Haiti considering controversial cholera plan

Haiti is now debating whether or not to adopt a controversial large-scale cholera vaccination program that is being fine-tuned by several international aid agencies.

Only months ago, when Haiti had little vaccine and cholera was spreading rapidly, the plan was chided as being impractical and probably ineffectual. Now, with emergency care centers in place in heavily-populated areas, health officials have more freedom to look ahead, according to Nature.

Difficult disputes on how to proceed remain. Most international experts prefer the use of a pilot program in Haiti, but, wary that those left out would feel resentful, the government is advocating immediate, broad coverage.

At the end of October, a local aid agency, GHESKIO, which is supported by the United Nations Children’s Fund, proposed vaccinating all of the children living in two major slums that have yet to report large outbreaks.

"There are 200,000 people without any toilets," Jean-Claude Mubalama, UNICEF's chief of health in Haiti, said according to Nature. "They collect it and dump it in the sea. If cholera arrives there, it will be very bad."

The Haitian ministry of health and the World Health Organization rejected that plan, however, saying vaccine was not available. They also said that the vaccinations would foster a false sense of security that would lead to relaxed sanitary measures and that it would take away from treating the sick, Nature reports.

In December, a WHO expert committee said Haiti should try a vaccination regime, in part because it had located extra sources of the cholera vaccine. A committee that includes U.S. health organizations is now recommending that a pilot program begin using 300,000 doses of the found vaccine, Dukoral. It is also recommending the creation of a vaccine stockpile.

The campaign is not believed to be able to have a profound effect in Haiti, but it could reveal how effective a mass vaccination program could be.

"You can find areas where cholera is endemic, and that may give you a targeted population where it may have a larger impact," Médecins Sans Frontières epidemiologist Kate Alberti said, according to Nature.

Even if the program manages to acquire the trust of the skeptical Haitian population, using the entire world’s stockpile of vaccine could not cover those believed to be at risk in the Caribbean nation.

Jean Cadet, the ministry of health’s vaccination program manager, told Nature that the country is 90 percent ready to move forward with vaccinations, but not on the small scale envisioned. Cadet said that Haiti would only consider starting the vaccine with more than a million doses and with the goal that all of the country’s 6 million be vaccinated.

"It would depend on the pressure that the international community can put on manufacturers," Cadet said, according to Nature.

When asked who would pay for it, Cadet responded, “The international community," he says. "They brought us cholera, they have to take responsibility for taking care of it."