Cholera Cases Down, But Are Past Mistakes Being Repeated?

October 03, 2011

Although cholera cases decreased by nearly half from July to August following the predictable spike during the rainy season, on average, cholera infected more than 500 people and killed three people each day in September. Although these numbers are still well below previous peaks, they should not provide false confidence, as a decreased caseload in March and April did previously. Cases could increase quickly at almost any time, as cholera is a highly cyclical disease. Indeed, Haiti Libre reported just this week that Medecins Sans Frontieres (MSF) has seen a significant increase in their case load in Port-au-Prince. Romaine Gitenet, MSF head of mission, told Haiti Libre that “”In one month we went from less than 300 admissions per week to over 850, which suggests a worsening situation in the coming weeks.”  Also worrisome is the continued lack of support to the United Nation’s cholera appeal as humanitarian relief efforts continue to dwindle as funds run out.

In our paper, “Not Doing Enough: Unnecessary Sickness and Death from Cholera in Haiti” we noted that funding for the UN’s appeal largely stagnated beginning in February when the caseload began to slow. This led to health actors pulling out of cholera relief right as the rainy season was about to begin. Yet in the last three months, despite the surge in cases, funding has only increased by $13 million. This is the nearly the same amount that was contributed in the three previous months, despite the significantly smaller caseload. The UN cholera appeal, originally set at $175 million, was based on estimates that severely underestimated the seriousness and longevity of the current epidemic. Nevertheless, the UN has since reduced its appeal to $110 million (and the overall humanitarian appeal from $900 million to less than $400 million) and in the most recent OCHA Humanitarian Bulletin it states that “97 per cent of the initial cholera appeal of $110 million” has been funded. However the original appeal, itself based on an underestimate, was for $175 million. There seems to be no evidence that Haiti’s needs for cholera relief have decreased. In fact, the UN itself, even while reducing their appeal, is sounding the alarm over the lack of funding. As Emergency Relief Coordinator and United Nations Under Secretary General for Humanitarian Affairs Valerie Amos warned after recently traveling to Haiti:

Funding gaps have resulted in reductions in the number of humanitarian agencies working in key sectors such as water and sanitation and camp management. Hundreds of latrines are now unusable. The overflowing latrines, particularly during this rainy season, pose significant health risks, including spread of cholera.

The number of health partners responding to the cholera epidemic continues to decline. The number decreased from 128 organizations in January to just 48 by July. That number has since decreased further to 44 with the UN warning that this includes “8 that will run out of funds at the end of Sept. 2011.” Additionally, another UN document on cholera notes that as the “end of the year approaches, certain organizations are struggling to find necessary funding to maintain their activities. In the Nippes and Grande Anse, actors are planning to leave late October.” These two departments have the second- and third-highest fatality rates in the country. In fact, in the same document that touts the cholera appeal being 97 percent funded the UN states that “additional needs will not be covered should severe outbreaks of cholera occur due to rains and flooding.” The document also notes that “[i]t is projected that the current epidemiologic curb will remain the same for the coming 2 to 3 years with moderate peaks before stabilizing into an endemic phase.”

It is vital, given the cyclical nature of cholera and the disease’s ability to peak rapidly that treatment efforts are maintained at a high level and that the international community and Haitian government evaluate the use of the cholera vaccine. These ramped up treatment efforts, combined with serious investment in health and water infrastructure is the only way that Haiti will be able to overcome this fatal disease. Now is not the time to repeat past mistakes and be unprepared for the next spike, leading to more uneccessary deaths.

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