When Haiti Was Hit by Its First-Ever Cholera Outbreak, This Doctor Made Sure Locals Got Vaccinated

Author: Jacky Habib

Courtesy of Ralph Ternier

After more than a decade, Ralph Ternier still recalls one of the most challenging times of his career as a physician in Haiti, when cholera was detected in the country only 10 months after an earthquake killed over 200,000 people and displaced 1 million more. 

“The whole country was on [its] knees after the earthquake,” Ternier told Global Citizen. “They never expected such an outbreak would happen, especially because this island has never faced cholera. For the medical community, it was like a thunderstorm.”

Ternier, who at the time was the director of community care and support for the health care nonprofit Zanmi Lasante/Partners In Health is now the organization’s chief medical officer.

Cholera, an acute diarrheal illness, is contracted by ingesting food or water contaminated with bacteria. Cholera is often transmitted in areas with inadequate water and sanitation facilities, such as informal settlements.

In Haiti, the 2010 cholera outbreak saw 820,000 cases and nearly 10,000 deaths, according to the Centers for Disease Control and Prevention (CDC).

In this Nov. 25, 2010 file photo, people suffering cholera symptoms receive treatment at a local hospital in Limbé village, near Cap-Haïtien, Haiti.
Image: Emilio Morenatti/AP

At the time, some Haitians were misinformed about the spread of cholera, believing that Vodou priests were using their powers to spread the disease. Amid a nationwide cholera outbreak, these traditional priests were lynched by mobs, leading to the deaths of at least 45 people.

When Ternier heard of such cases, he decided to travel to Cerca-la-Source, in the Centre department of Haiti, to help educate the population about the disease. 

“I had to go deep in their belief to let them understand that cholera wasn’t coming from any spirit,” he said. “Seeing a local doctor that they trust come in and give them the right explanation in their dialect, could make them understand.”

Meanwhile, Ternier said the medical community spent months trying to plan how best to respond to the outbreak given the country’s already weak infrastructure, which was devastated by the earthquake. 

“By the time we knew how to combat the disease, it really spread throughout the country,” he said. “By the end of 2011, cholera was in the whole country — all the cities, all the villages.”

As the outbreak began to peak, Ternier said those in the medical community like himself began advocating for oral vaccines to combat the outbreak.

A boy carries a bucket containing water he collected from a stream in Thomazeau, about 10 kilometers northeast of Port-au-Prince in Haiti on Dec. 13, 2012.
Image: Dieu Nalio Chery/AP

He said the decision on whether Haitians should be vaccinated was “controversial” and that “the international authorities and international medical community didn’t believe it was the best path to follow.” 

According to Ternier, international and bilateral partners “thought it was worthless to think about the vaccination for the reason that it may distract people from continuing the WASH [water, sanitation, and hygiene] component and they mostly thought it was a big investment that would make people focus less on the WASH component.”

“We had to fight for a year to convince the government to do a pilot to the most affected area,” Ternier added.  

Through Zanmi Lasante/Partners In Health, Ternier helped roll out a pilot that aimed to vaccinate 100,000 people in two areas of the country. Nearly everyone was eligible to receive the vaccine, except pregnant women and children under 1, and 90% of the population in the target areas received both doses of the vaccine.

Leading up to the vaccinations, Ternier and other health experts hosted community meetings to educate people about the oral vaccine. According to Ternier, the vaccine was widely accepted — and as a result, the transmission of cholera rapidly declined among the population in the pilot, paving the way for a successful national vaccine campaign.

According to a study on the effectiveness of the oral vaccine in Haiti, there were about 65% fewer cholera cases among people that were vaccinated than among those that were unvaccinated.

Partners In Health called it the “vaccination campaign that almost never happened.” According to the organization, 300,000 Haitians were given the oral vaccine, and the success of this campaign has led the World Health Organization to stockpile the vaccine for use in future outbreaks.

For Ternier, following his instinct to advocate for the oral vaccine was worthwhile, even though it was a year-long effort to convince international partners.

“We always have that feeling of true solidarity with our communities because I’m Haitian — that’s why I’m in the right place,” he said. “We will always be grateful to our partners, but Haitians have to stand and fix the [system].”

Ralph Ternier is pictured at a mobile clinic for malnutrition in Haiti in 2018.
Image: Courtesy of Ralph Ternier

If the last two years have taught us anything about global health, it’s the importance of vaccines. The World's Best Shot is a profile series dedicated to sharing the stories of vaccine activists around the world.

Disclosure: This series was made possible with funding from the Bill and Melinda Gates Foundation. Each piece was produced with full editorial independence.