Cholera vaccine plan splits experts

Officials of international health agencies are recommending a pilot roll-out of cholera vaccination in Haiti, despite the fact that even using the world’s entire stockpile of doses would leave most Haitians without vaccine.

Local and international experts argue that this approach is wrong-footed, and that although the country is ready to go ahead with a vaccination campaign, this should not be done on a small scale. A news exclusive in this week’s Nature investigates the issues.

The only approved vaccine, Dukoral, has been shown to be about 80% effective in large-scale studies, but it has not been used to tackle such a massive outbreak before. Senior officials from the World Health Organization and other health agencies want to go ahead, in part because it would reveal how effective Dukoral would be in a mass-immunization of a population already affected by the disease. At present, only 250,000-300,000 doses are available. The Haitian ministry of health insists it will consider starting to vaccinate only if it gets more than 1 million doses, with a goal of eventually reaching 6 million people.

Other experts believe the money that would be invested in vaccinations would be better spent improving water-supply networks and reinforcing sanitation activities, and one researcher has unpublished data suggesting that any coverage may be short-lived. With poor sanitation, little access to clean water and difficulties in treating people, however, most are agreed that the disease is there to stay.