24
Cholera Outbreak in 1991
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1. Letter from the Secretary General
2. Letters from the directors
3. Introduction of the committee
4. Introduction of the topic
5. history of the topic
6. Past international actions
7. Bloc positions
8. QARMAS
9. Position Paper Guidelines
10. References
Letter From the Secretary General
Dear Delegates and Faculty Advisors,
Last year the Casuarinas Debate Team organized our first Model United Nations conference called CASMUN, and once again it is an honor to have you back with us.
It has not been too long since the Casuarinas Debate Team started, and since then having our own Model UN competition was a goal: a difficult one, but not impossible to achieve. In 2020, we were planning to organize the conference at our school, following the measures for what appeared to be only a 3 month quarantine. However, because of the Covid-19 pandemic we were forced to organize a virtual conference, which we were able to accomplish through the hard work of our Faculty Advisors and the Casuarinas Debate Team.
This year is no different, and with much more experience in hand, we are organizing another virtual conference full of dedication, enthusiasm and transparency in order to offer all delegates a suitable space for self expression and formal discussions. Casuarinas Model UN is the result of the effort of many people, including our Faculty Advisors, your committee chairs, and all the members of our Secretariat who volunteered to participate. Personally, I would like to thank them all in advance for their commitment.
Finally, I would like to point out that Model United Nations is about having fun and learning not only about global issues, but also acquiring and improving soft skills that will benefit delegates in the long term. This is why we encourage all of you to actively participate in your committee sessions and make an effort to take advantage of the experience CASMUN has to offer.
We will look forward to having you at our Conference!
Letters From the Directors
Letter from the committee director
Dear delegates,
Hello and welcome to the second edition of Casuarinas Model United Nations! My name is Luciana Rodríguez and alongside Jorge and Daniela, I will be serving as your director for the World Health Organization.
To tell you a bit about myself, I am 18 years old and I am a second-year Communication Sciences student at Universidad de Lima. Something I am very passionate about is art, more specifically dancing. I did ballet for 12 years of my life, performed in plays and I’m still learning about new dancing styles, which I'm very eager about, so everything involving arts in general is very important to me. Besides my passion for dancing and arts I love Little Mix, Selena Gomez and Avicii. They are amazing, I listen to their music all day long. My neighbors probably hate me because I sing horribly (in my mind I could win The Voice). Apart from that, in my free time I enjoy rewatching RPDR and Dance Academy on Netflix, I also love watching makeup tutorials from James Charles, Nicky Tutorials and many others. My guilty pleasure is hearing about the lastest tea about famous people, especially if it involves the Kardashian family or Tik-tok influencers.
Regarding my Model UN journey, it started back in 2018 when I (finally) joined my school’s debate team. I wasn’t sure about joining the team because of some insecurities but the experience as a scholar delegate with my team was nothing but incredible, they will always be my family. MUN has given me a lot, not only it has helped me to get more knowledge about global issues and stay informed about what's going on with the world, but also given me the best friends anyone could ask for, they were by my side through all the ups and downs. I have grown so much as a delegate and as a person thanks to the experience.
Discussing the Cholera outbreak in 1992 is very important nowadays, considering we are in the middle of a pandemic, and like Covid-19, Cholera affected tons of people around the world. For this committee, I expect delegates that present viable solutions for the topic considering all the possible scenarios, always bearing in mind that it is in your hands to prevent this virus from spreading.
I am very excited to meet you delegates and to be part of this committee with my best friends and teammates. Even though because of the current situation it has to be via zoom, I hope someday I can get to know all of you in person. Finally, always bear in mind that Model UN is more than just a competition, have fun and don’t be afraid to step out of your comfort zone.
See you in april! Luciana RodríguezDirector of the World Health OrganizationEmail: [email protected]
Letters From the Directors
Letter from the Co-Director
Hello Delegates!
My name is Jorge Medina, and I am currently a third year Biomedical Engineering student at Pontificia Universidad Católica del Perú (PUCP) and Universidad Peruana Cayetano Heredia (UPCH). In this opportunity I will have the honour and pleasure to serve as your co-director in the World Health Organization alongside my co-chairs Luciana Rodriguez and Daniela Villafuerte for the second edition of Casuarinas Model United Nations. To know more about me, I am a huge football fan (Visca Barça) and a truly passionate person regarding action and science fiction films. In my free time I enjoy watching Dragon Ball and Naruto while procrastinating when the minimum opportunity is presented. In addition, I love listening to pop music, especially Big Time Rush, The Weeknd and Bruno Mars. My MUN experience started three years ago when I attended LiMUN 2017 and since then I have taken part in more than 45 conferences playing the role of delegate, Head Delegate, Faculty Advisor and Director. As a result, I have been awarded several times, but the most pleasant recognition was the Book Award obtained in the North American Model United Nations (NAIMUN) 2019 where, alongside United Schools of Peru (USP), I had the opportunity to travel to the United States and attend one of the most competitive conferences in the country.
