Cholera in disasters: do vaccines prompt new hopes?

Abstract

Humanitarian aid workers regularly encounter the challenge of setting up functioning surveillance systems immediately after a disaster. Detecting potential outbreaks of diseases, such as cholera, that might arise from disturbed living conditions, displacement and lack of clean water and sanitation is, therefore, extremely difficult. Fears of cholera outbreaks are often rife in such conditions and the pertinence of using cholera vaccines, now available on the market, merit attention. The case of Aceh province, Indonesia, following the 2004 tsunami is examined here: the government of Indonesia decided to carry out a mass vaccination campaign using oral cholera vaccines, a two-dose product that has not been used widely in the particular circumstances of complex emergencies. The preparation and implementation of this campaign faced many hindrances that unfavorably impacted on the time taken to vaccinate the target population and the costs involved. An estimated 69.3% of the target population received immunization. Evidence gathered during the Aceh campaign could be compared with those of a campaign held in another emergency context – Darfur (Sudan). In spite of many dissimilarities, both experiences illustrate the fact that the question of feasibility and relevance of interventions, as well as prioritization of health needs in complex emergencies, remain crucial to alleviate the affected population’s suffering in the most efficient way. Following these two campaigns, WHO recommendations on the use of oral cholera vaccines in complex emergencies were issued in 2006.

Keywords::

• Aceh
• cholera
• disaster
• emergency
• Indonesia
• outbreak
• tsunami
• vaccination campaign

Financial & competing interests disclosure

The mass cholera vaccination campaign in Aceh Province was funded mostly by the Swedish Government through its international cooperation agency, Swedish International Development Cooperation Agency. Additional expenses were paid by the Governments of Japan and The Netherlands from unearmarked funds for the tsunami-affected areas. C-L Chaignat has participated in the technical support for the preparation, implementation and monitoring of the vaccination campaign and in the analysis of data and collected evidence that was undertaken after the campaign. C-L Chaignat also has full access to the data in the campaign. V Monti has participated in the analysis of data and collected evidence that was undertaken after the campaign. J Soepardi, G Petersen, E Sorensen, J Narain and MP Kieny have participated in the decision-making, preparation and implementation of the mass-vaccination campaign. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.