* Partners in Health to start vaccinating in January
* Move follows months of debate over vaccine option
* Haiti's cholera epidemic is worst in world, expert says
MIAMI, Oct 19 (Reuters) - A U.S. NGO plans to start a ground-breaking cholera vaccination campaign in Haiti in January, it said on Wednesday, as experts warned that efforts to combat the year-old deadly epidemic were faltering badly.
Paul Farmer, co-founder of Boston-based Partners in Health (PIH), told a conference call that Haiti's cholera epidemic was now the most serious in the world proportionate to the size of the poor earthquake-ravaged Caribbean nation.
One year after the cholera outbreak began, close to half a million Haitians out of a population of more than 9.5 million have been sickened by the disease and more than 6,500 have died. The cholera started nine months after a 2010 earthquake wrecked the capital Port-au-Prince, killing tens of thousands and leaving many more homeless.
Farmer acknowledged that the cholera epidemic began and expanded even as one of the largest international humanitarian operations in the world was underway in Haiti to deal with the aftermath of the catastrophic Jan. 12 2010 quake.
"It's possible because of a list of flaws in the way that the humanitarian machine works ... It's possible to have right under the noses of a very vast operation a neglected problem that then explodes into a large one," he said.
For months after the epidemic began, Haiti's health authorities and the World Health Organization/Pan American Health Organization argued that logistical challenges and fears of social unrest made a nationwide cholera vaccination program impractical and unwise. There were also doubts about the effectiveness and availability of cholera vaccines.
But Farmer said with medical NGOs increasingly withdrawing from the cholera treatment fight in Haiti, partially because of lack of funding, it was essential to add a serious vaccination program to other important anti-cholera measures such as establishing clean water and sanitation facilities.
"We're not trying to win an argument ... we're trying to get this epidemic slowed," said Farmer, who is also chair of the Department of Global Health and Social Medicine at Harvard Medical School.
He noted that the WHO/PAHO had since swung behind the idea of a cholera vaccination program in Haiti.
AID "ATTENTION DEFICIT"
Working with a Haitian medical NGO, PIH planned to start administering an oral vaccine in January, aiming to treat 100,000 people in two areas -- one an urban zone of the capital Port-au-Prince and the other a rural community in the central Artibonite region that was the epicenter of the epidemic.
The vaccine used would be Shanchol, which is produced by Sanofi Aventis' India-based division Shantha. Currently some 200,000 doses of this vaccine were available to be purchased, PIH officials said.
"If we can get started and show it's feasible, we will be able to gain more leverage ... already there's momentum around this, it will help others to get on board," PIH's Senior Health and Policy Advisor Louise Ivers told the conference call.
Farmer said he and Ivers were campaigning to raise the funds needed to support the limited vaccination program.
PIH announced the vaccination initiative as a chorus of health charities, including Doctors Without Borders and International Medical Corps, warned that anti-cholera efforts in Haiti were running out of financial support and momentum.
"Even though the international community has pledged huge sums of money to assist Haiti, thousands of Haitians are still getting sick from cholera every week and some are still dying," MSF Haiti mission chief Romain Gitenet said in a statement.
PIH's Director of Policy and Advocacy Donna Barry said that out of $4.6 billion committed by international donors to Haiti's post-quake recovery for 2010-2011, excluding debt relief, only 43 percent had been actually disbursed.
U.N. agencies were also reporting that, due to a withdrawal of aid partners, levels of access to clean water and sanitation in camps housing 600,000 homeless quake survivors had declined significantly compared to earlier this year.
Farmer attributed this to what he called the "ADD" (Attention Deficit Disorder) of international humanitarian operations, in which the funding and work of aid groups in a particular country dropped off after initial intense activity.
Cholera is a water-borne disease transmitted when bacteria-contaminated human fecal matter gets into water, food or onto someone's hands. It can cause severe diarrhea and vomiting and kill in hours by dehydrating victims.