banda's son, Ndanji.

When he fell sick with diarrhea, he was treated with an oral rehydration solution at a clinic and released. He slipped back into dehydration that night at home. Banda feels terrible guilt.

“I should have noticed earlier that my son was not feeling well,” she said, sitting in her tiny concrete house. “I should have acted faster and taken him back to the clinic. I should have taken him back to save his life.”

Because of the vaccine shortage, Zambia couldn’t undertake a preventative vaccination campaign after neighboring Malawi's outbreak. That should have been a warning call, said de Oliveira. Zambia only made an emergency request when its cases started mounting.

The doses that might have saved Ndanji started arriving in mid-January. He died on Jan. 6.

In Zimbabwe, a drought worsened by El Niño has seen cholera take hold in distant rural areas as well as its traditional hot spots of crowded urban neighborhoods.

Abi Kebra Belaye, MSF representative for Zimbabwe, said the southern African nation normally has around 17 hard-hit areas, mostly urban. This year, cholera spread to 62 districts as the struggle to find water heightened the risk.

“This part of Africa is paying the highest price of climate change,” Kebra Belaye said.

Augustine Chonyera, who hails from a cholera-prone part of the capital, Harare, was shocked when he recently visited the sparsely populated rural district of Buhera.

He said he heard grim tales of the impact of the disease: a family losing five members, a husband and wife dying within hours of each other and local businesses using delivery trucks to take the sick to a clinic several kilometers (miles) away.

“It seems now the people in rural areas are in more danger than us. I still wonder how it happened,” Chonyera said.

He said he returned home as soon as he could — after giving a large bottle of treated water he had brought with him to an elderly woman.

Mutsaka reported from Harare, Zimbabwe. Imray reported from Cape Town, South Africa.

The Associated Press receives financial support for global health and development coverage in Africa from the Bill & Melinda Gates Foundation Trust. The AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

Children survivors of cholera play on a gate on the outskirts of Harare, Zimbabwe, Saturday, March 2, 2024. Extreme weather events have hit parts of Africa relentlessly in the last three years, with tropical storms, floods and drought causing crises of famine and displacement, and leaving another deadly threat in their aftermath: some of the continent's worst outbreaks of cholera. (AP Photo/Tsvangirayi Mukwazhi)

Street vendors sell phone cards under a billboard urging people to protect themselves from Cholera in Lusaka, Zambia, Sunday March, 10 2024. Extreme weather events have hit parts of Africa relentlessly in the last three years, with tropical storms, floods and drought causing crises of famine and displacement, and leaving another deadly threat in their aftermath: some of the continent's worst outbreaks of cholera. (AP Photo/Tsvangirayi Mukwazhi)

Hospital beds stand empty in a ward dedicated to Cholera patients at a government hospital in Lusaka, Zambia, Saturday, March 9, 2024. Lilanda, an impoverished township on the edge of the Zambian capital of Lusaka, is a typical cholera hotspot. Stagnant pools of water dot the dirt roads. Clean water is gold dust. Extreme weather events have hit parts of Africa relentlessly in the last three years, with tropical storms, floods and drought causing crises of famine and displacement, and leaving another deadly threat in their aftermath: some of the continent's worst outbreaks of cholera. (AP Photo/Tsvangirayi Mukwazhi)

A nurse exits from a cholera treatment centre in Lusaka, Zambia, Saturday, March 9, 2024. Lilanda, an impoverished township on the edge of the Zambian capital of Lusaka, is a typical cholera hotspot. Stagnant pools of water dot the dirt roads. Clean water is gold dust. Extreme weather events have hit parts of Africa relentlessly in the last three years, with tropical storms, floods and drought causing crises of famine and displacement, and leaving another deadly threat in their aftermath: some of the continent's worst outbreaks of cholera. (AP Photo/Tsvangirayi Mukwazhi)

A young girl fetches water from a well in Lilanda township in Lusaka, Zambia, Saturday March 9, 2024. Lilanda, an impoverished township on the edge of the Zambian capital of Lusaka, is a typical cholera hotspot. Stagnant pools of water dot the dirt roads. Clean water is gold dust. Extreme weather events have hit parts of Africa relentlessly in the last three years, with tropical storms, floods and drought causing crises of famine and displacement, and leaving another deadly threat in their aftermath: some of the continent's worst outbreaks of cholera. (AP Photo/Tsvangirayi Mukwazhi)

