Cholera is back in Malawi, the southeastern African country. And this time, the outbreak is worse than anything the country has ever experienced on record. More than 1,000 people have died and over 30,000 are infected. Malawi has appealed to the World Health Organization (WHO) for more than seven million oral cholera vaccines. Not much is known about when the vaccines will be delivered.

What’s particularly troubling is that in March and November, 2022, WHO sent 3.9 million and 2.9 million doses of the cholera vaccine respectively to Malawi. Yet, cholera continues to surge. The case of cholera’s resurgence in Malawi, even after just receiving 6.8 million doses of vaccines, is a microcosm of the global development industry’s problem: the incessant focus on alleviating symptoms.

For sustainable progress to be made, leaders in global development must change their mode of operation from one that solves symptoms to one that builds systems.

I fell victim to this problem of fixing symptoms when I first got interested in poverty and development. I visited a poor community in Nigeria where access to water was not easily attained. Instantly, I “knew” the solution to the problem: build a well. And that’s exactly what some friends and I did. We raised enough money to fund the construction of a water well in the community. Several months later, however, the well broke. And the community was back to square one.

This sequence of events happened four other times in different communities: a well is built, then it breaks, and no one is available or incentivized to fix it. And so, the investments we were making in the communities had little to no impact. After well number five, we stopped building wells altogether.

The problem isn’t that building wells is bad. It’s that building wells in a community where there is no system to maintain it is categorically unsustainable. And to continue doing it without regard for the waste it creates is simply wrong.

When this happens at scale, it is temporarily soothing, but can be permanently devastating. The situation in Afghanistan provides a stark example.

Michael Horn, Christensen Institute co-founder, and I write about Afghanistan’s failed development in this article. We highlight the fact that, in 20 years, the United States and allies spent hundreds of billions of dollars in “developing” Afghanistan but most of the dollars were wasted. In the time Afghanistan was receiving funding, its development metrics rose. More children were in school; gender advocates and women had a voice; maternal and infant mortality declined. A lot of the country’s poverty and economic development symptoms were assuaged.

But shortly after the U.S. and allies pulled out, Afghanistan’s economy crumbled and the symptoms worsened. Today, more than half the population is in urgent need of humanitarian assistance and gender equality gains are now reversed. Women can no longer register for university. One report summarizes the situation this way, “Afghanistan is facing an unprecedented humanitarian crisis with a very real risk of systemic collapse and human catastrophe. In addition to unimaginable human costs, this humanitarian crisis is reversing many of the gains of the last 20 years, including around women’s rights.”

There is little difference between how Malawi’s cholera crisis is being handled, how I tried to solve the water problem in the poor Nigerian communities, and how the U.S. government and allies tried to develop Afghanistan. We are all victims of fixing the symptoms of a much deeper systemic problem.

Thankfully, there is a better way.

Building systems that fuel prosperity
The most sustainable way to solve a development problem is by creating a market where producers and consumers can easily come together and transact. The creation of a market that allows this necessarily pulls into the society the innovations, talent, and products it needs to thrive. In effect, the market creates a system that solves the problem.

In 1870, a Boston physician, Henry Austin Martin, introduced a method of vaccinating people from smallpox in the United States. The new “animal vaccine” method had gained notoriety in Europe and quickly spread across the United States. After Martin introduced it to the country, many doctors set up vaccine farms to help people and make a profit. The vaccine farms were a precursor to the vaccine research and development industry today.

Without creating a market where vaccines could be manufactured and distributed affordably, the world would still be struggling with smallpox today. By doing so however, not only did we eradicate smallpox, but we also created a new industry that has created countless drugs, vaccines, companies, jobs, and economic prosperity. Building a system designed to solve a problem surpasses providing solutions that alleviate symptoms.

The World Health Organization will more than likely supply Malawi with the vaccines the country needs to overcome this crisis. But my hope is that the supply of the vaccines is simply the beginning of the engagement on how to rid the country of cholera forever. It must not be the end.


  • Efosa Ojomo
    Efosa Ojomo

    Efosa Ojomo is a senior research fellow at the Clayton Christensen Institute for Disruptive Innovation, and co-author of The Prosperity Paradox: How Innovation Can Lift Nations Out of Poverty. Efosa researches, writes, and speaks about ways in which innovation can transform organizations and create inclusive prosperity for many in emerging markets.