Don't forget cholera

For the last few months, Ebola has grabbed the media's attention around the world. Understandably, a significant number of news stories have portrayed the epidemic in West Africa as one of the most serious emergencies of modern times.

But we must not forget that another outbreak continues across the Atlantic. Cholera remains a crisis in Haiti, some parts of Africa and Cameroon has had her share of this endermic. The recent attention to the Ebola outbreak should be a reminder that we cannot drop our guard. Unlike Ebola, cholera is not a deliberate killer and easily treated with access to services, but it moves quickly, transmitted by contaminated food or water, and in environments without minimal health, hygiene, water and sanitation systems, it causes fatal epidemics, like the one that Haiti faces today.

Where Ebola and cholera are linked, however, is that both feed on weak public health systems, and require a sustained response to combat. And, as Ebola has reminded us, in today's globalized world, neither epidemic respects borders.

Haiti maintains the highest caseload of cholera cases in the Western Hemisphere. By the end of September, over 707,000 suspected cholera cases and 8,600 cholera-related deaths had been recorded since the outbreak in October 2010. When rains began heavy and late in October, cases tripled from previous months. And the situation can turn worse. Long before the earthquake and cholera, Haiti has been highly vulnerable to natural disasters. Every emergency is an opportunity for epidemics.

We are working on longer-term solutions. The UN is supporting the Government's efforts to increase access to water, sanitation and health services, and the Secretary-General and Prime Minister launched a national sanitation campaign in July and with the World Bank announced a three-year plan in October. But it also recognizes that strengthening systems and capacity will take time. Rapid response, prevention and treatment activities need to continue while water and sanitation infrastructure is built and service delivery can be improved.

A 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 has committed to vaccinating 600,000 people against cholera by 2015. Fresh off a vaccination campaign in September, it needs to reach 313,000 more people in 2015. The cost is only $3 million. As of now, there is zero funding available.

Four years into the outbreak, we are seeing the cost of fleeting support. Due to lack of funding, some partners have left and many cholera treatment centers have closed. This has reduced access to treatment, is limiting timely reporting and is delaying response time. Lack of medical staff in treatment centers is also hampering response. We must be able to respond to each alert and provide treatment to cut the transmission and prevent more infection and further deaths.

Without this, we will see more cases and more cholera-related deaths.

Haiti's Prime Minister Laurent Lamothe has said that cholera remained an emergency requiring all possible strategies to eliminate. In the longer term, we must for once invest in its public health systems, in particular water and sanitation, and the UN is working to support the Government of Haiti. But this will take years, and the humanitarian response is needed to respond to and control outbreaks today.

Both cholera and Ebola have had limited reach when confronting strong public health infrastructure. Lacking these, Haiti and the Ebola-affected countries must respond to outbreaks while keeping site of the future.

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