Regarding the topic in discussion, it is kind of special for me because it was one of the two topics I debated in NaiMUN. In times where we currently are living a pandemic, it is important to remember that Covid-19 has not been the unique virus the world has seen ´´recently´´. I expect holistic and well-crafted solutions regarding short, medium and long term measures that countries will take to prevent the spread of Cholera in the world.
One message I would like to give to you is that remember that MUN is an activity to debate and grow as a person, always taking into consideration diplomacy and maintaining a balance between soft-skills and your level of content. My ideal delegate is the one who knows how to maintain an adequate proportion between their abilities and their content quality, being both aspects at the same level. Being said that, I hope to see you in April for a dynamic and interesting committee. If you have any doubts or questions or simply you would like to introduce yourselves do not hesitate to send me an e-mail!Greetings!
Jorge Medina CélizCo- Director of the World Health OrganizationE-mail: [email protected]
Letters From the Directors
Letter from the Co-Director
Dear delegates,
My name is Daniela Villafuerte Succar and this year I have the pleasure to be part of the dais in The World Health Organization Committee in the second edition of CasMun alongside Luciana and Jorge. I’m 21 years old and I am a fourth-year communications student in Universidad de San Martín de Porres, something I really like is fashion and investigation. Besides my passion for fashion, I love to listen to music, especially Harry Styles, Danny Ocean, Little Mix and One direction in general. I can listen to their music all day long. Apart from that, in my free time I enjoy rewatching The Vampire Diaries and Gossip Girl, all over again and I also create fashion content on instagram and tiktok.
My MUN career started in 2014 when I was in high school, since then, I had debate at diverse national and international conferences in a school and university level. For me, the Model of United Nations, a part of a competition, it's a place where you can learn and develop a lot of soft and hard skills, in which oratory and the power of negotiation stand out. On the other hand, they help to expand your knowledge on different topics and situations that the international community face and we usually don’t have the information in our mass media.In this opportunity we have the chance to debate the Cholera Outbreak in 1991. Nausea, dehydration, and panic over the risk of renal failure and cardiovascular collapse all tremble under one name: Vibrio cholerae. In this committee, you will be the real decision-makers for your country here, as the health of the world will be in your hands. Remember to bring into the table real and viable solutions in your submitted proposals. If you have any questions, don't hesitate to write me an email, I will be happy to answer your doubts!
All the love,
Daniela VillafuerteCo- Director of the World Health OrganizationE-mail: [email protected]
Introduction of the committee
In 2003 WHO, headquartered in Geneva, was organized into 141 country offices which reported to six regional offices. It had 192 member countries and employed about 8,000 doctors, scientists, epidemiologists, managers and administrators worldwide.
After 1951 WHO was allocated substantial resources from the expanded technical-assistance program of the UN.WHO officials periodically review and update the agency’s leadership priorities. Over the period 2014–19, WHO’s leadership priorities were aimed at:
1. Assisting countries that seek progress toward universal health coverage2. Helping countries establish their capacity to adhere to International Health Regulations3. Increasing access to essential and high-quality medical products4. Addressing the role of social, economic, and environmental factors in public health5. Coordinating responses to noncommunicable disease6. Promoting public health and well-being in keeping with the Sustainable Development Goals, set forth by
the UN.
In regards of the control of epidemic and endemic WHO sponsors promote mass campaigns that involve vaccination programs, instruction in the use of antibiotics and insecticides, the improvement of laboratory and clinical facilities for early diagnosis and prevention, assistance in providing pure water supplies and sanitation systems, and health education for people living in rural communities.
The World Health Organization (WHO) was created in 1948 to coordinate health affairs within the United Nations system. Its initial priorities were malaria, tuberculosis, venereal disease and other communicable diseases, additional to women and children’s health, nutrition and sanitation.
From the beginning, the World Health Organization worked alongside member countries to identify and address public health issues, support health research and issue guidelines.
