A call for unified public health efforts on Hispanola

By  Willy Dunbar, MD, PhD

Earlier this month, Listin Diario, a Dominican news outlet, published a story raising concerns about the public health impact of international troops arriving on the island in light of the United Nations-linked cholera outbreak that killed thousands of Haitians in the 2010s. 

The relationship between Haiti and the Dominican Republic, which share the island of Hispaniola, is complex and intertwined, especially when it comes to public health, however, Dr. Robert Paulino Ramirez, who authored Kenya, Haiti and Dominican public health,overlooks the substantial efforts and progress Haiti has made in controlling epidemics.

“After fourteen years, cholera cases in both countries have been recorded in almost continuous outbreaks, the most recent on the banks of the Ozama, suggesting the persistence of the bacteria in the different tributaries of the country and the possibility of cases re-emerging periodically,” Ramirez wrote. 

“Haiti has followed a path of crisis that now calls on the international community to repeat the same actions, this time led by the Republic of Kenya. With the arrival of 400 Kenyan soldiers in Haiti, the question arises: Are we facing the possibility of new health events emerging?”

Haiti’s public health resilience

Despite the challenges, Haiti has demonstrated resilience and commitment to controlling various epidemics, even when governance structures have been less stable. The 2010 cholera outbreak , which followed the devastating earthquake, marked a significant public health crisis. However, the collaborative efforts between the Haitian government, international organizations like the Center for Disease Control (CDC), USAID,  World Health Organization (WHO), and numerous Haitian and international NGOs established a framework that significantly mitigated the epidemic over the years.

From 2010 to 2019, Haiti reported over 820,000 cholera cases, with nearly 10,000 deaths. However, intensive interventions, including establishing Cholera Treatment Centers (CTCs), widespread vaccination campaigns, and improvements in water, sanitation, and hygiene (WASH) infrastructure, dramatically reduced cases. By 2019, Haiti had not reported a single cholera case, a testament to the effectiveness of these measures.

During the COVID-19 pandemic, Haiti implemented strict measures to control the spread of the virus, including travel restrictions, public health campaigns, and testing protocols. These actions underscore Haiti’s proactive approach to epidemic control, contrary to the narrative that Haiti is a perpetual health threat to its neighbors.

The role of international and local collaboration

The re-emergence of cholera in 2022 underscored the necessity for sustained efforts and international cooperation. Organizations such as the CDC and WHO, alongside many others, have continuously supported Haiti through technical assistance, training, and resource provision. This support has been critical in enhancing laboratory capacity, improving disease surveillance, and conducting vaccination drives. However, it is essential to acknowledge the significant contributions of Haitian institutions, which have been pivotal in the national response to public health crises, offering essential healthcare services, conducting research, and implementing community health programs. In collaboration with international partners, their efforts have been instrumental in managing and controlling epidemics in Haiti.

The influx of tourists to the Dominican Republic, which receives millions of visitors annually, presents as high of a significant risk, if not more, for the introduction and spread of infectious diseases in Hispaniola and the Caribbean region. High tourist mobility facilitates the rapid transmission of pathogens, affecting both countries on the island. The dynamics of international tourism mean that tourists can inadvertently bring with them a range of infectious diseases, from gastroenteritis to respiratory infections such as COVID-19. 

For instance, a study by Public Health England highlighted that travel to regions with high tourist traffic is associated with outbreaks of gastroenteritis and other travel-related illnesses​​. Similarly, WHO has documented how the movement of people due to tourism can contribute to the spread of diseases like malaria, as travelers often venture into endemic areas and return as asymptomatic carriers​​. 

Research published in Current Psychology emphasizes that perceived health risks significantly impact travel intentions, indicating that a destination’s health security is a critical factor for both tourists and host countries​. This underscores the necessity for the Dominican Republic to implement stringent public health measures to protect its residents and maintain its status as a safe tourist destination. 

Consequently, the Dominican Republic shares an equal, if not greater, responsibility in maintaining robust public health defenses to prevent the spread of infectious diseases and ensure the well-being of all on the island.

A call for unified public health actions

The health security of Hispaniola cannot be achieved through isolationist policies or by placing blame. Instead, a unified approach is essential. Haiti and the Dominican Republic must collaborate on data sharing, joint health initiatives, and coordinated emergency responses. 

Haiti has consistently shown that it can control epidemics effectively, even in the face of governmental instability. The narrative that Haiti is a health threat overshadows the extensive and successful efforts to combat public health crises. As a Haitian, I confidently assert, Haiti has consistently managed to control epidemics effectively over the past 40 years, even in circumstances where the government has struggled to maintain overall control.

We can ensure both nations’ health security on Hispaniola by recognizing these efforts and fostering collaborative actions.

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Willy Dunbar, MD, PhD, is a global public health scientist and policy advisor, who currently serves as an expert scientific advisor at the National Collaborating Centre for Healthy Public Policy (NCCHPP) in Canada.

The views expressed in this article are solely of the author and do not necessarily reflect the opinions or positions of the international institutions with which he is affiliated. No financial support or compensation was received for the preparation of this article.

The post A call for unified public health efforts on Hispanola appeared first on The Haitian Times.

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A call for unified public health efforts on Hispanola was first posted on July 24, 2024 at 8:05 am.