International coalition expresses support for medium-term plan to fight cholera in Haiti

Washington, D.C., 9 September 2016 (PAHO/WHO) — Noting that cholera continues to take a heavy toll on the people of Haiti, representatives of international partner organizations are urging strong financial and political support for a medium-term cholera plan recently released in draft form by the Haitian government.

The 2016-2018 plan draws on lessons learned since the cholera epidemic began in Haiti in 2010. It calls for $178 million in investments to improve coordination among national and international partners, ensure rapid response to outbreaks, and implement cholera vaccination, water chlorination, and improvements in sanitation, with a focus on areas considered cholera “hot spots.”

The plan was presented in draft form last week to representatives of the international community in Haiti and was the focus of a Sept. 8 meeting of the Regional Coalition to Eliminate Cholera in Hispaniola, held at the headquarters of the Pan American Health Organization (PAHO) in Washington, D.C.

In addition to PAHO, which serves as the coalition’s secretariat, other members and supporters include UNICEF, the International Federation of Red Cross/Red Crescent Societies, the World Bank, the U.S. Centers for Disease Control and Prevention, the U.S. Agency for International Development, GHESKIO, Zanmi Lasante, World Vision, and other bilateral agencies and nongovernmental organizations (see link below for complete list).

Recent epidemiological data show that 26,799 people were reportedly sickened by cholera in Haiti between Jan. 1 and August 27, 2016, or an average of 788 per week. This number is higher than the weekly averages for 2014 (559 per week) and 2015 (693 per week) although significantly lower than the average 6,766 cases per week reported during 2011.

The number of reported cholera deaths has dropped from the 3,951 recorded in 2010 to 322 deaths in 2015, and 242 deaths so far in 2016. This is partly the result of a decline in the case fatality rate (deaths as a percentage of all cases) from 2.08% in 2010 to 0.9% in 2016, signifying improved access to and quality of treatment.

Coalition members said the evidence suggests that cholera is likely to remain a significant public health burden for years—or could even worsen—unless Haiti receives sufficient support to effectively fight the disease.

“Haiti still has, after six years of cholera interventions, unacceptably high numbers of ongoing cases of cholera,” said PAHO Deputy Director Isabella Danel. “Unless the number of new cases is dramatically reduced, cholera will continue to be a major disease burden for the people of Haiti.”

Medium- and long-term action

The current draft plan follows a short-term plan that was carried out during 2012-2015 and is part of a 10-year national plan that extends to 2022. The draft medium-term plan (for mid-2016 through 2018) proposes a package of integrated interventions in four priority areas: coordination of national and international actors, prevention of cholera, patient care, and reducing cholera transmission. In the area of prevention, the plan proposes to vaccinate nearly 2.5 million people living in high-risk communities and to improve access to chlorinated water through piped water or household chlorination.

Other key components of the draft plan include communication and social mobilization campaigns, the establishment of collective and individual sanitation systems to help communities eliminate the practice of open defecation, and measures to improve water and sanitation in schools and health facilities. The draft plan also calls for increased recruitment of and training for healthcare personnel to provide care for cholera patients and others with diarrheal diseases.

“Cholera can be stopped, even eliminated,” said PAHO Deputy Director Danel. “But we know it takes a concerted effort to heal the sick, cut off routes of disease transmission, and clean up the sites where the cholera pathogens thrive and multiply. This effort must involve the government taking the lead, humanitarian agencies both multilateral and bilateral, private sector organizations, charitable groups and, above all, the people of Haiti.”

In addition to urging support for the draft medium-term plan, members of the Regional Coalition emphasized the need for longer-term investments to expand water and sanitation infrastructure and to ensure quality, accessibility, and sustainability of water and sanitation services.

The coalition invited the Haitian government, with the support of technical and financial partners, to engage especially on Sustainable Development Goal (SDG) 6, which calls for ensuring the availability and sustainable management of water and sanitation for all. “This is the best way to combat all diarrheal diseases and boost the country’s economy,” said PAHO Representative in Haiti Jean-Luc Poncelet.

“Long-term action to improve water and sanitation infrastructure is key. Until every Haitian has access to clean water and sanitation, the threat of cholera or its reintroduction into the country will not disappear,” said Danel.

PAHO, founded in 1902, is the oldest international public health organization in the world. It works with its member countries to improve the health and the quality of life of the people of the Americas. It also serves as the Regional Office for the Americas of WHO.