Introduction of the topic
First of all, it is crucial to know some key definitions and information regarding the topic we will be addressing in committee.
● What is Cholera and why is it important to stop it?- Cholera is an infectious disease that causes severe watery diarrhea, which can lead to
dehydration and even death if untreated.- Important to stop it because it can lead to people’s death, economic decrease
● Cholera symptoms: - Dehydration- Rapid heart rate- Loss of skin elasticity (the ability to return to original position quickly if pinched)- Dry mucous membranes, including the inside of the mouth, throat, nose, and eyelids- Low blood pressure- Thirst- Muscle cramps
● What causes Cholera?- It is caused by eating food or drinking water contaminated with a bacterium called Vibrio
cholerae.- Municipal water supplies contaminated with Vibrio cholerae- Ice made from contaminated municipal water- Contaminated food and drinks sold by street vendors- Vegetables grown with water containing human wastes- Raw or undercooked fish and seafood caught in waters polluted with sewage
● What is the Vibrio Cholerae incubation period?- Short: 6‐48 hours but may be as long as 3 days
● Definition of a cholera case: ○ Suspicious case
■ Person of any age who presents a picture of watery diarrhea of appearance suddenly that quickly leads to dehydration.
○ Probable case■ Person of any age that suddenly presents a clinical picture of watery diarrhea with or
without vomiting, with severe dehydration or shock, and without presence of fever ■ Person of any age that dies from diarrheal disease acute watery.
Introduction of the topic
- Confirmed case■ In an area where the disease is not known to be present, a patient aged 5 years or more
develops severe dehydration or dies from acute watery diarrhea;■ In an area where there is a cholera epidemic, a patient aged 5 years or more develops
acute watery diarrhoea, with or without vomiting.■ Every probable case in a locality where cases of cholera have been confirmed in the last
2 weeks.■ Any probable case during an outbreak epidemic where the Vibrio cholerae O1 or O139 in
new cases.■ Any probable case family contact of a confirmed case.
- Compatible case■ Any case classified as suspicious or likely that it cannot be confirmed or discarded within
a period of 30 days after the initial classification
Now that have read this important information, this committee will take place on December 29th, 1991 (11 months after the first Cholera case was reported officially)
History of the topic
At this moment, the Cholera pandemic is mainly caused by El Tor O1 strain, which has not been the only agent that caused the six previous cholera pandemics. These pandemics have been active in the past through several geographical locations and regions:
1. First Cholera Pandemic (1818-1823): It started in India close to the delta of the Ganges River. It expanded by colonization and trading, which allowed it to spread through Southeast and Central Asia, the Middle East, eastern Africa, and the Mediterranean. As a consequence, more than 100,000 people succumbed on the island of Java (Indonesia) alone. At Basra, Iraq, as many as 18,000 people died during a three-week period in 1821. The pandemic spread through Turkey and reached the threshold of Europe.
2. Second Cholera Pandemic (1829-1849): It had its origin in India and expanded to Russia. Later it infected Finland, Poland, and England. Immigration due to poverty and famine carried the illness to North America, by first infecting Canada. In June more than 1,000 deaths were documented in Quebec. From Canada the disease moved quickly to the United States, disrupting life in most of the large cities along the eastern seaboard and striking hardest in New Orleans, Louisiana, where 5,000 residents died. In 1833 the pandemic reached Mexico and Cuba.
3. Third Cholera Pandemic (1852-1859): Considered the most deadly of the pandemics. It started in India and then expanded to ample disseminated areas of Asia, Europe, North America, and Africa, which was severely affected so as the disease spread from its eastern coast into Ethiopia and Uganda. Perhaps the worst single year of cholera was 1854; 23,000 died in Great Britain alone even though important discoveries took place as British doctor John Snow identified contaminated water as the source of infection.
4. Fourth Cholera Pandemic (1863-1879): Indian Muslim pilgrims transported the illness to the Middle East as they visited Mecca. Posterior migration infected Europe, Africa and North America.
