Cholera vaccine succeeds in rural Haiti
A vaccination campaign that almost didn't happen was widely effective in reducing transmission of cholera in the midst of an ongoing outbreak of the disease in rural Haiti.
According to a study led by Harvard Medical School researchers at Partners In Health, there were 63 percent fewer cholera cases among the thousands of adults and children who received the cholera vaccine Shanchol than among those who were unvaccinated. The results were published in the March issue of The Lancet Global Health.
"This study demonstrates that the vaccination campaign saved lives and reduced suffering," said Louise Ivers, HMS associate professor of global health and social medicine and a senior health and policy adviser at Partners In Health. "We undertook the campaign as a public health emergency, but having data to demonstrate how effective it 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 plan to provide the vaccine was surprisingly controversial. Skeptics cited several reasons: the vaccine had been proven effective in areas with smoldering, lingering cholera, not in a full-blown outbreak; the impoverished landscape and absence of a functioning health system in much of rural Haiti would present logistical challenges; and an approach common in resource-limited settings that delivers the minimum basic health care in order to save scarce funds.
Critics of the vaccination plan suggested that efforts would be better spent on basic hygiene education and hand-washing campaigns. The vaccine costs $1.85 per dose.
"When you see people dying, you want to do everything you can," said Ivers, who is also HMS associate professor of medicine at Brigham and Women's Hospital. This includes preventive measures such as hand washing, treatments like rehydration, and using the vaccine.
Working with the approval of the Haitian Ministry of Health, Partners In Health and its sister Haitian organization Zanmi Lasante carried out the vaccination program from April to June 2012, training field workers, fighting the rainy season mud and ensuring that 45,417 patients swallowed two doses of the drug two weeks apart.
"Our study contributes to mounting evidence that oral cholera vaccines have an important role to play as a component of comprehensive, integrated cholera control efforts in Haiti," the study concludes.
The study also highlights the importance of integrating the development and testing of new vaccines and therapies, the creation of health care delivery systems and the collection of crucial research data in comprehensive, coordinated efforts.
The team also included physicians and researchers from Brigham and Women's Hospital, Massachusetts General Hospital, Zamni Lasante and the Haitian Ministry of Health and Population. Molly Franke, HMS assistant professor of global health and social medicine, was senior author on the paper.
This research was funded by the National Institutes of Health, the Delivering Oral Vaccines Effectively project and the HMS Department of Global Health and Social Medicine.