Children fetch water using a wheelbarrow in Lilanda township in Lusaka, Zambia, Saturday March 9, 2024. Lilanda, an impoverished township on the edge of the Zambian capital of Lusaka, is a typical cholera hotspot. Stagnant pools of water dot the dirt roads. Clean water is gold dust. Extreme weather events have hit parts of Africa relentlessly in the last three years, with tropical storms, floods and drought causing crises of famine and displacement, and leaving another deadly threat in their aftermath: some of the continent's worst outbreaks of cholera. (AP Photo/Tsvangirayi Mukwazhi)

Children play near stagnant pools of water in Lilanda township in Lusaka, Zambia, Saturday March 9, 2024. Lilanda, an impoverished township on the edge of the Zambian capital of Lusaka, is a typical cholera hotspot. Stagnant pools of water dot the dirt roads. Clean water is gold dust. Extreme weather events have hit parts of Africa relentlessly in the last three years, with tropical storms, floods and drought causing crises of famine and displacement, and leaving another deadly threat in their aftermath: some of the continent's worst outbreaks of cholera. (AP Photo/Tsvangirayi Mukwazhi)

A picture of Mildred Bandas daughter, survivor of a cholera outbreak, is seen inside their family home in Lilanda, Zambia, Saturday, March 9, 2024. Lilanda, an impoverished township on the edge of the Zambian capital of Lusaka, is a typical cholera hotspot. Stagnant pools of water dot the dirt roads. Clean water is gold dust. Extreme weather events have hit parts of Africa relentlessly in the last three years, with tropical storms, floods and drought causing crises of famine and displacement, and leaving another deadly threat in their aftermath: some of the continent's worst outbreaks of cholera. (AP Photo/Tsvangirayi Mukwazhi)

Mildred Banda holds a phone showing a picture of her one-year-old son who died of Cholera in Lilanda township in Lusaka, Zambia, Saturday, March, 9, 2024. Lilanda, an impoverished township on the edge of the Zambian capital of Lusaka, is a typical cholera hotspot. Stagnant pools of water dot the dirt roads. Clean water is gold dust. Extreme weather events have hit parts of Africa relentlessly in the last three years, with tropical storms, floods and drought causing crises of famine and displacement, and leaving another deadly threat in their aftermath: some of the continent's worst outbreaks of cholera. (AP Photo/Tsvangirayi Mukwazhi)

FILE - Floodwaters are visible in Ombaka Village, Kisumu, Kenya, April 17, 2024. Extreme weather events have hit parts of Africa relentlessly in the last three years, with tropical storms, floods and drought causing crises of hunger and displacement. They leave another deadly threat behind them: some of the continent's worst outbreaks of cholera. In southern and East Africa, more than 6,000 people have died and nearly 350,000 cases have been reported since a series of cholera outbreaks began in late 2021. (AP Photo/Brian Ongoro, File)

FILE - People gather on a bridge after floodwater washed away houses near Nakuru, Kenya, Tuesday, April 30, 2024. Extreme weather events have hit parts of Africa relentlessly in the last three years, with tropical storms, floods and drought causing crises of hunger and displacement. They leave another deadly threat behind them: some of the continent's worst outbreaks of cholera. In southern and East Africa, more than 6,000 people have died and nearly 350,000 cases have been reported since a series of cholera outbreaks began in late 2021. (AP Photo/Brian Inganga, file)

FILE - A family uses a boat after fleeing floodwaters that wreaked havoc in the Githurai area of Nairobi, Kenya, April 24, 2024. Extreme weather events have hit parts of Africa relentlessly in the last three years, with tropical storms, floods and drought causing crises of hunger and displacement. They leave another deadly threat behind them: some of the continent's worst outbreaks of cholera. In southern and East Africa, more than 6,000 people have died and nearly 350,000 cases have been reported since a series of cholera outbreaks began in late 2021. (AP Photo/Patrick Ngugi, File)

PINEHURST, N.C. (AP) — Bryson DeChambeau climbed back into the most famous bunker at Pinehurst No. 2, this time with the U.S. Open trophy instead of his 55-degree sand wedge, filling the silver prize with grains of sand to commemorate the best shot of his life.

Rory McIlroy wanted to bury his head in the sand.

DeChambeau won his second U.S. Open title on Sunday by getting up-and-down from 55 yards in a bunker — one of the toughest shots in golf — to deliver another unforgettable finish at Pinehurst and a celebration just as raucous as when his hero, Payne Stewart, won with a big par putt in 1999.

“That’s Payne right there, baby!” DeChambeau screamed as he walked off the 18th green.

