Not Doing Enough: Unnecessary Sickness and Death from Cholera in Haiti

August 18, 2011

A new paper from the Center for Economic and Policy Research argues that cholera treatment and prevention efforts in Haiti have fallen woefully behind, leading to thousands of preventable deaths, even though the dramatic rise in new cases this spring and summer was entirely predictable. The paper, “Not Doing Enough: Unnecessary Sickness and Death from Cholera in Haiti”, by researchers Jake Johnston and Keane Bhatt, argues that it is not too late to bring the 10-month old cholera epidemic under control and save thousands of lives by ramping up treatment and prevention efforts. Below is the Executive Summary of the paper, to read it in its entirety, click here.

In October 2010, cholera, a waterborne disease spread by the Vibrio cholerae bacterium, first appeared in Haiti and rapidly spread through a vulnerable population that had not been exposed to the pathogen in over a century. This cholera outbreak—having afflicted 420,000 people, 6,000 of whom have perished as a result—is the most catastrophic epidemic the hemisphere has seen in decades. Yet ten months after its first detection, the disease has yet to be decisively halted. In fact, in recent months cholera cases have spiked dramatically. In July 2011, one person was infected with cholera almost every minute, and at least 375 died over the course of the month due to an easily preventable and curable illness.

The present health crisis did not originate as a natural byproduct of the January 2010 earthquake’s devastation—the organism was virtually alien to the country. Its inadvertent introduction is the result of the negligence of the United Nations Mission in Haiti (MINUSTAH), which has maintained an international, military troop presence in Haiti since 2004. A Nepalese contingent of UN peacekeeping forces is believed to have spread the illness by contaminating the Artibonite region’s water supply through a leaky sewage system and inadequate waste disposal. The specific strain of V. cholerae in Haiti is identical to a particularly virulent one endemic to South Asia. It infects the small intestine, provoking severe diarrhea and vomiting that, if left untreated, can fatally dehydrate a healthy adult within a matter of hours.

The health interventions launched to fight cholera have been hobbled by the initial missteps made in the wake of the epidemic. The international community underestimated the virulence of the outbreak; the UN initially denied responsibility for its introduction; and there was hesitation in investigating the circumstances surrounding its appearance. These errors led to a smaller and more delayed mobilization of funds and treatment interventions than could have been otherwise marshaled to contain the outbreak. The UN’s cholera appeal, which was based on its low estimate, is still barely more than 50 percent funded. Furthermore, despite myriad warnings, many nongovernmental organizations (NGOs) withdrew from cholera treatment efforts right before this summer’s rainy season and the predictable increase in the number of cholera cases that followed. To date, treatment is still unequally focused on urban centers despite the much higher fatality rates in Haiti’s more rural areas. With proper treatment, fatality rates should be below one percent. However, in some rural areas, they are as high as 5.4 percent.

Cholera is both eminently preventable and treatable. Much can be done immediately to curb the disturbingly large number of Haitians falling sick, and address cholera’s relative deadliness in rural and remote regions. In the short-term, the international community and NGOs should provide firm support for expanding the reach of inpatient facilities in areas hardest hit by the epidemic. Money and human resources should also be invested in the proposals of public health experts who advocate for scaling up treatment efforts through antibiotics and supplements, and integrating prevention and care through education campaigns and a vaccination strategy.

NGOs raised an astonishing $1.4 billion for Haiti relief efforts from the U.S. alone, yet many some have failed to disburse funds despite the dire situation on the ground. The international community pledged over $5 billion for Haiti, yet over a year later, less than 40 percent has been disbursed, while far less has actually made an impact on the ground. The U.S., having appropriated over $1 billion for Haiti, has only disbursed $180 million. International financial institutions (e.g. World Bank, Inter-American Development Bank), NGOs, and donor countries should use this opportunity to redouble their efforts to address the cholera epidemic and commit to assisting the Haitian government in carrying out projects for water and sewage treatment—the same infrastructure projects which have rendered cholera essentially nonexistent in most of the world.

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