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Not Doing Enough: Unnecessary Sickness and Death from Cholera in Haiti

Not Doing Enough: Unnecessary Sickness and Death from Cholera in Haiti

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Cholera is both a preventable and easily cured disease, yet in July--nine months after it was inadvertently introduced into Haiti by UN troops--a Haitian was infected almost every minute, and 375 had died over the course of the month. In October 2010, the V. cholerae bacterium spread through a vulnerable population that had not been exposed to the pathogen in over a century. It has thus far afflicted 420,000 people and killed 6,000, making it the most catastrophic epidemic the hemisphere has seen in decades. This report looks at the reduction in cholera treatment initiatives prior to cholera's recent, predictable upsurge, and argues that international financial institutions, NGOs, and donor countries — which all have substantial resources — should use more of their resources, especially undisbursed or unspent funds that they have already pledged or committed to Haiti, to redouble their efforts to prevent unnecessary sickness and death.
Cholera is both a preventable and easily cured disease, yet in July--nine months after it was inadvertently introduced into Haiti by UN troops--a Haitian was infected almost every minute, and 375 had died over the course of the month. In October 2010, the V. cholerae bacterium spread through a vulnerable population that had not been exposed to the pathogen in over a century. It has thus far afflicted 420,000 people and killed 6,000, making it the most catastrophic epidemic the hemisphere has seen in decades. This report looks at the reduction in cholera treatment initiatives prior to cholera's recent, predictable upsurge, and argues that international financial institutions, NGOs, and donor countries — which all have substantial resources — should use more of their resources, especially undisbursed or unspent funds that they have already pledged or committed to Haiti, to redouble their efforts to prevent unnecessary sickness and death.

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Published by: Center for Economic and Policy Research on Aug 18, 2011
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CEPR
Not Doing Enough: Unnecessary Sickness and Death from Cholera in Haiti
i
 
Contents
 
Executive Summary ........................................................................................................................................... 1
 
Introduction ........................................................................................................................................................ 2
 
Background ......................................................................................................................................................... 2
 
False Confidence ................................................................................................................................................ 5
 
NGOs Leaving the Field .................................................................................................................................. 6
 
Concentration of Resources in the Capital .................................................................................................... 9
 
 The Way Forward ............................................................................................................................................ 10
 
Scaling Up Treatment ...................................................................................................................................... 10
 
Improving Water Treatment Systems ........................................................................................................... 11
 
Linking Prevention to Care ............................................................................................................................ 13
 
Conclusion ........................................................................................................................................................ 13
 
References ......................................................................................................................................................... 15
 
 Appendix ........................................................................................................................................................... 18
 
cknowledgements
 The authors thank Donna Barry, Advocacy and Policy Director at Partners In Health, and Mark  Weisbrot, Co-Director of the Center for Economic and Policy Research for helpful comments, andSara Kozameh for editorial assistance.
bout the Authors
ake Johnston and Keane Bhatt are Research Assistants at the Center for Economic and Policy Research, in Washington, D.C.
 
CEPR
Not Doing Enough: Unnecessary Sickness and Death from Cholera in Haiti
1
 
Executive
 
Summary
 
In October 2010, cholera, a waterborne disease spread by the
Vibrio cholerae 
bacterium, first appearedin Haiti and rapidly spread through a vulnerable population that had not been exposed to thepathogen in over a century. This cholera outbreak—having afflicted 420,000 people, 6,000 of whomhave perished as a result—is the most catastrophic epidemic the hemisphere has seen in decades. Yet ten months after its first detection, the disease has yet to be decisively halted. In fact, in recentmonths cholera cases have spiked dramatically. In July 2011, one person was infected with choleraalmost every minute, and at least 375 died over the course of the month due to an easily preventableand curable illness. The present health crisis did not originate as a natural byproduct of the January 2010 earthquake’sdevastation—the organism was virtually alien to the country. Its inadvertent introduction is theresult of the negligence of the United Nations Mission in Haiti (MINUSTAH), which hasmaintained an international, military troop presence in Haiti since 2004. A Nepalese contingent of UN peacekeeping forces is believed to have spread the illness by contaminating the Artiboniteregion’s water supply through a leaky sewage system and inadequate waste disposal. The specificstrain of 
V. cholerae 
in Haiti is identical to a particularly virulent one endemic to South Asia. It infectsthe small intestine, provoking severe diarrhea and vomiting that, if left untreated, can fatally dehydrate a healthy adult within a matter of hours. The health interventions launched to fight cholera have been hobbled by the initial missteps made inthe wake of the epidemic. The international community underestimated the virulence of theoutbreak; the UN initially denied responsibility for its introduction; and there was hesitation ininvestigating the circumstances surrounding its appearance. These errors led to a smaller and moredelayed mobilization of funds and treatment interventions than could have been otherwisemarshaled to contain the outbreak. The UN’s cholera appeal, which was based on its low estimate, isstill barely more than 50 percent funded. Furthermore, despite myriad warnings, many nongovernmental organizations (NGOs) withdrew from cholera treatment efforts right before thissummer’s rainy season and the predictable increase in the number of cholera cases that followed. Todate, treatment is still unequally focused on urban centers despite the much higher fatality rates inHaiti’s more rural areas. With proper treatment, fatality rates should be below one percent.However, in some rural areas, they are as high as 5.4 percent.Cholera is both eminently preventable and treatable. Much can be done immediately to curb thedisturbingly large number of Haitians falling sick, and address cholera’s relative deadliness in ruraland remote regions. In the short-term, the international community and NGOs should provide firmsupport for expanding the reach of inpatient facilities in areas hardest hit by the epidemic. Money and human resources should also be invested in the proposals of public health experts who advocatefor scaling up treatment efforts through antibiotics and supplements, and integrating prevention andcare through education campaigns and a vaccination strategy.NGOs raised an astonishing $1.4 billion for Haiti relief efforts from the U.S. alone, yet many somehave failed to disburse funds despite the dire situation on the ground. The international community pledged over $5 billion for Haiti, yet over a year later, less than 40 percent has been disbursed, whilefar less has actually made an impact on the ground. The U.S., having appropriated over $1 billion forHaiti, has only disbursed $180 million. International financial institutions (e.g. World Bank, Inter-

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