Table of Contents

Preface Introduction 1. Upheaval 2. Vibrio Cholerae 3. Rumors 4. Stealth 5. Hypotheses 6. Maps 7. Altered Reality 8. Journalists 9. Secrecy 10. Obfuscation 11. Speculation 12. Pandemics and South Asia 13. Report 14. Vodou and Cholera 15. Inquiry 16. Politics before Science 17. Nepal 18. Concealed in the Field 19. Quarantine and Isolation 20. The Wall Cracks 21. Answers 22. Sanitation, Water, and Vaccination 23. Struggles and Elimination 24. Rapprochement Epilogue

About the Author

Ralph R. Frerichs is Professor Emeritus of Epidemiology at UCLA.

Reviews

"All public health students should read this book for two reasons: first, for the in-depth story of the scientific investigation of the source of the epidemic; and second, for the story of the political resistance and barriers, both powerful and subtle,that Piarroux encountered... The description of Piarroux's investigation is fascinating."-Laura Price,International Quarterly of Community Health Education (September 2016) "The CDC discouraged journalists from asking about the epidemic's origin, telling them that pinpointing the source was 'not productive,' 'not central,' and would likely never happen. Its epidemiologists did provide a key detail early on, when they identified the strain in Haiti as having a recent South Asian origin-meaning it could have come from Nepal and not from South America, Africa, or anywhere else cholera was circulating at the time. The CDC refused to take environmental samples from around the [UN Peacekeepers] base or test the soldiers during the small window when doing either would have been worthwhile. All of this detailed in a damning new book by Ralph R. Frerichs called Deadly River."-Jonathan M. Katz, "The Killer Hiding in the CDC Map," Slate "Deadly River tells two fascinating stories. One is about epidemiological and molecular biology detective work. This work justified the growing certainty that defective United Nations procedures had allowed Nepalese peacekeepers to start a devastating cholera epidemic in Haiti. The second story is about how the UN, the WHO, elements of the Haitian government, and the CDC did their best to prevent these facts from coming to light. They told themselves that they did this to serve what they thought was the greater public good. They pushed forward scientists with an academic ax to grind who had theories congenial to their agenda. We are used to industrial interests 'manufacturing doubt' about 'inconvenient truths.' This second story shows that governments do it as well."-Dr. Raymond Richard Neutra, retired chief of the Division of Environmental and Occupational Disease Control, California Department of Public Health "Deadly River tells the story of how the lethal disease cholera found its way from the high valleys of the Himalayas to the tropical landscapes of Haiti, months after the devastating 2010 Port-au-Prince earthquake. This knowledge didn't come easy but was acquired through the dogged efforts of many investigators (a dedicated French epidemiologist, international infectious disease experts, molecular biologists, and journalists) all of whom were focused on finding the truth rather than accepting speculation or unproven theories. Ralph R. Frerichs's book is a fascinating read that also provides many insights into the strengths and weaknesses of human nature-curiosity, skepticism, stubbornness, ignorance, pride, denial, deception-all framed by a tragic event that has changed the lives of millions of impoverished people."-John J. Mekalanos, Harvard Medical School "It is beyond the scope of the present report to recount the analyses and conclusions of the various studies, but this task has been undertaken systematically in [Deadly River]. Its author, Ralph R. Frerichs, is Professor Emeritus of Epidemiology at UCLA and the book provides a painstaking and even-handed assessment of the scientific debates that have taken place. For present purposes, it must suffice to note that the book concludes that the peacekeepers were responsible for bringing cholera. In doing so, it systematically vindicates the conclusions reached by one of the first international experts on cholera to investigate the outbreak in Haiti, Dr. Renaud Piarroux. It also deplores what it describes as a 'misinformation campaign to protect the UN and the peacekeeping program.'"-Philip Alston, UN Special Rapporteur for Extreme Poverty and Human Rights and Professor of International Law, New York University, Report to the United Nations General Assembly (A/71/367, August 26, 2016)