Combating the epidemic

Kerala, Tamil Nadu have shown the way on public health issues

India is facing one of its worst multi-disease epidemics in recent history. This has already affected nearly 50,000 people and caused over 60 deaths in different states. Worse still, the peak phase for seasonal diseases such as dengue and chikungunya has only just begun. It will continue till October and the disease toll is bound to mount further unless effective steps are taken to curb the vector population and ramp up health care services. Adding to this menace, the dreaded Zika virus has also arrived on the scene with a few confirmed cases already being recorded in the states. What sets the current epidemic apart from the usual single malady-based outbreaks is the co-circulation of more than one strain of dengue as well as chikungunya, which makes precise diagnosis and treatment all the more cumbersome.

Though the national capital region, where the incidence of these afflictions is swelling relentlessly, is hogging much of the media's attention, other states are not far behind. West Bengal, Odisha, Kerala, Uttar Pradesh and Telangana are among the other badly hit states. West Bengal alone has recorded over 5,600 cases with 24 deaths. The fear is that the unreported and unrecorded cases of these ailments are several times higher. A recent inter-institutional study, in which Delhi's National Institute of Health and Family Welfare and Madurai's Centre for Research in Medical Entomology participated, had concluded that for every officially reported dengue case at the national level, about 282 remain unreported. A common feature of the current sickness profile is that these infections are vector-borne, spread by mosquitoes, notably the aedes aegypti. A mitigating feature, however, is that the circulating strains of these viruses, except dengue, are not too virulent, and tend to subside on their own. But these viruses are highly debilitating and, therefore, cause considerable economic loss, besides human suffering, by impairing the work efficiency of the affected persons for weeks.

Worryingly, the strategies being followed to combat the health crisis are woefully inadequate. Creation of awareness among people to prevent mosquito breeding at homes and to guard against mosquito bites is important and must be pursued, but this alone will not be enough. Civic authorities cannot abdicate their responsibility to curb propagation of mosquitoes in public places, which poses a greater danger than domestic breeding. Also, fogging alone will not suffice even if done frequently. It can, at best, kill adult mosquitoes, but cannot destroy their eggs and larvae to end the spread. Spraying a pesticide in the breeding habitats is far more effective. Biological control through natural enemies of mosquitoes, including parasites, predators and larvae-consuming fish, has been tried out with reasonable success in other countries. Sri Lanka has become mosquito-free by using a mix of several anti-mosquito strategies.

Useful lessons must be learnt from the island nation's experience, but there are lessons within the country as well. Kerala and Tamil Nadu have shown that expansion and upgradation of health care infrastructure are indispensable for coping with such recurring public health issues. Nearly two-thirds of the country's medical facilities are in the private sector and not easily accessible by the average Indian. This leaves the poor at a great risk of not receiving proper and timely treatment. The public health system must provide an alternative to them.