I have a long walk to work, up and over a steep hill, and I often spend time thinking and problem solving about my day to come or, on my way back, my day behind. For almost six months I fretted for a good portion of my walks on how to enable the use of a new and less expensive cholera vaccine. Increasingly, my worry is tempered with optimism.
We have come far since I wrote in a 2012 blog post that: “We should not have to argue that the hard choices we have to make are between vaccination and water and sanitation.” By the end of 2013, the world had a cholera vaccine stockpile at the WHO, and GAVI had made the decision to provide limited support for the vaccine. Then, early this year, the stockpile was used pre-emptively in several internally displaced persons camps in South Sudan.
Recently, an excellent New England Journal of Medicine article showed vaccines protected against the spread of cholera even after an epidemic had started. It’s the first evidence of that kind and adds important information to the consideration of vaccine use.
Amidst all that progress, my walks back and forth to work are still full of concern about daily reports of outbreaks. In 2014 alone there is a large and continuing one in South Sudan that has caused 23 deaths and is affecting a wider non-vaccinated population in Juba. There are also recent reports of cholera deaths from places like the Philippines, Namibia, Haiti, Nepal, Cameroon and Nigeria – undoubtedly only a fraction of the actual deaths because they are reported in the news or to the WHO. Each death represents a family member – someone’s beloved brother, sister, child or parent is dead because of this preventable disease. Many have died needlessly from diarrhea in 2014.
I am so grateful for the work by the wider cholera community for the progress that has been made, but all of my fretful thinking makes me impatient. The world still needs adequate vaccine supply to provide to countries and partners; there needs to be better understanding of the epidemiology and burden of the disease so the vaccine can be targeted more effectively; additional resources are needed to go toward integrated prevention and treatment and it’s important countries and donors have a good understanding of the choices there are to combat cholera. There’s a lot of work still ahead to prevent deaths from this disease in 2015 and beyond. I know I’ll continue to think about this on my walks, but I’m hoping we’re getting close to the top of the steep hill.