Putting water and sanitation back at the heart of strategies for cholera elimination and control of other diarrheal diseases
While the world keeps its eyes on the Covid-19 pandemic, old public health scourges are still silently ravaging thousands of people, mainly in developing countries. This is the case of cholera and other diarrheal diseases in Africa.
Several actors involved in the fight against these diseases are calling for a multisectoral strategy led by African leaders and based on access to water and sanitation to sustainably eliminate cholera and better control all waterborne diseases.
Africa has experienced successive waves of cholera over the past five decades without achieving elimination.
While cholera has been eliminated in many parts of the world as a result of major sanitation projects and improved access to safe drinking water, this infectious disease transmitted by ingestion of water or food contaminated with Vibrio Cholerae remains one of the most important public health scourges in Africa, despite national and international efforts to respond to successive outbreaks.
The first outbreak of cholera in Africa coincided with the oil, socio-economic and climate crises of the 1970s, socio-economic and climatic crises of the 1970s. These were also the years of serious politico-military crises, such as the Biafra crisis. By the end of 1971, 25 African countries had reported a total of 72,415 cases and 11,389 deaths to the World Health Organization (WHO).
Each year, cholera affects 1.3 to 4 million people worldwide, causing between 21,000 and 143,000 reported deaths in nearly 70 countries, most of which are in sub-Saharan Africa. These seemingly high numbers are, however, vastly underestimated. According to the WHO, officially reported cases of cholera represent only 5 to 10% of actual cases.
Over the last 30 years, favored by the consequences of climate change, accelerated urbanization, population explosion, socio-political unrest and the consequences of successive socio-economic crises, cholera has become a re-emerging disease in Africa.
In addition to countries heavily affected by cholera such as the Democratic Republic of Congo (DRC), Nigeria, Ethiopia, Somalia, Mozambique according to the latest WHO reports, other countries are also facing a worrying situation. These are Kenya, Cameroon, Burundi, Zambia, Uganda, Sudan, Chad, Zimbabwe, Benin, Ghana, Togo, Malawi and Niger.
However, cholera is not a fatality. Cholera must, in Africa as in other parts of the world, become a disease of the past.
Cholera is not a reflection of poverty. If it is a corollary of socio-economic crises, it is also the consequence of impeded access to essential services. Its persistence in resource-limited countries is the result of inadequate response strategies that have pushed water and sanitation into the background.
Only a multisectoral strategy, driven by strengthened local leadership, can eliminate cholera sustainably. Cholera is not just a medical issue: it is through the concerted mobilization of public authorities, donors and field actors that a sustainable response can be provided. Contrary to an exclusively medical approach, better access to drinking water and sanitation allows us to fight not only against cholera but also against all waterborne diseases.
This is the approach advocated and implemented in the Democratic Republic of Congo since 2007,
Based on epidemiological research on the factors that contribute to the persistence of cholera in the Great Lakes region, the DRC has adopted a Multisectoral Strategic Plan for the Elimination of Cholera (PMSEC), involving the public authorities in several sectors (Ministries of Planning, Hydraulics, and Health), the national water distribution company, academics, foundations, NGOs, multilateral cooperation agencies, companies, and professional experts. The approach emphasizes the need for national leadership and enshrines the partnership approach. Consistent with the World Health Organization’s proposed roadmap for the elimination of cholera by 2030, this strategy includes a component on the rehabilitation and implementation of drinking water infrastructure, which is essential for the sustainable elimination of waterborne diseases.
Hence the consideration of the opportunity to generalize the elimination approach in other countries and the establishment of an international coalition for its implementation.
An international coalition under the aegis of the African Union would be the most appropriate to bring to the continent the multisectoral approach to cholera elimination as experienced in the DRC.
To definitively eliminate cholera in Africa and achieve better control of other diarrheal diseases, we call, on the occasion of the 9th World Water Forum in Dakar, for a paradigm shift.
Indeed, we collectively have the scientific evidence and technical resources to go beyond
necessary to go beyond the mere control of cholera epidemics.
We refuse to conceive of this disease as an inevitability for certain African countries that
be condemned to respond indefinitely to cholera epidemics. On the contrary, we believe that cholera can be eliminated in Africa through access to water and hygiene, as it has been elsewhere in the world.
We call on all actors involved in the fight against infectious diseases, access to water and health, and the reduction of inequalities to share this ambition.
We call on all countries involved in the fight against cholera and waterborne diseases, as well as technical and financial partners to take part in this initiative.
We call on the African Union and its health arm, CDC-Africa, whose leadership has been highlighted in the fight against the coronavirus, to take on the governance of this coalition. The African Union has, on this occasion, successfully given itself the means to mobilize technical and financial partners and to accompany the countries. It is this capacity to mobilize partners and support countries that is hoped for in other public health causes such as the elimination of cholera and the control of diarrheal diseases.
Finally, we draw the attention of the international community to the need to adopt a greater ambition than that of limiting cholera epidemics. If we are to sustainably eliminate this disease and truly control waterborne diseases, significant investments in a long-term strategy are required. We call on the mobilization of international donors.
Promoters of the Appeal
Ibrahim Assane Mayaki, former Prime Minister of Niger, President of the Global Alliance for Cholera Control (GAAC), Executive Secretary of NEPAD, Niger
Pierre Lokadi Otete Opetha, Secretary General for Public Health, Ministry of Health, Democratic Republic of Congo
Amadou Bocoum, Ambassador, Senegal
Jean-Marie Kayembe Ntumba, Rector of the University of Kinshasa, Democratic Republic of Congo
Rita Colwell, Professor Emeritus, University of Maryland College Park, Johns Hopkins Bloomberg School of Public Health, USA
Jean-Jacques Muyembe, Director of the National Institute of Biomedical Research, Ministry of Health, Democratic Republic of Congo
Didier Bompangue Nkoko, Head of the Department of Ecology and Infectious Disease Control, Faculty of Medicine, University of Kinshasa, Democratic Republic of Congo
Thierry Vandevelde, General Delegate of the Veolia Foundation, France
Amadou Sall, Director of the Pasteur Institute of Dakar, Senegal (tbc.)
Macky Sall, President of the Republic of Senegal, Chairman of the Assembly of Heads of State and Government of the African Union
Paul Kagame, President of the Republic of Rwanda
Félix Tshisekedi, President of the Democratic Republic of Congo
Amadou Diallo, Ambassador, Senegal
Alain Boinet, Founding President of Solidarités International, France
Dominique Franco, Special Advisor for Education, Institut Pasteur, France
Dennis B. Warner, WASH and Environmental Health Advisor, Millennium Water Alliance, Washington, DC, USA
Sy Rotter, President, Washington Liaison Office, USA
John Oldfield, President and CEO, Accelerate Global, USA
Pierre-Marie Grondin, Director, Programme Solidarité Eau, France
Antarpreet S. Jutla, Associate Professor, University of Florida (tbc.)
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