5. Fifth Cholera Pandemic (1881-1896): Arose from the Bengal region in India, ravaging through Asia, Africa, part of France and Germany, and South America.This was the last major outbreak in the latter continent until the current outbreak in 1991. Expansion to countries like England was prevented through developed quarantine public health measures
6. Sixth Cholera Pandemic (1899-1923): Particularly deadly in India, where it started, Arabia, and North Africa coast. Once again, it affected a number of pilgrims traveling to Mecca. By 1923, cholera was not present in most of the world
7. The seventh pandemic, unlike the previous ones, started in Indonesia in 1961 and lasts until present day. Nevertheless, it is the first one to be caused by El Tor biotype, which originated from a strain in the Middle East; although it took it multiple years to gain pathogenic and cause the outbreak that would start the seventh pandemic. In the next decade it roamed through the Middle East and reached Africa, where it caused one of the most severe epidemics. The relevance of this pandemic is that it is one of these outbursts that spawned the current epidemic in Peru
History of the topic
Origin of the outbreak:
In 1990, more than 90 percent of all cholera cases reported to WHO were from the African continent. But in 1991, cholera appeared in Peru, returning to South America after being absent for 100 years. It killed around 3,000 people in Peru in this first year and subsequently spread to Ecuador, Colombia, Brazil and Chile, and then Central America and Mexico.
The cholera epidemic in Latin America was originally suspected to have come from Asia and to have been facilitated by the discharge of contaminated ballast water into Peruvian ports by international trade ships.
Transmission methods:
After initial outbreaks, cholera can disappear or become endemic and remain a public health threat. High attack rates are more common in areas with poor sanitation and inadequate water supplies. In previous epidemics, documented vehicles of transmission have included contaminated water, raw or undercooked shellfish and other seafood, moist-grain gruels, and leftover rice.
Cholera transmission is closely linked to inadequate access to clean water and sanitation facilities. Also contaminated food is one of the main transmission vehicles of cholera. In an epidemic the contamination source is mainly the feces of an infected person that contaminates water or food. The infection does not spread directly from one person to another which means that having contact with a person with cholera does not mean a person will become ill.
Regarding contaminated water and food in Peru, one of the most affected countries by this pandemic about 4,000 hectares of agricultural land on the Peruvian coast were irrigated with drain water and water from clandestine breaks in sewage lines was used to irrigate crops, such as cabbage, lettuce, carrots, and watermelon. The cholera bacteria can live in the environment in coastal water and rivers, this means that this virus can be spread quickly in places where drinking water supplies, and sewage are inadequately treated.
Since cholera spreads rapidly mainly in places where there is inadequate sanitation, peri-urban slums, some rural areas and camps for internally displaced persons or refugees, where minimum requirements of clean water and sanitation have not been met are some of the typical risk areas.
History of the topic
Treatment:
Cholera is an easily treatable disease. The majority of people can be treated successfully through prompt administration of oral rehydration solutions. Patients with severely dehydrated are at risk of shock and require the rapid administration of intravenous fluids, also they are given appropriate antibiotics to diminish the duration of diarrhea, reduce the volume of rehydration fluids needed, and shorten the amount and duration of V. cholerae excretion in their stool.
When the profuse watery diarrhea and vomiting associated with severe cholera are not treated, patients may die from dehydration in hours. Treatment with oral and, if necessary, intravenous rehydration can decrease death rates of severe cholera from 50% to 1%-2%. Therapeutic antibiotics can decrease the volume of stool produced. Mass chemoprophylaxis, vaccination, and quarantine have proven ineffective and can divert valuable resources from efforts to ensure adequate treatment of cases and control of transmission
Rapid access to treatment is essential during a cholera outbreak. Oral rehydration should be available in communities, in addition to larger treatment centers that can provide intravenous fluids and 24 hour care. With early and proper treatment, the case fatality rate should remain below 1%.
Zinc is an important adjunctive therapy for children under 5, which also reduces the duration of diarrhoea and may prevent future episodes of other causes of acute watery diarrhoea.
Past International Actions
1. RESOLUTION CD35.R17 CHOLERA IN THE AMERICAS(PAHO)- 23-28 September 1991
To urge the Member Governments:
a. To report any case of cholera immediately, in compliance with the International Sanitary Regulations;
b. In the countries as yet untouched by the epidemic, to strengthen capabilities for epidemiological surveillance, control of the quality of drinking water, basic sanitation and food protection and control, social communication, and to strengthen diarrhea control programs with emphasis on proper case management, public information, and health personnel training.
