Last year's outbreak of cholera in Haiti shows how the perceived lack of expertise in a developing county can be wrongly exploited by experts in developed countries.
This particular outbreak led to a large number of deaths. Vibrio cholera, the known causative bacterial species in most cases of cholera, was blamed for the spread of the disease. The 'source' of the outbreak was narrowed down to an area inhabited by the UN Nepali peacekeeping battalion, leading to inevitable finger-pointing. The resulting riots fuelled further unrest and turmoil in Haiti, a country already embroiled in political crisis.
Scientists such as John Mekalanos, a prominent molecular biologist at Harvard Medical School in Boston, have suggested that the strain may have come from Nepal. But there has been no conclusive evidence to justify the claim, and the scientific community is still unsure about the origin of this strain.
The available evidence does indicate that the strain is a South Asian one, but Nepal is not the only South Asian country to have soldiers stationed in Haiti. Nepal is, however, the only country that witnessed a major cholera outbreak in 2009. This combination of factors seems to have been enough for many to conclude that Nepal is guilty as charged.
Rita Colwell, a veteran cholera scientist and former head of the US National Science Foundation, puts forward a different view. She notes that Vibrio cholera is present in coastal waters worldwide, and given the right environment (such as a rise in temperature), can turn deadly.
Colwell cites the example of the cholera outbreak in Peru in 1991, which killed over 2,000 people. At the time, suspicion first fell on ships coming in from the Asian subcontinent. However, it was soon ascertained that Peru's own coastal waters had warmed up due to El Nino, activating the cholera bacteria present. The origins of the strain were never established.
Although the Center for Disease Control (CDC) in the US has stated that the origin was most likely South Asia (without categorically mentioning Nepal), there are still questions regarding the method used to investigate the strain similarities. Crucially, no organisation has published any findings on Vibrio cholera isolated from cholera patients from the 2009 outbreak in Nepal, making it impossible to link the Nepali outbreak to Haiti.
Significantly, the samples and expertise required to establish such a link (or not) exist in Nepal itself. The governmental laboratory (NPHL) has bacterial strains from the outbreak areas in Nepal and the Center for Molecular Dynamics Nepal (CMDN) affiliated Molecular Laboratory has the DNA. Molecular biotechnology could have been used to determine whether the Nepali peacekeeping contingent in Haiti deserved the blame heaped upon it, through evidence-based findings, but it has not been.
Nepal needs to open up to the inevitable possibility of linking biotechnology to address public health concerns. In a globalised world, we cannot afford to be the weakest link as far as medical intervention is concerned.
(Source: Cholera choler (Nepali Times/Issue #543)