PHM-Exch> Fwd: Cholera - neglected disease of poverty - under review at WHO Executive Board

[Claudio Schuftan]

From: Editor <editor at phmovement.org>


PHM: cholera incidence 'an indicator of the crisis of neoliberal
globalisation'

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Cholera: neglected disease of poverty PHM: cholera incidence an indicator
of the crisis of neoliberal globalisation

In May 2018, following the publication of the Global Task Force Roadmap
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=76ba295625&e=916df65fd1>,
WHA71 adopted WHA71.4
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=26ff7d581f&e=916df65fd1>
on Cholera prevention and control.

WHO's Executive Board, meeting from 3 Feb in Geneva will review a report (
EB146/20
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=fcdc6567ef&e=916df65fd1>)
on
the global cholera situation and progress in recent efforts made in cholera
prevention and control. A more detailed update is provided in WER 94(48),
961
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=c0615e45c8&e=916df65fd1>.
See PHM comment
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=4495e7e355&e=916df65fd1>
for more links and comment.

WHA71.4
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=41f2b6ab51&e=916df65fd1>
affirms that “the prevention and control of cholera require a coordinated
and multisectoral approach that includes access to appropriate health care,
early case management, access to safe water, sanitation, education, health
literacy and improved hygiene behaviours, with adjunct use of oral cholera
vaccines, strengthened surveillance and information sharing, strengthened
laboratory capacity and community involvement, including action on the
social determinants of health”.

In its more detailed cholera report in WER 94(48), 961
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=e3907332e3&e=916df65fd1>
WHO notes that “The epidemiological accounting is, however, skewed by the
lack of full reporting from other high-burden countries in Asia. Bangladesh
acknowledged cholera as a major public health threat by reporting cases to
WHO in 2018 for the first time since 1997, although these were only
confirmed cases from sentinel sites. India has continued its practice of
reporting cases, primarily from West Bengal, but, again, only confirmed
cases in a limited geographical area. In these 2 countries, however, with a
total population of nearly 1.5 billion and heavily endemic for cholera, the
true number of cases is understood to be substantially far higher.” India
reported 697 cases in 2018 and no deaths. It seems likely that weak
surveillance and reporting may well be associated with lower public health
priority, delays in diagnosis and higher case fatality rates.

The Secretariat report on cholera in 2011 (A64/18
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=c43d40a7c2&e=916df65fd1>)
commented that “Under-reporting may also occur because of concerns over
possible sanctions on travel and trade. Sanctions have been shown not to
contribute to the efficient control of cholera.”
Vaccination

It appears that mass vaccination at an early stage of outbreaks has
contributed to the decline in cases and deaths observed in 2018 (not
including Yemen).

EB146/20 comments that, “Oral cholera vaccine is just one tool in a large
toolbox that includes sustainable water, sanitation and hygiene solutions,
but it serves as a critical bridge to such longer-term efforts.”
Water, sanitation and hygiene (WASH) infrastructure

EB146/20 does not report much progress in WASH infrastructure.  WHO’s SDGs
report for 2018
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=1a0b79f7dc&e=916df65fd1>
advises that:

*Unsafe drinking water, unsafe sanitation and lack of hygiene also remain
important causes of death, with an estimated 870 000 associated deaths
occurring in 2016. The WHO African Region suffered a disproportionate
burden from such deaths, with a mortality rate four times the global rate.
Available data from fewer than 100 countries indicate that safely managed
drinking-water services - that is, located on premises, available when
needed and free from contamination - were enjoyed by only 71% of the global
population (5.2 billion people) in 2015, whereas safely managed sanitation
services - with excreta safely disposed of in situ or treated off site -
were available to only 39% of the global population (2.9 billion people).*

One of the greatest challenges in most of the cholera burdened countries in
sub-Saharan Africa is the management of waste. The high rural urban
migration results in most large unplanned settlements without safe drinking
water or provision for the disposal of faecal waste.
Economic denialism

EB146/20
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=6400c121c4&e=916df65fd1>
remarks that cholera “remains a global threat to public health and an
indicator of inequity and lack of social development”.

What is not mentioned is that economic inequality is increasing globally.
Population displacement (through the impoverishment of small farmers,
unemployment in cities and towns, xenophobia and global warming) is
contributing to the growth of informal settlements without decent WASH
infrastructure. Fiscal austerity (impacting on public infrastructure
investment) is being imposed (or self-imposed) on more and more countries.

New technologies, such as improved diagnostics and new vaccines, can make a
marginal difference but in the context of a global economic regime which
drives inequality, austerity and displacement (neoliberal transnational
capitalism) it is unlikely that cholera will be eliminated any time soon.

PHM calls upon member state representatives to acknowledge the continuing
disease burden of cholera as an indicator of the crisis of neoliberal
globalisation. The roadmap for cholera control must contextualise the
challenge of cholera in relation to this crisis.

If UNDP (see HDR 2019
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=a607378655&e=916df65fd1>)
is able to name elite power as a barrier to equity so should WHO!
More

For further links and more detailed comment on the Cervical Cancer item on
the WHO Executive Board agenda see the PHM comment
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=a0748ed8b6&e=916df65fd1>
on this item.

The full agenda for the EB can be accessed through the WHO Tracker at
who-track.phmovement.org/eb146
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=1abcf64046&e=916df65fd1>,
including PHM comments on most items.

To provide feedback on this commentary please write to editor at phmovement.org
.
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in association with Medicus Mundi International
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=52567e81a7&e=916df65fd1>,
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Update Reports from previous WHO governing body meetings and earlier Item
Alerts regarding EB146 here
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=f2029b490e&e=916df65fd1>
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