When Haiti had its first cholera outbreak, this doctor made sure the locals were vaccinated

More than a decade later, Ralph Tiernier still remembers one of the most challenging times of his career as a doctor in Haiti, when cholera was discovered in the country just 10 months after an earthquake killed more than 200,000 people and displaced a million others.

“It was the whole country [its] knees after the earthquake,” Tiernier told Global Citizen. They never expected such an outbreak, especially since this island had never faced cholera. For the medical community, it was like a thunderstorm.”

Ternier, who at the time was the director of community care and support for the health care nonprofit Zanmi Lazant/Partners in Health, is now the organization’s chief medical officer.

Cholera, an acute diarrheal disease, is transmitted by ingesting food or water contaminated with the bacteria. Cholera is most often transmitted in areas that lack water and sanitation facilities, such as informal settlements.

In Haiti, the 2010 cholera outbreak saw 820,000 cases and nearly 10,000 deaths, according to the Centers for Disease Control and Prevention (CDC).

In this November 25, 2010 photo, people with symptoms of cholera receive treatment at a local hospital in the village of Limbe, near Cap-Haitien, Haiti. Photo: Emilio Morenatti / AP

At the time, some Haitians were misled about the spread of cholera, believing that Vodou priests were using their power to spread the disease. Amid a nationwide cholera outbreak, these traditional priests were executed by mobs, killing at least 45 people.

When Turner heard of such cases, he decided to travel to Cerca-la-Source, in the center of Haiti’s province, to help educate the population about the disease.

“I had to go deeper into their faith to make them understand that cholera doesn’t come from any spirit,” he said. “Seeing a local doctor they trust come to them and give them the right explanation in their dialect, can make them understand.”

Meanwhile, Turner said the medical community has spent months trying to plan how best to respond to the outbreak given the country’s already weak infrastructure, which has been devastated by the earthquake.

“By the time we knew how to fight the disease, it had already spread across the country,” he said. “By the end of 2011, cholera had spread throughout the country – all cities, all villages.”

As the outbreak begins to peak, Tiernier said those in the medical community like him are beginning to advocate for oral vaccines to combat the outbreak.

A boy holds a bucket containing water he collected from a stream in Thomazeau, about 10 kilometers northeast of Port-au-Prince in Haiti on December 13, 2012. Photo: Dieu Nalio Chery/AP

He said the decision on whether Haitians should be vaccinated was “controversial” and that “international authorities and the international medical community did not believe it was the best path to take.”

According to Ternier, “International and bilateral partners thought there was no point in considering vaccination because it might distract people from continuing with WASH. [water, sanitation, and hygiene] And they mostly thought it was a big investment that would make people focus less on the WASH component.”

“We had to struggle for a year to persuade the government to do a pilot in the worst affected area,” Tiernier added.

Through Zanmi Lasante/Partners In Health, Ternier helped launch a pilot project aimed at vaccinating 100,000 people in two regions of the country. Almost everyone was eligible to receive the vaccine, except for pregnant women and children under the age of 1, and 90% of the population in the targeted areas received two doses of the vaccine.

In the lead-up to vaccinations, Tiernier and other health experts hosted community meetings to educate people about the oral vaccine. According to Turner, the vaccine was widely accepted — and as a result, cholera transmission declined rapidly among the population in the trial, paving the way for a successful national vaccine campaign.

According to a study on the effectiveness of the oral vaccine in Haiti, there were about 65% fewer cases of cholera among vaccinated people than among those who were not vaccinated.

Partners in Health called it “The Vaccination That Never Happened.” According to the organization, 300,000 Haitians were given the oral vaccine, and the success of this campaign has led the WHO to stockpile the vaccine for use in future outbreaks.

For Turner, following the instinct to advocate for the oral vaccine was worthwhile, although it was a year-long effort to persuade international partners.

“We always have this sense of true solidarity with our communities because I am from Haiti – that is why I am in the right place,” he said. “We will always be grateful to our partners, but Haitians have to stand up and fix [system]. “

Ralph Tierney in a photo of a mobile malnutrition clinic in Haiti in 2018, Photo: Courtesy Ralph Tiernier

If the past two years have taught us anything about global health, it is the importance of vaccines. The World’s Best Shot is a profile series dedicated to sharing the stories of vaccine activists around the world.

Disclosure: This series was made possible with funding from the Bill & Melinda Gates Foundation. Each piece has been produced with complete editorial independence.

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