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In Haiti, thousands of people are ready and waiting to get vaccinated against cholera. The vaccine is sitting in coolers. The teams are all trained. A hundred thousand people have signed up. It's a mass vaccination project, something that's never been done before in the midst of an ongoing cholera epidemic.

And there is growing urgency. Cases are beginning to climb with the coming of the rainy season. But as NPR's Richard Knox reports, the vaccination campaign is bogged down in bureaucratic red tape.

RICHARD KNOX, BYLINE: Cholera is an ancient disease people in developed countries haven't had to worry about since the 1800s, in the days before municipal water supplies and sewage systems. But here in Haiti, there are few clean water and sewage systems, and cholera is everywhere, especially in places like this. It's called Cite de Dieu - the City of God. It's one of the worst slums in Port-au-Prince, Haiti's capital.

UNIDENTIFIED WOMAN: (Foreign language spoken)

KNOX: A health worker with a bullhorn meanders through the narrow streets. Avoid cholera, she says. Get vaccinated.

People in this community are anxious to get vaccinated. More than 40,000 people are packed into tiny dwellings. No running water, no latrines. We hop over a ditch in the dirt street. It's filled with bilious green water - an open sewer.

Nadia Simone lives right next to it. Last year during the rainy season her young daughter got very sick with cholera.

NADIA SIMONE: (Through translator) Don't talk about cholera. It's killing people.

KNOX: An army of health workers has already gone door-to-door, telling people the facts about cholera and the vaccine, painting house numbers above every door, entering everybody's name and age and willingness to be vaccinated into smartphones. And like Nadia Simone, almost everybody has said yes.

SIMONE: (Through translator) All my children will be vaccinated, because I don't want cholera to come back to my house.

KNOX: Our guide to the City of God is a young Haitian doctor named Vanessa Rouzier. She works with a medical group called Gheskio. It's organizing the vaccination campaign here. They had planned to be finished before the spring rains. That's when widespread flooding brings cholera directly into people's homes.

VANESSA ROUZIER: When it rains, everything mixes. It becomes a soup, which is a perfect breeding ground for every diarrheal diseases, cholera included.

KNOX: So you can't get away from it, basically?

ROUZIER: No, when it rains, the houses get flooded and people are up to their knees in water and they just have to wait for the water to recede.

KNOX: People will need two doses of the vaccine spread over several weeks. They could have been finished with the first round by now. But they're still waiting for the government to sign off on the project. Dr. Rouzier is frustrated by the delay.

ROUZIER: We know it's going to rain. We know it's going to flood, so we're afraid that we're wasting precious time.

KNOX: She takes me to the place where people go when cholera strikes.

ROUZIER: (Foreign language spoken)

KNOX: We wash our hands in chlorine water before going in. It's a long army tent lined with cots. At the moment, there's only one recovering cholera victim. But during last spring's rainy season, this place was jammed with desperately ill patients.

ROUZIER: It's shocking to see somebody dying of dehydration. I saw a young 20-year-old collapse in front of me because of paralysis because he had lost too much potassium. Healthy strapping 20-year-old, this is unheard of.

KNOX: Rouzier worries that if they don't start vaccinating soon, this tent will be full once again. Some critics of the vaccination project say it's better to focus on providing clean water and toilets to communities like this one. Rouzier says Haiti has to do both.

ROUZIER: Fixing the sanitation problem and giving access to potable water is the answer. But let's be realistic. When is that going to happen? And how many people can we allow to die in the meantime?

KNOX: The tragedy is, cholera was unknown in Haiti until recently. Then 10 months after the devastating earthquake of 2010, it appeared with explosive force. I asked our translator, Jean Magloire, to show me the place where it began.

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KNOX: It's a 3-hour drive away, up in the mountains of Haiti's central plateau.

JEAN MAGLOIRE: This is where it all started, by dumping waste here from the U.N. camp.

KNOX: It's a sleepy-looking United Nations encampment on the bank of a winding stream. There's strong evidence that peacekeeping troops stationed here brought the cholera germ from Nepal. And it spilled into the stream from a leaky latrine, and then into the Artibonite River, Haiti's longest.

The disease spread with astonishing speed. Within a week of the first case, Dr. Patrick Almazor says desperately ill cholera victims were overwhelming the hospital where he works in Saint-Marc, 50 miles downstream.

PATRICK ALMAZOR: I remember the second day of the outbreak. We saw 800 patients in here in all this hospital, like every single footage.

KNOX: Patients everywhere.

ALMAZOR: Everywhere, everywhere.

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KNOX: Most of those patients came from tiny villages down-river from Saint-Marc. It's a beautiful countryside, criss-crossed by canals and irrigation ditches that nourish emerald-green rice paddies.

JONATHAN LASCHER: Right now we're at the base of the Artibonite, basically the mouth of the river where it meets the sea.

KNOX: That's Jonathan Lascher. He works for Partners in Health, a Boston-based group that's organizing the rural arm of the cholera vaccination campaign. This area was chosen because it's at high risk of a new surge of cholera since people here draw their water from the contaminated Artibonite River.

LASCHER: People here, they know they should be washing their hands with soap. They know they should be drinking treated drinking water. They know they should be using latrines. But that's not always possible. It's not a question of ignorance. It's a question of access.

KNOX: Vaccinating the entire population in this rural area will be very difficult. People here are scattered across a broad area with wretched roads. Health workers have already fanned out with tablet computers to take a complete census, sign people up, and give them blue vaccination cards.

ALEXIS ROCHENEL: (Through translator) This is my card.

KNOX: Rice farmer Alexis Rochenel is anxious to get vaccinated. Last year cholera hit his family.

ROCHENEL: (Through translator) My wife was sick. And she was treated at the hospital. I am going to call her for you.

KNOX: His wife, Fifi, is a slender woman wearing a brown turban. She says her brush with cholera was terrifying.

ESPERANTE FIFI JEAN-LOUISE: (Through translator) I first felt it in my head. I couldn't stand up. I couldn't stand up. I was near death.

KNOX: Although Fifi survived, more than 7,000 other Haitians have died of cholera so far. And well over a half-million have gotten sick.

There's hardly a village anywhere in Haiti that hasn't seen cholera. A previous Haitian government was against vaccination. The current government supports it. But one bureaucratic glitch after another has stymied the plan. If the project does go forward and shows that cholera vaccination is possible, proponents face another hurdle: expanding vaccination to millions of Haitians before next year's rainy season.

Richard Knox, NPR News.

GREENE: And Richard's piece on the cholera epidemic in Haiti was produced by Jane Greenhalgh.

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GREENE: This is NPR News.

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