... The book highlights the success of oral rehydration therapy for cholera case management, and the futility of antimicrobial drug strategies because of drug resistance. Echenberg touches on the potential for vaccines, with appropriate caution, emphasizing that vaccination is no substitute for plumbing. Unfortunately, vaccines are often presented in a manner that entangles their weaknesses with those of antimicrobial drugs, underplaying the potential advantages that vaccines may have over drugs in dealing with outbreaks once they occur. It has taken cholera experts decades to advocate for vaccine use in high risk settings, culminating in World Health Assembly resolution WHA64.15 in May 2011, which urges that all states “give consideration to the administration of vaccines, where appropriate, in conjunction with other recommended prevention and control methods and not as a substitute for such methods.”

The most compelling arguments for vaccine use in conjunction with preventive interventions were published just as the book was being completed, and it is unfortunate that they were not included in this otherwise commendable analysis of intervention possibilities. However, Echenberg is to be commended for the strength of the key message of the book: that lack of potable water and sanitation, the factors that eliminated cholera from much of the world, is the principal reason why today’s cholera crisis (excluding complex emergencies, perhaps typified by the ongoing epidemic in Haiti) is largely African.

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