4.10 Cholera: mechanism for control and prevention

Agenda annotation by Secretariat

The 127th Executive Board discussed the item and a draft resolution and agreed to defer further consideration to its 128th session. This report provides information on the magnitude of cholera as a public health problem, and the role that lack of access to safe water and sanitation play as underlying factors. Efficient control measures including oral cholera vaccines are described. The report calls for a coordinated multidisciplinary approach to prevention, preparedness and response, together with an efficient surveillance system. The Board is invited to consider the draft resolution.

• Document EB 128/13
• Document EB 128/13 Add.1

More resources:

• Racketeering in the WHO's Cholera Vaccination Programme: Evil forces channel public funds into private pockets (Article from News From Bangladesh, Thursday August 06 2009 21:08:13 PM BDT)

Watch Report of EB Discussion

Background and Context of EB consideration of this item

The 127th Executive Board (May 2010) had discussed this issue (item 127#5.2) informed by the report from the Secretariat (EB 127/4, http://apps.who.int/gb/ebwha/pdf_files/EB127/B127_4-en.pdf) and considered a draft resolution but agreed to defer further consideration to its 128th session (January 2011). Although Global Task Force on Cholera Control was launched in 1992 with priority objectives such as improved access to safe water, evidence based support to countries for preparedness and response, the report EB 127/4 (link above) asserts that by the period 2004-2008 there has been a 24% increase in the number of cases reported to WHO.

The later report by the secretariat (EB 128/13, http://apps.who.int/gb/ebwha/pdf_files/EB128/B128_13-en.pdf) provides information on the recent outbreaks in Haiti and Zimbabwe, and endemic occurrence of the disease in South-East Asia and Africa Regions showing the magnitude of cholera. The draft resolution (EB 128/13 Add.1, http://apps.who.int/gb/ebwha/pdf_files/EB128/B128_13Add1Rev1-en.pdf) recognizes the disease as a “neglected” public health problem, and indicates the role that poverty, lack of access to safe water and sanitation play as underlying factors. Efficient control measures including oral cholera vaccines are described. The resolution calls for a coordinated multidisciplinary approach to prevention, preparedness and response with appropriate use of oral cholera vaccines but not as a substitute for prevention together with an efficient surveillance system. Bangladesh made several amendments on the draft resolution some of which seem critical such as the ones on research and transfer of manufacturing technology, and use of oral cholera vaccines. They also replaced the “GAVI” in the draft resolution operating paragraph 2.6 with “relevant international funding agencies”.

According to an article from News from Bangladesh (http://www.bangladesh-web.com/view.php?hidDate=2009-08-10&hidType=OPT), WHO’s role in the research and development of oral cholera vaccines is controversial. It is claimed that WHO has squandered a big amount of money on research for a vaccine that is being used for tourists instead of suffering people.

The Board was invited to consider the draft resolution.

Report on the Executive Board session

All the member states endorsed the report prepared by the secretariat and the draft resolution put forward by Bangladesh. Determinants of cholera were mentioned by the countries and development of oral cholera vaccines were supported as a new phase in the struggle. However none of the countries commented on the controversial research and development process of oral cholera vaccines, they instead seemed enthusiastic about the development of “effective” vaccines.

USA expressed its commitment on eliminating waterborne diseases and suggested a cholera response plan including chlorination of water, expansion of education, efficient use of rehydration therapy, and new treatments. Barbados called for an updated Cholera Action Plan and demanded vaccines to be sufficiently available to countries. Russia introduced its mobile anti-epidemic teams that are developed to be used in case of disaster. Seychelles addressed the need for intensive research for vaccines. France declared that they had prepared a draft resolution on drinking water, sanitation and health to be discussed in a side event during the EB Meeting. (Listed for discussion in Committee A at the WHA in May 2011 as WHA64#13.15.)

Dr. Keiji Fukuda, Assistant Director General, welcomed all the comments and committed to update the Global Task Force on Cholera. After the agreement on the amendments the draft resolution was adopted (EB128.R7, http://apps.who.int/gb/ebwha/pdf_files/EB128/B128_R7-en.pdf).

Implications for advocacy

There is a need for clarification regarding the controversy over the vaccine. The assertion made by News from Bangladesh is that WHO policy regarding research, development, procurement and use of oral cholera vaccines is unduly influenced by commercial considerations.

While vaccines are to be welcomed as a new tool in the struggle against cholera they should not be allowed to detract from the real determinants of cholera and waterborne diseases generally.