Wednesday, October 19, 2011

Cholera Vaccinations to Start

Photo by John Carroll
Cholera Treatment Center

Haiti turns to vaccinations a year after cholera struck

Jacqueline Charles

In a dramatic policy shift, Haiti has agreed to support a massive vaccination program to slow a cholera outbreak that has claimed more than 6,000 lives and sickened almost a half-million people.

Beginning in January, Boston-based Partners in Health will provide two dosages of the oral vaccine Shanchol to 100,000 Haitians living in two vulnerable communities: a neighborhood in Port-au-Prince, where potable water and latrines are luxuries, and to an isolated rural village in the lower Artibonite Valley region. The disease outbreak was first detected in the region a year ago this moth.

“We need to bring every resource available to stop the epidemic,’’ said Dr. Paul Farmer, a Harvard University professor who co-founded Partners In Health and serves as deputy U.N. Special Envoy for Haiti.

On the eve of last year’s presidential election, former President René Préval declined to launch a similar vaccination program, fearing social unrest. Government health officials said the program was not adopted because there weren’t sufficent vaccines for everyone.

President Michel Martelly, who was elected in March, and Prime Minister Garry Conille have voiced support for the new vaccination campaign.

“President Martelly is definitely behind the vaccine and so encouraged his ministry of health,’’ said Dr. Louise Ivers, senior policy adviser for Partners In Health. She believes continued deaths and advocacy from health groups helped shape the new policy.

The group is launching the program with Haiti’s health ministry and the GHESKIO Center, a well-respected Haitian aid group known for its groundbreaking work with HIV/AIDS patients in Haiti.

Partners In Health, which spends about $500,000 a month to treat cholera patients, says Haiti’s epidemic is the world’s largest. The decision to vaccinate Haitians comes as the country struggles to bring cholera under control, access to portable water and latrines in the country’s post-earthquake camps sharply decline and as international aid dollars wither.

“There is a steady erosion of support of people coming and leaving,’’ said Farmer, who calls it the “Attention Deficit Disorder” of humanitarian work. “Wavering attention, short cycle of interest.”

Still, getting the international community to pay for the vaccine, which costs $185 per dose, remains a challenge. The United Nations has struggled to raise $300 million for cholera outreach in recent months. At the same time, those opposed to vaccinations, are concerned that it will detract from public campaigns for better sanitary measures in Haiti, and from the need to promote potable water and improved sanitary conditions in a country were many people lack both.

A recent a survey of 626 camps with 502,000 homeless quake victims by water and sanitation experts, showed that access to potable water had gone from 48 percent in March to 7 percent in August. Meanwhile, the percentage of camps with available hand washing stations went from, 20 percent to 12 percent during the same period.

Conille, a medical doctor, said tackling cholera is among his top priorities. He wants to launch an army of young Haitians — one for every 200 households — to educate communities about prevention and treatment of waterborne disease.

“I see this, despite the fact that it has had a devastating effect, as an opportunity for us to quickly strengthen our system and address other big public health issues,’’ he said.

Meanwhile, those supporting the use of vaccines dismiss arguments that it will take away from public education campaigns promoting better hygiene among Haitians.

“I have access to potable water. That is not the case of the majority of the people who don’t have enough water to dink much less to wash their hands,’’ said Bill Pape, director of the GHESKIO Center.

Across from the clinic are two well known slum communities, the City of God and Eternal, constructed below sea level.

“If you start to dig for latrines you hit water,” Pape said.

Pape said the best solution to solving cholera in Haiti is improving water and sanitation in the country, which has some of the worst conditions in the world. But that cannot be done overnight, he said. The benefits of the chosen vaccine, which provides 70 percent effectiveness, last for about two years and the impact on the community is “enormous,” Pape said.

By vaccinating about 50 percent of a population, the immunity could spread to the entire community, experts say.

“I don’t see why you don’t provide it. It’s like going to war, using the artillery and not the aviation,’’ Pape said. “We need to give everything that is available. The disease is going to be here for a long time.’’

Still, introducing the disease has been controversial. Last year, as some pushed for vaccination, Haitian government health officials rejected the idea. They were concerned about social unrest because there were only 200,000 doses available.

Some officials also feared usage could divert attention from public prevention campaigns pushing potable water and sanitary measures. The Pan-American Health Organization was also reluctant to introduce a limited supply of vaccines early in the outbreak. The group “strongly recommended” after a meeting last December with cholera, immunization and disease control experts that a stockpile of vaccines should exists before vaccinations begin.

Jon Andrus, deputy director of PAHO, said the multiple doses that must be ingested could pose a problem.

“The more doses of vaccines makes it more difficult, particularly in Haiti,’’ Andrus said. “If there was to be developed a single-dose vaccine, particularly for children, that would be marvelous. Trying to get a second dose in a person in a refugee emergency, new settlements (and) migrating earthquake population is going to be tough.”

Dr. Arthur Fournier, co-founder of University of Miami’s Project Medishare, which operates three cholera treatment centers in Haiti’s central plateau, said the cholera epidemic has not received the attention it deserves.

“I am OK with doing a cholera vaccination program as long as we do all we can in terms of community education,’’ he said.

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