The Epidemic that Shouldn’t Have Been

For 35 seconds in January of 2010, an earthquake ravaged Haiti. Soon after, the world’s most well-known humanitarian and intergovernmental organizations sent help. Nine months later, a cholera epidemic began. Desperate for an assist, Haiti’s authorities went to the French seeking support. France sent Renaud Piarroux, a disease detective of sorts, to figure out what happened.

Piarroux puzzled over the numbers. One day everyone was fine and the next, there was an explosion of cases. Hundreds were sick — kinda like food poisoning, where you share a plate of bad mussels with friends and all of you start vomiting.

Piarroux noticed all the sick people used water from the Artibonite River delta. He got a tip from local residents and went upstream to a small town named Mirebalais, where cholera cases had popped up days before the explosion downstream. Across the river from Mirebalais was a United Nations camp that housed peacekeepers from Nepal. They’d been caught mismanaging their sewage waste, pouring it into the river. For the locals, there was no doubt: the UN had brought cholera to Haiti. But Piarroux needed scientific confirmation.

Evidence was mounting against the peacekeepers. Turns out, there had been a cholera epidemic happening in Nepal. Politically, though, it was tricky: an election was looming and Haitian politicians hesitated to blame people who’d come there to help. The UN — which did not screen peacekeepers for illnesses — stonewalled, refusing to accept responsibility. They were adamant that the origin of the epidemic was irrelevant.

The World Health Organization and the U.S.’ Centers for Disease Control sided with the UN. “Cholera exists in the environment,” they argued. “This is no one’s fault!” They hired U.S. experts to say as much. A panel went into the field, facing pushback from Haitian experts. In their report they admitted that it had been caused by humans and their handling of waste, but they added that Haiti’s struggling health system and unreliable access to potable water made it worse. More papers were published, blaming climate change. Meanwhile, the UN was still stalling.

Figuring out how an epidemic started is key: if it’s in the environment, the most you can do is mitigate it. You can throw your hands up and say, “ah well, too bad, we tried!” But if it was brought by humans, there may be more you can do. You can trace contacts, teach people to chlorinate their water, prevent cases with prophylactic antibiotics. You can break the chains of transmission.

In 2012, a Danish researcher contacted scientists in Nepal and convinced them to share the genetic sequences of the cholera strains circulating there. Sure enough, one of them matched exactly the one in Haiti. They searched in other parts of the world and they couldn't find it. This confirmed the UN workers from Nepal were responsible, but they were still stonewalling.

It would take four more years for the UN to apologize formally. This unlocked funds to help Haiti ($20 million were promised, just over $10 million were actually paid out), but it also changed the strategy to fight cholera: instead of reduction, they went for full elimination — just like they would with ebola.

It took six years of denial, stonewalling, and shaky hypotheses before the UN admitted that they caused the epidemic; it took another three to end it. By early 2019, Haiti was finally cholera-free, but it cost the country nearly a decade of unnecessary suffering. (In October 2022, after civil unrest caused the breakdown of the health system, cholera returned.)

The notion that the origin of a disease informs the strategies to fight it isn’t new, but it’s a lesson we can’t seem to learn from one epidemic to the next. Probably because the entire process — from investigating the sources to coordinating a public health response — hinges on politics. This applies to Covid, too. “Isn’t it strange to you that we still don’t know the origins of Covid?” Piarroux asked me. “We found the animal reservoir of the bubonic plague from centuries ago, and the exact paths it took through humanity. We found the sources of previous coronaviruses… but we can’t find Covid’s?” And I just wonder: what would be different if we’d figured it out?