Thousands of Lives Could Be Saved, and Haiti's Cholera Epidemic Managed, With Greater Treatment and Prevention Efforts, CEPR Paper Finds

A new paper from the Center for Economic and Policy Research argues that cholera treatment and prevention efforts in Haiti have fallen woefully behind, leading to thousands of preventable deaths, even though the dramatic rise in new cases this spring and summer was entirely predictable. The paper, "Not Doing Enough: Unnecessary Sickness and Death from Cholera in Haiti", by researchers Jake Johnston and Keane Bhatt, argues that it is not too late to bring the 10-month old cholera epidemic under control and save thousands of lives by ramping up treatment and prevention efforts.

"Haiti's cholera epidemic has been much worse than it could have been, and thousands more people have died, due to an inadequate response from the international community, going back to when the outbreak began," CEPR Co-Director Mark Weisbrot said. "It's time to reverse course and get serious about controlling and eventually eliminating cholera from Haiti."

"In July 2011, one person was infected with cholera almost every minute, and at least 375 died over the course of the month due to an easily preventable and curable illness," the paper notes. A March 2011 article in the medical journal The Lancet predicted that cholera infections would spike with the onset of the rainy season following a drop-off during the drier months of late 2010 and early 2011. Yet overall cholera efforts were scaled back just as infections were increasing: only 48 nongovernmental organizations (NGOs) were addressing cholera in July, down from 128 in January.

As predicted, new cholera infections increased with the onset of the rainy season this year, reaching an average of 1800 new infections per day in June - almost twice as many as in May and three times as many as in March and April, the paper notes.

The paper also notes that NGO's and international agencies have targeted urban centers over rural areas, despite the anticipated spread of the disease to all corners of Haiti, and significantly higher case fatality rates in some rural areas. The department of Sud Est, for example, currently has the highest fatality rate, at 5.4%, but no Cholera Treatment Centers.

The authors recommend several ways in which the cholera epidemic could be brought under control -- and thousands of lives saved -- including expanding the reach of inpatient facilities in the hardest-hit areas, scaling up antibiotic and supplement treatment efforts, prevention and care through education campaigns, and a vaccination strategy. International donors also have fallen far behind on their pledges for cholera assistance.

The paper outlines a number of other factors that contributed to the severity of the epidemic, one of the most important being the relative scarcity of potable water in Haiti. The authors describe various ways in which public water systems have been under-funded and implementation delayed by the international community, while some donors have pushed instead for "cost recovery" water systems in camps for internally displaced persons (IDP's) and elsewhere. These would require residents to pay for potable water, and likely lead to an increase in cholera infections as potable water would be put out of reach of IDP's and other low-income Haitians.

"Safe, clean drinking water for all Haitians should be a top priority for international donors," Weisbrot said. "And if it had not been so neglected years ago, when loans for this purpose were blocked by the United States, the severity of this outbreak might have been drastically reduced."

The paper's lead author, Jake Johnston, added: "The money is there: the U.S. Congress appropriated $1.14 billion for Haiti a year ago, and most of that money has not been spent; and a lot of the $1.4 billion that Americans gave to private charities after the earthquake - including the biggest organizations such as the American Red Cross -- also remains unspent. And there are also hundreds of millions of dollars of international aid that were pledged by governments but not yet delivered. These funds can be used to expand treatment and prevention of cholera in Haiti, and to build the necessary water infrastructure."