- Associated Press - Monday, November 14, 2011

PORT-AU-PRINCE, HaitiHaiti’s two most prominent health care groups are preparing a new assault on the country’s deadly cholera epidemic: the dispatch of hundreds of workers to remote villages and gritty alleys in the capital to administer a vaccine against the raging disease.

But the pilot project, which has not yet secured the $870,000 it is estimated to cost, has set off a debate among some public health experts who question the wisdom of a program that will inoculate only 1 percent of the population and could deplete the world’s stock of available cholera vaccine, potentially putting people at risk in other vulnerable places.

Experts also wonder whether it even will be possible to successfully administer a vaccine that must be given in two dosages two weeks apart. They contend the money would best be spent cleaning up the waterways that have allowed cholera to flourish in Haiti.

“Everybody thinks it’s going to do some good,” said Richard Garfield, a professor of public health and nursing at Columbia University. “But it’s hard to specify how much good and benefit will come out of that … There are bigger-bang-for-the-buck activities out there.”

Partners in Health, based in Boston, and the Gheskio Center, a health nonprofit that has focused on AIDS, are joining in the vaccine campaign, hoping it will save lives.

Partners in Health co-founder Paul Farmer, a Harvard professor and special U.N. envoy, became an early advocate of the vaccine, and his opinion carries weight in Haiti, where he has been working to improve public health for more than 20 years.

He’s adamant that the vaccinations should be done for Haiti’s poor regardless of the cost.

“It’s been a joke to focus on how much it costs,” Dr. Farmer said by telephone. “The Haitian cholera epidemic is the largest in the world.”

Doctors Without Borders estimates it would cost up to $40 million to inoculate the entire country and points out that the immunity from the vaccine begins to wear off within three years.

“Money spent on vaccines should not come at the expense of money spent on permanent water and sanitation measures,” Dr. David Olson, a medical adviser for Doctors Without Borders, wrote in an October press release.

The proposal for a vaccine campaign in Haiti surfaced soon after the disease emerged in October 2010, when U.N. peacekeepers from Nepal apparently triggered the contagion through an inadequate sanitation system installed near the country’s largest river, the Artibonite, according to several studies.

The studies were cited as evidence in a claim announced last week by the Boston-based Institute for Justice and Democracy in Haiti, which argues that the world body is responsible for the epidemic and should compensate more than 5,000 cholera victims.

Cholera, spread by water and contact with other people who have the disease, has sickened nearly 500,000 and killed more than 6,500, according to Haiti’s Health Ministry. The disease causes rapid dehydration that can kill someone within hours, but it is easily treatable.

In the first weeks of the outbreak, assistance poured into the country from Doctors Without Borders, Oxfam, Partners in Health and many smaller groups.

Following the outbreak, public health experts discussed the possibility of introducing an oral vaccine, but the administration of then-President Rene Preval didn’t want it unless the entire country of 10 million could be treated.

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