When a cholera outbreak occurred during a health conference in Nairobi earlier this year, it made headlines around the world. For many, the idea of cholera spreading at a high-profile event was surprising. But for my colleagues in the global health community working to contain this disease that can claim lives in just hours, another preventable outbreak in a year marred by devastating outbreaks in Somalia and Yemen was a sobering blow.
Ahead of an upcoming high-level panel on cholera due to be held in Geneva in October, the Kenyan outbreak has taught us many lessons on how we fight this disease.
Most commonly caused by contaminated water, cholera causes acute diarrhoea and often – as a result – severe dehydration and death. As the world marks World Water Week, it is a sad reminder that waterborne diseases like cholera continue to affect Africa, with a particular impact on East Africa. In 2015, more than four out of every 10 reported cases of the disease took place on the continent, totalling at least 70,000 cases and 937 deaths.
Cholera outbreaks in East Africa this year in Somalia and Kenya serve as a sombre reminder of how much further we have to go on the road travelled since the world's first cholera pandemic in 1817.
In the past 200 years, we have increased the number of weapons in our arsenal to defeat cholera. We understand the importance of hand-washing and we have developed ways to clean water more efficiently and effectively, better processes to treat human waste, and an easy-to-deliver oral cholera vaccine. But too often, we're not using these tools together to fight cholera. To truly defeat outbreaks, we need a comprehensive and integrated response.
Just this week, the World Health Organization released a new position paper on cholera outlining the need for an integrated response to curb preventable outbreaks seen in Somalia and Kenya. While clean water and sanitation are crucial, we also need to invest and deliver vaccines in areas prone to outbreaks, such as Internally Displaced People's camps and endemic regions. The most effective way to tackle the disease is to integrate all the tools available to us: clean water, sanitation and immunization.
This three-pronged approach has influenced Kenya's reaction to its most recent outbreak but must go further in order to truly protect communities living in endemic areas.
In response to over 300 cases of cholera reported in Nairobi County alone and 14 deaths, the Government established a Cholera Task Force. I was impressed with the actions taken by the Cholera Task Force, in identifying cholera hotspots around the country.
Yet again, we were reminded of the importance of reliable and accurate surveillance data for integrated health efforts. Surveillance data and outbreak maps that drill down to the district level can help end predictable cholera outbreaks in Kenya by identifying where best to direct tools and resources.
Clean water is one of the best tools we have in preventing cholera. Following the recent outbreak, the task force stocked hospitals with water-treatment chemicals that could be distributed to residents. The task force also distributed potable water to known hotspots to further combat the spread of the disease.
The measures taken by the taskforce to tackle water and sanitation are welcome but it is important that an equal emphasis is placed on immunization for people living in outbreak zones. The two-dose oral cholera vaccine protects children and adults from cholera for up to five years. In line with the new WHO position paper, even a single dose can be used for short-term immunity during epidemics. The vaccine has also recently even been deemed safe for pregnant women. While the medical community like the Public Health Society of Kenya have encouraged immunization against the disease, this should be accompanied by campaigns targeted at cholera hotspots.
Disease of the poor?
Cholera is a disease often associated with poverty and that is absolutely true. Added to that are regions like East Africa which are more susceptible to outbreaks due to factors beyond human control like seasonal flooding. Cholera outbreaks – and the causes behind them – are nothing to be ashamed of.
Many outbreaks are more predictable in certain areas of Kenya, Tanzania and Somalia but they are certainly not inevitable. With better sanitation, clean water and access to immunization, there is no reason for a 19th Century pandemic to become a 21st Century way of life for Kenyans.
By drawing on the tools we've honed over the last 200 years in a sustained and integrated way, we will finally be able to wash our hands of cholera for good.
Ms Zaidi is the director, Enteric and Diarrheal Diseases (EDD) programme at the Bill and Melinda Gates Foundation.