One year on, cheap but untested vaccines to be deployed against cholera in Haiti

The UN introduced cholera to Haiti and is now embarking on a vaccination program with a vaccine which has been hurriedly approved just in September this year.

Last October the claims that the UN had introduced the disease into Haiti were initially denied but in May this year the United Nations released a long-awaited report indicating that human waste from Nepalese peacekeepers along with dirty drinking water likely triggered the spread of the cholera epidemic that has gripped Haiti since October 2010.

As of last week the cholera outbreak in Haiti has caused 473,649 cases 251,885 hospitalizations and 6,631 deaths. The number of deaths is thought to be an underestimate.

The situation is worsening in the rainy season:

Haiticoramdeo: Cholera is still prevalent among the population and is far from under control in Haiti. After having greatly affected the province in June, it takes hold with force now in the capital… Currently in the rainy season, the cholera epidemic is spreading with greater intensity in Port-au-Prince. Indeed, the humanitarian organization Medecins Sans Frontieres (MSF) notes a significant increase in the number of cases in its Cholera Treatment Centres (CTC).
….  MSF teams have seen a marked increase in the number of patients admitted. “In one month we went from less than 300 admissions per week to over 850, which suggests a worsening situation in the coming weeks” indicated Romain Gitenet, MSF Head of Mission.

Nature News:

The Pan American Health Organization (PAHO) in Washington DC expects the epidemic to ease partially, but nonetheless predicts a further 250,000 cases next year, says Peter Graaff, the PAHO/World Health Organization (WHO) representative in Haiti.

Shanchol, a vaccine approved by the WHO for worldwide use on 29 September, could brighten the outlook. It was developed by the International Vaccine Institute in Seoul with support from the Bill & Melinda Gates Foundation, and is produced by Shantha Biotechnics in Hyderabad, India, a subsidiary of vaccine company Sanofi Pasteur. Two groups of non-governmental organizations (NGOs) operating in Haiti now intend to include the vaccine in their own emergency responses to cholera.

At US$ 1.85 a dose, Shanchol is cheaper than the only other currently available cholera vaccine — Dukoral, made by Crucell, based in Leiden, the Netherlands. Shanchol is also given orally, and requires fewer doses in children under six, who are among the most vulnerable to cholera. The vaccine’s benefits “are really clear for the outbreak contexts in which MSF works”, says Julia Hill, vaccines policy adviser at Médecins Sans Frontières (MSF), also called Doctors Without Borders, in Geneva, Switzerland. ….

The WHO opposed vaccination during the chaos of the initial cholera outbreak in Haiti; Claire-Lise Chaignat, coordinator of the WHO’s Global Task Force on Cholera Control, argued at the time that the logistics would have been impossible to manage (see Nature 468,483–484; 2010). But the chaos has subsided, and the peaks in numbers of cholera cases are coming less frequently, so the WHO now supports targeted vaccination in Haiti, says Chaignat.

Shanchol is still relatively unproven and it is claimed to provide a 2 year protection to about 67% of those treated.

Haiti Libre: The vaccine Shanchol will be administered orally to patients, in two doses. The vaccine approved by the World Health Organization (WHO) will not replace awareness among the population said Dr. Timothé.
There are 3 brands of vaccine against cholera in the world: Dukoral ($40 per dose) is manufactured in Sweden and approved by the WHO, Shanchol, now approved by WHO, ($6 per dose – $1,00 per dose with sufficient demand) is produced by Shantha Biotechnics in India and the Morc VAX-VaBiotech is produced in Vietnam.
International Vaccine Institute scientists developed this vaccine, with funding from the Bill & Melinda Gates Foundation, the Government of Korea, and the Swedish International Development Cooperation Agency (SIDA), by significantly modifying a vaccine used and produced only in Vietnam so that it meets international Good Manufacturing Practice (GMP) standards and WHO production guidelines.
The trial in Calcutta (India), which enrolled nearly 70,000 people, has shown that the vaccine provides 67% protection for at least two years in this highly-endemic population.

Shanchol has been approved in an accelerated process only in September this year after a trial which only began in Bangladesh in February 2011. The speed of approval is more than a little surprising. The program in Haiti does therefore seem to be a little experimental but I suppose that the difference between $1.85 for Shanchol or or $40 for Dukoral is quite compelling.

I just hope that after having introduced cholera in the first place, the vaccination program does not fall flat on its face and is not something being driven by the manufacturers of the vaccine Sanofi Pasteur through their Indian subsidiary Shantha Biotechnics.

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2 Responses to “One year on, cheap but untested vaccines to be deployed against cholera in Haiti”

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