Haiti: Ezili Dantò on Wash Post Cholera editorial

by Ezili Dantò

Washington Justice For Haiti:
In support of Paul Farmer’s pharmaceuticals and the Farmer groups – Brian Concannon/IDJH – asking the UN to judge itself guilty on behalf of Haiti cholera victims, Washington Post opines, justice for the Haiti cholera victims would be collectively awarding $40million to Paul Farmer pharmaceuticals for cholera vaccines

Ezili Dantò on Washington Post editorial supporting expansion of Farmer’s ineffective cholera vaccines

The Washington Post editorial entitled “Really quite disastrous,” supporting that more money be handed over to the NGOs on behalf of Haiti is simply unprofessional if not immoral.

Ezili Dantò

It is filled with inaccuracies and false declarations. It uses its powerful Washington D.C. platform and journalistic weight to make dangerous, irresponsible assertions and recommendations for Haiti hurt cholera victims.

In advocating the expansion of more cholera vaccines in Haiti, the editorial claims that:

“It would take just $40 million to administer oral vaccines to every person in Haiti…But until recently, international health organizations…preferred a systemic infrastructure fix.”

The US and international community ruling Haiti behind UN guns, did not FIRST decide to fix infrastructure, that is, clean up the water infrastructure in Haiti the UN poisoned. That’s untrue.

It would be more appropriate to say the UN, along with the silence of the World Health Organization (WHO) and the US with the active involvement of the Center for Disease Control and and Prevention (CDC) combine with the help of the unquestioning corporate media, like Washington Post, spent most of their time figuring out how to blame the cholera outbreak on Haiti than anything else. (HLLN analysis of Times’ cholera article)

“The source of the cholera outbreak in Haiti” they uniformly opined, was not important. Or, these internationals would simply whine and wail to all and sundry the racist, capricious and facile catch-all: “Let’s not play the blame game!”

The UN, Obama’s State Department, Paul Farmer, Billy and Hillary of the Bill and Hillary UN-Fund for Haiti, of course, back up the official UN position that the UN is not legally nor morally responsible for bringing a deadly disease to Haiti that’s killed over 7,000, and infected more than 550,000 in less than two years.

This perhaps clues us into why the Washington Post editorial maintains: “Groups representing thousands of Haitian cholera victims have demanded millions of dollars of reparations from the United Nations, citing the disease’s introduction by the peacekeepers. But the United Nations’ money, if it manages to raise any, would be more profitably spent on a much more aggressive cholera vaccination program.”



Ezili Dantò of HLLN, Aug. 11, 2011, with anxious-for-help Mirebalais residents take a sampling of their water.
More Ezili Dantò photos for Cholera in Mirebalais Haiti at Cholera Thursday ; Flickr and at website.

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Endorsing the profiteering

The editorial seems written by the big pharmaceutical lobbyists or their patron doctors. It maintains that justice for the Haiti cholera victims is “more profitably served” if the UN gives, whatever monies it manages to raise to pay for the damages it caused when it poisoned Haiti’s waterways and the Haiti cholera victims, back to Paul Farmer’s pharmaceutical friends to buy their own drugs. That’s clearly more just, presumably, than awarding money damages to the hurt Black Haitian and systematically detoxifying the land and waterways the UN troops poisoned?

This level of indifference and proposed profiteering is almost as alarming as that of the un-named “groups representing thousands of Haitian cholera victims.” That group is led by the Institute For Justice and Democracy in Haiti (IDJH), has the UN-big pharmaceutical and CDC-affiliated doctor, Paul Farmer on its board and claims to be the lead lawyers defending the human rights of the Haiti cholera victims.

Since the carpetbaggers and scalawags sent the UN a demand letter back in early November 2011, this group, with obvious conflicts of  interests, has been waiting around for the UN to punish itself. Giving speeches, interviews and attempting to raise more monies along the way on Haiti imported misery. The fact that the UN-MINUSTAH mission has ignored all human rights complaints under the Status of Force agreement with Haiti, hasn’t even bothered to set up a standing claims commission for over 8-solid years causes no embarrassment to these associates of the UN Deputy Envoy to Haiti. Afterall, its just grateful, loser Haitians involved, right? What powerful conscience is there out in the corporatocracy, who is uncomfortable with these convenient alliances? Is there a power, in these times, willing to scrutinize their conflict of interests or the ethics behind asking the UN to be its own investigator, judge and jury? Their association with Haiti human rights lawyer, Mario Joseph, is the only real deal in the mix.

