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Posted July 10, 2011

Haiti refused cholera vaccine, chief says

By Andrew Jack in London

Haiti refused an offer of tens of thousands of doses of cholera vaccine late last year that could have helped limit the spread of an epidemic that has since claimed more than 5,500 lives, the chief of the vaccine maker said.

Ronald Brus, chief executive of Crucell, the Dutch company that makes the leading cholera vaccine Dukoral, said he had proposed significant donations but was turned down by health officials.

The news will inflame an intensifying debate over the management of the epidemic, which diverted substantial resources from reconstruction and has caused more than 363,000 infections, triggering appeals for $175m to respond.

It comes after vaccine experts met last Thursday in Argentina to discuss vaccine policies across Latin America, against a backdrop of growing calls for the use of a cholera vaccine in Haiti and the creation of a stockpile to tackle future outbreaks.

It also follows a continuing debate over the origins of Haiti’s cholera epidemic and the responsibility of international institutions, with several recent reports arguing the infection was most likely brought into the country by UN peacekeepers.

Crucell’s donation was designed to “ring fence” infections in the remote Haitian region of Artibonite where the disease was first identified last October, in an effort to prevent its spread towards the more densely populated regions of the country.

Company executives said Haitian officials were under intense pressure to tackle multiple crises with scant resources following the earthquake in January last year which killed more than 230,000 people.

Peter Graaff, the current Haiti representative of the World Health Organisation, said he was unaware of the specific Crucell offer, but that a decision had been taken by the country’s health ministry at the time to reject proposals for cholera vaccination.

He questioned whether such “ring fencing” would have worked, given that it would have taken time to bring the vaccine in remote rural areas while cholera was spreading very quickly.

The vaccine requires two doses staggered a week apart, further complicating its use. At the time, Haitian officials were juggling alternative priorities including water and sanitation support, while distracted by upcoming elections.

His agency and a number of health charities oppose drug and vaccine donations, arguing that they are not sustainable and reduce the chance of low cost generic competition.

No Haitian officials responded to requests for comment, but Jon Weigel from Partners in Health, the US based non-governmental group active in Haiti, who followed the discussions, said the rejection was justified at the time by concerns over the social tensions that could be sparked by distributing limited quantities only to some Haitians.

Experts, including Paul Farmer, co-founder of Partners in Health, had been fighting at the time for the use of vaccines alongside treatments despite resistance from many public health “minimalists” who were opposed.

Studies in recent months have suggested even a single dose of the cholera vaccine would have provided important protection, and vaccinating just 5 per cent of Haitians could have reduced the number of cases by 11 per cent.

Peter Hotez, president of the Sabin Vaccine Institute in Washington, said that with hindsight the Crucell donation “could have made a difference”. But he stressed it was not possible to deliver medicines to treat the outbreak, fresh water and to simultaneously vaccinate.

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