Dengue: From Panic to Prevention

Each year in India, dengue appears epidemically, wreaks havoc among our settlements and citizens, and takes an avoidable toll on life and resources. Given that a single unsuspecting mosquito bite is all it takes to be infected, dengue makes easy indiscriminate targets of both the rich and the poor. As a result, at least for a short while, the conversations around public health and our health system take on an urgency that is usually absent from our discussions.   

As dengue threatens the health of all, crucial questions are being raised: What is the government doing to ensure the onslaught of this disease is prevented or contained? How can our health system become resilient enough to cope with disease outbreaks and epidemics? Why doesn't the government fast-track the development and procurement of a dengue vaccine?

All of these questions are as predictable as they are valid.

Valid because they locate and constructively point out the problem with implicit solutions. They are predictable because these almost proverbial questions about public health are always raised when the well-being of the well-insulated is also under threat.

While it is true that the dengue outbreak is alarming - in the national capital region close to 3,800 cases have been recorded out of which 3,000 were registered in September alone and nationally, 21,000 cases of the vector-borne fever have been logged so far for 2015 - it still doesn't come close to being as ruthless as other preventable diseases like pneumonia and diarrhoea.

In 2014, close to 3 lakh children under the age of five died from pneumonia and diarrhoea, making them the largest killers of children under the age of five. Therefore, it is a bit surprising that, when public health experts and scientists; health activists and health workers raise the same questions on diseases such as pneumonia and diarrhoea, which claim the life of a child every two minutes, the response amongst the public, in contrast, is rather muted. Preventive vaccines are available for both these diseases, but so far only in the private sector. Till recently, we have been slow in introducing them in the public sector. The Government is now planning to introduce a safe, indigenously produced vaccine for rotavirus diarrhoea in the public sector and yet, some people are objecting for reasons that are not based on scientific evidence.

As the polio campaign has shown us, investing in vaccines is critical and also makes economic sense for India. They positively impact last mile health by preventing infection at the very outset, and in turn avert recurring sickness, death and unnecessary social and economic costs. Analyses have also shown that vaccines can not only help save lakhs of lives each year but also help avoid substantial medical costs to the families and the exchequer. In many cases vaccines offer 'herd protection', thus lowering susceptibility to disease and consequently affording its health system, resilience. Arguably, vaccines are one of the most cost-effective solutions in the history of health and development. In principle, we must advocate for safe and life-saving vaccines at large - not only against seasonal killers such as dengue but also against persistent killers such as pneumonia and diarrhoea, which especially target the unprotected poor.  

The dengue outbreak, however, while most unfortunate, is teaching us an invaluable lesson. Those whose near and dear ones have been afflicted by dengue are accepting, even if retrospectively, the potential benefits of prevention. It has galvanized public opinion in favour of measures such as eliminating breeding habitat, rescheduling outdoor activities, wearing protective materials - some of the preventive measures that effectively discourage this disease. At the same time, a very strong case is being made for the availability of a dengue vaccine. A similar case should be made for all diseases that are preventable and cause huge losses of life.

Public discourse on health must maintain this momentum that the dengue outbreak has set in motion. The inclusion of preventive tools in our health programmes, especially advancing India's Universal Immunization Programme as an efficient and the largest programme of its kind in the world, must be prioritized and remain on the top of the nation's health agenda.

(Anjali Nayyar is Senior Vice President, Global Health Strategies (GHS) and  has more than 18 years of experience in global health issues.)

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