The Cholera roadmap: Is it doable?

The latest edition of The Lancet journal discusses the question in its Editorial section of the recent roadmap announced by the World Health Organization to end the fifty-year pandemic called Cholera, concluding that we have the technical ability but that there are also many challenges.

The article, "Cholera: ending a 50-year pandemic", quotes the annual burden posed by cholera, estimated at 2.9 million cases occasioning 95,000 deaths, and quotes the shocking example of Yemen this year, where 750,000 cases have caused 2,000 deaths - and now with the humanitarian crisis in northern Myanmar/Bangladesh, there are serious concerns of an outbreak among the Rohingya refugees. These are the type of challenges which will confront the recent Roadmap to reducing cholera deaths by ninety per cent by 2030, announced by the World Health Organization on October 3.

The seventh pandemic

The article in The Lancet traces the outbreaks of cholera back over two hundred years, stating that the latest pandemic, the seventh traced since records registered the first in the Ganges Basin in 1817, began in 1961 and describes it as an "ongoing" situation. And it is one which affects the poor, those who have less access to clean water and sanitation/hygiene systems, called WASH (Water, Sanitation, Hygiene).

The article states that cholera is endemic in no less than 47 countries and humanitarian crises are often accompanied by an epidemic, as we see today in Yemen, where the statistics are shocking. For the last three years, since September 2014, warring factions in Yemen supported on one side by the Saudis (Sunni) and the other, the victims, defended by Iran (Shiite) with the West wading in on the side of the Saudis, have destroyed the country to breaking point. The victims as usual are civilians in general and children in particular. Over the last two years, from May 2015 until August 2017, the United Nations Organization has documented 5.144 civilians killed and 8.849 injured. Of these 1.184 children were killed and 1.592 were injured. 

Saudi-led airstrikes have included funeral gatherings, fishing vessels, schools, hospitals, markets, residential areas and public and private property.

"Operations were conducted heedless of their impact on civilians without regard to the principles of distinction, proportionality and precautions in attack" (UN Report, 2017).

This has been described as a man-made crisis by the UNHCR, since apart from the shelling and bombing ("collateral damage" in the words of some, except when someone does to them what they do to others), Yemen is facing the world's worst cholera outbreak with over 750.000 cases.

Seventeen million people are on the brink of famine and what is the response? Insufficient funding.

But it is not only in Yemen that the figures are so depressing. The Lancet editorial informs that 60 to 70 per cent of cases of cholera take place in Africa, in areas where the disease is endemic and even when there is no conflict, fast urbanization processes and uncontrolled spatial planning can give rise to the appearance of massive slums, breeding grounds for the disease.

The Lancet claims that WASH is an effective policy but an expensive one and for that reason its implementation has been slow. What is also effective, is the Oral Cholera Vaccine treatment, called OCV, and a massive vaccination campaign undertaken by the WHO has started to have a significant effect.

Three mainstays will underpin the roadmap: Rapid response to outbreaks and fast implementation of WASH systems; long-term strategies based on sustainable WASH infrastructure and financed healthcare systems; coordination of support locally and globally.

These measures depend on the goodwill of Humankind and on the good governance of those running the countries where the systems are implemented. For The Lancet, a leading medical journal, the Roadmap is  bold initiative and a welcome one and concludes with the question: "After 50 years, could the tide be finally turning on the seventh pandemic" (of cholera)?

Sustainable development and governance

The answer to that question is for the countries which have developed themselves by using the resources, in many cases, of the countries where cholera and other water-borne diseases are endemic, to provide sustainable development and in so doing, to ensure that good governance practices take into account the needs of the people most affected. This means transparency and responsibility, not corruption and syphoning off resources on the quiet. It takes two to tango.

It is inconceivable that in today's world, in a country like Yemen, with 750,000 cases of Cholera and almost total devastation in some areas, there is insufficient funding to put the mechanisms into place. Until there is a fundamental change in attitude, how can the cholera roadmap have a chance?

Timothy Bancroft-Hinchey

Pravda.Ru 

Twitter: @TimothyBHinchey

[email protected]

*Timothy Bancroft-Hinchey has worked as a correspondent, journalist, deputy editor, editor, chief editor, director, project manager, executive director, partner and owner of printed and online daily, weekly, monthly and yearly publications, TV stations and media groups printed, aired and distributed in Angola, Brazil, Cape Verde, East Timor, Guinea-Bissau, Portugal, Mozambique and São Tomé and Principe Isles; the Russian Foreign Ministry publication Dialog and the Cuban Foreign Ministry Official Publications. He has spent the last two decades in humanitarian projects, connecting communities, working to document and catalog disappearing languages, cultures, traditions, working to network with the LGBT communities helping to set up shelters for abused or frightened victims and as Media Partner with UN Women, working to foster the UN Women project to fight against gender violence and to strive for an end to sexism, racism and homophobia. A Vegan, he is also a Media Partner of Humane Society International, fighting for animal rights. He is Director and Chief Editor of the Portuguese version of Pravda.Ru.