World Bank announces additional $5m grant to fight cholera in Haiti

The World Bank on Tuesday "announced a $15 million grant to Haiti to fight a persistent cholera epidemic," SAPA/Health24 reports. In a press release, the bank said it approved an additional $5 million to be added to a previously announced $10 million grant. "The funds, said the organisation in [the] statement, will go towards public campaigns to prevent infection and increase the capacity of Haiti's health ministry to deal with the emergency," the news service writes (1/19).

"Key to the success of these efforts is the joint response to the emergency, involving not only agencies and NGOs (non-governmental organizations) but, especially, the Haitians themselves," said Alexandre Abrantes, the World Bank's special envoy to Haiti, Agence France-Presse/My Sinchew writes. "Abrantes said the new grant also will be used to contract experienced NGOs for immediate cholera response activities."

"The program is part of the World Bank's $479 million reconstruction support following the devastating earthquake a year ago that left about one million people homeless and living in shelters in the poorest country in the Western hemisphere," according to the news service (1/18).

Nature News Examines Haiti Cholera Vaccine Debate, Developments

Nature News reports on developments related to the plan for a cholera vaccination campaign in Haiti and experts' varying opinions about how to proceed. "Most experts in the international community recommend a limited pilot project that would determine whether to scale up and how to use cholera vaccines in future outbreaks elsewhere. The Haitian government, caught in a febrile political environment and fearful that those denied vaccination might feel resentful, is demanding immediate, broad coverage," Nature News writes.

An expert committee, convened by the WHO, met in December and "decided that vaccination should be tried," Nature News notes. "On 13 January, the expert committee, including representatives from the WHO, the U.S. Centers for Disease Control and Prevention, the U.S. National Institutes of Health (NIH), UNICEF, the U.S. National Vaccine Program Office and others, held a teleconference to fine-tune a vaccination plan that could form the basis of a more detailed WHO-coordinated campaign strategy. The committee is recommending a pilot project using the currently available 250,000-300,000 doses of Dukoral, and the creation of a stockpile of the vaccine for the future." According to the news service, "Dukoral has not been used on such a scale before, although studies of thousands of people have shown it to be about 80% effective. The committee has not worked out where the campaign would be focused."

The article notes some of the challenges facing the vaccination campaign. "Although vaccine drives in Africa and elsewhere have faced resistance, Haitian people are eager to be vaccinated, says Francois Lacapere, a vaccine expert for Pan American Health Organization (PAHO)/WHO in Haiti. Yet many Haitians are also sceptical of aid agencies' motives. ... Even if the programme can win enough trust, using the world's entire stockpile of doses would still leave most Haitians without vaccine - a controversial prospect for the beleaguered government," the news service writes.

Jean Ronald Cadet, the vaccination program manager at the Haitian health ministry, said the country is "90 percent" ready to go ahead with a vaccination campaign, but said the WHO's pilot plan is too small. "He insists that Haiti would only consider starting to vaccinate with more than 1 million doses, with a goal of eventually reaching 6 million people. 'It would depend on the pressure that the international community can put on manufacturers.'" In response to a question about who would pay for the vaccine, Cadet responded, "The international community. They brought us cholera, they have to take responsibility for taking care of it."

The article also looks at the viability of scaling up vaccine production and includes opinions from health experts about the size of the campaign. Kate Alberti, a Medecins Sans Frontieres epidemiologist; Jon Andrus, deputy director of PAHO; Jean-Claude Mubalama, UNICEF's chief of health in Haiti; Renaud Piarroux, an epidemiologist at the University of the Mediterranean; and Matthew Waldor, an infectious-disease expert at Harvard Medical School are quoted in the article (Cyranoski, 1/18).

PBS NewsHour Examines Cholera In Haiti

In related coverage, PBS NewsHour also reports on Haiti's cholera outbreak. "Nationwide, in the first outbreak of cholera this country has seen in more than 100 years, there have been some 140,000 cases, with the death toll now well over 3,000," according to the report. "While cholera began in the countryside, a great fear has been that it will sweep the overcrowded city as well ... La Saline is one of Port-au-Prince's notorious slums. This is a kind of unofficial community of thousands who live without municipal services. Conditions here are dreadful, with fields and ditches of human waste and garbage."

The piece includes interviews with Nigel Fisher, deputy special representative for the U.N. Secretary-General in Haiti; Ivan Gayton of Doctors Without Borders; Hebert Thelusma, who runs Partners in Health's main cholera clinic in Haiti; David Walton, a physician who set up the clinic; and several people working with and volunteering for Oxfam (Brown, 1/14).