Turning the Tide on Cholera

 

Cholera is a dreadful illness caused by the bacterium Vibrio cholerae. Patient with severe cholera often die, and administration of rehydration therapy reduces the mortality of severe cholera dramatically.

Donald McNeil’s article in yesterday’s New York Times about efforts to fight cholera in Bangladesh was thought provoking. The photos and videos by Ismail Ferdous were powerful.

And yet, I feel compelled to respond, because the article felt incomplete.

First of all, access to aggressive volume repletion (treatment), and a cholera vaccine (prevention) and are certainly good ideas.

The cholera vaccines may be useful as part of cholera prevention programs, although that has not been definitively proven. And their 60-80% efficacy is worrisome.

McNeil ended the article,

With 1.4 billion people at risk, the potential cost of vaccination in cholera-endemic countries is enormous. And the disease tends to move, surging and vanishing among the many causes of diarrhea.

Even Bill Gates, who paid for much of the research, has asked, “We actually have cholera vaccine, but where should it be used?”

Looking back on his long struggle to prove the vaccine’s value, and then to win acceptance, Dr. (John) Clemens offered an explanation that blended wistfulness and cynicism. “We’re probably not bad scientists,” he said, “but we were lousy advocates.

“If this disease had been in American kids, there would have been trials as fast as the Sabin polio vaccine.”

In 1848, Rudolph Virchow published his Report on the Typhus Epidemic in Upper Silesia. This document was one of the classics of ‘social medicine,’ and Virchow did not recommend more doctors, hospitals, or medical technology. Instead, he focused on full employment, higher wages, the establishment of agricultural co-operatives, and universal education.

Bangladesh’s extreme poverty rate has dropped, and yet, it remains one of the world’s most densely populated countries with 150 million people.

What will happen when climate change and sea level rise leads millions of people to migrate from the Sundarabans mangrove forest in the Ganges River Delta to the capital city of Dhaka?

Will the government be able to maintain a clean water supply and appropriate sanitation in a refugee crisis?

Cholera is likely to surge again.

Scientists must learn to be better advocates. See the work of Prof Michael Eisen from Berkeley, also in yesterday’s New York Times.

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