Once again I’m grateful to H5N1 for bringing cholera news to my attention. This week, epidemiologists from France have presented evidence suggesting that the Haitian cholera outbreak began when the causative bacteria were brought in by Nepalese UN troops.
In an article in the July issue of Emerging Infectious Diseases, just out, Piarroux and colleagues assert that (quoting from their abstract) “Our findings strongly suggest that contamination of the Artibonite [River] and 1 of its tributaries downstream from a military camp triggered the epidemic.”
So the mystery is solved, more or less. The news media have taken note: articles on the EID report have already been written by the AP, Guardian, and other sources, and are being picked up fairly widely today.
The news, based on a report ordered by UN Secretary-General Ban Ki-moon, is being treated as an about-face on the UN’s part — because the organization, along with WHO and CDC, refused last fall to do an in-depth investigation of the origin of the outbreak. So, according to the media’s coverage, this week’s report exposes some hypocrisy on the part of the health organizations.
That’s silly, and wrong. I’m usually critical of WHO and CDC, but in the case of the Haitian outbreak they were completely correct to refuse to “investigate.” As I wrote last fall, cholera isn’t a detective story, it’s a disaster. To investigate the so-called origin of an outbreak that is as self-evidently the result of calamitous conditions, state poverty, and helpless officialdom is to shift the blame. Dodge the truth.
The work by Piarroux and colleagues in establishing a clear description of the origin and progress of the Haitian outbreak is impressive, often elegant, quite convincing. But to believe, as some do, that it somehow proves that the UN and WHO are responsible for a catastrophe, or that sending foreigners into Haiti is always bad, or even that (as the authors of the EID paper say)
Putting an end to the controversy over the cholera origin could ease prevention and treatment by decreasing the distrust associated with the widespread suspicions of a cover-up of a deliberate importation of cholera
is to misunderstand public health.
The problem in Haiti is, and has been, a problem of predisposition — nature out of balance, people on the move, dire straits of all kinds (food, medicine, clean water, toilets, housing, etc.) too tolerable to weak leaders. Colonization by one aid group after another (UN included). It was inevitable that cholera was going to break out.
To take the Piarroux report as definitive is to mistake the germ for the disease, mistake the outbreak for the problem, mistake the detective story for the real disaster — the real disaster being self-explanatory and not in need of “investigation”: not enough money and not enough political will to keep the public from getting sick.