2. International Health Regulations(IHR)- 1983
a. PART II - NOTIFICATIONS AND EPIDEMIOLOGICAL INFORMATION i. Article 7 (a) in the case of plague or cholera, a period of time equal to at least twice the
incubation period of the disease, as hereinafter provided, has elapsed since the last case identified has died, recovered or been isolated, and there is no epidemiological evidence of spread of that disease to any contiguous area;
b. Chapter II—Cholera: Article 62 :1. If on arrival of a ship, aircraft, train, road vehicle or other means of transport a case
of cholera is discovered, or a case has occurred on board, the health authority (a) may apply surveillance or isolation of suspects among passengers or crew for a period not to exceed five days reckoned from the date of disembarkation; (b) shall be responsible for the supervision of the removal and safe disposal of any water, food (excluding cargo), human dejecta, wastewater including bilge water, waste matter, and any other matter which is considered to be contaminated, and shall be responsible for the disinfection of water tanks and food handling equipment.
3. TWENTY-FIRST REGULAR OAS SESSION SANTIAGO, CHILE June 3 - 8, 1991
RESOLVES:1. To note, endorse, and transmit to the Pan American HealthOrganization the observations and recommendations of the Permanent Council on its Annual Report, with particular emphasis on the need to give due attention to the outbreak of cholera in the region.
Past International Actions
4. FORTY-FOURTH WORLD HEALTH ASSEMBLY- 13 MAY 1991 -
a. CALLS UPON Member States and multilateral organizations to consider health and environmental issues as an integral part of development policies and plans and to allocate resources and to undertake action, accordingly, including health education and public information in order to prevent the risks of epidemics of this kind or diminish them, giving due attention to the situation and the needs of the population groups most at risk;
5. Report by the Director-General of the Implementation of resolution WHA44- 20 November 1991
a. The Global Task Force on Cholera Control was set up by the Director-General on 24 April 1991 to coordinate the Organization's global action in relation to cholera control, in cooperation with the regional offices.
b. Specific targets for 1992-1993 are: i. Each of the 30 most affected or threatened countries will have:
a. A national commission on cholera control;b. Written policies on control measures, including policies on case management,
vaccination and vaccination certificates, mass and selective chemoprophylaxis, water supplies and sanitation, food handling, tourism, cordon sanitaire and frontier controls, and international and domestic food trade;
c. Written plans for managing cholera cases, mobilizing emergency treatment services, providing emergency safe water and sanitation systems, and informing and educating the public;
d. An effective and efficient disease surveillance system in place; e. Health workers trained in the case management of acute diarrhoea, including
cholera; f. reference laboratories with adequate supplies and staff capable of identifying
Vibrio cholerae 01;
Past International Actions
6. Global Task Force on Cholera Control -1991
● Aimed at Coordinating the World Health Organization’s global action in relation to cholera control, in cooperation with the regional offices and several WHO departments at Headquarters level. To reduce mortality and morbidity associated with cholera and to reduce the social and economic consequences of cholera through: o Intensified cooperation in national control activities; o Enhanced information exchange; o Review and revise policy; o Intensified research efforts; o Mobilize financial resources; o Activate a global technical resource network.
● This partnership brings together UN agencies, governmental and non-governmental organizations, scientific institutions, and different departments and regional offices of WHO. It aims at coordinating activities for prevention, preparedness and response to epidemic enteric diseases at country and sub-regional level, and at providing technical support and training. Developing and disseminating standard guidelines and norms and gaining evidence on the use of new public health tools for improved control of endemic and epidemic diseases are also part of the Task Force responsibilities.
Bloc Positions
America: Countries with an uprising trend in cholera cases: countries in this situation, like Peru or Colombia, at the moment, are characterized by an increasing need of medical resources to treat the ill and requirement of prevention techniques at community and national levels to crusade the expansion of the disease. Disease. Member States in this situation are more likely to prioritize these needs before long term investments in disease prevention. On the other hand, countries that are in danger of infection such as Brazil and Bolivia, or those to which the epidemic is predicted to expand, like Central America. While there may not be an increasing need for medical resources, it might be important to suggest preventive action plans in case of an outburst. Nevertheless, these countries should be prepared to prioritize the requirement of resources to treat the ill, as its position may progress into those of affected countries. Asia: The Southeast Asia Region, which includes Bangladesh and India, has the largest populations at risk for cholera. In Southeast Asia and elsewhere, cholera is underreported and leads to an underestimation of the global burden of this disease. The World Health Organization estimates that officially reported cases of cholera represent only 5–10% of the actual number occurring annually worldwide because of inadequate laboratory and epidemiological surveillance systems and economic, social and political disincentives to case reporting. Cases of cholera officially reported to WHO in Southeast Asia do not include an estimated 500,000–700,000 cases labeled as acute watery diarrhea.
