Al Jazeera & Declan Butler / Nature – 2011-11-08 23:07:34
UN Hit with Cash Demand over Haiti Cholera
Petition made on behalf of more than 5,000 victims of outbreak allegedly caused by infected peacekeepers from Nepal
PORT-AU-PRINCE, Haiti (November 9, 2011) — The United Nations has been hit with a demand for hundreds of millions of dollars in reparations because of a year-old cholera outbreak that has killed more than 6,700 Haitians.
The demand was made on Tuesday on behalf of more than 5,000 Haitian cholera victims and their families in a petition filed at UN headquarters in New York by the Boston-based Institute for Justice and Democracy in Haiti. The human rights group said the peacekeeping soldiers were not adequately screened by the United Nations.
The human rights group argues that infected UN peacekeeping troops from Nepal, where cholera is endemic, caused the outbreak by dumping untreated waste from their rural base camp into a tributary of the most important river in the earthquake-ravaged Caribbean nation.
“The cholera outbreak is directly attributable to the negligence, gross negligence, recklessness and deliberate indifference for the health and lives of Haiti’s citizens by the United Nations and its subsidiary, the United Nations Stabilization Mission in Haiti (MINUSTAH),” the petition said.
It said numerous studies, including those by the UN, traced the virus to UN personnel from Nepal. “Until MINUSTAH’s actions incited the cholera outbreak, Haiti had not reported a single case of cholera for over 50 years,” the petition said.
The petition sought a minimum of $100,000 to compensate the families or next-of-kin of each of the individuals who lost their lives to the deadly epidemic. It also demands at least $50,000 to compensate each victim who suffered illness or injury from cholera.
UN spokesman Martin Nesirky told reporters he disputed the claim of UN responsibility for the cholera in Haiti. He said the peacekeeping mission and other agencies were working to control the spread of the disease and treat it.
He said UN Secretary-General Ban Ki-moon had appointed a panel of independent scientific experts to study the cause of the epidemic.
But the panel, which issued its report in May, “determined that it was not possible to be conclusive about how cholera was introduced into Haiti,” Nesirky said.
Close to half a million Haitians out of a population of more than 9.5 million have been sickened by cholera since the outbreak began in October last year and more than 6,700 have died. The cholera started nine months after a 2010 earthquake wrecked the capital Port-au-Prince, killing tens of thousands and leaving many more homeless.
Cholera is a water-borne disease transmitted when bacteria-contaminated human fecal matter gets into water, food or onto someone’s hands. It can cause severe diarrhea and vomiting and kill within hours by dehydrating victims.
No Quick Fix for Haiti Cholera
As outbreak enters its second year,
relief bodies move to roll out vaccine for the first time
Declan Butler / Nature
(October 18, 2011) — A year after cholera broke out in the aftermath of the January 2010 Haiti earthquake, the epidemic has disappeared from the headlines, but it continues to wreak a deadly toll. Mortality rates remain high in some areas, but donor funding for front-line response teams is drying up, even as a newly approved vaccine offers a glimmer of hope.
The epidemic has already caused almost half a million cases, half of which have required hospitalization. Haiti’s health ministry says that roughly 6,500 people have died from their infections — a figure widely believed to be an underestimate.
The Pan American Health Organization (PAHO) in Washington DC expects the epidemic to ease partially, but nonetheless predicts a further 250,000 cases next year, says Peter Graaff, the PAHO/World Health Organization (WHO) representative in Haiti.
Shanchol, a vaccine approved by the WHO for worldwide use on 29 September, could brighten the outlook. It was developed by the International Vaccine Institute in Seoul with support from the Bill & Melinda Gates Foundation, and is produced by Shantha Biotechnics in Hyderabad, India, a subsidiary of vaccine company Sanofi Pasteur. Two groups of non-governmental organizations (NGOs) operating in Haiti now intend to include the vaccine in their own emergency responses to cholera.
At US$1.85 a dose, Shanchol is cheaper than the only other currently available cholera vaccine — Dukoral, made by Crucell, based in Leiden, the Netherlands. Shanchol is also given orally, and requires fewer doses in children under six, who are among the most vulnerable to cholera. The vaccine’s benefits “are really clear for the outbreak contexts in which MSF works”, says Julia Hill, vaccines policy adviser at MÃ©decins Sans FrontiÃ¨res (MSF), also called Doctors Without Borders, in Geneva, Switzerland.
