Cholera vaccination an additional tool, not a cure all

THE start of the cholera vaccination programme yesterday, which presumably will be carried out with the normal efficiency by the Ministry of Health and Child Care, is not going to be a cure all for the outbreak and we will continue to rely on the standard defence of high-end hygiene, proper water supplies, proper sewage disposal and garbage removal.

After careful consultation with the World Health Organisation and Unicef, the decision has been made to spread the 2,3 million doses of vaccine allocated to Zimbabwe as thinly as possible, using single does rather than the double doses usually recommended. This will give 85 percent protection to the vaccinated, for six months.

So the vaccination programme is not the same sort of programme that we use to gain universal immunity against say measles or polio.

Basically, by concentrating the available vaccines in the main hotspots, largely the southern part of Harare Metropolitan and several districts in Manicaland and eastern Masvingo province, the Health Ministry is obviously creating what can be thought of as “firebreaks”, swamping the epicentres of the outbreak so that the disease is dried up within them and they no longer send out infected people into other districts.

Although almost all districts have no recorded cholera cases, in many we are talking about single figures, basically someone who has travelled to a hit spot and returned infected.

So long as they are sensible and seek medical attention promptly, that new source of infection can quickly be shut down and probably not extend beyond immediate family at worst.

But in the hot spot districts, and this includes a large slice of Harare Metropolitan, infection rates have proved to be remarkably sticky, despite the basic hygiene measures introduced which includes boreholes for better water supplies, that huge garbage removal blitz in Harare, and working on prompt repairs to sewers.

While numbers in, say, Harare, have never exploded into the epidemic levels seen in 2008 and 2018 that continual few dozen new cases each day is worrisome, and could explode, but for the sterling efforts of the health services.

It appears that in parts of southern Harare Metropolitan and in around half a dozen districts of Manicaland and the border districts in Masvingo province, there are pockets of infection that have so far been shown to be very resistant to being wiped out.

People are probably being infected by body contact, rather than just eating some dubious unwashed food. It is in those circumstances that the limited vaccination campaign will show the best results, and even with only 85 percent effectiveness will probably be good enough to dry up these concentrated hot spots of infection.

Once they have gone the isolated cases we have been seeing in most other districts will also probably disappear, and the betting is that these are the result of someone from the district visiting a hot spot and coming back with the infection.

But this will not protect the bulk of the population of Zimbabwe, since it simply removes the immediate source of infection.

There will still be infections coming over the borders, since cholera is persistent on large stretches of Africa, and there could even be sources of infection festering within Zimbabwe, despite the major effort to remove the garbage and other incubators.

This means we need to redouble our efforts for a cleaner and more hygienic environment so that we can push cholera and similar diseases into the history books rather than have them living in our midst.

Here the massive borehole drilling programmes are making headway. The village programme sets a target of having a borehole in every one of the 35 000 villages.

Added to this are the programmes to have a borehole at every school, and one at every clinic. As an emergency measure some urban areas, and Harare is one of them, have had their own boreholes, although an urban borehole can service a lot more people crowded together than a village borehole.

This continual drilling is a major, but achievable, goal.

Already more than 3 000 boreholes have been drilled in the early months of the programmes, and the rigs are out there drilling. There have been the odd dry boreholes, but that can be expected and the main setback is in time.

A dry borehole does not get fitted with lining pipes, pumps, storage tanks or solar panels. The costs is mainly time, plus a bit of fuel and a bit of wear on the drill bits.

So we can assume that the water teams will every month add more batches of boreholes and advance the frontier of a more convenient, safer and more hygienic country.

We clearly need to press harder on the garbage side. It is all very well for the Government to step in and shift the huge mounds that had built up in Harare, and the problem appeared to be a lot worse that originally estimated from the need to keep the extra fleet of trucks and earth moving equipment hard at it for longer.

But we also need to stop people creating the mounds in the first place and to take far greater responsibility for their own garbage. We clearly need to accelerate the provision of vegetable markets and other food sales in the informal sector.

Harare City Council knows exactly what is needed, but seems to be reluctant to create even the temporary market stalls surrounding functional taps and public toilets so that the informal sector can be made a lot more hygienic.

But these are battles we have to fight every day to both push back cholera, where we will be helped by the hotspot vaccination programme, and then to keep it away.

And both goals are important and both require roughly the same sort of effort, initiative and action. We can create safer cities, villages, and business centres, but we need to create these ourselves, rather than wait for some rescuer to move in.