Contending with epidemics

Govt must install national coordination mechanism to control epidemics, disease surveillance, prevention programmes.

Dengue fever reached epidemic proportions this year, particularly in Punjab. While this particular health menace will come to an end soon — due to changing weather, rather than any feat of our public health system — the threat of its recurrence next year remains high.

Pakistan is in fact considered increasingly prone to being hit by major epidemics due to a variety of reasons. These range from lack of access to safe drinking water and sanitation, inadequate health care facilities and low vaccination coverage. Recently a significant number of people have been displaced due to conflict or natural disasters and are residing in conditions of squalor. Such factors when combined provide a very conducive environment for the spread of infectious diseases.

Dengue itself seems to have become a serious problem in Pakistan, even though its prevalence was historically rare in South Asia. Since the past decade or so, however, dengue began making a regular occurrence, usually peaking in September and October. This is because an increasing number of the urban population lives cramped in slum dwellings, amidst unhygienic conditions with inadequate sanitation and drainage services, where dengue-carrying mosquitoes can breed rampantly.

Another potential cause of the spread of dengue is climate change. Like most other infections spread by intermediary organisms such as mosquitoes, dengue transmission are probably increasing with the rise in atmospheric temperature and humidity, which enables increased mosquito breeding.

According to experts, there are four different types of the dengue virus, and while infection with one type usually gives lifelong immunity to that type, it provides only short-term immunity to the other types of dengue. Moreover, subsequent infection with a different type increases the risk of severe complications. Given that so many people have been infected by one type of dengue already, it is imperative to take steps to prevent its recurrence, or else the mortality rates may increase significantly, if those who have already suffered from one type of dengue fever get infected by one of the other three types.

Though insecticide spray and fumigation was undertaken in major cities during the current outbreak, this attempt did not produce very effective results. Besides suspected adulteration problems, mosquitoes seem to be developing resistance to insecticides commonly used to eliminate them.

It is thus vital that our government put in place a national coordination mechanism for controlling epidemics, as well as a disease surveillance and prevention programme. Our health specialists need to develop overarching strategies to help reduce factors leading to transmission of epidemics. These should include interventions to minimise public health hazards and boosting the overall of our public health care system, much of which has also been extensively damaged in flood-hit areas.

But before any of this can be done, we need to address a more basic question of priorities. After all, the basic reason why Pakistan has amongst the most dismal health indicators in South Asia is due to the miniscule proportion of our national budget which gets allocated for health spending. The resulting lack of resources makes it impossible to meet the basic health care needs of a bourgeoning population, much less to contend effectively with epidemics. If no major changes occur within this broader context of reassessing our national priorities, more and more Pakistanis risk exposure to a host of life-threatening epidemics in the future.

Published in The Express Tribune, October 22^nd, 2011.