Upcoming Bangladeshi mass cholera vaccine program might shed light on strategy effectiveness

Feb 17 2011

TIME reports on an oral cholera vaccination program to kick off on Thursday in Bangladesh that researchers hope will determine how good of a "weapon" the mass vaccination strategy can be "against an old disease" (Marshall, 2/15).

"The project will involve 240,000 people from Mirpur, one of Dhaka's [Bangladesh] poorest suburbs, two thirds of whom will receive two doses of [Shanchol,] the cheap Indian-made vaccine," Agence France-Presse/ChannelNewsAsia.com reports. "Both the control group and those who are given the liquid vaccine will be monitored over the next four years," according to the news service (2/16).

"We think of it as a demonstration project rather than a trial," Stephen Luby, Bangladesh country director for the CDC said, according to TIME. "We don't have a big question in our minds over whether this vaccine is going to prevent cholera. What we're trying to do is illustrate the feasibility of using it as a public health intervention."

The article notes how governments in countries that have faced devastating cholera outbreaks in recent years will be watching the outcome of the cholera vaccine project in Bangladesh. For instance, "[i]n Zimbabwe, where cholera claimed 5,000 lives in 2008 and 2009," authors of a study published in PLoS Neglected Tropical Diseases in January estimated "a swift vaccination program could have cut the death toll by 40" percent. Likewise, WHO and CDC experts recently recommended a small cholera vaccine be carried out in Haiti, where "cholera has killed about 3,800 people and sickened 189,000 since October," TIME reports.

The article elaborates on the conditions in Dhaka that contribute to cholera outbreaks and how they burden the region's health system. The piece also describes the development of Sanchol, which will be administered to patients through a collaboration between the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) in Dhaka, and the Bangladesh government. Previous trials have found the vaccine to be safe and effective, according to TIME, and the price - running $3 per two doses of the vaccine - is "about a tenth the price of its only rival, the Dutch-made drug Dukoral."

The piece notes mass vaccination programs are not without their critics. "Today's drugs do not offer long-term coverage or protect against every cholera strain. And even a cheap vaccine, in high quantities, is expensive and could divert resources from the only thing proven to eradicate cholera: improved water and sanitation infrastructure." However, Luby noted that improving Dhaka's water and sanitation structure "could take decades. The same is true for hundreds of cities in our rapidly urbanizing world, and indeed for disaster zones such as Haiti," TIME writes. "What we're trying to do is generate some evidence on what's feasible and cost-effective," Luby said, according to the magazine.

Mark Pietroni, medical director at ICDDR,B; Regina Rabinovich, director of Infectious Diseases at the Bill & Melinda Gates Foundation; and Anita Ashfaqunnesa, a health worker in Dhaka are also quoted in the article (2/15).