Preventing cholera outbreaks through early targeted interventions

PLoS Medicine
(Accessed 3 March 2018)

Preventing cholera outbreaks through early targeted interventions
Lorenz von Seidlein, Jacqueline L. Deen
| published 27 Feb 2018 PLOS Medicine
Cholera outbreaks: Hit or miss
With funding from Gavi in place and an increasing OCV supply assured, one would think that large and disastrous cholera outbreaks would have been confined to history. However, events during the past few months have demonstrated how much of a hit-or-miss affair cholera outbreak control and prevention remains. In October 2017, 900,000 doses of OCV were mobilised from the international stockpile to prevent cholera outbreaks in Rohingya camps along the border between Bangladesh and Myanmar, even before cholera cases were reported [14]. Considering the cholera endemicity in Bangladesh in combination with desperate conditions in the refugee camps, WHO and the stockpile managers are to be congratulated for their timely action and foresight.

In contrast, OCV doses did not arrive in Yemen despite a humanitarian crisis of enormous proportions (994,751 suspected cases; 2,226 deaths by December 2017) [15]. Not only did WHO fail to mount the essential mass vaccination campaigns, but the explanation for this omission was once more that oral cholera vaccinations during an ongoing outbreak are inappropriate [16], a statement that is factually incorrect. Management of the Yemen cholera outbreak has been complex, and many parties carry responsibility for the lack of successful interventions. Yet, WHO has the mandate to support decision-making in such difficult circumstances. By the time the vaccines were requested and shipment was finally approved (though never used), the outbreak had already reached its peak, highlighting the critical need for a rapid response.

The decision of which requests to the OCV stockpile should be granted (and for how many doses) falls to an International Coordinating Group (ICG) composed of representatives from United Nations Children’s Fund (UNICEF), Médecins Sans Frontières (MSF), the International Federation of Red Cross and Red Crescent Societies (IFRC), and WHO [17]. Over the years, some requests were rejected on technical grounds, while others were assigned too low a priority to ever be delivered. Ultimately, only half the requested doses (51%; 12.8 million doses) have been shipped in 46 deployments between 2013 and 2017 [10]. The criteria for these decisions and any competing interests of the coordinating group members are not transparently disclosed, and the decisions do not always appear fair; yet they have far-reaching consequences…