Tackling dengue — too late, too little

Proper sanitation, advance planning to manage excess monsoon rain, would have perhaps prevented dengue’s advance.

Way back in 2006, I had written a scientific piece about how dengue was plaguing the Indian subcontinent. At that time, over 2,000 cases had been registered in Pakistan and the situation in India was equally grim, with over 5,000 cases so far. Five years on, and the situation could not have become more worrying and catastrophic.

Unofficial figures put the number of afflicted people in Punjab at 5,000, with 4,000 in Lahore alone. The death toll at the time when this was written was 24, and this figure is widely believed to be much lower than the actual number. The situation has come to such a head start that the Punjab government has ordered all schools to be closed for 10 days. Although dengue strikes every year, it has struck relatively early this year and with a much greater ferocity. The disease is thriving because of poor hygiene, relatively negligible control measures and the heavy monsoon that provided ideal breeding grounds — pools of stagnant water — for the mosquitoes.

There has been a public outcry now, as one would expect, but it is already quite late. The whole point of fumigation is to target the mosquito-breeding areas well in advance, when the eggs are being laid. Furthermore, there are reports that substandard fumigation kits are being used and this is not going to be of much help.

The media has also reported that a team of specialists is flying in from Sri Lanka to help manage the crisis. Dengue does not have any miraculous cure; there is no vaccine to date. We should not expect the Sri Lankans to come and take us out of this misery. The initiative and effort needs to come from us and this involves proper planning and preparation. Right from having a proper sewerage and water infrastructure, to having a clear and well-thought-out framework to combat dengue in the future, a lot needs to be done.

And while the cases may be concentrated in Lahore for now, there is no guarantee that the disease will not spread to other parts of the country. Many cases have already been reported from Sindh and Khyber-Pakhtunkhwa. It is worth mentioning here that there have been no measures from the government to announce and enforce travel restrictions — even if they were instituted, their effectiveness is debatable in the context of our healthcare system, where policy is hardly translated into concrete action. The fact that people have started heading back from Lahore or villages surrounding it, to other parts of the country post-Eid, means that it is likely that the disease will spread.

The heavy rains have overburdened an already fragile sewerage system, which in turn has created the ideal breeding ground for the dengue-carrying mosquito. Proper sanitation facilities devised in advance to properly dispose off the excess monsoon rain, would have perhaps prevented dengue’s advance, but these measures were not undertaken. The fact that Lahore had heavy rains for the second year running means the authorities should have been prepared, but this year’s experience suggests that they were anything but prepared for what was to come.

Considering the winter season is still some time away, dengue can create a lot of havoc. No doubt, expanded fumigation at airports to prevent spread to other cities is a well-intended but half-baked initiative to stall the spread of the disease to other parts of the country. The ongoing crisis should serve as an eye-opener for the future, and provincial governments need to initiate planning and thinking well in advance. Spending hard-earned taxpayers’ money on ineffective, last-minute strategies not only leads to loss of precious human life but also costs a lot. Prevention and planning before the crisis begins can save lives, as well as money. One can only hope this same scenario is not repeated next year.

Published in The Express Tribune, September 17^th,  2011.