The colonial blueprint remains: paint a soul brother’s picture on the fort, the Indian warriors won’t shoot.  The beat goes on. Deprave indifference from the powerful for Haiti human rights goes on. Haitians die on. The unscrupulous invaders and perennial rescuers thrive very nicely.

Of course, Ezili’s Haitian Lawyers Leadership (HLLN) has been on the scene defending the cholera victims before the carpetbaggers. Here from the beginning defending the demonstrating Haitian mourners who were then called “insurgents” by the UN guns and corporate media for rightly accusing the UN of bringing cholera to Haiti.  The Washington Post cannot recognize this work. Certainly, it will not quote Haiti’s indigenous defenders with a track record on the cholera issue, the mineral wealth of Haiti issue, the UN occupation issue, for good colonial reasons. But its editorial found its title from a truly objective personage: The United Nations’ humanitarian coordinator for Haiti, Nigel Fisher.

Until Ezili’s HLLN can, if at all, find the financial support to file our tort case in U.S. Federal District court these public responses are our only option for keeping the pressure for justice, not charity for Haiti on, defending Haiti rights and the cholera victims’ human rights.

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Disaster Capitalism

The CDC, UN, World Bank, the Clintons, accommodationist Obama use the ravages of the UN’s imported cholera, like the earthquake, as an opportunity to implement disaster capitalism and the NGO humanitarian invasion as its cover.

What the Washington Post editorial board should have rightly noted as immoral, indefensible and “really quite disastrous” is that the Clinton Global Initiative put together cholera insurance to sell to traumatized, hurt and  impoverished Haiti market women before clean water and sanitation projects although the UN says clean water is a human right. What’s more indefensible than the Red Cross building for-profit hotels with Haiti relief donation dollars and the Bush-Clinton Haiti fund putting in $29 million in donation relief dollars to build a for-profit, luxury hotel for foreigners in Haiti? (See, Corruption uninterrupted in Haiti and Haiti Not For Sale.)

The “humanitarians” in Haiti did not make a choice between systemic water sanitation infrastructure and cholera vaccination as the Washington Post article explains.

When the UN cholera hit Haiti in October 2010, it was during the tenure of former President Preval. At that time,  both the Haitian ministry of health and the WHO rejected the aggressive Paul Farmer cholera vaccination campaign, pointing out the logistical difficulties in getting it to people in time, that not enough vaccine stockpiles were available for mass inoculation, and it was expensive.  (See, Cholera Vaccines Unnecessary, Ineffective, Expensive, and Dangerous.) The Shanchol oral vaccine was not then approved by the WHO yet. (Cholera Vaccines Unnecessary, Ineffective, Expensive, and Dangerous. Shanchol wasn’t approved until September 2011.

WHO approval was needed so that  U.N. agencies like UNICEF, the PAHO Revolving Fund and some donor funding, including the US government, could procure the vaccine.

In a November 2011 report, even the CDC agreed with Ezili’s HLLN (though not for the same reasons), that oral cholera vaccines were ineffective.

CDC reported that while there has been evidence of the efficacy of oral cholera vaccines in endemic areas, reactive use after an outbreak has started are limited. One of the authors of this CDC study is John Andrus, who is also the head of immunization and deputy director at the Pan American Health Organization (PAHO), the UN regional global health affiliate, headquartered in Washington D.C.

How come UN-Andrus, who initially explained that oral cholera vaccines were fairly ineffective for reactive use after an outbreak just months ago, is keeping quiet on the efficacy issue as the UN Special Deputy Envoy to Haiti hungrily campaigns for an additional $40 million in funding for a nationwide oral cholera vaccine program?

The editorial fails to mention this, as well as fails, to track the UN/CDC/WHO/PAHO/Harvard multi-layered ethical conflicts. Their interconnectedness to pharmaceutical companies with great interests in finding unregulated markets in the developing world for their drugs. Fails to note the CDC or PAHO‘s changed position, cautious approval or silence about the experimental nature of using oral cholera vaccines after an outbreak.  Fails to tell the readers that the Shanchol oral cholera vaccine last only two years, is only a little above 50% effective, is not effective on young children.

