A multi-sector approach to end cholera as a threat
“WHERE is your toilet?” This is often the first question I ask when I visit the site of a cholera outbreak anywhere in the world. More often than not, the answer is: “We don’t have one. We go wherever we can.”
Cholera, an ancient disease, has become a disease of poverty. It does not discriminate geographically, but it preys mostly on vulnerable communities in areas with poor sanitation.
Carried by contaminated floodwaters to sources of drinking water, transported by unsuspecting travelers, or brought into homes on produce irrigated with untreated sewage, the Vibrio cholerae bacterium settles in the small intestine after it is ingested, causing severe diarrhea and dehydration.
Those who are fortunate enough never to have witnessed cholera’s effects firsthand might assume that it is just another stomach bug. But without swift medical attention, cholera can sap the life out of an adult or child in a matter of hours. Each year, cholera kills an estimated 95,000 people; many of them children.
This year, images of listless, glassy-eyed cholera victims awaiting treatment have emerged in countries worldwide. The disease has spread at an unprecedented rate in Yemen, where more than 2,000 people have died since April.
Cholera outbreaks are ongoing in Somalia, South Sudan, Haiti, and other countries across sub-Saharan Africa and Asia.
But the saddest fact about cholera’s recent toll on human lives is that every single death was preventable. The world already has the knowledge and tools to control cholera effectively, but existing resources are not being aligned with the necessary global commitments.
That is why the new global strategy developed by the Global Task Force on Cholera Control, a diverse network of technical partners, is so vital. “Ending Cholera — A Global Roadmap to 2030” emphasizes a shift to proactive approaches, and aims to reduce cholera deaths by 90 percent over the next decade. With full implementation, the plan could also help as many as 20 countries eliminate disease transmission in the same timeframe. Based on three pillars — early detection, integrated prevention tactics, and coordination between countries and partners — the roadmap provides a concrete path for ending cholera as a public health threat.
Once cholera grips a community, it becomes increasingly difficult to control. It is important, therefore, that the disease is not forgotten even when it is not claiming victims.
A multi-sector approach that includes investments in water, sanitation, and hygiene — so-called WASH services — can keep cholera at bay. So can the proactive use of oral cholera vaccines and quick access to treatments, such as oral rehydration solution and intravenous fluids.
Improving WASH infrastructure is the most effective path to prevention, though implementing these services will take time in countries with fewer resources. For this reason, the roadmap also encourages the preemptive and large-scale deployment of oral vaccines in cholera hotspots. The vaccines work immediately, and can prevent cholera for up to three years, serving as a bridge to the implementation of longer-term solutions.
Ending cholera as a health threat by 2030, as global partners and the WHO recently pledged, will require sustained collaboration and commitment from cholera-affected countries, technical partners, and international donors. The goal may seem daunting, given that millions of people around the world are at risk of contracting the disease each year.
Dominique Legros, a medical doctor, is currently the Cholera Team lead at the World Health Organization. Copyright: Project Syndicate, 2017. www.project-syndicate.org