ALLENTOWN, Pennsylvania— In 2010, the global cost of cholera approached $3.11 billion. Now, as long term vaccination studies and research regarding an oral cholera vaccine begin to yield results, many health officials are optimistic that the 76 cent vaccine could end this waste of life and resources.
“Global efforts to control a resurgence of cholera worldwide are now entering a new phase,” said the World Health Organization (WHO) in regard to the Oral Cholera Vaccine (OCV). “Currently the WHO is facilitating a multi-partner initiative aimed at establishing an OCV stockpile along with criteria for its use and monitoring.”
This new era comes in the wake of several resurgences of a disease that many believed to have been severely declawed (at least in OECD nations) due to new regulations regarding water sanitation. The most recent memory of this was between 2011 and 2012, where the Haitian cholera resurgence coupled with a spike in levels of infection in Sub-Saharan Africa.
During this wave of infection, Haitian capital Port-Au-Prince saw almost 2,000 cases in one week. Additionally, African cholera, which represented 46% of all globally reported cases, saw a backward trend in cholera’s case fatality rate (CFR).
Where the rest of the world was seeing a decrease in CFR, Africa’s remained stable at 2%, according to the U.S. National Library of Medicine and National Institutes of Health.
When cholera surged in 2011-2012, the world was reminded of the devastating effects of a disease with the potential to kill in 24 hours following infection. From this came an increase in research, development and trialing of the OCV, a vaccine that has become central to emergency containment efforts as well as a staple in the public health systems of many developing nations.
Upon the clearance of the cholera vaccine in the late 90’s, Vietnam was among the first to implement a wide scale roll-out effort. Doses of OCV were provided to children below the age of five in two week intervals. Groups selected for vaccination were elected by Vietnam’s EPI on the basis of the groups most likely to contract and spread the disease.
The results of the OCV mass vaccination campaign yielded astronomical results. Where cases of cholera had previously ranged form 2,500 to 6,000 annually before the campaign, the average case count decreased to 0 to 343 annually between 1998 and 2006. This was most effective in the provinces of South Vietnam, like the Hue province, which has detected zero cases of cholera since 2003, according to a PLOS Journal of Medicine Study.
Even those who were not directly vaccinated felt the effects of a greater population of immunized children, according to the WHO. This “herd immunization” effect is perhaps one of the most powerful facts gained from the Vietnam programs: it is possible to build a population that would one day become cholera resistant without the frequent booster doses of OCV.
Even more recently, the assertion that the cholera vaccine can be administered cheaply and effectively, even for those who do not receive the OCV directly, has dramatically changed the way health officials approach containment efforts in emergency situations.
Nowhere was this more evident than in Haiti, which, despite the skepticism of many public health officials who maintained that the oral vaccine was nearly impossible to distribute en masse in emergency situations, created its own emergency OCV campaign following the nation’s first cholera outbreak in 2011. Despite the fragility of the glass vials that contained the oral vaccine, as well as the importance that each person vaccinated receive booster doses within two weeks of the first dose, the Haitian Ministry of Health managed to vaccinate nearly 300,000 Haitians.
Mass distribution of a specific treatment like the OCV through rapid training sessions and emergency transportation made the Haitian vaccination campaign unique. This was a dramatic shift away from the “basic minimum package” a broad (and many argue, ineffective) low-cost measure which does little to address the highly specific ranges of ailments that emerge from emergency situations like the Haitian earthquake.
The result of this bold change? 63% of the Haitian population found themselves immunized against a disease that can kill almost instantly. The cost? An average of $1.85 a dose, according to Partners in Health.
“We undertook the campaign as a public health emergency, but having data to demonstrate how effective it really was helps to solidify the case for using vaccines in this kind of setting—and that helps transfer lessons from Haiti to other places where cholera occurs or may appear for the first time. The Haiti cholera epidemic has really reinvigorated the public health community’s efforts to address the problem of cholera, and it’s exciting to be part of the progress that’s being made,” said Dr. Louise C. Ivers of Brigham and Women’s Hospital to Partners in Health.
The OCV is just one example of the WHO’s new face of emergency disease treatment and prevention. The “stockpile” of vaccines currently being developed by Geneva’s administration is just the first step toward a more dynamic approach to Cholera control, and perhaps a model for outbreaks to come.
Sources: PIH, Infectious Disease Cost Calculator, The Lancet 1, NIH, WHO 1, WHO 2, WHO 3, The Lancet 2, PLOS