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Vaccines in the Time of Cholera: Response to The outbreaks-Zambia news

About seven months ago, a cholera outbreak hit Zambia — an event that has drastically changed the lives of many.

Although easily treated, cholera can lead to severe diarrhoea, vomiting and dehydration in those who contract it, usually through water contaminated by infected faeces, the United States nonprofit the Mayo Clinic says on its website.

Zambia’s cholera outbreak began in late September 2017. By February, there had been about 3200 cases of the bacterial infection and 74 deaths, according to the United Nations Children’s Fund.

The Zambian government launched a huge effort to control the outbreak, forbidding public gatherings, including weddings, funerals and church meetings. Markets were shut down, as well as bars, nightclubs and other public places the government claimed “posed a risk of spreading cholera”. In the badly affected township of Kanyama in Lusaka, a 6pm curfew was imposed. The country even postponed the start of the school year.

And the Zambian military enforced a ban on street vending in Lusaka.

The rub? Cracking down on street vendors, imposing curfews and even enacting quarantine zones don’t work to control cholera, says the World Health Organisation (WHO) website, because they don’t eradicate the source of outbreaks or stem transmission.

Responses such as these often do more harm than good, diverting scarce resources and undermining public trust and co-operation.

But not all of the country’s prevention and control efforts have been as bizarre and unscientific as curfews. Zambia has started to provide clean drinking water to people living in cholera-affected areas and is increasing household efforts to chlorinate water to stamp out the bacterium. It has also rolled out vaccines, and intends to vaccinate more than 74% of adults and children against the infectious disease, said Zambian health minister Chilufya Chitalu in a media statement released in mid-January.

“We have recorded in the last 24 hours … a drastic reduction in numbers,” he said. “Now we are [on] terra firma [feeling safe].”

Cholera is as familiar to most Zambians at the summer holidays. Its first major outbreak occurred in 1990 and lasted until 1993. Since then, the country has registered cholera cases almost every year. The number of people affected fluctuates from a few hundred cases to thousands admitted to hospital, according to the WHO.

Vaccines such as those being used in Zambia may be a standard part of controlling cholera outbreaks now but this wasn’t the case just a few years ago. And the world continues to find new ways of using vaccines to fight cholera with each new rainy season, it seems.

Today, the WHO has approved four oral cholera vaccinations. But Luquero says Zambia’s 2016 outbreak amid a worldwide shortage of such immunisations remains a stark warning.

“While the availability of vaccines has improved in recent years, the number is still far from being sufficient to tackle the large-scale outbreaks we are currently seeing, such as those currently ongoing in the Democratic Republic of Congo or Yemen.”

But vaccines can’t solve the real reason cholera continues to make regular appearances in Zambia.

“The single biggest intervention [to prevent cholera is the provision of safe water accompanied by good sanitation. In the absence of that, you are always going to have a population that’s at risk,” says Karen Keddy, head of the centre of enterology at South Africa’s National Institute for Communicable Diseases.

Most Lusaka neighbourhoods don’t even have sewer lines, says Mweemba Siyankuku, an engineer for Zulu Burrow Development Consultants. The Lusaka-based company is working to provide clean drinking water and sanitation to more than 1.2-million Lusaka residents as part of a $355-million (R4.1-billion) US-funded project.

Part of this will include expanding Lusaka’s sewer system.

“When someone moves on to the plot they build a pit latrine and also a shallow well. That shallow well will eventually be infected with faecal matter,” Siyankuku says.

A second major aim is to rehabilitate old water lines, where leakages risk not only water loss but also allow contaminated groundwater to seep into drinking water.

But the new project brings its own problems, such as the interruption of trade.

When Siyankuku spoke to Bhekisisa, he was in the township of Gardens identifying which marketeers operated along the “construction corridor” of a new intended water pipe.

“We will need them to resettle,” he explains. “They will be compensated but how much we will pay them depends on what they are selling. Most people have been co-operative, others are not.”

Changes in the way Lusaka gets and uses its water may take time to get used to but it’s the only way to protect Zambians in the long run.

“Even if you bring them clean water, some people will still go back to their old ways. People are swimming and throwing trash in the expensive drains we have built,” Siyankuku says.

“In a few weeks’ time, when the cholera cases go down to zero, you will see the government will do nothing again. It’s about sanitation and drinking water; it’s not about chasing street vendors.”

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