Tackling an epidemic

In response to reports showing that cholera will continue to spread in Haiti, and to evidence that even a limited vaccination campaign could save thousands of lives, Partners In Health continues to advocate that the international community must step up vaccination and efforts to provide clean potable water to all Haitians.

Drs. David Walton, Arjun Suri, and Paul Farmer write that the international community should not be arguing the “value of competing interventions when in fact complementary ones are needed.”

In “Cholera in Haiti: Fully Integrating Prevention and Care,” published in the March 7 edition of Annals of Internal Medicine, the team of PIH physicians contend that: “Because cholera is part of a vicious cycle of poverty, poor sanitation, water contamination, and a weak health system, we argue for an approach that combines prevention and care at every step.”

PIH’s Drs. Walton, Suri, and Farmer argue three points in their article: 

• Cholera will continue to spread, and it will continue to be deadly. 

Morbidity and mortality rates during the epidemic phase of cholera is likely to last well into 2011… [C]holera may become endemic in Haiti.

Since October, 2010, at least 215,936 cases of cholera have been reported across all 10 of Haiti's geographic departments, and among these, at least 4,131 patients (or 1.9 percent of those infected) have died. These numbers very likely underestimate the actual scope of infection and death.

• Even a limited vaccination campaign would significantly impact the number of new infections.

[Evidence supports our] initiating and expanding cholera vaccination in Haiti as soon as possible. Although vaccines can be effective even with limited use, broader and earlier intervention leads to greater risk reduction, highlighting the need for a global stockpile of cholera vaccine to respond rapidly to epidemics.

[W]idespread rapid vaccination in previous epidemics in the last decade may have averted 40 percent of cases and deaths… even a “reactive” cholera vaccination campaign with 50 percent coverage could have prevented more than 10,000 cases of the disease in Zimbabwe in 2008 and 2009.

• An impactful intervention must recognize the complexity of Haiti’s current situation.

The dual approach of vaccination and clean water illustrates the positive synergies of a comprehensive strategy that combines multiple interventions.

The challenge of cholera in Haiti reveals the biosocial complexity before us. A comprehensive strategy that ranges from oral and intravenous rehydration and antibiotic therapy to strengthening Haiti's public water and sanitation systems, while also including vaccination, is the best way to limit the spread of cholera in Haiti.

Read “Cholera in Haiti: Fully Integrating Prevention and Care” in its entirety.

Read more about PIH’s response to Haiti’s cholera outbreak.