In the current state of affairs, where fewer organizations are working with a smaller pot of resources, it’s crucial to allocate funds to the most effective intervention. Yet despite recommendations from experts like Farmer, there’sstill no consensusabout what that intervention would be.
The question of how to respond to cholera is fundamentally a technological one. There are several identifiable constraints: existing water and transportation infrastructure, the capacity of medical facilities and NGOs, and available funding. It’s possible, given these constraints, to determine the most effective potential intervention. Ideally, the response would be structured based on such a determination.
Unfortunately, as is often the case, events have instead been dominated by political logic. Former President of Haiti RenéPreval opposed vaccines; therefore, vaccines weren’t used under his administration. Current President Martelly and his Prime Minister, Garry Conille, endorse them; therefore, thevaccination program is moving ahead.
Nonetheless, proponents of each of the various responses have stuck to their guns. Paul Farmer was anearly advocate for vaccines, and he’s still promoting this response today. Likewise, early critics pointed out that there would only be enough supply for afew hundred thousands vaccines– a reality which remains true. Aside from new political leadership, the only factor that has changed is theapproval of a new and cheaper vaccine, Shanchol. However, current plansonly seek to vaccinate 100,000, reflecting a continuing lack of adequate supply.
Meanwhile, outside the policy sphere, the response looks quite different. The UN Population Fund responded to the cholera outbreak bydistributing hygiene kits. The hygiene/sanitation approach is also taken by many NGOs, such asClean the WorldandGlobal Soap. By contrast, most medical NGOs have focused on the oral rehydration solution to treat the “dangerously ill.”
Further adding to the lack of clarity is the fact that many critics dismiss these approaches outright, arguing instead that the focus should be ondeveloping infrastructure for clean water delivery. This argument is bolstered by the fact that 10 years ago, the USblocked loans to develop this infrastructurefor political reasons.
With a variety of public and private sector actors all pursuing different approaches, the response has been uncoordinated. Moreover, it’s extremely unlikely that this has yielded the most effective mix of efforts.
In the context of a complex humanitarian emergency, identifying that effective mix is enormously complicated. However, while plenty of people have thrown in their two cents about what ought to happen, there has been no serious effort to think about this from a systems level.
Haiti Rewired is a community of empirically minded practitioners who are passionate about exploring the best approaches to rebuilding. Thus, it seems like a natural place to set a precedent for how the conversation about cholera response should be structured.
Let’s draw on the diverse range of expertise present in this forum. This isn’t just a question for the medical experts, because many of the barriers to service delivery revolve around issues as diverse as physical infrastructure/accessibility and donor coordination. How should we go about determining the most effective response? Should it be divided by sector (e.g. public actors vaccinate, private NGOs rehydrate)? Does the most needed intervention vary from location to location, or are the needs similar everywhere?
Let’s open this up to a concerted dialogue. Hopefully, in doing so, we can spark the broader dialogue that has been missing.