New England Journal of Medicine. The United States and Northern Europe were able to defeat cholera without vaccines and antibiotics by ensuring improved sanitation and safe water access for all citizens. While the solution may be easy in theory, it is much harder in practice.
Ensuring safe water and improved sanitation is a difficult proposition. The technological problems are manifold — rapid urbanization and growing megacities are outstripping the existing municipal waterworks, which cannot keep up with construction and maintenance demands. In rural areas, treating drinking water with point-of-access and point-of-use solutions, including chemical and solar disinfection and safe water storage in the home, must be further expanded as an interim measure toward providing access to safe water sources.
The costs of improving and maintaining infrastructure in order to meet the MDGs can be daunting, depending on the technologies used; some estimates put these costs at well over $50 billion per year. To justify the expenditures that will be required, we need cost–utility analyses that are based on the best data possible, not just those that are readily available. These calculations should take into account the direct benefits of reducing diarrheal diseases and accompanying mortality and also other benefits, such as improved nutrition of children and lower rates of helminthic infection, hepatitis, and other diseases transmitted by the fecal–oral route.Analysis continues on Humanosphere