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HEALTH: Water, Sanitation Could Erase Cholera and Guinea Worm

Isolda Agazzi

GENEVA, May 19 2011 (IPS) - The World Health Assembly could adopt landmark resolutions asking governments to improve water and sanitation to eradicate cholera and guinea worm, the latter of which exists in just four countries in Africa. While safe drinking water and toilets are the most cost-effective public health measures, they have not been a priority for most developing countries.

“In 1989, when we started our programme, 180,000 people were affected by guinea worm,” Dr. Andrew Seidu Korkor, national coordinator for guinea worm at the Ghana Health Service, told IPS in a phone interview. “In 2010 we had only eight cases and today there are none. But it takes three years to get the certification that the disease is not endemic in your country any more.”

The guinea worm causes Dracunculiasis, a waterborne parasitic disease that exists in only four countries – Ghana, Mali, Ethiopia and Sudan. It lives in stagnant water. When people drink contaminated water, the parasite grows up to three feet and lives just below the skin, often crippling its human host.

There are no medicines to treat the disease or vaccines to prevent it. The only cure is to slowly, painfully extract it over days. While the disease is not lethal, its disabling effect prevents those affected from working or attending school, putting already vulnerable individuals and communities at further risk of chronic poverty.

“If potable water was provided, then guinea worm could be definitely eradicated,” Seidu Korkor continued. “But you cannot get 100 percent water supply immediately, because it is expensive and it takes time. Therefore, we also educate people on prevention measures, we look for cases and treat them, we use filters to improve the water supply and apply chemicals to kill the intermediate host.”

If completely eradicated, guinea worm would become the second disease wiped out by humankind – the first since smallpox was eradicated in the 1970s.

But safe water supply is also very important in other waterborne diseases, like cholera and diarrhoea. Cholera has appeared again in countries that had been free of it for decades, like Haiti after the earthquake and Nigeria, Uganda and Pakistan after the floods

“Ghana is cholera endemic, every year it gets reported and we have it in some regions at the moment,” Seidu Korkor confirmed. “As a public health agency, we are advocating for safe water supply”.

The issue, precisely, is being addressed by the World Health Assembly (WHA), the highest decision-making body of the World Health Organisation, which is holding its annual session this week in Geneva.

“The only way to achieve good public health is to invest in water and sanitation, more than in vaccines and antibiotics,” Yael Vellemann, senior health policy analyst at WaterAid, told IPS in an interview. “The issue has not been discussed by the WHA for more than two decades, but this year there are three resolutions on the table: on cholera, on guinea worm and on drinking water, sanitation and health.”

WaterAid is an international NGO created in the early 1980s by the UK water companies to improve access to clean water and sanitation in the world’s poorest countries.

Yael Vellemann argues that the promotion of sanitation and hygiene – basically safe drinking water, separation of human beings from faeces and hand washing with soap – is the most cost-effective public health intervention.

Some 884 million people in the world don’t have access to safe drinking water and 2.6 billion lack access to basic sanitation. In Africa, 4,000 children are killed by diarrhoea every day because of poor access to water and sanitation. “It is more fatal than malaria, AIDS and measles put together,” she stressed.

According to the United Nations Development Programme (UNDP), half of the beds in the hospitals of developing countries are occupied by people suffering from bad water and sanitation diseases. “It is incredible that we still need to treat people for diarrhoea in 2011!” Vellemann said.

The WHO has repeatedly said that while vaccines are important, they cannot replace traditional prevention measures such as improved water and sanitation.

For cholera there are two oral vaccines, which are relatively low cost. But vaccination campaigns can be expensive and complicated. “In Uganda, for example, the health centre can be very far, you have to convince a mother to take her child there. And if you vaccinate your child against typhoid and next month he gets a disease that is not typhoid, but looks the same, then you will think that the vaccine does not work,” she says.

According to the World Bank, simply changing people’s practices and behaviour is the most cost-effective public health policy.

Vellemann is convinced that investing in water and sanitation will give the best return for your money. The U.N. estimates that for every dollar invested in this area, you get eight dollars back because people are healthier and don’t spend so much time fetching water.

Then why isn’t it a priority of the international community? “This is the million dollar question,” she replies. “In most developing countries, the water and health sectors don’t work together. Also, if you are a minister of health, you may get more votes by building a new hospital rather than going around talking about toilets.”