Editing Cholera (section)

=== Health policy ===
In many developing countries, cholera still reaches its victims through contaminated water sources, and countries without proper sanitation techniques have greater incidence of the disease.<ref>"Cholera vaccines. A brief summary of the March 2010 position paper" (PDF). World Health Organization. Retrieved September 19, 2013.</ref> Governments can play a role in this. In 2008, for example, the [[Zimbabwean cholera outbreak]] was due partly to the government's role, according to a report from the [[James Baker Institute]].<ref name="bakerinstitute.org" /> The Haitian government's inability to provide safe drinking water after the 2010 earthquake led to an increase in cholera cases as well.<ref name="pmid21142690">{{cite journal | vauthors = Walton DA, Ivers LC | title = Responding to cholera in post-earthquake Haiti | journal = The New England Journal of Medicine | volume = 364 | issue = 1 | pages = 3–5 | date = January 2011 | pmid = 21142690 | doi = 10.1056/NEJMp1012997 | s2cid = 41672119 | doi-access = free }}</ref>

Similarly, South Africa's cholera outbreak was exacerbated by the government's policy of privatizing water programs. The wealthy elite of the country were able to afford safe water while others had to use water from cholera-infected rivers.<ref name="pmid14758861">{{cite journal | vauthors = Pauw J | title = The politics of underdevelopment: metered to death-how a water experiment caused riots and a cholera epidemic | journal = International Journal of Health Services | volume = 33 | issue = 4 | pages = 819–30 | year = 2003 | pmid = 14758861 | doi = 10.2190/kf8j-5nqd-xcyu-u8q7 | s2cid = 24270235 }}</ref>

According to [[Rita R. Colwell]] of the [[James Baker Institute]], if cholera does begin to spread, government preparedness is crucial. A government's ability to contain the disease before it extends to other areas can prevent a high death toll and the development of an epidemic or even pandemic. Effective disease surveillance can ensure that cholera outbreaks are recognized as soon as possible and dealt with appropriately. Oftentimes, this will allow public health programs to determine and control the cause of the cases, whether it is unsanitary water or seafood that have accumulated a lot of ''Vibrio cholerae'' specimens.<ref name="bakerinstitute.org" /> Having an effective surveillance program contributes to a government's ability to prevent cholera from spreading. In the year 2000 in the state of Kerala in India, the Kottayam district was determined to be "Cholera-affected"; this pronouncement led to task forces that concentrated on educating citizens with 13,670 information sessions about human health.<ref name="John, T. Jacob 2004">{{cite journal | vauthors = John TJ, Rajappan K, Arjunan KK | title = Communicable diseases monitored by disease surveillance in Kottayam district, Kerala state, India | journal = The Indian Journal of Medical Research | volume = 120 | issue = 2 | pages = 86–93 | date = August 2004 | pmid = 15347857 |citeseerx=10.1.1.477.3795 }}</ref> These task forces promoted the boiling of water to obtain safe water, and provided chlorine and oral rehydration salts.<ref name="John, T. Jacob 2004" /> Ultimately, this helped to control the spread of the disease to other areas and minimize deaths. On the other hand, researchers have shown that most of the citizens infected during the 1991 cholera outbreak in Bangladesh lived in rural areas, and were not recognized by the government's surveillance program. This inhibited physicians' abilities to detect cholera cases early.<ref name="pmid1500643">{{cite journal |last1=Siddique |first1=AK |last2=Zaman |first2=K |last3=Baqui |first3=AH |last4=Akram |first4=K |last5=Mutsuddy |first5=P |last6=Eusof |first6=A |last7=Haider |first7=K |last8=Islam |first8=S |last9=Sack |first9=RB |title=Cholera Epidemics in Bangladesh: 1985-1991 |journal=Journal of Diarrhoeal Diseases Research |date=1992 |volume=10 |issue=2 |pages=79–86 |jstor=23498147 |pmid=1500643 |url=http://dspace.icddrb.org/jspui/handle/123456789/262 |access-date=2021-08-23 |archive-date=2021-08-23 |archive-url=https://web.archive.org/web/20210823220145/http://dspace.icddrb.org/jspui/handle/123456789/262 |url-status=dead }}</ref>

According to Colwell, the quality and inclusiveness of a country's health care system affects the control of cholera, as it did in the [[Zimbabwean cholera outbreak]].<ref name="bakerinstitute.org" /> While sanitation practices are important, when governments respond quickly and have readily available vaccines, the country will have a lower cholera death toll. Affordability of vaccines can be a problem; if the governments do not provide vaccinations, only the wealthy may be able to afford them and there will be a greater toll on the country's poor.<ref name="sciencedirect.com">{{cite journal | vauthors = DeRoeck D, Clemens JD, Nyamete A, Mahoney RT | title = Policymakers' views regarding the introduction of new-generation vaccines against typhoid fever, shigellosis and cholera in Asia | journal = Vaccine | volume = 23 | issue = 21 | pages = 2762–74 | date = April 2005 | pmid = 15780724 | doi = 10.1016/j.vaccine.2004.11.044 }}</ref><ref>{{cite journal |last1=Choe |first1=Chongwoo |last2=Raschky |first2=Paul A. |title=Media, institutions, and government action: Prevention vs. palliation in the time of cholera |journal=European Journal of Political Economy |date=January 2016 |volume=41 |pages=75–93 |doi=10.1016/j.ejpoleco.2015.11.001 }}</ref> The speed with which government leaders respond to cholera outbreaks is important.<ref>{{cite web|author= Pruyt, Eric |title= Cholera in Zimbabwe |url= http://www.systemdynamics.org/conferences/2009/proceed/papers/P1357.pdf |date= 26 July 2009 |publisher= Delft University of Technology |url-status= dead |archive-url= https://web.archive.org/web/20131020151002/http://www.systemdynamics.org/conferences/2009/proceed/papers/P1357.pdf |archive-date= 20 October 2013 }}</ref>

Besides contributing to an effective or declining public health care system and water sanitation treatments, government can have indirect effects on cholera control and the effectiveness of a response to cholera.<ref name="Kapp, Clare 2009">{{cite journal |last1=Kapp |first1=Clare |title=Zimbabwe's humanitarian crisis worsens |journal=The Lancet |date=February 2009 |volume=373 |issue=9662 |pages=447 |doi=10.1016/s0140-6736(09)60151-3 |pmid=19205080 |s2cid=5267332 |doi-access=free }}</ref> A country's government can impact its ability to prevent disease and control its spread. A speedy government response backed by a fully functioning health care system and financial resources can prevent cholera's spread. This limits cholera's ability to cause death, or at the very least a decline in education, as children are kept out of school to minimize the risk of infection.<ref name="Kapp, Clare 2009" /> Inversely, poor government response can lead to civil unrest and [[cholera riots]].<ref>{{cite news|url=https://www.google.com/hostednews/afp/article/ALeqM5ghlWQu4P1ofFBBy7jGwvtexoj6dw|archive-url=https://archive.today/20120731170854/http://www.google.com/hostednews/afp/article/ALeqM5ghlWQu4P1ofFBBy7jGwvtexoj6dw|url-status=dead|archive-date=July 31, 2012|title=AFP: Riot police break up Zimbabwe protests as cholera deaths mount |agency=AFP |access-date=25 June 2017}}</ref>