. Memories from the previous epidemic, which killed close to 10,000 Haitians between 2010 and 2019, are still raw; now, with violent gangs fighting for control over the country and the health system in disarray, things could again get very bad.
The outbreaks are part of what the World Health Organization calls an “unprecedented” surge in cholera cases, driven in part by climate change and fallout from the COVID-19 pandemic. Thirty countries have reported outbreaks this year, up from fewer than 20 on average the past 5 years. “There is a trend of more countries affected, in more regions, with a longer duration of outbreaks,” says Daniela Garone, the international medical coordinator at Doctors Without Borders .
Extreme weather fueled by global warming is part of the reason cases are instead trending up, says Philippe Barboza, who heads WHO’s Cholera and Epidemic Diarrheal Diseases section. Droughts in West Africa and the Horn of Africa, massive flooding in Southeast Asia, and cyclones in southern Africa have displaced people and destroyed water and sanitation infrastructure. COVID-19’s toll on the health care system made matters worse.
David Sack, an infectious disease expert at Johns Hopkins University’s Bloomberg School of Public Health, says he is “puzzled” by the decision to abandon the second dose instead of postponing it. A clinical trial in Cameroon that Sack and colleagues suggests giving the second dose after 1 year instead of 2 weeks actually increases the immune response. But unless the outbreaks slow down in the coming months, the vaccine supply won’t allow even a delayed second dose.
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