By Dr. Carissa F. Etienne, Director, Pan American Health Organization
THE cholera outbreak that began in Haiti in October 2010 caused some 820,000 cases and killed 9,792 people.
Thanks to the hard work of the government and people of Haiti, in partnership with PAHO and other agencies, there have been no confirmed cases of cholera since the end of January 2019. As Haiti approaches one year free of cholera, the disease may be gone, but it is certainly not forgotten. Now is the time to act to ensure that cholera in Haiti remains a distant memory.
Cholera is a disease of inequity that unduly sickens and kills the poorest and most vulnerable people – those without access to clean water and sanitation. It causes severe diarrhoea and dehydration that can kill a formerly healthy person within hours. So long as diseases such as cholera remain, we will simply not achieve universal health, nor will we ensure the very crux of the sustainable development agenda – leaving no one behind.
Death from cholera is preventable with the tools that we have today. Primary health clinics have been established throughout Haiti with trained personnel that are able to manage cases and save people with adequate rehydration and care. Surveillance is in place to detect and respond to possible flare-ups. And a vaccine is available, which PAHO/WHO can mobilise from the global stockpiles.
Early detection is key, and the PAHO/WHO Labo-moto project works on the ground to enable field nurses to rapidly transport samples from patients from treatment centres to laboratories on motorcycles. Thanks to this initiative, in 2019, 95 per cent of suspected cases were tested for cholera. But to make sure that cholera truly remains a distant memory, we must also accelerate investments in clean water and adequate sanitation. Improving food safety was key to controlling the 1990s outbreak of cholera in Peru and is equally important in Haiti.
Ensuring the right to health of everyone, everywhere, in Haiti and beyond, requires a multi-sectoral approach to address many of the other sustainable development goals. Ensuring clean water and sanitation is just one of the goals that will determine whether we achieve universal health and well-being. Despite progress, Haiti remains behind the rest of Latin America and the Caribbean in terms of access to potable water and sanitation. Over a third of the population (35 per cent) lacks basic drinking water services and two-thirds (65 per cent) have limited or no sanitation services. This is far below the regional average of three per cent and 13 per cent, respectively. It also means that while cholera is under control for now, we must collectively remain alert and ready to maintain this status and verify elimination.
Only when we ensure all Haitians enjoy access to clean water and sanitation can we breathe more freely. It is also vital that we maintain epidemiological surveillance and laboratory testing, and ensure that an effective, immediate response mechanism remains in place, including the oral cholera vaccine for flare-ups. We have made tremendous progress to get to where we are today, but the process to document and verify elimination requires at least two more years. We must continue our work with Haiti, and other UN agencies and partners, to ensure that our concerted efforts pay off in the long-term for the health and wellness of all. Together we can make sure that cholera is gone and remains a distant memory in Haiti.