Ralph Frerichs is professor emeritus of epidemiology in the UCLA Fielding School of Public Health. He recently authored, in collaboration with Renaud Piarroux, “Deadly River: Cholera and Cover-up in Post-earthquake Haiti.” This op-ed appeared in the Boston Globe.
It is not enough that the United Nations is finally beginning to acknowledge its involvement in the lethal cholera epidemic in Haiti. Now it must urgently do everything in its power to eliminate cholera in Haiti before thousands more die.
Cholera was brought to Haiti in October 2010 by UN peacekeepers from Nepal. Some of the Nepalese peacekeepers had been infected with the disease in their home country. And due to close quarters and poor sanitation practices, the disease quickly spread throughout the Nepalese camp near the interior town of Mirebalais.
Early on, some contaminated fecal waste from the Nepalese camp leaked into a nearby stream, infecting a few Haitians. Then the accumulated camp waste was dumped into the local river by a poorly supervised UN vendor. This local river flowed on to the mighty Artibonite River, which runs through the breadbasket of Haiti before emptying into the Caribbean Sea.
An explosive epidemic ensued in communities along the Artibonite, eventually killing 10,000 or more persons, with more still dying every month. The deaths in this one poor country are comparable in number to all the deaths attributed to the Ebola epidemic that erupted in several nations of West Africa in 2014.
When epidemiologists from the World Health Organization and the US Centers for Disease Control and Prevention were not interested in finding the source of the cholera outbreak, the Haitian government turned to French epidemiologist Dr. Renaud Piarroux, who proceeded during a three-week field investigation to unravel what had occurred. The UN immediately began an active cover-up campaign that has lasted more than five years.
Meanwhile, Piarroux and his French and Haitian colleagues devised a strategy for eliminating cholera in Haiti. That strategy recognizes that the cholera bacteria spread least effectively during the dry season and gallop forward during the wet season. Piarroux stresses that if cholera can be stamped out during the dry season, there would be no more cholera to spread during the wet season, unless reintroduced by outside human activity.
Throughout the year, but more intensely during the dry season, the strategy uses rapid response and detailed mapping to identify households with cholera cases. A mobile team rushes out, treats the reported cases, and visits neighboring households with prophylactic measures, including chlorine for water, to limit spread from the initial household. This is repeated throughout the country.
Unforgivably, the UN has not provided enough funding to keep the mobile teams active and sustain the supplies necessary to smother the epidemic.
Universal vaccination of the Haitian people could also be considered but, for the moment, neither the large vaccine stockpile nor the financing to distribute it is available.
In the long term, a significant improvement in access to drinking water and sanitation is essential to permanently eliminate cholera. But it will take time, and right now the strategy favored by Piarroux and his group is the only way to immediately lessen the cholera impact. With sufficient funding, great strides could be made to rid the disease during the dry season, typically beginning around November.
The UN, having introduced cholera to Haiti, must now commit to eliminating cholera in Haiti. Time is of the essence, and many more lives hang in the balance.