Africa: Cholera remains a major public health risk in the Region since the seventh cholera pandemic reached Africa in 1971, and the Region has faced regular large outbreaks in recent years. Major underlying causes of these outbreaks are poor environmental infrastructure, lack of health care services, lack of safe water and sanitation, and increased population movement. Complex emergencies, which affect several countries in the Region, further compound these risk factors.
Europe: On the 19th-century cholera epidemics, Denmark provides an excellent source as its population was not exposed to cholera, likely due to a quarantine at the Danish coast. Finally, in 1853, a year after the quarantine was lifted, a single and catastrophic outbreak hit the nation, including Copenhagen. The outbreaks were largely unmitigated, as contemporary physicians had no effective medical treatment and the miasmatic theory was the dominant paradigm for cholera transmission. While others have conducted detailed epidemiological studies of 19th-century cholera outbreaks in several European cities. By the middle of the 19th century, Soho had become an insanitary place of cow-sheds, animal droppings, slaughterhouses, grease-boiling dens and primitive, decaying sewers. And underneath the floorboards of the overcrowded cellars lurked something even worse, a fetid sea of cesspits as old as the houses, and many of which had never been drained. It was only a matter of time before this hidden festering time-bomb exploded. It finally did so in the summer of 1854.Dr Snow took a sample of water from the pump, and, on examining it under a microscope, found that it contained "white, flocculent particles." By 7 September, he was convinced that these were the source of infection, and he took his findings to the Board of Guardians of St James's Parish, in whose parish the pump fell. Though they were reluctant to believe him, they agreed to remove the pump handle as an experiment. When they did so, the spread of cholera dramatically stopped.
Bloc Positions
Case Studies
Perú
cholerae was detected in at least three water supply systems and in fluvial and coastal waters in several places of Peru.
The conditions of Peruvian rivers were so poor that 17 people died because they washed the clothes of an infected person that had died.
The Peruvian Ministry of Health began advising that all drinking water should be boiled, and all fruits and vegetables be washed with boiled water, since contaminated food was one of the main transmission vehicles of the virus. By March, the disease had an attack rate of 2.6% and had spread to neighboring countries such as Ecuador and Colombia.
Peru was the most affected country on Latin America, the first cases of cholera were reported in Peru on January 31 in Chancay and Chimbote and by March of 1992, Peru had already reported 400 000 cases of cholera and more than 3100 deaths. The contamination of water and inadequate sanitation helped to spread the virus in the country. Approximately 143,325 people obtained drinking water from standpipes, clandestine breaks, or tanker trucks, and many people stored water in barrels as a backup. Many municipal water supply systems had high rates of fecal coliform bacteria, indicating contamination of the water and insufficient chlorination. V.
In the case of Lima 25% of the population drank water transported by trucks and in the centre of Lima 400 families live with only one sink. Regarding the city of Iquitos, the primary drinking water source was a nearby river, from which water was pumped to the city, approximately 50% of the residents of Iquitos accessed drinking water from in-home taps, 33% public standpipes or shallow wells, and 18% directly from the river. Moreover, in Trujillo the main city drinking water came from 43 wells drug 60 feet into the ground and engineers failed to realize the fact that 35% of the city's water was supplied by public standpipes or tanker trucks.
Bloc Positions
The war on ceviche
The Fishing Vice minister copied his example and also ate a plate of ceviche. The Health Minister had to quickly affirm, although diplomatically, that to eat raw fish is dangerous. He quickly accelerated the campaign for sanitary consumption. Moreover, all the infected people in Chimbote stated that they had eaten fish or ceviche before they had cholera.It is estimated that in 1991, the internal consumption of fishery products decreased by 33.6%, in relation to 1990. This led to fishermen stopping going to sea, lack of consumers and the sellers had a big number of monetary losses. The internal fishing had a loss or cost indirectly of more than 32 million dollars. Ceviche was one of the main affected dishes in the cholera epidemic because it is made from raw fish and it is not cooked, the measures were completely extreme to a point where the government of Lima confiscated plates of ceviche that were sold by street food sellers.
Brazil
The Health Minister recommended to all Peruvians that they should not eat ceviche, boil water before drinking it nor go to the beach. Only three days after this announcement, President Fujimori and his family took a beach vacation. The war came to a climax when after two weeks, President Fujimori visited the town of Pisco. He ate ceviche in front in public and stated that his family never stopped eating fish during the outbreak of the virus.
