By Dady Chery
English | French
In a radio interview on April 18 with Claire Hédon of Priorité Santé (Priority Health), Professor Renaud Piarroux voiced strong reservations about the design of Haiti’s cholera vaccination campaign by the Ministry of Public Health and Population.
Dr. Piarroux also highlighted new evidence to support a conclusive attribution of the cholera on the island to Nepalese troops from the United Nations mission in Haiti (MINUSTAH).
Dr. Piarroux is a Professor of Parasitology who specializes in infectious and tropical diseases. He holds an M.D. in pediatrics and a Ph.D. in microbiology, and he works as a medical practitioner and researcher in the area of epidemics and endemic tropical diseases. He directs the public health Department of Parasitology and Mycology (teaching hospital) of Marseille and teaches on tropical and parasitic diseases at Aix-Marseille University. In parallel, he participates in fighting epidemics in developing countries (Sub-Saharan Africa, Comoros, Middle-East, Central America).
According to Dr. Piarroux who has access to up-to-date medical information and laboratory results about Haiti’s cholera epidemic, and contrary to the daily announcements of mayhem in the mainstream news, Haiti’s cholera epidemic is waning and now exists principally as a series of clusters in the North of the country. Specifically, Dr Piarroux says:
“The number of cases has declined dramatically even compared to last year’s relative calm around the same time. For example, while there were over a thousand deaths from cholera during the first quarter of 2011, only about 40 cases have been identified between January 1st and March 27th of this year.
“However, beware, there are still active foci particularly in the north of the island, and with the rainy season, these foci could expand.”
With regard to the Nepalese origin of the cholera bacteria in Haiti, Dr Piarroux adds:
“It is certain that the epidemic was brought to Haiti from Nepal on the arrival of a battalion of blue helmets [UN troops] in the north of the country.
“Since the study that I published on this subject, two major elements add support to these results.
“First, a mission of experts appointed by the UN showed that the sanitation in the camp where these blue helmets were installed was very poorly designed, poorly protected. For example, the septic tank where the soldiers’ feces were discharged was a mere pit, unfenced, situated above a river. Feces could easily flow into the river.
“And also, Nepalese biologists agreed to provide an international scientific team the strains that they had isolated during the cholera epidemic that occurred just at the time of departure of the blue helmets to Nepal. They found that the cholera strains from Nepal and Haiti are identical. This approach is a bit like a police investigation. One examines the DNA of the #1 suspect and finds that it is the same as the one collected at the scene of a crime.
“Moreover, a UN expert — one paid by the UN to investigate this outbreak — told the New York Times that for him this meant irrefutable proof. He used the word ‘irrefutable.’”
Many key aspects of the design of the vaccination campaign are quite unfounded, according to Dr. Piarroux. He especially questions the choice of St. Marc as a target region for the vaccination.
“Disappointing this vaccination campaign…. the vaccine that will be used is of mediocre efficiency. The protection afforded by this vaccine is a little above 50%. This is not a very effective vaccine.
“…first they will vaccinate only 1% of the population. So do not expect an effect on the epidemic.
“And then the other problem is the areas chosen for immunization. One of these areas is in the territory of St. Marc, near the Artibonite River Delta….
“It is true that this takes us right back to where the epidemic started. Around October 20, 2010 there was massive contamination of the Artibonite and the canals fed by the Artibonite, and the territory of St. Marc, which is crisscrossed with these canals.
“Between October 20 and 27, epidemiological surveillance could account for 67 deaths in the town of St. Marc alone. So it was very hard hit. But since then, the contamination of the water has abated and the health situation has improved.
“Basically, in the two months that followed, there were 14 more deaths. This was instead by inter-human transmission and in urban areas of St. Marc.
“…since the beginning of the year 2011 and until now, the situation has been very quiet in St. Marc. There were a total of 3 deaths suspected to be from cholera — and this, since over 14, 15 months. Three deaths in just over 3,500 in the rest of the island over the same period. So St. Mark is not the place where there is currently a cholera problem.
“The history of cholera in St. Marc is a history of contamination of the canal waters that people drank, and they died within hours of drinking the water from these canals. Since then, the septic tank that contaminated these channels has disappeared, and it no longer exists; the Nepalese soldiers have disappeared. Now there are soldiers from Uruguay in the camp on top of the septic tank, and Uruguay is a country without cholera.”
Dr. Piarroux further notes that the vaccination is a waste of resources, and the administration of this vaccine to an insignificant fraction of the population would have doomed the vaccination to fail even if the vaccine had been efficacious, which it is not.
“50,000 people will be vaccinated from a total of 250,000 [in the St. Marc region where] the epidemic has declined substantially. The American Red Cross has donated more than a million dollars [$1,000,000] for this vaccination…. [Another major donor is USAID, directly and via Gheskio.]
“People do not have the means. The vaccines do not exist [in sufficient numbers of doses]. Only a few hundreds of thousands doses are available [in the world], and as you recall, the vaccine is not very effective.”
Dr. Piarroux recommends that
“first, we must understand that the cholera is… not in St. Marc, and not in the Artibonite Delta. It is in the north of the island, in mountainous areas… and some residual foci in the south. I think it’s there and there alone that the cholera should be fought with a maximum of tools.
“For example, we must bring chlorine, we must bring water, we must bring soap. If some companies that are marketing a vaccine want to test their vaccine, want to use it in field trials, this is where they should intervene. But not in an area that has been unaffected for the past 15 months.”
Contrary to projections in the popular media of a long-term cholera epidemic, Dr. Piarroux, who is an expert in fighting such epidemics, adds that Haiti has a chance of eradicating the cholera completely within a few months.
“…I am really, deeply convinced that if we acted like that, we would still have a chance to get rid of the cholera. I mean, not in the next decade, in my opinion in a few months, we could get rid of it. But we would have to hit the ground running in the areas where the cholera transmission is occurring. Of course, with the means to identify [the infection]: epidemiological surveillance that is quicker and more effective than what is there currently.”
Sources: Haiti Chery (English) | Priorité Santé