On the world map, several homes are flashing red. Since January, 29 countries have reported cases of cholera, including Haiti, Malawi and Syria which are facing large outbreaks. The situation is quite exceptional: the World Health Organization (WHO) recalled that during the previous five years, less than 20 countries, on average, reported outbreaks. “The appearance of cholera is an indicator of inequity and poverty in the world”, explains to L’Express Anne Sénéquier, co-director of the Observatory of global health at Iris and author of Simply Geopolitics published by Eyrolles.
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A highly contagious disease, it is transmitted via water contaminated with human excreta. After a short incubation period of two to five days, cholera causes severe diarrhea and dehydration of the body. If not treated quickly, it can lead to death. The cholera epidemic is all the more difficult to manage as it breaks out in countries with often failing health infrastructures, like Haiti. Already plunged into a humanitarian and security crisis, the small country had 964 suspected cases as of October 19. The spread of the disease is explained by the blocking of the port by the gangs, who do not let the fuel out of it. And without fuel, there is no water.
Whether in Southeast Asia (India, Pakistan, Bangladesh) or in Africa (Nigeria, Kenya, Malawi), the least developed states remain more exposed to the risk of cholera in the event of natural disasters. “For example, in residential areas, the drinking water and waste water circuits must be in parallel and not mix. But all it takes is an earthquake, a flood or a storm. a high-intensity conflict so that they mix and access to drinking water is no longer possible If, in this context, there is no safe place for defecation, this is the ideal breeding ground to allow the pathology to spread”, specifies Anne Sénéquier.
This resurgence of contaminations in the world is favored by a multitude of factors: the war in Ukraine which causes food insecurity in the countries of the South, natural disasters linked to climate change or even conflicts which undermine access to food. water or its sanitation, essential to prevent and control the transmission of the disease. An example: the war is responsible for the resurgence of the epidemic in Syria, which has caused at least 60 deaths and more than 13,000 suspected cases since September 10. The appearance of this cholera epidemic is due to the presence of contaminated water sources near the Euphrates, as well as to a severe water shortage in the northeast of the country.
A border country, Lebanon is also contaminated by cholera, while it is already plagued by serious economic difficulties. Lebanese Health Minister Firas Abiad warned Wednesday, October 19, of an “accelerated” spread of the disease. In the land of cedars, five deaths have been recorded and 169 cases have been confirmed, mostly among Syrian refugees. “With population movements, it is illusory to think that we can maintain a transmissible pathology within certain borders. This was already not possible in previous centuries, it is even less true today “, analyzes the specialist.
A shortage of vaccines
In addition to the factors mentioned above, the political situation associated with the Covid-19 pandemic plays a role in this resurgence of cholera outbreaks. This is explained by Renaud Piarroux, professor at Sorbonne University and head of department at the Pitié-Salpêtrière hospital (Paris), specializing in parasitic and tropical diseases: “Other diseases are seeing their number of cases increase such as measles, malaria… For two and a half years, there has been a disorganization of healthcare services and an orientation of budgets towards the fight against Covid-19”. In other words, the attention paid to SARS-CoV-2 would have led to a decrease in the vigilance given to other diseases.
While the number of outbreaks of the disease is making an unprecedented jump, the shortage of cholera vaccines further complicates the situation. Current supply is extremely limited: of the total 36 million doses expected to be produced in 2022, 24 million have already been shipped for preventive (17%) and reactive (83%) campaigns, and an additional 8 million doses have been approved for the second cycle of emergency vaccination in four countries, underlines the WHO in its press release. “Once again, we are in reaction and not in anticipation, while the context of recent years could make us fear such a situation”, deplores Anne Sénéquier.
A lack of anticipation, of course, but also a “commercial choice”, points out Renaud Piarroux. The professor is referring here to the decision of an Indian serum manufacturer, a subsidiary of the French group Sanofi, to stop production by the end of the year. “It’s just a producer who stops production, because he should not find his account there. It would have been possible to make more vaccines”, he unrolls. On the Sanofi side, the spokesperson attributes the current shortage to the resurgence of cases “and not to a cessation of vaccine production by Sanofi, since we are currently continuing to deliver doses of the Shanchol vaccine”. In the meantime, vaccine manufacturers are “producing at their maximum current capacity”, warns the WHO. The organization says there is “no short-term solution to increase production”.
1.3 million cases of cholera per year
Vaccines are therefore distributed in dribs and drabs. And the health authorities find themselves forced to administer a single dose – instead of the two recommended. “Although the temporary discontinuation of the two-dose strategy results in reduced and shortened immunity, this decision will allow more people to be vaccinated and provide them with short-term protection, should the global cholera situation continue. to deteriorate,” insists the WHO. The latter judges that the single-dose strategy has shown its effectiveness in the past to fight epidemic outbreaks, although it is not known how long it protects.
In the meantime, the resurgence of cholera is an opportunity to shed light on this disease, which may spread further in the years to come. “There is a risk that cholera cases will increase in the future. We can clearly see that we are heading towards more inequalities and also more disinterest in the situation of poor countries”, estimates Renaud Piarroux, who notes a certain indifference to infectious diseases. However, cholera, responsible for 1.3 million cases per year, “is not a disease that can be eradicated with a tablet”, concludes Anne Sénéquier.