This was nothing like DeChambeau winning at Winged Foot in 2020, when there were no fans and no drama. This was high suspense that ultimately came down to a trio of short putts.

McIlroy, who for so much of the final round looked certain to end 10 years without a major, had a one-shot lead until missing a 30-inch par putt on the 16th hole. Tied for the lead on the 18th, with DeChambeau behind him in the final group, McIlroy missed a par attempt from just inside 4 feet.

He was in the scoring room watching, hoping, for a two-hole playoff when DeChambeau got into trouble off the tee as he had done all day. But then DeChambeau delivered the magic moment with his bunker shot to 4 feet and made the par putt for a 1-over 71.

“That bunker shot was the shot of my life,” DeChambeau said.

Moments later, McIlroy was in his car, the wheels spinning on the gravel to get out of Pinehurst without comment. There wasn't much to say. This one will sting.

“As much as it is heartbreaking for some people, it was heartbreak for me at the PGA,” said DeChambeau, who a month ago made a dramatic birdie on the 18th hole at Valhalla, only for Xander Schauffele to match him with a birdie to win the PGA Championship.

“I really wanted this one,” DeChambeau said. “When I turned the corner and saw I was a couple back, I said, ‘Nope, I’m not going to let that happen.’ I have to focus on figuring out how to make this happen.”

True to his form as one of golf's great entertainers, he put on quite the show.

The par putt wasn't as long or as suspenseful as Stewart's in 1999. The celebration was every bit of that. DeChambeau repeatedly pumped those strong arms as he screamed to the blue sky, turning in every direction to a gallery that cheered him on all week.

As much as this U.S. Open will be remembered for DeChambeau's marvelous bunker shot, McIlroy played a big part. He not missed a putt under 4 feet for 69 holes on the slick, domed Donald Ross greens. And then with the U.S. Open on the line, he missed two over the final three holes for a 69.

McIlroy had the look of a winner. He ran off four birdies in a five-hole stretch around the turn. He was a model of cool, the opposite of DeChambeau's exuberance. He walked confidently to the 14th tee with a two-shot lead as the chants grew louder.

“Ror-EE! Ror-EE!”

DeChambeau could hear them, and he pounded a 3-wood on the reachable par-4 13th — the tees were moved forward to 316 yards — to the middle of the green for a birdie to stay close.

McIlroy took bogey from behind the 15th green, but he stayed one ahead when DeChambeau, playing in the group behind him, had his first three-putt of the week on the 15th when he missed from 4 feet.

And that's where this U.S. Open took a devasting turn for McIlroy.

He missed a 30-inch par putt on the 16th hole to fall back into a tie. On the 18th hole, McIlroy's tee shot landed behind a wiregrass bush. He blasted out short of the green and pitched beautifully to 4 feet. And he missed again.

DeChambeau kept fans on the edge to the end. He pulled his drive to the left into an awful lie, with a tree in his back swing and a root in front of the golf ball. The best he could manage was to punch it toward the green, and it rolled into a front right bunker.

“One of the worst places I could have been,” DeChambeau. But he said his caddie, Greg Bodine, kept it simple.

“G-Bo just said, ‘Bryson, just get it up-and-down. That’s all you’ve got to do. You’ve done this plenty of times before. I’ve seen some crazy shots from you from 50 yards out of a bunker,’” DeChambeau said.

During the trophy ceremony, the shot was replayed on a video screen.

“I still can't believe that up-and-down,” DeChambeau said.

Since he won the U.S. Open at Congressional in 2011, McIlroy has seven top 10s in this championship without a victory — it's been more than 100 years since anyone did that well without going home with the trophy.

DeChambeau becomes the second LIV Golf player to win a major, following Brooks Koepka at the PGA Championship last year.

An image of Stewart's famous pose was on the pin flag at the 18th, and DeChambeau put on a Stewart-inspired flat cap during the trophy presentation, later replacing it with his “Crushers” cap from LIV.

He finished at 6-under 274.

Patrick Cantlay lingered around this duel all afternoon, unable to get the putts to fall at the right time until he missed a 7-foot par putt on the 16th hole that ended his chances. He closed with a 70 and tied for third with Tony Finau, who matched a Sunday best with 67 without ever having a serious chance of winning.

This is not the same DeChambeau had become such a polarizing figure — a target of heckling for slow play and his spat with Brooks Koepka. In the sandhills of North Carolina, he had thousands on his side. He signed autographs during his round, he engaged with fans and he delivered one hell of a show.

