Haiti: could an “all-out” effort end the cholera now?

The cholera epidemic that has killed more than 7,200 people in Haiti since October 2010 could possibly be brought to an end “in just months,” according to a leading French cholera expert, Dr. Renaud Piarroux. “But it would be necessary to go all out in the areas where cholera is being transmitted,” he added in a little-noted interview with Radio France Internationale on Apr. 16, “and, of course, we’d need to have the means of identifying [the cholera], with an epidemiological surveillance that is faster and more effective than what is being done currently.”

Piarroux is an epidemiologist and specialist in tropical medicine at a public hospital in Marseilles and at the University of Aix-Marseilles. He was the first medical expert to identify a base maintained by the United Nations Stabilization Mission in Haiti (MINUSTAH) near Mirebalais as the source of the outbreak. Later studies confirmed MINUSTAH’s role in bringing the epidemic to Haiti.

In the radio interview, Piarroux based his conviction that the epidemic can ended quickly on the decline in cases earlier this year compared to the same period last year. “[W]hile there were more than 1,000 deaths because of cholera during the first trimester of 2011,” he said, “only some 40 have been counted between Jan. 1 and Mar. 27” of this year. But Piarroux warned that “there are still active centers [of the disease], particularly in the north of the island, and these centers could expand in the rainy season.” In these places “it’s necessary to fight the cholera with the maximum of tools. For example, it’s necessary to bring chlorine, to bring water, to bring soap.”

The Haitian government and the United Nations deputy special envoy for Haiti, Paul Farmer, a US doctor who started the widely respected clinics of Partners in Health/Zanmi Lasante, are promoting a vaccination campaign instead of the sort of effort Piarroux described. Piarroux expressed doubts about the campaign. “[T]he vaccine that will be used is of mediocre effectiveness,” he said. “The protection afforded by this vaccine is a little above 50%. This is not a very effective vaccine.”

He also questioned the plans for the initial phase of the campaign, in which about 1% of the population would be vaccinated. This would take place in areas like the western coastal city of Saint-Marc, where there are now very few cholera cases, rather than in the active centers that remain dangerous. “Maybe if the companies that are marketing a vaccine want to test their vaccine, want to use it in field trials, that’s is where they should intervene,” Piarroux said. (Haiti Chery blog, April 20; interview transcript by Haiti Chery, April 20; AlterPresse, Haiti, June 15)

[A field trial of the cholera vaccine, Shanchol, in February 2011 on 240,000 inhabitants of Mirpur, a suburb of Dhaka, Bangladesh, led to protests by the Health Rights Movement National Committee of Bangladesh, citing many of the same concerns raised by Piarroux. (News from Bangladesh Special Report Sept. 29, 2011)]

US media coverage has been promoting the vaccination option. In a May 26 editorial, the Washington Post wrote that “until recently, international health organizations dragged their feet on vaccines, worrying they might be too expensive or difficult to administer. They preferred a systemic infrastructure fix. That’s simply indefensible.” The editorial predicted that “[I]t would take just $40 million to administer oral vaccines to every person in Haiti,” while admitting that “there will be logistical hurdles” for a vaccination program.

The Post dismissed the claims of “thousands of Haitian cholera victims [who] have demanded millions of dollars of reparations from the United Nations, citing the disease’s introduction by the [MINUSTAH] peacekeepers.” Money from the United Nations “would be more profitably spent on a much more aggressive cholera vaccination program,” the editors wrote. (WP, May 26)

From Weekly News Update on the Americas, June 24.

See our last post on Haiti.