Brazil reported in the State of Amazonas on the border between Peru and Colombia its first case on April 10. In July and August, the cases multiplied by eight, as the disease began to spread eastward along the Amazon. By November, cholera had left Manaus, the capital of the State of Amazonas, behind and reached at least three neighboring states. In December, the disease was present in Belém, capital of the State of Pará, located on the Atlantic coast, so that in 10 months the epidemic had crossed the 3,500 kilometers wide of the South American continent.
Bloc Positions
Colombia
Colombia reported its first case near the Pacific meridional seaside on March 10th, 1991 and by the end of the year 28 states and municipalities were already infected including in its totality the Pacific and Caribbean coasts. The cholera incidence surpasses 500 cases during 3 of the last 4 weeks of the year, 95% of the cholera cases are in the 12 coast departments were inhabit the 49% of the total population, there were 11 979 cases and 207 diseases, however it was spread with less intensity than Peru and Ecuador.
Chile
Chile reported 41 cases between April 12 and May 23, 33 of which occurred in the area of Santiago; there were no cases after May. Apparently, the government was able to control the outbreak by limiting the distribution and consumption of raw vegetables. However, later that year, V. cholerae was detected in sewage water from different parts of Chile, which indicated that the infection could persist and could reappear as a clinical disease.
Ecuador
First case was informed on March 1st, 1991 in a prawn fishermen community that worked in Peruvian waters, cholera spread to all the provinces and there were 46 320 notificated cases and 697 diseases. Even though the amount of cases decreased after May, high transmission rates continued during July and August and new outbreaks were registered in seaside provinces and in Guayaquil, which is the main port in the country. However, the incidence of cholera started to increase in December, surpassing 500 cases per week.
Questions A Resolution Must Answer (Q.A.R.M.A.S)
1. How can Cholera transmission be controlled in rural zones, especially the ones that do not count with basic sanitary? Should community level measures be applied to contain the spread?
2. What economic measures should the affected countries by Cholera should adopt in order to mitigate as much as possible the consequences of the pandemic?
3. Which strategies should governments apply to create awareness in the population effectively? Taking into consideration the power of the media, how it should be used in order to reach all sectors of the population?
4. Which role will the Pan American Health Organization (PAHO) and each local Ministry of Health play in the eradication of the virus? Should they partner with the private sector or NGOs to improve the distribution of oral rehydration therapy rather than distributing it by themselves?
5. What medium and long term actions need to be taken to prevent future outbursts of cholera and other possible viruses?
6. To what extent can we prevent primary transmission and outbreaks in new countriesby Vibrio cholerae? Which specific measures should be taken to achieve it regarding commerce and transport?
Position Papers Guidelines
As part of the conference every delegation must attach a position paper, which must be written in Times New Roman size 11 with simple space and an extension of no longer than one page. The document should follow the following structure:
● Heading: In this section it should be included:○ Coat of arms and the official name of the country○ Committee’s full name ○ Delegate ́s full name ○ Delegation ́s/school’s name
● First paragraph: In this paragraph it is crucial that delegates analyze the current situation and express their respective policies and projects related with the issue. Here there are some recommendations:
○ Using statistics and proportions helps to create an interesting reading and improve the quality of the arguments.
○ Including the names and their effects of the current projects that your country has implemented with the aim of demonstrating deep and concise research.
○ If you include a subtopic about the issue, it is expected to be solved with your proposals in the last paragraph.
● Second paragraph: ○ It must include the relevant past UN actions (pacts, resolutions or engagements) that are related
with the issue. ○ Besides that it is recommendable to analyze the effectiveness of these actions and if they were
significant in the reduction of the issue.
● Third paragraph: It is the most important paragraph of the document because it is the section where your proposals to solve the issue are presented.
○ The proposals must be innovative, this means that the plan currently does not exist. However if your country developed an effective plan that worked in the past it is recommendable to imitate it and adapt it to the context of every country.
○ The proposals must be complete in the sense of having in mind the aspect of funding, supervision and participation of all sectors of the country.
Position Papers Guidelines
References: ○ All information must be referenced at the end of the document following APA rules.○ The list of references could be either at the footnotes or in another page. ○ You need to bear in mind that if you do not cite your sources it will be considered as plagiarism
and it will affect negatively in your final evaluation.
