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 First, historical data were analysed for cholera death rates and a range of well-established cholera risk factors (particularly those included in the best fit models), using correlation, regression, autocorrelation function and AutoRegressive Integrated Moving Averages. Next, future scenario datasets were created (based on varying degrees of socioeconomic development and emission reductions) and used to project future cholera outbreak occurrence and transmission to 2070. The two models used were a generalised linear model and a random forest model. The historical data highlighted the significant cholera burden in Nigeria and its correlation with sanitation access. 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 unachievable and we propose a new 2050 target focusing on reducing regional inequities. 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.