Since 2017, Yemen has suffered the largest and fastest-spreading cholera outbreak in modern history. Initially, daily reports were issued reporting the emergence of thousands of new cases, more than half of which affected children. Yemen, moreover, was not alone: that year, more than 1.2 million people contracted cholera in 34 countries, and 5,654 died. Because this disease is preventable and treatable, this should never have happened. Fortunately, there are reasons to hope that this will not happen again.
Cholera is a diarrheal disease caused by the consumption of water or food contaminated by the bacteria Vibrio cholerae. It spreads rapidly in areas where sewage and drinking water supplies are not properly treated, making it a disease of the poorest and most vulnerable – the very young, the very old, the malnourished and the displaced. Without treatment, cholera can cause death within hours. While the treatment, which consists of basic rehydration therapy, is simple, it is also unlikely that the most marginalized members of society will have access to it.
However, for the last three years, the Global Task Force on Cholera Control (GTFCC), an association of more than 50 organizations, has been working to eliminate cholera, considering it a threat to public health . In my capacity as President of the GTFCC, I proudly support our world roadmap, which aims to eradicate the disease in 20 countries and achieve a 90% reduction in associated deaths by 2030, both by expanding the use of the oral cholera vaccine and by improving water services, sanitation and hygiene (WASH services).
In accordance with what is indicated in the roadmap, the GTFCC partners began to work at the end of 2017 with the purpose of establishing a support system for the countries affected by the disease. By scaling up technical assistance and offering tools and recommendations to support the development of national cholera control plans, the GTFCC has contributed to enabling national governments to take the lead in implementation.
In Haiti, for example, the Ministry of Public Health and Population deployed rapid response teams to affected areas, where they disinfected houses, supplied hygiene materials and provided health education. In 2018, the country recorded the lowest number of cholera cases since its epidemic began in 2010. Haiti has not had a confirmed cholera case in much more than a year, attesting to the power of strong surveillance for the disease. and WASH services.
Many countries, such as Ethiopia, Kenya and Sudan, have committed to developing multisectoral cholera control plans with the help of the GTFCC
In addition, with the support of GTFCC partners, nine affected countries administered 10.5 million doses of oral cholera vaccine during 2017. In the span of one year, the World Health Organization reported that cases plummeted by 60%, dropping to 499,447 in 34 countries, with 2,990 deaths. While the precise role the vaccine played in that drop in cases has not yet been fully documented, it is very clear that this is an important part of the solution.
The countries affected by cholera continue in this fight. For the past three years, with the support of the Global Alliance for Vaccines and Immunization (Gavi), have been administered more than 50 million doses of oral cholera vaccine. Outbreaks occurred in Burundi, the Democratic Republic of the Congo, Ethiopia, Mozambique, and Sudan; however, affected countries were able to respond more effectively, in part thanks to the support of the GTFCC.
Efforts are also underway to go beyond responding to outbreaks. Efforts are underway to strengthen long-term control and eradication in Bangladesh, Zambia and Zimbabwe. Last year the power of preventive action was demonstrated in Mozambique: After typhoons raised the risk of an outbreak, the government quickly launched a vaccination campaign and successfully prevented the disease from taking hold.
But the oral vaccine – which is only effective for three years– it is not a long-term solution. Instead, it provides a bridge between outbreak response and long-term disease control. As climate change, urbanization and population growth create an ideal breeding ground for cholera, we need more countries to cross that bridge, and to cross it soon.
Oral cholera vaccine – only effective for three years– it is not a long-term solution. Provides a bridge between outbreak response and disease control
That means continuing to work with manufacturers to expand access to the vaccine. The successful $ 8.8 billion repayment to Gavi last June will help go a long way toward achieving this goal. It also means increasing investment in strengthening WASH services, which can protect populations long after the protection provided by the vaccine wears off.
Furthermore, to achieve our goals set out in the global roadmap within a rapidly changing global landscape, countries need flexible support mechanisms and they also need adequate resources. That is why the GTFCC Secretariat is establishing the Country Support Platform, which will complement the WHO cholera program.
The Country Support Platform will be responsible for ensuring the effective organization of resources for cholera control and for supporting the communities and countries most in need. This will include building capacities for surveillance, reporting and analysis. After all, we cannot fight it unless we know precisely where it is present.
To this end, we need to end the stigma around the disease. The embargoes on the movement of people and goods are not only ineffective to prevent their spread, but also make governments reluctant to report outbreaks, for fear of economic consequences. If countries were guaranteed support, rather than punishment, they could take a proactive approach to prevention. The objective of the Country Support Platform is to strengthen its capacity to stop outbreaks before they start.
Fortunately, many countries, such as Ethiopia, Kenya, and Sudan, have committed to developing multisectoral cholera control plans with the help of the GTFCC. For this to work, effective cross-border communication and cooperation between policy makers, health workers, WASH service providers and local communities is essential. The Country Support Platform will facilitate such efforts by serving as a hub for the work of the GTFCC and by helping to foster effective collaboration.
The pandemic has put great pressure on health systems around the world. The last thing countries need is also to deal with cholera outbreaks. The new Platform to Support Countries and the GTFCC they are ready to help ensure this does not happen.
Frew benson is Chief Director of the South African National Department of Health and Chairman of the Global Task Force on Cholera Control.
Translation from English: Rocío L. Barrientos. Copyright: Project Syndicate, 2020.