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Cholera Situation in Haiti a Reminder of the Seriousness of the Forgotten Pandemic

Updated: Jun 16, 2023

What is Cholera?

Cholera is an acute diarrheal disease caused by the consumption of food or water contaminated with the Vibrio cholerae bacterium. Symptoms of the disease are absent in some infected persons while others might experience a mild to severe illness.

The classic symptom associated with the disease is watery diarrhea which can result in dehydration. Where water, hygiene, and sanitation issues exist, the Vibrio cholera organism is easily shed from the infected persons back into the environment, potentially affecting others.

Retrospection on Cholera in Haiti and the rest of the Caribbean

The first outbreak of cholera in Haiti occurred after the 2010, 7.0 magnitude earthquake that impacted Hispaniola. This disaster caused many structures, in Haiti to collapse while displacing at least one million people throughout the country.

In 2011, Haiti recorded the greatest peak of the Cholera outbreak, with approximately 9700 deaths; a situation of previously having no case of Cholera to several hundred cases and even deaths associated with the disease. Unlike Haiti, between the years 1833-1872, Jamaica, Cuba, Antigua, Dominican Republic, The Turks and Caicos Islands, The Bahamas, Trinidad amongst other countries in the region experienced devastating effects due to the outbreak of cholera. Jamaica's death toll was up to, 40,000 deaths, one-tenth of the island's 400,000 population at that time.

Cholera in the 21 Century a Global Perspective

The use of technology in healthcare coupled with vaccination, implementation of improved public health surveillance systems as well as improvement in sanitation, water, and hygiene has led to the global decline in morbidity and mortality rates associated with Cholera, nevertheless, since 2021, globally there has been an increase in cholera cases and deaths after years of decline.

Noteworthy, is the fact that, some countries which had not experienced cholera in 30 years and others that never reported any cases have now begun to report incidences of disease all of which is considered as a resurgence associated with the 7th cholera pandemic that began in 1961. Factors Fueling the Haitian Cholera Epidemic

Sanitation, hygiene, and the implementation of effective public health surveillance systems and programs are the basis on which most infectious diseases are averted.

Poor sanitation, and lack of access to safe water, social and economic instability coupled with a fragile health care system and the impact of climate change are the underlying factors that have led to the current outbreak of Cholera in Haiti. At present, 80 % of Haitians living in rural communities have no direct access to sanitation and approximately 60 % percent have no access to safe water sources all of which makes the country vulnerable to outbreaks of infectious diseases including cholera.

Economics of Cholera in Haiti

As seen from the current outbreak in Haiti the viability of healthcare resources has been tremendously impacted and has exposed the vulnerability of the healthcare system. Since Haiti’s first case of Cholera in 2010 an unprecedented healthcare, social and economic crisis has been created, therefore. In 2022, $145.6 Million (USD) was needed to support the humanitarians’ response relating to the disease whilst a total of $400 Million (USD) is still needed to eradicate the disease.

Reminders for Caribbean Governments and citizens

Currently many Caribbean countries struggle with water scarcity issues hence 12 % of the regions water is obtained from desalination while approximately 10 percent of Caribbean nationals still lack access to proper water and sanitation; notwithstanding Cholera remains an ongoing pandemic unbothered by the fact that Public Health systems remain overstretched from the Domino Effects of the Covid 19 Pandemic.

Similar to Haiti, in recent years, countries such as Malawi and Zambia have been plunged into facing sporadic outbreaks of cholera as climate change, drought, migration and reduction of access to water and sanitation continues to fuel “this forgotten pandemic”.

Having observed the devastating impact that this disease has in other parts of the world as well as within the Caribbean region, it is imperative that governments and citizens become proactive by taking actions necessary to avert every and any catastrophe associated with the spread of cholera throughout the region and whilst cross border spread of the disease is imminent within the region, the focus on prevention must be within a global scope.

Procurement of vaccines such as Dukurol and others which are approved by the World Health Organization must be budgeted for and given priority attention by all governments within the region. Furthermore, where scarcity of these drugs exists, the development and implementation of policies that support the sharing of vaccines intra-regionally must be given due attention.

Undoubtedly the entire Caribbean region is vulnerable to cholera as infrequent supply or no access to clean water, poor hygienic practices, improper disposal and infrequent collection of solid waste in addition to improper sewage disposal exist throughout the region and are amongst the supporting factors associated with the outbreak of this disease.

In keeping with the United Nations Sustainable Development Goal 6, access to equitable sanitation, water, and hygiene must become a priority agenda item for all leaders of government within the Caribbean region. Strengthening of policies and systems that support the safe disposal of excreta and solid waste , provision and treatment of water for domestic purposes, adherence to good hand hygiene and food hygiene practices along with efforts geared towards the reduction of actions that contribute to climate change will prove useful in averting the impacts associated with the current cholera situation.

From no cases to an epidemic. What is next?

Accordingly to the World Health Organization in recent years some strains of the Vibrio cholera bacterium have become resistant to first-line antibiotics; compounding the issue regarding the possibility of an ongoing cholera pandemic Policy makers supported by citizens must therefore take responsibility and make efforts to create cleaner environments thereby lessening the possibility for the Vibrio Cholera bacterium to grow, multiply and cause disease The implementation of improved Public Health surveillance systems supported by capacity development and capacity building in epidemiology will also prove beneficial and allow for proper screening of visitors from cholera affected countries, ultimately reducing the risk associated with cholera and other infectious waterborne diseases which are contributing to loss of lives.

Karlene Atkinson (PHDc) is a Public Health Specialist and Lecturer at the School of Public Health, University of Technology Jamaica



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