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Shots - Health Blog

As Cholera Season Bears Down On Haiti, Vaccination Program Stalls

Originally published on Wed March 14, 2012 1:07 pm

The vaccine — $417,000 worth of it — is stacked high in refrigerated containers to protect it from the Haitian heat.

Hundreds of health workers are trained and ready to give the vaccine. They're armed with programmed smartphones and tablet computers to keep track of who has been vaccinated and who needs a second dose.

And 100,000 eager Haitians, from the teeming slums of Port-au-Prince to tiny hamlets in Haiti's rice bowl, have signed up to get the vaccine.

But everything is on hold. A long-planned project to find out whether vaccination is feasible in the midst of an ongoing cholera outbreak in Haiti has been stymied — temporarily, its proponents insist — by the kind of glitch that bedevils many projects in Haiti, large and small.

Vaccination was supposed to begin this week in two carefully selected target populations.

One is in a densely packed slum called Cite de Dieu along Port-au-Prince's waterfront, where raw sewage snakes its way from countless gutters into a garbage-clogged canal and into the sea.

The other target area is in a rice-growing area bordering the Artibonite River about 50 miles north of the capital. This was the initial epicenter of Haiti's cholera outbreak in October 2010.

But the campaign was abruptly halted when a Port-au-Prince radio station reported that the impending vaccination effort was actually a "medical experiment on the Haitian people" — a potentially incendiary charge.

The Haitian Ministry of Health scrambled to counter that report, which apparently arose from a mix-up that occurred during last year's change of government.

The previous government opposed cholera vaccination. It would distract from cholera treatment, officials said, and might spark dangerous resentments because there is only enough cholera vaccine in the world to protect 2 percent of the Haitian population.

But the government of Haiti's new president, Michel Martelly, supports a cholera-vaccination demonstration project. His health ministry gave the go-ahead in December.

The problem is, the two sponsoring medical groups — Partners in Health and GHESKIO — submitted their proposals last year to the previous government at a time when the World Health Organization hadn't yet certified the vaccine they were going to use.

That government judged the vaccine to be "experimental" because it lacked WHO's imprimatur. So it referred the proposals to the National Ethics Committee. There they sat, apparently ignored, until the recent radio report woke everyone up.

The committee has called for revised proposals, which were submitted Monday. It usually requires four weeks to review and decide, but proponents hope that can be accelerated.

The rush is for meteorological reasons. Haiti's heaviest rains start in April. Those rains send the contaminated Artibonite over its banks and into villages in the low-lying river delta.

The rainy season also floods the low-lying slums of Port-au-Prince, sometimes carrying sewage into people's crowded homes.

Haiti's biggest spike of cholera cases and deaths occurred last May.

Since Haiti's cholera outbreak began in October 2010, it has sickened more than 500,000 people and killed more than 7,000. Before then, there had never been a recorded cholera outbreak in Haiti.

All evidence suggests the disease was introduced accidentally by United Nations peacekeeping forces from Nepal, a cholera-endemic country, when a latrine spilled sewage into a tributary of the Artibonite, 60 miles upstream from the rice-growing villages. President Bill Clinton, now the U.N.'s special envoy to Haiti, acknowledged that was the "proximate cause" of cholera in Haiti during a visit here last week.

Villagers in the Artibonite delta are well aware of the cholera risk, and anxious to get the vaccine.

Last Saturday, Alexi Rochnel pulled out blue vaccination cards for himself, his wife and his children. They live in a rice-growing village that pulls its drinking water from the Artibonite River.

"Lately we have been facing this cholera disease that we didn't have before, so it's good to be vaccinated," Rochnel says. A year ago, during Haiti's rainy season, his wife fell ill with cholera. "It was very bad," he says, but she survived with hospital care.

Jonathan Lascher of Partners in Health says the organization is confident the vaccination campaign will go ahead later this month. So are officials at GHESKIO in Port-au-Prince.

If they succeed in showing that cholera vaccination is feasible, the next debate will be whether and how it can be scaled up to a much bigger proportion of the population in time for next year's rainy season.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

STEVE INSKEEP, HOST:

Let's go next to Haiti, where the 2010 earthquake is just one of the disasters the country is facing. Cholera broke out in that nation about a year and a half ago, and has been killing people ever since. NPR health correspondent Richard Knox is in Haiti, tracking the latest effort to contain it: a plan to give a vaccine to about 100,000 people. We'll be hearing his stories in the coming weeks on NPR News, and we've got a preview now. Richard is in the Haitian capital Port-au-Prince. Hi, Richard.

RICHARD KNOX, BYLINE: Good morning, Steve.

INSKEEP: What have you been seeing?

KNOX: Well, we've been traveling from the slums of Port-au-Prince to the remotest villages up in the hills of various parts of Haiti and the rice-growing areas in the valleys north of here, looking at cholera and looking at people's experience of cholera last year during the rainy season - which was about a year ago - and asking people about how do they get their drinking water, what kind of sanitation facilities they have - or actually, more to the point, usually don't have.

INSKEEP: When you talk about rice-growing areas in the Caribbean, I imagine just gorgeous landscape, but terrible suffering in that landscape.

KNOX: Yeah. The rice-growing area of Haiti is lush and green, brilliant emerald green fields of rice, but very, very poor villages. I mean, the rice economy has really imploded, but that's what they've been doing for generations.

INSKEEP: You know, I was talking with your editor, Richard, and he mentioned that he sent you down to Haiti to be there for the start of this vaccine program. But I gather while you're ready to see it, they're not actually ready to do it.

KNOX: No, they're very ready to do it. It's just that there's been some - a big glitch lately that's held it up. There are two medical groups who've been working for most of the past year to vaccinate against cholera. But there's been a controversy about whether it's a medical experiment or not. And so they're having to work through that.

INSKEEP: You know, Richard, people get vaccines by the millions all the time. Why would it be controversial to give a vaccine for cholera?

KNOX: Well, a couple of things. Some people think that the effort should be spent on getting clean water and sanitation. But secondly, there's been concern that this vaccine was experimental, and that's been really just a confusion of timing. Last year when they originally proposed it, this vaccine was not approved by the World Health Organization. Now it is. But lately, people have said this is an experiment. So, they're trying to work that out and make it clear that it's really not an experiment. This is a certified safe and effective vaccine.

INSKEEP: So, this isn't just a question of medicine. It's a question of politics.

KNOX: It is a question of politics, which is often the case here in Haiti.

INSKEEP: So, what are some of the stories we can expect to hear from you in the coming days, Richard?

KNOX: Well, we're also going to report on the basic problem, which is most people don't have access to reliably clean water. And many people we talk to around Haiti know that the water's unsafe. They know that's how they get cholera, and yet they really don't have any choice.

INSKEEP: NPR health correspondent Richard Knox, keeping us up to date on the basics, which are a life or death matter in Haiti. Richard, thanks very much.

KNOX: You're welcome. Transcript provided by NPR, Copyright NPR.