By Anthony Robbins, MD, MPA
I am surely not an expert on cholera. I have never seen a patient with the disease. And I have never been to Haiti. Yet I keep reading about the epidemic in Haiti. The first case reports appeared in October 2010, about 10 months after the powerful earthquake that shook Haiti. Unrepaired damage to hospitals, clinics, and roads made it difficult to bring oral rehydration to patients with cholera. The country lacked potable water and infrastructure to treat human fecal waste. By 2014, at least 700,000 Haitians had been infected and more than 8000 had died. The disease continues to spread.
Cholera had spared Haiti for a century or more, so it was not unreasonable that people asked where did the pathogen come from in 2010. But public health people might have explained that the question was a distraction. Why so? Very simply, knowing how Vibrio cholerae arrived in Haiti would not help control its spread or prevent future outbreaks.
As Declan Butler reported in Nature: “Cholera is a disease of poverty, and spreads rapidly in communities lacking clean water supplies and sanitation.” “Until clean water and sanitation are readily available in Haiti, cholera outbreaks will continue.”
Early this year I realized that this public health message was often shoved off course.
- At a board meeting of the Public Health Advocacy Institute, a lawyer working with Haitian cholera victims told us of his efforts to win compensation from the United Nations. It seems that the strain of cholera afflicting Haiti came from Asia and may have been imported by Nepalese soldiers participating in earthquake relief efforts.
- A similar focus on the source of the Vibrio cholerae received excessive attention in a draft policy statement for the American Public Health Association.
I pulled out my editor’s pen and wrote an Editorial for the Journal of Public Health Policy. Now I have been invited to opine on cholera in Haiti on Scientific American’s guest blog. In my JPHP editorial, I wrote:
The bottom line is that all low-income countries that lack potable water and sanitation are vulnerable. Haiti presented an ideal environment for cholera to spread. But it might have struck other communities in other countries. The world must invest in the infrastructure that will prevent the kind of epidemics we are witnessing in Haiti. Most of the world, middle- and high-income countries, was made safe from cholera before we could identify the pathogen or treat the disease with oral rehydration fluids.
Anthony Robbins, MD, MPA is co-Editor of the Journal of Public Health Policy. He directed the Vermont Department of Health, the Colorado Department of Health, the U.S. National Institute for Occupational Safety and Health, and the U.S. National Vaccine Program.