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Haiti launches vaccination campaign against cholera after much debate

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2748 (Published 16 April 2012) Cite this as: BMJ 2012;344:e2748
  1. Nigel Hawkes
  1. 1London

A vaccination campaign against cholera has been launched in Haiti after months of medical and political argument. The final hurdle was approval for the programme from Haiti’s National Ethics Committee, which became involved after a local radio station charged that the campaign was an “experiment” in which the Haitian people were being used as guinea pigs.

The first phase of the campaign is targeting 50 000 people living in Port-au-Prince and will be followed by a further 50 000 in the Artibonite River valley, all of whom will be given the oral cholera vaccine, Shanchol, made in India. The organisers hope to show that it is possible to give the two doses needed over a two week period in areas of high deprivation and to convince the government and international donors to commit to a much bigger campaign aimed at millions of Haitians.

The vaccination drive has had to survive the scepticism of several organisations, including the Pan American Health Organization and the US Centers for Disease Control and Prevention (CDC); the opposition of the previous Haitian government; and an atmosphere poisoned by the belief—now confirmed by whole genome sequence typing—that cholera was introduced into Haiti by Nepalese peacekeeping troops sent there by the United Nations after the devastating earthquake of January 2010.

Since the outbreak began in October 2010 more than 530 000 Haitians have been infected, 7040 of whom have died. Two organisations, Partners in Health and a Haitian group, Gheskio, are organising the vaccination drive and have had to overcome considerable scepticism, Louise Ivers of Partners in Health told US National Public Radio.

“The general culture around cholera vaccination in public health agencies has been that it’s not a good idea. It’s too complicated. It’s too hard. It’s costly. The Haitians can’t even get measles coverage to be high enough. There’s a kind of apathy about introducing another vaccine into such a place,” she said.

“Then there’s the philosophical notion: an ideological argument that you shouldn’t be trying to vaccinate against cholera when really the solution is water and sanitation.” The vaccination groups accept this argument but say that improvements in water supply and sanitation will take too long. Jean William Pape, the head of Gheskio, said, “In the best conditions, with the best government, it’s not going to be done in five years. So you need this vaccine.”

Other obstacles have included approval of Shanchol by the World Health Organization (granted last September), working out the cost, and ensuring availability of the vaccine. The 200 000 doses will cost around $400 000 (£250 000; €305 000), and further supplies will depend on additional funds being available.

Opposition to the plan from public health bodies has eased over the past six months. John Vertefeuille, the CDC’s country director in Haiti, told National Public Radio that the project “will provide an important piece of information around the feasibility and acceptability of a vaccine.” But he also pointed out that a cholera vaccine had never been used in an ongoing outbreak of the disease and that the CDC’s focus remained on improving water, sanitation, hygiene practices, and medical services.

Notes

Cite this as: BMJ 2012;344:e2748