The CDC/PAHO study that decided against pursuing vaccination maintained that “experience and guidelines for reactive use after an outbreak has started are limited.” The CDC study was titled “Considerations for Oral Cholera Vaccine Use during Outbreak after Earthquake in Haiti, 2010−2011. This CDC/PAHO position against vaccination was released a mere six-months ago, so what Haiti experience is there that oral cholera vaccines are effective post outbreak? Were last month’s (April, 2012)  initial 1% (100,000) Shanchol vaccinated Haitians, Dr. Paul Farmer’s guinea pigs for providing the CDC and Harvard with the “experience” and field notes to prepare “guidelines” for appropriate reactive use of oral cholera vaccines after an outbreak? Was this the best use of available relief resources in the middle of an outbreak where over 7,000 have died, 550,000 infected, 300,000 hospitalized in just 19-months?

Who pushed for this rash Washington Post editorial endorsing nationwide Haiti inoculations barely a month after the start of these experimental vaccination, without examining side effects and efficacy?

Was is the same doctor who, last month, was quoted by NPR on his big plans to “ramp up vaccine production and build a global stockpile” for Haiti and the Democratic Republic of the Congo (DRC)?

Before writing its editorial, did the Washington Post have information showing that all the 100,000 who were supposedly inoculated, starting around April 15, 2012 got their follow-up second doses over a two-week period? Are any of them in hospital or at home sick with cholera, too weak, or without resources and transportation to have gone to take their required second doses?

To vaccinate, at this juncture, smack in the middle of the planet’s most deadly outbreak makes no sense. Population displacement from the apocalyptic 2010 earthquake is still a critical issue as well as the difficulty of Haiti rural life. What has changed to make a multidose vaccine regimen logistically possible since PAHO/CDC rejected it 6-months ago?

Doctors Without Borders and other respected relief groups say that the money for the short-lived vaccine protection, would be better spent on improving Haiti’s inadequate water and sewerage system.

Haiti misery is an industry

The oral cholera vaccines are a quick fix mostly not about saving Haiti lives but using UN-imported misery to channel public funds into private pockets.

Vaccines for cholera in Haiti also does not address the other diseases possible, previously even more likely, by means of not solving the waste treatment and safe water infrastructure. Moreover,

“Cholera vaccine is not supposed to be given at the same time as polio vaccine in children under 10. So that has forced Partners in Health and GHESKIO to defer cholera vaccination in 9-and-under children until after they’ve received polio vaccine, and then to track them down and give them the cholera vaccine.” -Richard Knox, NPR, in Vaccination Against Cholera Finally Begins In Haiti

If the Washington Post board wishes to write a legitimate editorial, it ought to write an editorial in context and based on the complex reality of the situation.

It ought to examine why poverty-pimping Paul Farmer is giving cholera vaccines in St. Marc where a world renowned epidemiologist, who is an actual cholera EXPERT say there is NO CHOLERA? ( Piarroux: Haiti Epidemic Could Be Gone in Months, Vaccination Target St Marc Has No Cholera.)

The Washington Post ought to write about how Paul Farmer of Partners in Health (PIH), dubbed by some Haitians as “Partners in Death,” completely fabricated the story he is “flat broke and has to go out and seek funding for cholera vaccines. He (says he) finds this ridiculous that he is forced to do this. But his balance sheet shows $64 million in liquid assets (cash/stocks). Double what it was in 2009. This is the classic charade played by the NGO’s on the good hearted people of the world. “ (Quoted from http://bit.ly/IMCZF8 . Hard copy of PIH 2011 and 2010 Consolidated Financial Statement at http://bit.ly/Ipo6Ji & 2009 HIP Form 220 at http://bit.ly/JFxcVQ .)

For Farmer’s “Partners in Death,” collecting on Haiti’s foreign imposed misery is an industry. Like all the NGO-lifers, poverty-pimp Farmer gets his reputation, prestige, power and makes his living peddling the victims of the US-Euro one-percenters and victims of US-Euro warmongering, narcissism, invasions, perverted elections, corporate welfare, false aid, unfair trade, imposed hunger, diseases, land/resource-grabbing and containment-in-poverty.

“One would be hard put to find a more fitting metaphor than cholera for the aid given and its end result. Indeed cholera has appeared in Haiti, Afghanistan, and the DRC.” –Dady Chery, Foreign Aid, Foreign Wastes. (See also, Clinical Megalomania sold as humanitarian intervention at Corruption uninterrupted in Haiti.)

