Lessons from Zambia’s fight against cholera
FOLLOWING a cholera outbreak in Zambia, the country’s government unleashed a raft of interventions including invoking a statutory instrument that has effectively banned gatherings such as church services, funeral crowds, drinking at bars and taverns to ensure there is no further transmission through contact.
BY PHYLLIS MBANJE
The militant moves, although viewed by some as too drastic, have displayed the government’s high level of commitment, something that has been missing in Zimbabwe when dealing with disease outbreaks of this nature.
The 2008 cholera outbreak in Zimbabwe left over 4 000 dead and thousands more hospitalised. The needless deaths from a primitive disease exposed just how ill-prepared the country is when it comes to managing outbreaks.
Over the years there have been several typhoid outbreaks in the country and each time the authorities are caught napping.
Instead there has been a flurry of blame game with the health ministry saying the city fathers are not honouring their responsibility of supplying clean water and collecting garbage on time.
They have also said the local authorities are failing to deal with the vendors who have contributed to the filth creating an environment conducive for diseases like cholera and typhoid.
Health and Child Care minister David Parirenyatwa is on record saying: “There is uncollected garbage, overflowing raw sewage and no running water. This is a conducive environment for diseases like typhoid to thrive.
“Yes, we will treat and we have put measures to deal with the cases, but if situations like this persist we will not win this war.”
Places like Mbare, Glen Norah and other highly populated suburbs have always been epicentres for such diseases but no meaningful measures have been implemented, just empty promises and lipstick measures.
Typhoid is spread through contaminated food and water, the lack of these basic services means that typhoid bacteria can easily spread throughout the city.
Although there are two vaccines for typhoid on the market, both of which have proven safe and effective, they are not readily available to Zimbabweans, even those that live in high-risk areas.
The Zambian strategy
When cholera cases (over 2 900 to date and 67 deaths) in Zambia kept on rising after the cholera outbreak was declared in October last year, the government under the guidance of the health ministry instituted a number of measures to curtail the disease.
The Minister of Health, Chitalu Chilufya, pushed for the invoking of Statutory Instrument 79 to ban gatherings such as church services, funeral gatherings, gathering to drink at bars and taverns.
The minister told journalists in Lusaka that the government had roped in the armed forces to patrol places where the ban has been placed.
Also inspectors are on the ground re-inspecting businesses that were closed after being found with germs that cause cholera.
To emphasise the importance of the situation the Local Government minister Vincent Mwale said bars and night clubs that will not follow the stipulated opening and closing hours will be closed down and risk losing their licenses.
Mwale said his ministry and the Zambia National Farmers Union will soon announce to the public the new conducive places where, farm produce and vegetables will be sold following the closure of markets.
On Wednesday, Zambia started rolling out a cholera vaccine as a measure designed at ensuring that the uninfected maintained their status.
What should Zimbabwe do…?
According to Alice Lee, an associate at the Sabin Vaccine Institute, in Washington, United States, an ideal sustainable solution would be to properly vaccinate typhoid-susceptible populations, breaking the cycle of infection and disease spread while building proper water and sanitation infrastructure.
Last year the Harare city health department dispensed the vaccine to its employees and said they would seek permission from the health ministry to roll it out to the rest of the city.
The government formed an inter-ministerial committee to oversee the process of halting the disease. Some of its intended measures where to include banning food vendors on the streets, improve waste management, stop illegal dumpsites and provide health education. However Lee said not all of these measures are popular.
“Street food vendors have protested that they should not be stripped of their livelihoods for an outbreak that arose in part because of the government’s failure to uphold public services. The emergency measures also don’t address the underlying conditions that caused the outbreak — conditions that have persisted in Harare for over a year now,” she said.
Until the government institutes a sustainable typhoid immunisation program, the government must prioritise clean water supply, working sewage pipes and reliable trash pickups.
Although the underlying funding and infrastructure required might take years of money and effort, it is well worth it to invest in the long-term health of the population.
Other preventative measures, such as using vaccines for outbreak control or rapid chlorination of the water supply, can save lives and prevent suffering while the government develops long-term water and sanitation interventions.
“Vaccination and water and sanitation improvements can be a powerful one-two punch in battling typhoid and stop
the spread of typhoid,” said Lee.
Recently, Parirenyatwa said Zimbabwe was on “high” alert for cholera, but there remains great concern on the failure to come up with long-term measures that are more sustainable and proactive.