The Cholera Vaccine Campaign: An Update from Dr. Louise Ivers

by Dr. Louise Ivers
PIH Senior Health and Policy Advisor

In April, Partners In Health responded to Haiti’s cholera epidemic by providing oral vaccinations to 45,000 people living in the country’s Artibonite region—specifically, to two rice-farming communities hit hard by cholera. In partnership with Haiti’s ministry of health, hundreds of community health workers fanned out across the rural, flood-prone area, delivering two doses to each person by the end of May.

The vaccination campaign had an immediate impact. Providing a second dose ensured that people received the vaccine’s full protective effects, which—while not perfect—reduces the likelihood that they will get cholera for up to three years. For example, in a previous study where cholera is prevalent, the oral vaccine provided 65 percent protection to people in the third year after vaccination. We explained this less-than-perfect protection to recipients, who also received information about the importance of hygiene and potable water in minimizing their risk to cholera.

In April and May, Partners In Health distributed oral cholera vaccinations to thousands of people living in Haiti's Artibonite region. Photo by Jon Lascher.

The wider community also benefitted because of the vaccine’s “herd protection” effects—that is, the more people who are vaccinated in a particular area, the higher the protection for all, including the unvaccinated. Between 60 and 80 percent of all people in the two communities we targeted received both doses of the vaccine—an outstanding completion rate—which also lowered the risk for the remaining unvaccinated people. We will continue to evaluate the impact of the vaccine in the next six-12 months and will share the information on the campaign’s effectiveness.

But the vaccination campaign also had more far-reaching effects. Going forward, Haiti’s ministry of health now has information it can use to plan future vaccination campaigns, including “real-time” feedback about logistical challenges and how to solve them, the costs involved, and the acceptability of the vaccine. Haiti’s health workers also now have the benefit of a training curriculum PIH developed on administering this vaccine, and the materials we purchased to keep the vaccine cold can be used by the ministry of health for any future vaccination campaign, not just cholera.

At an international level, other countries that have considered a similar campaign can now learn from Haiti’s experience. And researchers will be able to follow the impact of this vaccine on rates of cholera in the region.

Clean water is a basic tenet of public health, and we remain strong advocates for improvements in Haiti’s water and sanitation systems. Improving these systems will reduce not just cholera but other waterborne diseases. But building public water systems takes time. In the meantime, we will continue to advocate for expanded use of oral cholera vaccine for people who are most vulnerable.

Lacking access to clean water, people use water from rivers and canals to bathe, clean, and cook. Photo by Jon Lascher.