Following many large outbreaks of cholera in Haiti, sub-Saharan Africa, South Asia and elsewhere, experts are proposing the U.S. establish an emergency stockpile of vaccine.
The speedy delivery of vaccine would have immediate humanitarian benefits. But it would also prevent the disease from slowing recovery following natural and man-made disasters.
Professor Peter Hotez of George Washington University, Professor Matthew Waldor of Harvard medical School and Dr. John Clemens of the International Vaccine Institute have published their proposal in the New England Journal of Medicine.
“What we’ve been concerned about is the fact that now there’s been multiple outbreaks of cholera over the last several years,” says Hotez, “So, we’ve been really trying to be thoughtful about are we fully using our armamentarium of interventions against cholera, which of course is such a highly lethal disease.”
Need a better option
The latest outbreak is reported on the island of Hispaniola, which includes the countries of Haiti and the Dominican Republic.
“We came to the conclusion that this is an opportunity to really think about ways to use the vaccine in what we would call reactive situations,’ he says.
Hotez explains, “Traditionally, vaccines are used to prevent outbreaks of diseases, but once the outbreak has occurred, the cholera vaccine has not been widely used. And we think there’s an opportunity to do that. The problem of course is we don’t have the vaccine available.”
There are three cholera vaccine makers. Two of them are major manufacturers: Crucell of Sweden and Shanta of India.
“The problem is they only have about a hundred thousand or so doses on hand in each place. And if you are going to entertain the possibility of a widespread use of a vaccine in Hispaniola, you would want millions of doses. So, right now, even if we wanted to embark on an ambitious vaccination campaign in Hispaniola, you don’t have that as an option,” says Hotez.
“So what we’re proposing is at least to have the option of having the vaccine available in horrific situations, like we’re seeing now in Haiti and the Dominican Republic. To give us the option of having large doses of vaccine available,” he says.
Hotez says millions of doses would be needed for the proposed stockpile, but he does not have an exact figure at this time. He says vaccine manufacturers could scale up to produce millions of doses, but that could take months.
“If you have wait months and months every time an outbreak occurs, then you’re way behind the game,” he says.
The three tropical disease experts propose the United States take the lead.
“The United States does stockpile potential interventions for bio-terrorist threats. So, for instance, they stockpile medicines for anthrax and in some cases smallpox vaccine. They also have the ability to add cholera to that,” Hotez says.
The G.W. University professor says a cholera vaccine stockpile would be both a humanitarian and diplomatic resource.
“Particularly,” he says, “with Secretary Clinton now coming out and talking about a new role for the State department.” That role would link the department’s diplomatic activities with its development work through USAID.
“We’re going to see more and more use of what she terms civilian power,” he says.
Of the latest cholera outbreak on Hispaniola, Hotez says, “This cholera outbreak is actually part of a larger pandemic that’s been going on for several decades.”
Besides oral vaccines, treatment of cholera includes replacing lost fluid with oral or intravenous rehydration solution, as well as antibiotics.