On May 10, the Minister of Health, Frédéric Valletoux, announced that the cholera epidemic in Mayotte was “circumscribed”, “under control”. A month later, however, the toll has worsened. The cases recorded in the French overseas department have almost tripled, going from around sixty to 166 at the last official count, on June 11. Two people have died from the bacteria since this speech.
How to explain such disappointment? More than a century ago, the last epidemics of this kind were contained in a few weeks, recalls Professor Antoine Flahault, major specialist in the spread of diseases at the Institute of Global Health in Geneva (Switzerland). However, science was not as advanced as it is now. If victims accumulate in Mayotte, it is because of a lack of political will, denounces the scientist.
L’Express: Is the epidemic “under control”, in your opinion?
Professor Antoine Flahault: We speak of an epidemic “under control” at least when the number of new cases drops significantly and sustainably. This is not the case in Mayotte. And yet, if the French government really wanted to, it could completely curb this epidemic in just a few weeks.
We could have already put an end to the epidemic, really? However, as we have clearly seen with Covid-19, health crises are often uncertain…
Yes, but Covid is a whole different story. Despite vaccines, we don’t know how to get rid of them. No more than the flu anyway. There are diseases that resist us. But cholera is not one of them. Except in France, where the bacteria returns in a very localized manner, in Mayotte, rich countries have succeeded in eliminating it.
There has not been a single indigenous case reported in any developed country for decades. For the simple reason that we know how to eliminate this disease. The bacteria only circulates in countries that do not have drinking water available to all their inhabitants.
What do you think we should do to stop the spread?
Some neighborhoods in Mayotte are real slums. Their inhabitants do not benefit from drinking water or wastewater treatment. The population sends its excrement into the rivers and draws the same water to wash, drink and eat. If we want the epidemic to finally stop, we must offer the same standards of hygiene to the inhabitants of the department of Mayotte as in the rest of the national territory.
To do this, it would be enough to provide drinking water to all the inhabitants of the island of Mayotte, regardless of their residence status, legal or not. The French authorities know very well how to set up these connections. This is already the case elsewhere in France. And since the population of Mayotte is not that large, this objective is not out of reach, far from it.
Why, then, is this not done?
For lack of determination and will.
L’Express revealed that the State had not added a water connection before the explosion of cases in the first two centers of spread. How do you judge this decision?
Water connections should have been installed as soon as the risk of cholera spread was realized. And even much earlier, in fact. Wanting to be present in outermost regions certainly offers international rights, such as access to a vast maritime and fishing zone. But it also confers duties and obligations, notably those of respecting the human rights of all residents who stay there. The right to drinking water is a human right that seems elementary today to all metropolitan residents, whatever their origins and their social or economic conditions. The same should be true for Mayotte.
Who do you think is responsible for these failings?
Beyond the ARS [NDLR : l’Agence régionale de santé], which is mainly responsible for the health sector on the island, and in particular the hospital, the management of this epidemic is the responsibility of the prefecture, and therefore of the French state. From the moment an indigenous case of cholera was reported on the island, it would have been necessary, I repeat, to redouble efforts to carry out the water supply and sanitation works which were underway. all over the island. The French state seems not to have fully understood the consequences of its procrastination in this matter.
You often cite the example of the last epidemic in London, in 1854. Why?
In 1854, the bacterial origin of cholera was not known. All major European metropolises were plagued by epidemics of this disease. Dr. John Snow, physician to Queen Victoria in England, one of the first epidemiologists of contemporary times, then managed to get the British authorities to cut off access to the pump on Broad Street, in the neighborhood from Soho to London, in fact inviting residents of the neighborhood to no longer drink this contaminated water from the Thames.
“It is filtered, treated and drinkable water, accessible to all, which protects us from cholera.”
Parisians, for their part, drank unfiltered and untreated water from the Seine by drawing it from the Samaritaine at the same time. The Berliners that of the Sprée. In a few weeks, the epidemic was completely brought under control in London, thereby showing that the only intervention which consisted of no longer drinking water contaminated by human waste made it possible to very effectively control the epidemic. We have known all this since 1854! Since then, all developed countries have made massive investments in the purification of drinking water and the sanitation of wastewater.
We also have vaccines today… Shouldn’t we count on them, rather than on the water network?
There are several vaccines against cholera, in fact. The most used is administered orally. It greatly reduces the risk of becoming ill in the event of exposure. It also reduces the carriage of the bacteria and therefore contagion. But these effects fade over time. In Paris, in Berlin, in London, no one fears the return of cholera, and it is not thanks to access to the vaccine, which is rarely used in reality. This is filtered, treated and drinkable water, accessible to all. This is what protects us from cholera.
Until recently, the World Health Organization did not even vaccinate its staff when they traveled to investigate cholera outbreaks. This shows that the water sanitation strategy is important. The organization told its staff that there was no risk of contracting vibrio cholera, the bacterial agent responsible, if they correctly followed basic hygiene recommendations: washing their hands with uncontaminated water, using exclusive to drinking water, for drinking but also for food, in particular washing fruits and vegetables.
You say that France should consider cooperating with the Comoros, the closest neighboring country. In what ?
Kwassa-kwassa, these frail boats which connect the Comoros to Mayotte daily, often clandestinely, brought the cholera vibrio to Mayotte.
“If we gave drinking water to the Comoros and Mayotte, we would definitely no longer hear about indigenous cholera there.”
Beyond questions of borders, which rarely stop viruses and bacteria, France would have everything to gain from helping this country in the grip of a heavy cholera epidemic to equip itself with water supply and wastewater sanitation. It could also help the archipelago medically. Providing doses of vaccines for example. Sending health contingents is not exceptional. So why not ? When we understand that prevention is a profitable investment and not a cost, we will all benefit. In terms of health, but also in economic, social and political terms.
What is happening in Mayotte shows that treating foreigners and nationals differently on its territory can go against health security. Do you fear the multiplication of this type of situation with current xenophobia?
France is experiencing massive influxes of arrivals of people from abroad. And not just migrants, but also tourists and passengers from all origins and destinations. More than 100 million people visit the country every year. The vibrio regularly arrives at several metropolitan airports, and has done so every day for decades, without ever having caused local or otherwise very small chains of transmission. The question is therefore not to see foreigners visiting or settling in France as a threat to health security, but rather to understand that diseases are not only the business of doctors and caregivers but also and above all that of development and infrastructure conditioning hygiene and standard of living.
If we gave drinking water to the Comoros and Mayotte, we would definitely no longer hear about indigenous cholera there. It is the same thing for malaria and many other diseases of great poverty. Regardless of the mode of propagation, they often boil down to the underdevelopment in which we leave a portion of the planet’s inhabitants.
We need more political courage, and ambition at the international level. This is how we eradicated smallpox. This is also how we are chasing polio. But for cholera and malaria, there are not many consciences that are raised to say to the leaders of the G7 or the OECD: “Wake up, have a little audacity, finish the job, for the good of all humanity!” However, it is crucial.
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