The vaccine hasn’t been used before, partly to focus medical resources on treating cases, but also because little is available, as vaccination is not standard in acute outbreaks. Cholera, however, has changed, says Peter Hotez at George Washington University in Washington DC. “Dramatic outbreaks used to last a few weeks; gone by the time you could vaccinate anyone,” he says.
But Haiti’s epidemic will not peak for another few months, and will linger and recur, suggest analyses presented at a meeting on 17 December in Washington DC.
Ten million Haitians are at risk but only about 400,000 doses of vaccine could be ready by April, and a million by late 2011. Available stocks will be used in a pilot project, possibly in central Haiti. Inevitably, many Haitians will miss out. “This is why we want a cholera vaccine stockpile,” says Hotez, so such hard choices need not be made again.