The cholera crisis in South Sudan continues to worsen, as do fears of a probable outbreak in Syrian refugee camps in Iraq. The World Health Organization (WHO) reports that 2,400 people have been infected and 62 have been killed so far. As these numbers rise, the demand for a more comprehensive international response grows. This urgent situation polarizes aid providers into two camps: those advocating for widespread vaccination and those directing their focus toward sanitation.

Cholera is highly contagious and fast-acting. It spreads through bacteria-contaminated food and water, and is most common in places with poor water quality and sanitation. Many at-risk areas lack a widespread and comprehensive strategy for cholera prevention. The effectiveness of vaccines overshadows this issue, especially during time sensitive periods when outbreaks have already begun.

A study by The New England Journal of Medicine about a cholera outbreak in Guinea shows that two doses of a particular vaccine were able to protect people with 86 percent effectiveness.

Doctors Without Borders and the Guinean Ministry of Health were able to vaccinate 75 percent of the affected population, thereby containing the outbreak. Similar results were observed in a larger trial in Kolkata. Another benefit is that the vaccine is inexpensive – at approximately $3 per two doses – making it affordable to patients in vulnerable developing countries.

Successes like those seen in Guinea and Kolkata have encouraged the use of vaccination to control future cholera outbreaks and provide quick, inexpensive protection.

However, vaccines are not always suitable for settings with weak health systems. They require refrigeration – often up to the point of delivery – which, in some areas is impossible. Developing countries often must deal with unreliable electricity, transportation issues, high temperatures and deliveries to remote, rural  communities. Also, it is necessary to mix the vaccine with clean water – a scarce commodity in the poor areas where cholera is most likely to take hold.

Factors such as these have created debates over how best to allocate resources. Instead of spending them solely on vaccines, some argue that resources should be used to develop and strengthen basic water and sanitation infrastructure. Vaccinations, though effective, can only reach a percentage of the population, while proper sanitation benefits all.

Also, vaccinations are often implemented only after an outbreak has begun, rather than as a preventative measure. Water and sewage facilities play a major role in preventing cholera once they have been implemented. The WHO has endorsed the use of re-hydration solutions and antibiotics for the treatment of cholera, rather than advocating for vaccination alone.

Access to clean water and sanitary conditions are necessary to effectively control and eliminate cholera. It may be a challenge to focus on these basic needs when the research behind vaccines is so promising. Though providing better hygiene infrastructure for communities will not only help prevent diseases, but also set the foundation for growth in other areas such as health and development.

It is hopeful that both vaccination and sanitation will be used in tandem to provide a multifaceted, integrated approach to preventing and controlling cholera in the future.

– Mari LeGagnoux

Sources: The Guardian 1, The Guardian 2, New England Journal of Medicine
Photo: The Guardian