Paul Farmer is not a cholera expert. Experts on cholera object to the waste of resources in Haiti with ineffective vaccines.

Under President Preval the Haitian Ministry of Health rejected cholera vaccinations. The Haiti Ministry under Martelly had an ethics committee that initially blocked the Farmer cholera vaccination as “experimental.”

But, despite the fact that Sanchol was not approved by WHO at the start of the outbreak,  was rejected by two Haiti health ministers, held back by one Haiti ethic committee, was initially rejected by the CDC/PAHO, then given “cautious approval”, despite all this, the powerful Dr. Farmer  – who is Deputy UN Envoy behind only Haiti proconsul, Bill Clinton – managed to reverse Haiti government objections, PAHO/WHO objections and relieved his power on the cholera victims as laboratory rats for his Partners in Death.

Farmer’s project cost a reported $1.3 million. The American Red Cross contributed $1 million, Hillary Clinton’s USAID apparently supported part of the cost.

Dr. Piarroux who points out that there is NO CHOLERA in Saint Marc where the Farmer group supposedly administered vaccine to 50,000 Haitians further points out that if the international will truly existed, cholera could be eradicated in Haiti in MONTHS.

Thing is, if UN-imported Haiti cholera was eradicated immediately this would not make enough monies and work for the 42,000 charitable organizations “helping” Haiti, nor allow for the perpetual NGO dependency and US occupation behind UN guns.

Ending UN cholera immediately would give the career do-gooders with for-profit-hotel plans in Haiti, no excuse for their feeding frenzy, money laundering, tax evasions. Ending Haiti cholera quickly would take the benevolent industry’s most currently profitable Haiti reason to gain further access and useful career contacts with key corporatocracy stakeholders at big pharma, at the UN, WHO, PAHO, State Department,  at the World Bank , or to better tap Wall Street venture capitalist foundation monies, hang out on the red carpet in Cannes with Sean Penn raising funds (for Haiti cholera victims?).

Recall folks, President Obama nominated Farmer’s partner and PIH co-founder, Dr. Jim Yong Kim, to head the World Bank.

God forbid UN-imported cholera to Haiti should quickly end, taking away defenseless Black Haiti bodies for testing new pharma products, or for fueling the good doctor’s next, best selling Tracey Kidder Tarzan  narrative. That’s simply an unthinkable prospect.

Farmer’s Shanchol oral cholera vaccines supposedly were given, last month, to only 1% of the population, half of that 1% was in a place where there was no cholera to begin with. That should tell the Washington Post about the intentions of these foreign health organizations to combat and have an expeditious effect on an epidemic where 5% or 550,000 of the population are infected by foreign feces.

But who would expect something different from the U.N. Deputy Special Envoy to Haiti – the godly doctor Farmer – other than the disingenuous, sweater-muffin-Harvard-(fake progressive)-cliques?

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Open for Business


George W. Bush, Barack Obama, Bill Clinton

Obama unleashed Bill Clinton and Hillary Clinton on Haiti’s head for the duration, not to mention the Bush-Clinton partnership for earthquake “relief”–Corruption uninterrupted; Haiti: The soul of Africa, not for sale and Haiti’s Hotel Boom: Only for the Rich. The bi-partisan war against Haiti with Obama as General LaPlume the Black general in Haiti who fought to keep slavery for the enslavers. PHOTOS: US occupation of Haiti through UN imperial army is terror, pillage and conquest through USAID, UN, NGOs, unfair trade, all, masked as Paul Farmer/Bill Clinton’s humanitarian intervention– a gift from the strong to the weak.

Haitians are alarmed, no traumatized, by the use of the Haiti sick and poor as Paul Farmer’s very own living canvases and vaccination laboratory in Haiti. But no one wishes to hear this Haitian voice.

As I’ve written elsewhere:

“The humanitarians are masturbating on Haiti pains, panting, salivating for more cholera outbreaks, more hurricanes, more floods, more imposed instability, more Martelly rose militia with old disbanded soldiers storming Parliamentary grounds, more such business opportunities.