The format of the document must be Times New Roman size 11 with regular margins and single spacing. And it must be no longer than 1½ pages, including references.The deadline for position papers is April 8 at 23:59 and must be sent to the following e- mail: [email protected]. It is important to know that if you do not send a position paper you will not be eligible for an award.
Final recommendations
Congratulations on finishing the Study Guide! At this point your knowledge about cholera and its implications is on a superficial level, that is to say that you have acquired basic concepts regarding this complex and interesting topic. However, it is essential that you expand your borders by doing more research beyond the references provided by the study guide. The success of your participation in this committee is directly dependent on your level of research and you have to solve this multisectorial issue.
In order to create a more dynamic and complete debate, the dais expect that the topic is solved in a holistic way. Being said that, we expect to hear different multisectorial and viable solutions. Do not focus at all times on a specific aspect such as education and awareness campaigns because the debate will turn monotonous and different sub topics would be ignored.
Finally, we can only say that we expect an incredible committee alongside the level of delegates at all aspects. If after reading the study guide you have any doubts or a section was not clear enough, do not hesitate to send us an email so we can answer your questions (we will try to answer them as soon as possible)
Best of luck!Luciana, Jorge & Daniela
References
1. Encyclopaedia Britannica. Cholera: Cholera through history » Seven pandemic Encyclopaedia Britannica Online2009. Available from: https://www.britannica.com/science/cholera/Cholera-through-history
2. World Health Organization. Guidelines for cholera control. Geneva: World Health Organization, 1986; publication no. WHO/CDD/SER/80.4 Rev 1.
3. Reiff, F., 1992. Cholera in Perú. World Health, [online] (VII), pp.18-19. Available at: <https://apps.who.int/iris/bitstream/handle/10665/52728/WH-1992-Jul-Aug-p18-19-eng.pdf?sequence=1&isAllowed=y>
4. UN DHA. (1991, February 12). Peru Cholera Epidemic Feb 1991 UNDRO Situation Reports 1 - 9 - Peru. ReliefWeb. https://reliefweb.int/report/peru/peru-cholera-epidemic-feb-1991-undro-situation-reports-1-9
5. World Health Organization. Guidelines for cholera control. Geneva: World Health Organization, 1986; publication no. WHO/CDD/SER/80.4 Rev 1.
6. Evolution of Seventh Cholera Pandemic and Origin of 1991 Epidemic, Latin America. (2010, July 1). PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321917/
7. WHO. (n.d.). Cholera. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/cholera
8. Brief History of WHO | Credible Voice: WHO-Beijing and the SARS Crisis. (n.d.). Credible Voice. https://ccnmtl.columbia.edu/projects/caseconsortium/casestudies/112/casestudy/www/layout/case_id_112_id_776.html#:%7E:text=The%20World%20Health%20Organization%20was,children’s%20health%2C%20nutrition%20and%20sanitation.&text=It%20also%20classified%20diseases.
9. The Editors of Encyclopaedia Britannica. (n.d.). World Health Organization | History, Organization, & Definition of Health. Encyclopedia Britannica. https://www.britannica.com/topic/World-Health-Organization
10. Cólera en las Américas. (1992). David Brandling-Bennett, Marlo Eibel y Américo Migliónico. https://repositorio.cepal.org/bitstream/handle/11362/12809/NotaPobla60.pdf?sequence=1#:~:text=La%20epidemia%20de%20c%C3%B3lera%20de%201991&text=Se%20hab%C3%ADa%20detectado%20el%20V,propag%C3%B3%20al%20interior%20del%20pa%C3%ADs
11. PAN AMERICAN HEALTH ORGANIZATION. (1991, September). Cholera in the Americas. https://iris.paho.org/bitstream/handle/10665.2/1548/CD35.R17en.pdf?sequence=1&isAllowed=y
12. Global Task Force on Cholera Control. (2013, March). https://www.who.int/cholera/task_force/1stWG_GTFCC_meeting_report.pdf?ua=1
13. CHOLERA (Implementation of resolution WHA44.6). (1991, November). WHO. http://apps.who.int/iris/bitstream/handle/10665/170490/EB89_22_eng.pdf?sequence=1&isAllowed=y
14. OAS. (1991, August). PROCEEDINGS VOLUME I. http://www.oas.org/en/sla/docs/ag03805E01.pdf15. The War on Ceviche. (2010, November 6). Blogspot.
http://birksnboots.blogspot.com/2009/11/ceviche-war.html.
