[2] This pandemic is based on the strain called El Tor; it started in Indonesia in 1961 and spread to East Pakistan (now Bangladesh), by 1963.

[7] This rapid transmission of the pathogen around the globe in the 20th century can be attributed chiefly to the major hub, the Bay of Bengal, from where the disease spread.

But, as noted, the El Tor strain has persisted for decades to the present, causing repeated epidemics in varied locations, with 570,000 cases in 1991 alone.

Most commonly the contamination of food or water occurs via faecal matter, and the infection is spread through the faecal-oral route.

The transmission of cholera is closely linked to inadequate access to clean water and sanitation facilities and hence, people at risk largely live in slums and poor communities.

[12] Makassar, South Sulawesi was the source of a 1960 outbreak of the El Tor strain, where it gained new genes that likely increased transmissibility.

Many studies point to Indonesia as the source of the seventh cholera pandemic; however, research has indicated that outbreaks in China between 1960 and 1990 were associated with the same sub-lineages.

[13] The El Tor cholera outbreak was first reported in Java, a seaside community near Kendal which was visited by travellers from Makassar in May 1961.

By September, despite a massive vaccination campaign, cholera had rapidly moved through the Philippines, where the number of infected people reached 15,000 by March 1962, with 2,005 deaths.

[15] In 1963, WHO declared that cholera remained the number-one killer in diseases subject to international quarantine, having been reported in Taiwan, Pakistan, Afghanistan, Iran, Southern Russia, Iraq, Korea, Burma, Cambodia, South Vietnam, Malaysia, Singapore, Nepal, Thailand, Uzbekistan and Hong Kong.

The El Tor strain moved further westward, invading South Asia in 1965, including Pakistan, Nepal, Afghanistan, Iran and part of Uzbek SSR.

[18] From 1970 to 1971, Sierra Leone, Liberia, Côte d'Ivoire, Ghana, Togo, Benin, Nigeria and southern Cameroon, experienced outbreaks.

[18] An international campaign began in 1970, including the research laboratory in Dhaka, Bangladesh; the Southeast Asia Treaty Organisation (SEATO), the United Kingdom, Australia, and various American agencies.

[20] This has heightened the risk of unknowing transmission from asymptomatic carriage in humans, as opposed to the classical biotype that caused the first six cholera pandemics.

Such practices as appropriately cooking food before consumption, using sterilised water, following general personal hygiene, and sanitising environments, decrease the spread of cholera.

[21] In the 21st century, cholera control activities have typically still been focused on emergency responses to outbreaks, with limited attention to the underlying causes that can prevent recurrence.

Subsequently, these advances have resulted in the development of experimental cholera vaccines derived from non-living and attenuated live strains.

[citation needed] The clinical severity of the El Tor biotype causing pandemic cholera in 1962, also resulted in modern research assessing administration of antimicrobials in the initial phase of an outbreak.

[26] In 2017 they convened a high-level meeting with officials from cholera-affected countries, donors, and technical partners to announce their strategy “The Global Roadmap to 2030”, an initiative to end cholera as a threat to public health by 2030.

The three components of the strategy are: “early detection and quick response to contain the outbreaks; a multi-sectorial {sic} approach to prevent cholera recurrence, and, coordination of technical support and advocacy, resource mobilisation and partnership at the global level.