Haiti launches ambitious cholera vaccination campaign

Nolan Hyppolite, 24, seeks help at a cholera clinic at Port-Salut Hospital HCR in Haiti on Sunday, October 9, 2016, after Hurricane Matthew.
Nolan Hyppolite, 24, seeks help at a cholera clinic at Port-Salut Hospital HCR in Haiti on Sunday, October 9, 2016, after Hurricane Matthew. pfarrell@miamiherald.com

With rain continuing to fall on a hurricane-ravaged Haiti, the country’s health ministry and international aid organizations will launch an ambitious campaign on Tuesday to vaccinate 816,000 people in seven days against a deadly cholera epidemic.

Believed to be the largest cholera vaccination campaign of its kind after a disaster, the effort will begin in the southwestern city of Les Cayes. A total of 16 communes, or counties, in the Grand’ Anse and South regions will be targeted. Those two regions were the most affected by Hurricane Matthew, which made landfall on Haiti’s southern peninsula on Oct. 4.

In the aftermath of the Category 4 storm, the number of suspected cholera cases have spiked to about 3,000 cases, including more than 800 children with possible cholera, said officials with the United Nations. The world body is supporting the Haitian government’s effort along with the Pan American Health Organization.

“We have to be very cautions with the numbers,” said Dr. Jean Luc Poncelet, representative of the Pan American Health Organization/World Health Organization in Haiti. “Seventy percent of the people with cholera are asymptomatic.”

Poncelet said while it’s clear that cholera has increased in the month since Matthew, it is also the rainy season in Haiti — evidenced by last weekend’s torrential downpour. As heavy rain battered Haiti’s North, Northeast, Northwest and Grand’ Anse departments, the northern city of Cap-Haïtien suffered from muddy, waist-high flood waters. At least 10 people were confirmed dead by Haiti’s Civil Protection Office.

“It puts an additional weight on the country and risk in terms of cholera,” Poncelet noted.

The World Health Organization, like some physicians, is a critic of the cholera vaccine. It’s not a panacea, critics warn, and unlike other vaccines that have 90 percent efficacy, the cholera vaccine has only 65 percent efficacy. And the single oral dosage that Haitians will receive lasts only six month.

“The vaccine is only part of the solution; it’s not the only solution,” said Gregory Bulit of UNICEF, which will conduct an information campaign along with the vaccinations so that Haitians understand “they need to wash their hands, chlorinate the water and wash their food.”

Bulit, who is in charge of emergency response, said that since Matthew, UNICEF has increased the number of emergency response teams from four to 17 in the two most-affected departments to help cut transmission rates by providing early treatment. If someone with cholera isn’t treated in time by re-hydrating, they will die.

Preventing transmission from the Grand’ Anse and South — the areas least afflicted by cholera before the hurricane — to heavily-populated Port-au-Prince and others parts of the country that already had higher rates of the disease is a top priority of the ambitious effort.

“It’s going to be extremely challenging and difficult in terms of access and logistical constraints, and community acceptance,” said Sean Casey, emergency response team leader for International Medical Corps, which is in charge of the logistics.

Between Tuesday and Nov. 14, Casey said, the nongovernmental organization will dispatch 9,000 health providers to administer the vaccine to anyone over a year old.

“The fact that we’re going into disaster affected communities means we have a lot of work to do on messaging around the vaccine and cholera in general, and hand washing and sanitation for this to be effective,” he said.

With an estimated 1.2 million people residing in the two regions — and 169 communities that remain unreachable by road — not everyone will receive the vaccine.

One million doses of the vaccine were shipped to Haiti last week from Dubai, courtesy of Global Alliance for Vaccines and Immunization (GAVI), a public-private health initiative whose partners include the World Health Organization, UNICEF and the Bill & Melinda Gates Foundation. The doses were part of an emergency cholera stockpile.

Last week, the Pan American Health Organization sounded the alarm on both cholera and Matthew’s devastating impact to Haiti’s already fragile health system. In the South, 28 percent of the health facilities sustained severe damage with 8 percent closed. In the Grand’ Anse, 43 percent of health facilities were severely damaged and 7 percent are closed.

The launch of the vaccination campaign comes as U.N. Secretary General Ban Ki-moon, who visited Haiti last month, prepares to present a $400 million proposal to the General Assembly at the end of the month. The proposal will include his plan to intensify the response to outbreaks of cholera and preventing future high-risk public health crises in Haiti, and a support package to those directly affected by the waterborne-disease. The disease has led to more than 9,000 deaths and sickened more than 790,840 in six years.

Ban continues to be criticized for his handling of Haiti’s cholera outbreak despite expressing “regret and sorrow” during opening of the U.N. General Assembly last month.

He has warned world leaders that the U.N. cholera proposal is coming, including in a private discussion with President Barack Obama. But funding remains a question. A $120 million U.N. appeal for emergency assistance for Haiti after Matthew has only generated $43.7 million or 36 percent funding.

David Nabarro, the public health expert tapped by Ban to raise the money among foreign donors to eliminate cholera in Haiti, welcomed the campaign.

“The vaccine is vital and I am delighted that it has proved possible to start a campaign quickly now,” he said. “The vaccine coupled with water chlorination, rapid response to cases, effective medical treatment and community mobilization is the right way to tackle this kind of outbreak.”

Jacqueline Charles: @Jacquiecharles