Home | Comment & Analysis    Sunday 1 April 2018

WHO silence prevents deployment of oral cholera vaccines in Sudan

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By Eric Reeves

Cholera was first reported in Sudan in August 2016, during an outbreak in Blue Nile State. The deadly disease spread to nearly all Sudan’s eighteen states and continues to be reported in Darfur, where the number of cases has risen and fallen for months. As recently as March 15, 2018, Radio Dabanga reported:

After a few days of showing a downward trend, 12 new cases of “acute watery diarrhoea,” suspected to be cholera, have been reported in Central Darfur. (“12 new cases of suspected cholera reach Central Darfur centres,” Radio Dabanga, March 15, 2018, | NIERTETI )

The cholera bacterium (Vibrio cholerae) almost certainly remains in significant reservoirs in Sudan, and the upcoming rainy season poses extraordinary dangers of an explosive resurgence.

That the disease is cholera is beyond dispute, as Radio Dabanga has repeated reported (most recently March 21, 2018):

In spite of numerous independent confirmations (conducted according to World Health Organisation (WHO) standards) that the disease which broke out in Blue Nile State in August 2016 was cholera, the Sudanese authorities and several international organisations still call it “acute watery diarrhoea.”

That the UN’s World Health Organization is one such “international organization,” that the WHO refuses to name the disease for what it is—out of deference to the sensibilities of the brutal Khartoum regime—is disgraceful. Such silence not only sets a terrible precedent in yielding to a country’s desire to avoid the “stigma” associated with cholera but prevents the deployment of medical resources that could be used to control the ongoing cholera outbreak in Sudan.

The failure of WHO to name the disease has clear and deadly consequences; this is made clear in the conclusion of a recent article from the distinguished New England Journal of Medicine (February 8, 2018):

“Single-Dose Cholera Vaccine in Response to an Outbreak in Zambia,” New England Journal of Medicine, February 8, 2018 [378:6 | www.nejm.org/]

Our results show the short-term effectiveness of a single dose of Oral Cholera Vaccine (OCV) during an outbreak. Previous studies measuring the protection provided by a single dose of OCV were conducted in areas with recent exposure to cholera, which raises the possibility that single-dose regimens might act to boost natural immunity [footnotes 2, 3, 5]. Our results indicate that single-dose regimens provide protection in populations with less exposure to cholera, such as those in Lusaka [Zambia] and much of sub-Saharan Africa, where multiyear lull periods are punctuated by explosive outbreaks.

Authors:

Eva Ferrera, M.Pharm., M.Sc. (Epicentre | Paris, France

Elizabeth Chizema-Kawesha, M.D., PhD (Ministry of Health | Lusaka, Zambia)

Marc Poncin, Ph.D. (Médecins sans Frontières | Geneva, Switzerland)

Francisco J. Luquero, M.D., Ph.D. (Epicentre | Paris, France)

and Others

This is clear evidence that the populations at risk in Darfur and elsewhere in Sudan could be protected from what all evidence indicates is cholera. Yet continued silence by WHO—and thus continued refusal to begin an OCV campaign in areas where there have been many very recent reports of cholera—simply adds to a disgraceful performance to date.

Moreover, a WHO mission to Central Darfur in mid-February was confirmed to me by several high-level officials in the UN and U.S. government; and yet even now WHO refuses either to confirm or disconfirm the presence of Vibrio cholera in Sudan (see the Washington Post, “As the death toll climbs in Sudan, officials shy away from the ‘cholera’ label,” September 14, 2018).

The Khartoum regime is destroying—by way of uncontrolled inflation—the ability of ordinary Sudanese to purchase inordinately expensive (because imported) medicines. It is especially disgraceful that Khartoum’s fear of being stigmatized by the presence of cholera in Sudan is paralyzing a feckless leadership at the UN’s World Health Organization and preventing the deployment of critically necessary medical resources, including Oral Cholera Vaccines.

This UN treatment of the people of Darfur and Sudan is an outrage.



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