Epidemics are symptoms of poverty, a proxy indicator of lack of social development and weak health systems. Ebola in West Africa is a good example but not the only one.

In Haiti, which is the poorest country in the Western Hemisphere, the cholera outbreak that started in October 2010 has produced more than 707,000 suspected cases and over 8,600 deaths to date and will continue until health, water and sanitation systems are addressed.

Like Ebola, cholera feeds on weak public health systems and requires a sustained response.

Cholera is not a deliberate killer without a cure but an easy treatable disease that just requires antibiotics and rehydration salts to stem the diarrhoea and vomiting. However, the bacteria moves quickly, transmitted by contaminated food or water and in areas lacking minimum conditions of water, sanitation and hygiene, it bursts into deadly epidemics.

If anything, Ebola is a reminder that the job in Haiti is not done.

Both cholera and Ebola have had limited reach when confronting strong public health infrastructure. But Haiti presents the lowest coverage in water and sanitation in Latin America and the Caribbean; only a quarter of the population have access to basic latrines and one out of three lack access to safe drinking water. On top of this, Haiti lives in an emergency-prone context. Apart from the 2010 earthquake, Haiti has suffered through at least six major hurricanes and floods and dozens of storms. And every emergency is an opportunity for epidemics.

Longer-term solutions to increase access to water, sanitation and health services are much required in Haiti and the UN is supporting the government to make it possible. UN Secretary-General Bank Ki-moon and Prime Minister Laurent Lamothe launched a national sanitation campaign in July and, together with the World Bank, they announced in October a three-year plan as the next stage of the 10-Year National Plan for the Elimination of Cholera in Haiti.

With a clear road map of what needs to be done, the international community has now the opportunity to extend its solidarity with Haiti. To date, support for Haitian initiatives against cholera and other waterborne diseases has been disappointing.

At the current rate of disbursement, it would take more than 40 years to get the funds needed for Haitians to gain the same access as its regional neighbours.

Until these systems are in place, humanitarian response is essential and the reason why we have seen caseloads decline.

We are at a tipping point and the European Union – the world’s largest single donor of development aid – could be a leading actor: Haiti cannot wait two generations until reaching the same levels of coverage as the rest of the region. Two centuries ago, Europe struggled against cholera epidemics, leaving hundreds of thousands dead in Germany, England, France, Spain… until London and others extended its sewage systems connecting entire cities.

History will repeatedly show that you cannot get rid of cholera unless you address the water and sanitation systems.

History shows you do not get rid of cholera without addressing water and sanitation systems

But health, water and sanitation systems are a cost-effective measure whose benefits go far beyond the elimination of cholera and waterborne diseases. Improved public infrastructures also help in nutrition (50 per cent of childhood malnutrition is associated with repeated diarrhoea or intestinal diseases), poverty reduction (healthy people are more productive and do not lose working days due to illness) and even the economy (one dollar invested in water and sanitation in Latin America gives $7.2 in return, according to the World Bank).

Another key preventive measure, complementing the response and systems-building, can be oral cholera vaccines. Safe, affordable and effective, this intervention protects vaccinated individuals and reduces transmission and, consequently, the burden of disease in a community. The government of Haiti intends to vaccinate some 300,000 people next year. The cost is only $3 million. However, at this point in time, there is zero funding available. The donor community has to do better.

All in all, given adequate resources and sustained interventions, coupled with improvements in long-term water, sanitation and health infrastructure, it may be possible to eliminate cholera in Haiti over the next decade. However, if the response falters and resources are not forthcoming, hard-won gains may be compromised and cholera could persist in localised areas.

Pedro Medrano Rojas is the United Nations’ assistant-secretary-general and senior coordinator for the cholera response in Haiti.

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