Via The Lancet, a report by Louise C. Ivers, Paul E. Farmer, and William J. Pape: Oral cholera vaccine and integrated cholera control in Haiti. Excerpt:
There have been objections to integrating vaccine into the response. Initial resistance to deploying vaccine as a complementary tool in the fight against cholera occurred for various reasons: fear that using only the limited number of available doses would be inequitable and might trigger social unrest during an election year; fear that logistics capacity (especially for cold chain storage) would be insufficient to implement the programme effectively;8 concerns that use of the vaccine would reduce other prevention practices of good hygiene and use of potable water;8 concern that the project would interfere with a planned national campaign to reinforce other basic childhood vaccinations, including polio;11 and uncertainty about the use of vaccine in epidemic settings compared with endemic settings, in which oral cholera vaccines have been better studied.10, 12
A new Haitian President and the nomination, in October, 2011, of a Minister of Health who viewed the situation with urgency and called for integrating vaccination into the ongoing response to cholera, brought a change in political will.
The debate has occurred largely among those not at risk of waterborne disease. During the early stages of this pilot in both rural and urban Haiti, we found that communities were interested in the vaccine and uptake of the first dose has been high. Within 2 weeks of commencement, 52 000 first doses of the vaccine have been administered.
The capacity of the health system in the region is being reinforced by the cholera vaccination programme through the promotion of the national childhood immunisation campaign; community health workers have been trained to better prevent and, failing that, refer cases; cold chain capacity has been expanded; and a new vaccine has been delivered through the public sector vaccination programme.
There have, of course, been challenges. Days before the launch of the cholera vaccine programme, a national bioethics committee wrote to the Minister of Health objecting to the use of cholera vaccine, which delayed the start date beyond the onset of the rainy season. Some villages are now flooded making it difficult to access health posts.
The delay also caused a scheduling overlap with a national polio campaign, which led to reduced cold chain storage space and additional planning to ensure an appropriate interval between cholera vaccine and oral polio vaccine for children. These challenges, however, have been far from insurmountable.
