Monsoonal Epidemics: The Cost of Complacent Attitudes
Monsoon is here, and with the rise in greenery and levels of ground and surface water, it also brings a rise in the spread of communicable diseases, most notably, vector borne diseases. Every year, our cities witness numerous small and large outbreaks of malaria, dengue, and chikungunya. In recent years, malaria has taken the backstage to dengue and chikungunya, which causes havoc with people’s health and lives.
This year, Karnataka has seen the maximum rise in people affected by vector borne diseases, with more than 8,000 suspected cases. Maharashtra and Gujarat follow with more than 2,000 suspected cases each. Delhi faces an outbreak every monsoon. Last year, till December, more than 12,000 cases of vector borne diseases were suspected, out of which more than 9,000 were confirmed and 17 are suspected to have died because of them. Every year, Punjab faces serious outbreaks of vector borne diseases affecting more than 10,000 people. Uttar Pradesh and West Bengal are also amongst the states that face the onslaught every monsoon.
It is not just India that suffers from the problem. Africa, Asia, and the Indian subcontinent, falling in the tropical region, are breeding grounds for a variety of mosquitoes. Thus, the spread of the virus, which is carried by mosquitoes, can be far and wide, and sudden. According to a WHO report, since 2005, approximately two million chikungunya cases have been found in the Indian subcontinent.
While an increase in the mosquito population is natural in the Monsoon, it is exacerbated by the unhygienic and unsanitary conditions in the cities. Poor urban planning leading to open drains, inadequate waste disposal, and congested living arrangements makes people vulnerable to Aedes Aegypti, the specie of mosquitoes that spreads the Dengue and Chikungunya virus, in spite of any reasonable precautions they may take.
What Has The Government Done?
The ministry of health recently pledged to eradicate vector borne diseases by 2027, including malaria. The Directorate of National Vector Borne Disease Control Program under Ministry of Health is the nodal office for implementing strategies to control and prevent these diseases. It undertakes the framing of guidelines and policies that need to be implemented by states, and monitors the implementation. It has issued various guidelines, as well as a mid-term strategy and a long-term strategy for this purpose.
The strategy includes surveillance, case reporting and management, vector control (fogging, pesticides, breeding control), researching new treatments, introducing and promoting hygienic and sanitary behaviour among the population among other things.
Is It Effective?
While the targets, as well as the plan, are impressive, experts are not convinced that the Government will be able to complete them, even with the help of the private sector. While synchronization between public and private sector in healthcare is desperately needed, the National Health Policy of 2017 avoided any mention of involvement of the private sector in the Government’s plans.
The previous targets set by the governments have been largely unmet. The current plans too, depend upon the strength of implementation. Unfortunately, last year, the National Vector Borne Disease Control Programme received only 68% of its declared funding from the Central Government, only a part of which was utilized. This means that there is a shortage of field workers, especially entomologists who are responsible for controlling the vectors (mosquitoes).
The resulting lack of healthcare means that only a part of population receives the treatment considering that most of the vulnerable population can hardly afford private healthcare services. This enables the pathogens to develop antimicrobial resistance, rendering available treatment useless, as the resulting herd immunity is inadequate.
The Government’s health care policy is impressive, but it is lacking on the implementation front. India’s expenditure on healthcare in 2016 was a dismal 1.2% of the GDP, as opposed to the expected 2.5% of GDP outlined in National Healthcare Policy 2015. This year too, while the Government laid out various impressive healthcare targets, its policy was worryingly silent on methods to achieve them, especially funding allocations.
While rarely fatal, these vector borne diseases are debilitating, and continue their course for several months. During the period, the victims suffer pain, fevers, and weakness. This reduces their capability to work, which most of them can ill afford. They also cause huge health care expenditures, not to mention the costs incurred in prevention and control of the diseases, such as vaccination programs, campaigns to spread awareness, and mosquito control measures. These are costs that can be avoided, and spent elsewhere. Until we start spending effectively on healthcare, as a nation we will continue to keep paying the costs of our complacency.