Most of us will never have to imagine being struck with cholera, or having our children suffer with this deadly disease. But in many areas of the world, cholera is a yearly occurrence. Cholera causes such watery, profuse diarrhea that it can kill within
a few hours without medical treatment. Many of us followed the news of the devastating earthquake in Haiti and the tragic cholera outbreak that occurred as families were pulling together to rebuild their lives and their communities. Much less is reported,
however, on how others continue to suffer around the world from this deadly, yet preventable disease.
When my family and I lived in Bihar, India, my youngest daughter seemed especially prone to monthly bouts of “normal” diarrhea – she would be listless and out of it until she had enough fluids to snap back into an energetic 5 year old. How stressful and
worrisome “normal” diarrhea was – it is unfathomable to imagine how crazy worried I would have been if she had contracted cholera.
As I write, there are communities - children, parents, grandparents - enduring large cholera outbreaks in Sierra Leone, Guinea, and other areas of West Africa. Daily reports over the past month have highlighted the severity of these outbreaks, which have
largely been centered in urban slums. Over 15,000 cases have been reported in Sierra Leone and 5,000 cases have been reported in Guinea, with rates of death sometimes as high as 8 percent, depending on the area.
The world responds to a cholera outbreak with quick access to treatment, and disease control through the provision of safe water, proper sanitation and health education to the community. While these measures can be effective, long-term improvement of water
and sanitation can mean costly infrastructural improvements that can take years to implement.
Now there is one more tool: a safe and effective vaccine against cholera.
In late 2011, the World Health Organization (WHO) approved the first cholera vaccine specifically developed for low-income countries, called
Shanchol. Unfortunately, the vaccine is currently stuck in a vicious cycle - uncertain demand for the vaccine causes the manufacturer to keep production low; little supply means that countries cannot quickly access the doses they need when they want
the vaccine. Thus the vaccine has not yet been part of the early response in West Africa.
Two reports in August bode well for breaking this vicious cycle for the vaccine. The WHO published a report supporting the creation of a global oral cholera vaccine stockpile to respond to outbreaks just like the ones we’re seeing in Sierra Leone and elsewhere.
Had a stockpile been in place in this current outbreak, and with countries willing to use it, many cases may have been prevented and lives saved.
Also in August, a Technical Advisory Group to the Pan American Health Organization (PAHO), which serves as the Regional Office for WHO for the Americas, issued a statement supporting use of the cholera vaccine in Haiti. In a brave step, two humanitarian
groups, Partners in Health and Medecins Sans Frontieres, provided the cholera vaccine during outbreaks in Haiti and Guinea. The successful use of the vaccine is, in part, what helped inform these recent policy changes.
The creation of a cholera stockpile is not a panacea; it may need several years to grow large enough to have larger health impact and does not address the large numbers of cholera cases that occur annually in countries without the explosive and news-making
intensity of an outbreak. Additionally, an integrated response to cholera control that includes the longer term water and sanitation infrastructure improvements are all part of the necessary measures to permanently control cholera.
Still, the cholera vaccine works. Though many of us may never need it, millions of people living in some of the poorest regions of the world face cholera outbreaks all too often. We have a way to alter the course of an outbreak and save lives. Let’s use