They’re open for business on top of our ground water contaminated by their diseased feces. Open for business on top of our decomposed dead bodies, on top of our crushed bones, on top of our intense grief. They’ve made so much money… They’ve even calculated how much they’ll make pushing our decomposed dead bodies around to sell grieving, walking dead Haitians more vaccines, more vitamins on empty stomachs, more vaccines to be digested by Clorox hunger from the Clintons’ destruction of Haiti agriculture and fertile lands. The humanitarians and democracy-bringers are open for business building an oasis on top of an open grave, investing in walking dead remains. Selling more aquatabs, subsidized US foods/manufactured goods, imported bottled water, nitrate-laced fertilizers, Monsanto herbicides and hybrid seeds. Building hotels for foreigners.”

Haiti pays this unendurable price because the  copy-‘n-paste schooled folks are too brainwashed to see the constant morphing, re-branding of the same old slaver mindset, same ol’ wine in new bottles with new labels. Haiti and much of the world, pays this price because We-the-People are pacified and homogenized by the corporate media, church establishments, bureaucratic  universities, even the arts into suffering in silence, accepting  the corporate state’s virtual divine authority to simply masturbate and gorge itself on the wretched workers’ goodwill, forbearance, pain and suffering. Most of the public clamor trumpets that this is the best humankind may hope for. It’s progress, technological brilliance no less – the way of light, liberty and beauty.

Those of us who point out the travesty are offensive, Officialdom drones. We’re playing the blame game when we, the nearly huddled masses, should be blaming ourselves for not being able to step up to the warmongering, nearly omnipotent corporatocracy.

“Happiness rings loud laughter at the World Bank, totally orgasmic at the International Monetary Fund (IMF). Rwanda-Clinton, NAFTA-Clinton, Welfare-to-Work Clinton, Katrina-Bush, WMD-Bush, along with Farmer’s Partners-in-Death-NGO-ilks  and Haiti’s cholera-democracy-Martelly say Haiti is open for business, now.”  –Ezili Dantò’s Note on April 21, 2012 Listserve post.

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Two world renowned cholera experts alarmed by Farmer’s cholera vaccinations, say its a waste of resources, ineffective. Prof. Piarroux also explains the vaccine targets where there is no cholera

Two world renown cholera experts alarmed by Farmer’s cholera vaccinations, a waste of resources, ineffective, targets where there is no cholera:

– 1. Professor Piarroux:  Haiti Epidemic Could Be Gone in Months, Vaccination Target St Marc Has No Cholera

– 2. Pioneering Cholera Scientist Gives Thumbs Down to Oral Vaccines Promoted for Haiti. Prof. Richard A. Finkelstein, an eminent microbiologist and Nobel-Prize nominee for his pioneering studies on cholera, advises that for cholera the best solution resides in providing safe drinking water and sewage disposal. Alarmed by the oral vaccination .. ( See also HLLN’s Paul Farmer is not a God but the face of the UN/USAID/World Bank ; Did Harvard scientists cover-up UN source of Haiti cholera? and Support Zili Dlo- clean water for Haiti. Clean water sustains life and health.)

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If the Washington Post wishes to be taken seriously as journalists, why not contact cholera experts like Nobel-prize nominee, Prof. Richard Finkelstein or speak to Professor Piarroux; who say the Haiti cholera vaccination program is ineffective. These experts, along with Ezili’s HLLN, other Haiti-led, Haiti-capacity-building and community-base Haiti organizations basically agree the solution to cholera is not ineffective vaccines but clean water and sanitation infrastructure. The Farmer piecemeal oral vaccination program is a waste that promotes foreign dependency, enriches foreign pharmaceutical companies and the NGOs.

Before the Washington Post’s editorial board ask that more money for Haiti relief go to the NGOs, why not investigate where the $6 billion collected in donation dollars went?

The map of Haiti Riches: oil sites, gold, silver, iridium – mineral and fossil fuel wealth, deep water ports


This photo shows why accommodationist Barack Obama conveniently masks the imperial take over of Haiti. Those who wish to be counted in the global warmongering of the nasty profit-over-people monsters, their resource exploitation and slow genocide in Haiti, Africa, Asia of the poor and colonially disenfranchised, should actually do the research on how, under Obama, $6 billion in so-called “relief aid” to Haiti, presided over mostly by Bill Clinton and the Paul Farmer NGO ilks, was spent?

Investigate the Clinton-Bush Haiti pillage and their corporatocracy’s use of the “Black president” to complete the annihilation and submission of the first Black nation to abolish slavery, forced assimilation, ethnocide and direct colonialism in this Hemisphere.

