The government of Yemen has suspended a request for cholera vaccine to fight the deadly outbreak that since 27 April has infected a reported 320,199 Yemenis and killed 1742. One million doses of the vaccine had been allocated from a global stockpile and immunizations had been set to begin this month; now, the first half-million doses that were en route to the country will be rerouted to other at-risk countries.
“Plans for a cholera vaccination campaign planned in Yemen have been suspended based on a decision of the government,” Tarik Jašarević, a World Health Organization (WHO) spokesperson in Geneva, Switzerland, wrote to ScienceInsider in an emailed statement, adding that the decision was made in consultation with Yemeni government partners, including WHO, which advises the Ministry of Health. The news was first disclosed during a press briefing by a United Nations aid committee in Geneva on 11 July.
Jašarević noted that “in an outbreak setting, the impact of [oral cholera vaccine] is greatest when used to protect communities that are not yet affected. … There are few such areas in Yemen now.” Since the epidemic began last October, there have been cholera cases in 21 of 23 of Yemen’s governorates.
The move to drop the campaign reverses a difficult decision taken last month by the International Coordinating Group on Vaccine Provision, which agreed to ship out about half of its total supply of cholera vaccine to the war-torn country. The Yemeni government had requested 3.5 million doses from the group. Yemen has roughly 27 million people, half of whom are younger than 20. But the Yemeni government, with the help of a Saudi-led coalition, is battling Shiite Houthi rebels backed by Iran and there were concerns over whether the vaccine could be used effectively as battles raged in parts of the country, and whether administering it might distract health workers from treating patients, a cornerstone of epidemic response.
Even advocates of the vaccination plan concede that the government had few good options. “Vaccination was a good idea. But I also recognize that they are only able to secure a very small supply of vaccine and there are many competing priorities,” says Andrew Azman, an epidemiologist at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, who in the last month has been part of a team advising WHO on how to allocate the cholera vaccine in Yemen.
But some Yemeni physicians bemoaned the suspension of the campaign. They note that about 26 million Yemenis have not yet been infected. “It is important to protect these others—especially those in governorates not yet involved in this disaster,” says Abdul Rahim Al-Samie, an infectious disease doctor in the city of Taiz, Yemen. Al-Samie is also the general director of the Taiz Governorate Health Office, where 22,903 cases of cholera have been reported and 150 people have died since 27 April.
To control the spread of cholera during an outbreak, rapid care for infected people is vital, including providing ready access to rehydration therapy—a huge challenge in a country where civil war has wreaked havoc on public health and other infrastructure. Azman says he expects tens of thousands more cases before the epidemic burns itself out. “They could have had a huge, huge impact if vaccination was done early, a few months ago,” he says. “Even now, though, if [vaccine was] targeted appropriately and rapidly, I have no doubt that cases would be averted and lives would be saved.”
When oral hydration doesn’t work for the diarrheal disease, cholera, caused by the comma-shaped bacterium Vibrio cholera, can sometimes be treated by intravenous fluids and antibiotics. It is much riskier in malnourished people, as is common in Yemen, where hunger has compounded the miseries caused by the civil war.