The cholera eradication conversation inevitably turns back to the need for potable water and better sanitation. "Without improving access to clean water and proper sanitation, cholera will undoubtedly keep coming back," Olson said.
And that infrastructure is expensive to build. But as Mirta Roses, director of PAHO, said in a press briefing Wednesday, not improving water and sanitation will be even more costly. "It might take years, but the journey begins today," she said.
At the end of the day, however, the path forward will be for the Hatian government to select and see through. Haiti's President Michel Martelly addressed the PAHO briefing, noting, "the time has come to address these deficiencies," adding that "only a joint, comprehensive and strategic approach can lead us to eliminate cholera."
Martelly, PAHO and others have taken as a model for cholera's eradication the lessons learned from the reemergence of the pathogen in Latin America in the 1990s, which took a decade to vanquish.
But for many Haitians at risk for contracting cholera, 2022 could come too late. Farmer and his colleagues at PIH are hoping that widespread use of the vaccine could bolster other longer-term investments to combat cholera. "We do hope that will be a model for Haiti, and the Ministry of Health has been extremely excited about it," Weigel says of the PIH demonstration.
And like water improvement, the vaccine shakes out to look like a good investment—and one that could draw quicker dividends. The $40 million needed to pay for vaccine doses for the entire country—if they were to be available—seems like just a drop in the bucket of the billions of dollars promised following the disaster two years ago. But, as Vicari points out, "what is pledged is not necessarily what is available." So far, "just 30 to 40 percent was received."
Nevertheless, investing in cholera prevention by procuring more vaccines could also cut down on costs in the future, Weigel notes. In the 14 months since the first cholera cases appeared, the disease has cost some $176 million—many times more expensive than the cost of vaccination, he notes. "This is low-hanging fruit—this is not some complex intervention."