It was and has always been about the one-percenters’ narcissism, megalomania and their conviction that they are entitled to, Haiti’s Riches.

A $40 million dollar band-aid, 19-months later

The Washington Post editorial opines, nilly willy, without specificity or any primary reference, that it would “take many years to provide adequate water and sanitation systems in Haiti.”

It fails to calculate how many more additional years and lives would be lost to keep immunizing cholera victims, every two years, with the UN/Farmer/Clinton oral vaccines taken with what, imported bottled water? That’s simply indefensible.

It has been noted that in a country with a population of approximately 10 million, one has

“to consider nearly everybody at risk in Haiti for cholera….. To vaccinate the entire country with the required two-doses per person, it would … take a five-year effort (with immunity waning in each person after two years)..”

Let’s further note other important points the Washington Post editorial failed to mention. The Shanchol oral cholera vaccine contains “6-30 fold higher thiomersal (mercury) content than the WHO upper limit,” might cause autism, has an overall maximum protective efficacy of only 45% after one year,  and only 17% efficacy for children under 5 years of age during one year after vaccination.

Also, according to Haiti researcher Dady Chery, Shantha Biotechnics (India), the company that manufactures Shanchol, has a questionable track record in the production of bacterial vaccines.

In the article, Pioneering Cholera Scientist Gives Thumbs Down to Oral Vaccines Promoted for Haiti, Dady Chery writes:

“Early in 2011, the World Health Organization (WHO) recommended the recall and destruction of all lots of Shan5, a pentavalent vaccine that was produced for children by Shantha Biotechnics and distributed by UNICEF. A white insoluble sediment was detected in the vaccine vials distributed in countries such as Colombia, Comoros, and Nepal. Subsequently, Shan5 was removed from the WHO’s list of prequalified vaccines.” (See also, Rights of Haitians Should be Respected.)

Clean water is life and health and the solution to cholera

The solution to cholera is filtered water, not oral cholera vaccines on empty hungry stomachs that are barely 50% effective, last only 2-years at most, have not been tested on this virulent strain mutating in Haiti and do not inoculate younger children.

There are surely more interim and sustainable options for Haiti, options without dependency, such waste and that use the advantages of the indigenous Haiti landscape – both environmental and cultural.

Haiti is an ISLAND filled and surrounded by water and the hot sun. (For one option and a Haiti vision of relief with human rights, healing, self-reliance and dignity, see Zili Dlo: Solar engineers for Haiti). How many solar farms and stand-alone filtering units, like the one Ezili’s HLLN has in Haiti, capable of servicing up to 165,000 families with clean water per month, could be bought and put into Haiti with the $40 million the Washington Post is advocating go to the pharmaceuticals and their doctor-patron NGOs?

“If you have come here to help me then you are wasting your time, but if you have come because your liberation is bound up with mine then let us work together.” — Lila Watson

Ezili Dantò
President, Haitian Lawyers Leadership Network (HLLN)
May 29, 2012
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Clean water is life, health & solution to cholera

Photos of the Zili Dlo project –on the EziliNetworkFB pages, Flickr and on OS blog.

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Additional Relevant Background

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“Under President Obama, U.S. imperialism masquerades as the protector of the planet’s peoples. Each American aggression, every violation of centuries of international law, is couched in the rhetoric of humanitarian intervention – a gift from the strong to the weak. Wars of pure pillage and conquest are heralded as acts of nobility and service to humankind. The former colonizers from Europe and their cousins from the United States, the nation that grew rich from indigenous genocide and African slavery, have assumed a Responsibility to Protect the very same Asians, Africans and Latin Americans they were slaughtering…it seems like only yesterday.” — Glen Ford, Mercenaries for Empire: Amnesty International and Human Rights Watch

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‘Really quite disastrous’

By Editorial Board, Published: May 26, Source: Washington Post

AS THE WORLD’S worst outbreak of cholera continues to ravage Haiti, international donors have averted their gaze.

Humanitarian relief groups, short of cash, are folding their tents. A pilot project to vaccinate Haitians against the disease, recently undertaken at a cost of $400,000, reached only 1 percent of the population, with no immediate prospect of expansion. Of the 100 or so cholera treatment centers that sprang up around the country after the disease was detected 19 months ago, fewer than a third remain.