And when it was over, he looked at the double-decker grandstands around the 18th and thousands circling the 18th green and invited them to his party.

“I want all of you guys somehow,” he said, pointing at them in every direction, “I want you guys to touch this trophy because I want you to experience what this feels like for me. You were a part of this journey this week, and I want you to be a part of it for the after party.”

DeChambeau wasn't flawless. He hit only five fairways, the fewest in the final round by a U.S. Open champion since Angel Cabrera at Oakmont in 2007. He couldn't escape the trouble on the 12th, leading to a bogey that dropped him two shots behind. He had his first three-putt of the week at the worst time, on the 15th to briefly fall behind.

But he showed the mettle of a two-time U.S. Open champion at the end.

“What's most impressive about Bryson is not that he hits the ball far. Everybody knows it,” said Matthieu Pavon, who played with DeChambeau and shot 71 to finish fifth. “I was amazed by the quality of the short game on 18. It's a master class.”

AP golf: https://apnews.com/hub/golf

Bryson DeChambeau holds the trophy in the bunker after winning the U.S. Open golf tournament Sunday, June 16, 2024, in Pinehurst, N.C. (AP Photo/Matt York)

Bryson DeChambeau shows the trophy to fans after winning the U.S. Open golf tournament Sunday, June 16, 2024, in Pinehurst, N.C. (AP Photo/George Walker IV)

Bryson DeChambeau celebrates after winning the U.S. Open golf tournament Sunday, June 16, 2024, in Pinehurst, N.C. (AP Photo/Mike Stewart)

Corey Conners, of Canada, reacts after missing a putt on the eighth hole during the final round of the U.S. Open golf tournament Sunday, June 16, 2024, in Pinehurst, N.C. (AP Photo/Matt York)

Hideki Matsuyama, of Japan, hits from the bunker on the 12th hole during the final round of the U.S. Open golf tournament Sunday, June 16, 2024, in Pinehurst, N.C. (AP Photo/Frank Franklin II)

Patrick Cantlay waves after making a putt on the seventh hole during the final round of the U.S. Open golf tournament Sunday, June 16, 2024, in Pinehurst, N.C. (AP Photo/Frank Franklin II)

Bryson DeChambeau celebrates after a putt on the eighth hole during the final round of the U.S. Open golf tournament Sunday, June 16, 2024, in Pinehurst, N.C. (AP Photo/Frank Franklin II)

Bryson DeChambeau looks at his ball in the native area on the 12th hole during the final round of the U.S. Open golf tournament Sunday, June 16, 2024, in Pinehurst, N.C. (AP Photo/George Walker IV)

Bryson DeChambeau celebrates after a putt on the 11th hole during the final round of the U.S. Open golf tournament Sunday, June 16, 2024, in Pinehurst, N.C. (AP Photo/George Walker IV)

Rory McIlroy, of Northern Ireland, hits from the fairway on the 10th hole during the final round of the U.S. Open golf tournament Sunday, June 16, 2024, in Pinehurst, N.C. (AP Photo/Matt York)

Rory McIlroy, of Northern Ireland, celebrates after a birdie on the 12th hole during the final round of the U.S. Open golf tournament Sunday, June 16, 2024, in Pinehurst, N.C. (AP Photo/Matt York)

Bryson DeChambeau celebrates after winning the U.S. Open golf tournament Sunday, June 16, 2024, in Pinehurst, N.C. (AP Photo/George Walker IV)

Bryson DeChambeau celebrates after winning the U.S. Open golf tournament Sunday, June 16, 2024, in Pinehurst, N.C. (AP Photo/Mike Stewart)

Bryson DeChambeau holds the trophy in the bunker after winning the U.S. Open golf tournament Sunday, June 16, 2024, in Pinehurst, N.C. (AP Photo/Matt York)

Bryson DeChambeau holds the trophy after winning the U.S. Open golf tournament Sunday, June 16, 2024, in Pinehurst, N.C. (AP Photo/George Walker IV)

Bryson DeChambeau holds the trophy in the bunker after winning the U.S. Open golf tournament Sunday, June 16, 2024, in Pinehurst, N.C. (AP Photo/George Walker IV)

Bryson DeChambeau holds the trophy after winning the U.S. Open golf tournament Sunday, June 16, 2024, in Pinehurst, N.C. (AP Photo/Matt York)

Bryson DeChambeau celebrates with fans and the trophy after winning the U.S. Open golf tournament Sunday, June 16, 2024, in Pinehurst, N.C. (AP Photo/Frank Franklin II)