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Humans have been battling cholera outbreaks for centuries. The disease is caused by poor sanitation, and while there had been progress made in controlling infections, the World Health Organization says that in the last couple years, the number of cases has soared. Last year alone, well over half a million cases were recorded in Africa, Asia and Haiti. Now, there is a vaccine, but as NPR's Gabrielle Emanuel reports, demand for it is so great, the global stockpile is empty.
GABRIELLE EMANUEL, BYLINE: A few years ago, Haiti was declared cholera free. But that was premature. Last year, the country had one of the world's deadliest outbreaks. Ralph Ternier is the chief medical officer for Zanmi Lasante, a prominent health care organization in Haiti. He says the disease can be so debilitating that there are special beds for cholera patients with a hole in the middle. One of the symptoms is diarrhea.
RALPH TERNIER: And you put a bucket underneath because, when they have diarrhea, it's all day long.
EMANUEL: He worries more cholera is on its way. Haiti is struggling with a lack of basic infrastructure due to gang violence and political upheaval, so clean water can be hard to find. Ternier says one thing that could help prevent an outbreak is vaccinating people now.
TERNIER: When you vaccinate, like, million of people, you give yourself time, like three or five years of low cases of cholera.
EMANUEL: But these days, he says, all the doses are being used for active cholera outbreaks, so there aren't any left in the global stockpile, which is in a warehouse in South Korea.
ALLYSON RUSSELL: And it's this very long hallway with a lot of big metal doors on the side.
EMANUEL: Allyson Russell works at Gavi, the Vaccine Alliance. The group helps fund and facilitate the stockpile.
RUSSELL: Inside those doors are the refrigerated caverns that hold all of the vaccine.
EMANUEL: There are supposed to be millions of doses in reserve here. Russell says 700,000 doses are made each week, but...
RUSSELL: As soon as they're on the shelf, they're in a box and on an airplane going somewhere.
EMANUEL: Experts saw the vaccine shortage coming. More than a year ago, they started giving just one dose of the vaccine instead of the usual two, even though the protection doesn't last as long.
RUSSELL: It basically allows you to vaccinate twice as many people.
EMANUEL: And Russell says scientists have crafted a simpler way to make the vaccine. But these changes aren't enough. Philippe Barboza of the World Health Organization says there are a few big reasons why. First, the demand is greater than ever, especially with climate change.
PHILIPPE BARBOZA: Many of these very large outbreaks were triggered by massive, very large climatic events being drought or cyclones.
EMANUEL: Too much water or too little water can mean contaminated water. Conflict and migration are also giving cholera the chance to spread. Meanwhile, Barboza says there's only one company making the global cholera vaccine. A few other manufacturers are slated to start producing in the coming years.
BARBOZA: But this is taking time, especially for a vaccine which is cheap, which is only for the most poor part of the population in the poorest country in the world. So it does not attract, you know, big manufacturer to produce vaccine.
EMANUEL: The vaccine shortfall, he says, captures the broader situation.
BARBOZA: It's a good indicator of the lack of commitment to control cholera.
EMANUEL: To control cholera long term, he says the answer is better infrastructure. If you have clean water to drink, you won't get cholera in the first place.
Gabrielle Emanuel, NPR News.
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