High time to wage war against vector-borne diseases

By Ramesh Kumar Raja
In Health
October 6, 2016
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India must take a lead from its successful polio eradication program to eliminate the viral disease against all oddshealth-care

It’s déjà vu all over again in India. From Delhi to Kolkata and Mumbai to Chennai, large swathes of the country have  been laid low by vector-borne diseases, thanks to political apathy and administrative recklessness to contain them. Although diseases like malaria, filariasis and kalaazar  are no longer fatal like they used to be and their incidence has also decreased significantly, new vector-borne infections like dengue, chikungunya and acute encephalitis syndrome (AES) are on the rise and claiming lives like never before. As vector species rage across the country, killing and incapacitating thousands, the crisis has exposed the poor preparedness of the civic authorities and fragilities of the health system in the country of over 1.2 billion population. What could be worse than a health service infrastructure crippled by lack of hospital beds and massive short supply of doctors and paramedics? Definitely, a pathetic situation for  HEALTHCARE the nation aspiring to achieve an eight per cent growth rate.

Forget other parts of the country. New Delhi, the national capital, peculiarly, is the worst hit, where there seems to be no let-up from the viral onslaught. Dengue claimed over 20 lives in the city with the total number of cases going up to 1,692 this year. August alone accounted for 652 cases whereas 921 cases were registered in September. However, many experts say real numbers are much more than official ones. Last year, the city saw a staggering 15,867 dengue cases – the worst in two decades – with the disease claiming 60 lives, as per municipal reports. In 1996, a severe outbreak of dengue had occurred in Delhi when about 10,252 cases and 423 deaths were reported. While dengue cases have gone mild this year, chikungunya cases in this city of 18.6 million have spiralled up to over 2,600 with 1,568 of them being recorded in the second week of September, according to a municipal report, marking a massive rise of nearly 150 percent from the previous count. So far, chikungunya has claimed over 15 lives in the city (though many say government figures are falsified to underreport fatalities) turning on its head conventional medical knowledge that the disease is not fatal. There’s also a mystery fever going around with symptoms akin to dengue. Recently, when a 30-yearold  person succumbed to malaria, the city recorded its first death from the disease in five years.

health-care1The rest of the country is not getting on any better. According to data released by the National Vector Borne Disease Control Program, around 12,255 cases of chikungunya  had been reported across India as of August 31 this year, when the census was last done. Karnataka in southern India tops the list with over 9,000 cases, while Maharashtra and Andhra Pradesh recorded 839 and 492 cases respectively.

According to Dr Navin Khanna, a dengue researcher at governmentrun International Centre for Genetic  Engineering  and Biotechnology in New Delhi, India is today the epicentre of the global epidemic of dengue, sheltering the largest number of dengue infections in the world. Dengue, as per Khanna, had become hyper-endemic in the country, whose incidence had increased 30 fold in the past five decades. Over 99,000 dengue cases were reported all over the country last year. The disease is stretching the already strained healthcare system year after year.

Some of the inconsistencies in data could be due to the fact that the government records only laboratory confirmed cases as dengue, with a very large majority of cases going unreported, and seen as routine viral infections. The underreporting has major impact on the way dengue is treated, since  repeat infections, usually due to a different strain of the virus, can be far more devastating as compared to the primary infection.

Sheer numbers make it imperative that public health measures aimed at controlling the breeding of mosquitoes are adopted. There is no way a hospital system can be designed to cater to such gigantic numbers. WHO experts warn that dengue is the fastest growing vector-borne disease in the world and climate change will only aggravate the situation.

One of the most disturbing trends in India relates to AES, commonly known as Japanese encephalitis (JE), which has become rampant since 2005. The health ministry has documented over 4,400 cases of JE and 786 JE-linked deaths between 2013 and 2015, most of the cases clustered in Assam, Bengal, Bihar and Uttar Pradesh. This year, until August 31, Bengal reported 91 cases and 18 deaths, while Bihar reported 43 cases and nine deaths. While the JE virus is transmitted through mosquito bites, the diagnosis of the encephalitis has been challenging because of simultaneous outbreaks of what public health experts call acute encephalitis syndrome in these states. AES is a group of neurological diseases, also called brain fever, caused by wide range of viruses, bacteria, fungus, parasites, chemicals and toxins. Despite introduction of vaccination for Japanese encephalitis virus, the cases of JE have not decreased significantly.

One of the principal causes for failure of the National Vector Borne Diseases Control Program (NVBDCP), which the government had launched in 2003, is that it has not been fully utilising the planned budget for the control of vectorborne diseases, even as the budget  allocated by the Centre to the states  and  Union Territories for VBD has declined by 14 per cent since last year. The budget allocated in 201415  was Rs 541 crore where as Rs 463 crore is allocated in 2015-16 for VBD control. To prevent a large scale dengue epidemic, like the one in Delhi last year, the NVBDCP should be well-funded and well implemented.

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Moreover, there is no cooperation between different government ministries and departments. The program, formed under the Union Ministry of Health and Family Welfare, works to coordinate with other government agencies to reduce VBDs in India, besides providing healthcare services. The Union Ministry of Drinking Water and Sanitation is required to ensure clean habitation and water for consumption. The Union Ministry of Human Resource Development has to work for awareness among students. Research agencies involved need to find causes of the diseases and solutions. However, most ministries and government departments work separately, missing an all-inclusive methodology to reduce VBDs. The NVBDCP must concentrate on building cooperation and also try to understand the changing trend in VBDs to formulate better strategies.

Unfortunately, the current state of affairs paint a rather grim picture of a country already struggling with various other medical miseries. As per Indiaspend.org, a data-driven, public-interest journalism non-profit organization, millions of Indians cannot access India’s overburdened hospitals and inadequate medical facilities. The country remains nearly 500,000 doctors short of reaching the WHO norm of one doctor per 1,000 citizens. What’s more, the successive governments seem to have done little to upgrade primary health amenities. Public awareness campaigns are limited, and often disappointing. The attention remains mostly on fumigation.

While health systems across Indian states is under huge pressure, Sri Lanka just joined Maldives as the second South Asian country to eradicate malaria. When our neighbours could succeed in preventing this annual outbreak of gloom, why can’t we? India needs to readjust its healthcare urgencies and lay emphasis on preventive measures, in order to realise its goal. Since a vigorous public health system acts as the first line of defense by averting outbreaks, the nation’s approach to healthcare needs to take a comprehensive view and pay more attention to wider elements of health such as sanitation and safe drinking water. Generating finance should not be an issue now as India has a standalone  Swachh Bharat cess to raise resources for sanitation. What India lacks is vision and accountability. Beyond putting catchy slogans, the governments lack the determination to act instead of simply passing the buck from one party to another. Only recently, Aam Aadmi Party-led Delhi government and the Lieutenant Governor Najeeb Jung were at odds with each other during the dengue chikungunya  controversy. We must take a lead from India’s successful polio eradication program how we eliminated the viral disease against all odds. We can repeat the success story again if government leaders, small and big, at the central, state and district levels cooperate on fight against the vector-borne diseases.

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