The United Nations’ humanitarian coordinator for Haiti, Nigel Fisher, said this month that donors have so far met just 9 percent of the $230 million U.N. appeal for 2012 — not only for cholera but for a range of relief programs including flooding, tent cities and food insecurity. “It’s really quite disastrous,” he said.

Meanwhile, cholera’s deadly toll has mounted in the Western Hemisphere’s poorest country. Unknown in Haiti for a century before the first cases appeared in October 2010, cholera has now killed 7,100 people, infected more than 550,000 and hospitalized nearly 300,000.

It has also spread across the border to the Dominican Republic, killing more than 400 people there. Five percent of Haiti’s 10 million people have already been infected, and health experts estimate that 200,000 could contract the disease this year.

Epidemiologists now believe that cholera was unwittingly introduced in Haiti by Nepalese troops in the U.N. peacekeeping force, whose encampment lacked adequate sanitation facilities. After that, there was no mystery about the conditions that enabled the disease to flourish. Spread by water or food that has been contaminated by fecal matter, it raced through a country where just a third of the population has safe drinking water and fewer than one in five people have access to latrines and modern sanitation.

The tragedy is that the solution is equally well known but costly. Haiti needs modern water and sanitation infrastructure, an undertaking that might cost $1 billion. But while donors tend to respond generously to emergencies, such as the earthquake that devastated Haiti in early 2010, they lose interest in long-term fixes of the sort that would deal decisively with cholera.

Groups representing thousands of Haitian cholera victims have demanded millions of dollars of reparations from the United Nations, citing the disease’s introduction by the peacekeepers. But the United Nations’ money, if it manages to raise any, would be more profitably spent on a much more aggressive cholera vaccination program.

It would take just $40 million to administer oral vaccines to every person in Haiti. That’s about the same amount a U.S. presidential campaign collects in a month or a footwear manufacturer recently agreed to pay to settle charges that it exaggerated the fitness benefits of its shoes. But until recently, international health organizations dragged their feet on vaccines, worrying they might be too expensive or difficult to administer. They preferred a systemic infrastructure fix.

That’s simply indefensible. It may take many years to provide adequate water and sanitation systems in Haiti, but a two-dose vaccine that costs $4 per person can be manufactured right now. Granted, there will be logistical hurdles to overcome in procuring the vaccine, distributing it and ensuring it is properly ingested by a poorly educated, widely dispersed and largely rural population. But to do nothing in the interim is immoral.
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Doctors Urge Cholera Vaccine For Haiti, Neighbors

A man looks over a room of cholera victims in Port au Prince, Haiti

Enlarge David Gilkey/NPRA man looks over a room of cholera victims in Port au Prince, Haiti, Dec. 10

Source: NPR , December 10, 2010

Leading public health officials and researchers are calling for a crash vaccination campaign against cholera in Haiti and neighboring countries.

A vaccine is needed, they say, to control what researchers say is a more lethal strain of cholera circulating widely in Haiti and starting to affect the Dominican Republic.

Until now, experts felt that there wasn’t enough vaccine to be effective and that a vaccination campaign would distract from efforts to treat the thousands with the disease.

But a consensus is emerging around the idea that the vaccine is urgently needed.

One factor behind the shift: The Pan American Health Organization has discovered far more vaccine is out there than previously thought.

Dr. John Andrus, deputy director of PAHO, tells NPR that there may be more than 1 million doses in manufacturers’ storehouses.

“That’s new information to us and that basically changes our thinking,” Andrus says.

Cholera has infected at least 100,000 people in Haiti over the past seven weeks and killed more than 2,100. But that’s only a fraction of what health officials predict in coming months.

About two dozen cases of cholera have been confirmed in the neighboring Dominican Republic, which shares the island of Hispaniola with Haiti. Some 208 more cases are under investigation. They are in the rural border area and in urban Santo Domingo, an ominous indication that cholera is already widely dispersed in the Dominican Republic.

Both countries should be considered for a vaccination campaign, Andrus says. But he wouldn’t limit it to Hispaniola.

I worry about some of the poorer countries of the Caribbean. I worry about Central America.

“I see a real opportunity to vaccinate vulnerable groups in countries that have yet to see the outbreak but we know would be very vulnerable if cholera was imported,” Andrus says. “I worry about some of the poorer countries of the Caribbean. I worry about Central America.”