MSF has one of the largest ongoing emergency-response operations in Haiti, treating as many as one-third of all reported cholera cases. It intends to begin vaccinating with Shanchol soon in Haiti; it is also considering a vaccination campaign in West and Central Africa, where cholera is currently resurging. MSF has yet to finalize details of its campaign, but will probably focus vaccination efforts on vulnerable groups, such as people in remote rural areas, who lack timely access to treatments.
Because mountainous communities can often be reached only after half-a-day’s journey on foot, “a whole village can be infected before help arrives”, says Michel Van Herp, an epidemiologist in the MSF office in Brussels. Van Herp oversaw MSF’s field response at the start of the epidemic, when as many as 9% of cases resulted in fatalities. In the capital, Port-au-Prince, that figure has now been brought down below 1%, but in remote rural areas, death rates as high as 5â€“10% persist, he says.
A separate campaign aims to vaccinate 100,000 vulnerable Haitians using 200,000 doses of Shanchol. That effort will be carried out jointly by GHESKIO, an NGO based in Port-au-Prince, and Partners in Health (PIH), a non-profit organization in Boston, Massachusetts, that is affiliated with health groups at Harvard University in Cambridge, Massachusetts.
The group intends to launch its campaign in January 2012, says Louise Ivers, a senior adviser to PIH working in Haiti. The lack of clean water and sanitation in Haiti, and the poor prospects for improving that infrastructure in the near future, makes for a “compelling argument” to use cholera vaccines, she says.
The WHO opposed vaccination during the chaos of the initial cholera outbreak in Haiti; Claire-Lise Chaignat, coordinator of the WHO’s Global Task Force on Cholera Control, argued at the time that the logistics would have been impossible to manage (see Nature 468, 483â€“484; 2010). But the chaos has subsided, and the peaks in numbers of cholera cases are coming less frequently, so the WHO now supports targeted vaccination in Haiti, says Chaignat.
Eventually, the Haitian government will have to assume responsibility and run its own vaccination programmes, but persuading them to do so could be tough, warns Van Herp — not least because there is little economic or political interest in the rural target communities that might benefit most. Van Herp and other experts also warn that cholera vaccination is no panacea.
The focus of relief efforts must be on rehydrating the dangerously ill with a cheap and highly effective oral solution of glucose and salts, he says. Building infrastructure to provide clean water and sanitation is the only way to prevent cholera in the long term.
But a reduction in donor support for NGO frontline responders is hindering these efforts, says Pascale Zintzen, MSF’s deputy head of mission in Haiti. “Different international groups dependent on donors are no longer receiving funds or having their funding renewed,” she says. At the same time, the government’s health ministry has been slow to launch projects with the funds it has already received, she complains. Ivers adds, “Over the past few months, we have seen a number of cholera treatment centres closing down.”
Graaff says that Haiti needs to begin integrating routine cholera surveillance and treatment into the health services, moving away from its reliance on emergency response. Ivers argues, however, that the Haitian governÂ¬ment is years away from being able to make that transition, and that continued support from NGOs is essential.
“I think it is a little misleading to suggest that it’s OK that there is less support, because the government is somehow going to take over,” she says. “Does it have the money, the supply chain and the human resources to provide the services that are needed? I don’t think the ministry of health has any of those things.”
Mass vaccination is not the only option. Rebuilding neighbourhoods in Haiti with good sanitation and clean drinking water is the only real long-term solution. Cholera vaccines are less effective in people with prevalent parasites (particularly common in an unsanitary environment).
The vaccines will also need to be re-administered to keep the majority of the population protected. In the meantime any unvaccinated people (e.g. children too young to have been vaccinated, immuno-suppressed individuals too ill to receive/respond to the vaccine) will be at risk because they still live in an unsanitary environment.
Vaccination gives long-term profit for pharmaceutical firms, but does not offer a solution to the huge public health problem of cholera. Tackling cholera and the range of other infections in Haiti requires everyone to live in sanitary, clean homes.
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