Dengue in Pakistan: what drives the epidemic’s resurgence?
Looking at data emerging from different sources, Pakistan is in the grips of the worst ever dengue epidemic to date. Around 50,000 people tested positive by mid-October and the epidemic has claimed 250 lives so far, with Islamabad and Rawalpindi the worst affected cities with 25,000 cases reported from the twin cities alone.
Along with malaria, dengue is one of the world’s leading mosquito borne illnesses, and infects tens of millions of people around the world. Dengue virus is transmitted by Aedes mosquitoes, which are highly sensitive to environmental conditions. Rainfall, humidity, and temperature are all critical to the survival and reproduction of the mosquito. Higher temperatures coupled with humid conditions minimize the time required for the virus replication and dissemination in the mosquito.
According to research published in the journal of clinical epidemiology, climate change will be one of the leading causes for an increase in the proportion of global population at risk of dengue fever. However, this is not the only reason for the outbreaks of the epidemic. There are many environmental and social factors contributing to the increase of the disease. Rapid urbanization, lack of, or poor health services, ineffective surveillance and a lack of political will are all linked to the increase of dengue cases.
World Health Organization (WHO) in it’s Dengue Prevention and Control Strategy 2012-2020 described dengue as a “neglected” tropical disease due to a lack of global coordination efforts, research and political will, which seems to ring true for Pakistan in the current scenario.
The biggest failure on the part of the concerned authorities was a delayed response to the spread of the epidemic. They had a more reactive approach instead of a proactive one, and they could have prevented the loss of precious lives.
Dr. Mehreen Mujtaba
In Pakistan, the summer of 2011 saw an outbreak of dengue in Lahore that claimed 300 lives and 14,000 people tested positive for the disease. At that time, little was known about the epidemic and there was next to nothing in terms of surveillance and early warning systems in place to cope with the outbreak. However, regional cooperation between Sri Lanka, WHO and the government of Punjab saw the formation of the provincial and territorial dengue monitoring and coordination committees, and as a result the data for the past few years showed a downward trend in the epidemic and the number of cases fell to somewhere around 2,000 during the summer months from 2016-2018 according to data compiled from the National Institute of Health (NIH).
Then why are we seeing a sudden resurgence of the epidemic and that too in such a vicious way? There are a few factors responsible for this, the foremost being the utter negligence on part of the health departments of the current government to use proper fumigation during the larvicidal stage of the disease. There is a lack of and poor allocation of funds for procurement of medicines, and a lack of availability of specific medication for the treatment of dengue virus, despite the fact that Sanofi Pasteur, the vaccines division of the multinational pharmaceutical giant, recently developed a tetravalent dengue vaccine licensed for clinical use in several epidemic countries.
Apart from this, in my opinion, the biggest failure on the part of the concerned authorities was a delayed response to the spread of the epidemic. They had a more reactive approach instead of a proactive one, and they could have prevented the loss of precious lives. There’s also no accounting for the lack of technical and operational preparedness, despite the fact that the present government had a blueprint from their predecessors on how to deal with the situation. Prayers and amulets alone cannot combat diseases, as so eloquently preached by the deputy commissioner of Toba Tek Singh in Punjab, and a proper roadmap is required to deal with such situations.
A lot needs to be done to ensure that the country is not in the throes of a similar or worse situation next year. Spraying the vector sites at the onset of the season, disseminating knowledge on preventive methods at the beginning of the summer months, availability of nets, repellant creams and proper medication at the basic as well as district health levels could ensure we don’t see the same data again.
– Dr. Mehreen Mujtaba is a freelance consultant working in the areas of environment and health.