He would also consider vaccinating people traveling to these areas if they are living in countries where cholera outbreaks already going on.

New Cholera Strain More Lethal

Another factor leading to the emerging call for vaccination are new studies out this week showing the Haiti strain appears to be more lethal than first thought.

“Nearly half of the people who died, died outside of the hospital, before they got to the hospital,” says Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention. “They die in as little as two hours after first becoming ill with cholera.”

The CDC says the death rate in Haiti is 12 times higher than it was in a cholera epidemic that hit Peru in 1991. That epidemic spread to many countries in the Western Hemisphere — though strangely not to the Caribbean.

The death rate is going down in Haiti, Frieden says, but he warns that there are discouraging signs from the new studies that the disease will persist in Haiti for many years to come.

Meanwhile, Harvard researchers announced Thursday that they have worked out the entire genetic code of the Haitian strain. Their findings appear in the New England Journal of Medicine.

They also found that this strain of Vibrio cholera produces a toxin that’s genetically identical to the toxin produced by an especially lethal strain of cholera that popped up in India four or five years ago.

That explains why the Haitian bug can kill so fast, says Dr. Matthew Waldor of Brigham and Women’s Hospital, who led the research.

Cholera in Haiti

Enlarge David Gilkey/NPRBody collectors spray bleach on a 3-year-old boy’s body after he died from cholera in Petionville. Cholera is claiming the lives of hundreds of people while thousands of people are hospitalized across Haiti with symptoms including serious diarrhea, vomiting and fever.

Strain New To Haiti

The Haiti strain is also has a missing string of genetic material in the same place as the Indian strain.

“That’s a fingerprint,” he says. “A very strong fingerprint.”

It proves the new cholera bug was imported to Haiti from South Asia, Waldor says, probably inside the body of a traveler who was infected but not sick.

The Harvard group can’t say if this person bringing it in was a soldier from Nepal in a U.N. peacekeeping force, as many Haitians believe. Waldor says there’s no point in playing a blame game.

“Whether it was a Nepalese peacekeeper, or a Bangladeshi, or an Indian relief worker in Haiti, I think the evidence is strong that it was introduced by human activity into Haiti,” he says.

“That’s a more important conclusion because then we can take action in the future to prevent that.”

He agrees that it’s time to seriously consider vaccinating people who live in Haiti and the Dominican Republic, not only to save lives there, but to prevent the spread of this new strain to other countries in the region.

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Source: cdc.gov
Volume 17, Number 11—November 2011
THEME ISSUE
CHOLERA IN HAITI

Synopsis

CDC on Considerations for Oral Cholera Vaccine Use during Outbreak after Earthquake in Haiti, 2010−2011

Kashmira A. DateComments to Author , Andrea Vicari, Terri B. Hyde, Eric Mintz, M. Carolina Danovaro-Holliday, Ariel Henry, Jordan W. Tappero, Thierry H. Roels, Joseph Abrams, Brenton T. Burkholder, Cuauhtémoc Ruiz-Matus, Jon Andrus, and Vance Dietz

Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K.A. Date, T.B. Hyde, E. Mintz, A. Henry, J.W. Tappero, T.H. Roels, J. Abrams, B.T. Burkholder, V. Dietz); Pan American Health Organization, Washington DC, USA (A. Vicari, M.C. Danovaro-Holliday, C. Ruiz-Matus, J. Andrus); Ministère de la Santé Publique et de la Population, Port-Au-Prince, Haiti (A. Henry)

Suggested citation for this article

Abstract

Oral cholera vaccines (OCVs) have been recommended in cholera-endemic settings and preemptively during outbreaks and complex emergencies. However, experience and guidelines for reactive use after an outbreak has started are limited. In 2010, after over a century without epidemic cholera, an outbreak was reported in Haiti after an earthquake. As intensive nonvaccine cholera control measures were initiated, the feasibility of OCV use was considered. We reviewed OCV characteristics and recommendations for their use and assessed global vaccine availability and capacity to implement a vaccination campaign. Real-time modeling was conducted to estimate vaccine impact. Ultimately, cholera vaccination was not implemented because of limited vaccine availability, complex logistical and operational challenges of a multidose regimen, and obstacles to conducting a campaign in a setting with population displacement and civil unrest. Use of OCVs is an option for cholera control; guidelines for their appropriate use in epidemic and emergency settings are urgently needed.

Full study at cdc.gov.

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