Just after I had finished placing an order for Odomos, Good Knight and other chemical-loaded products for my family in Mumbai, I received a call from my sister in Delhi. Our father had developed a worryingly high fever. Neither my sister nor I are doctors, but within minutes, we reached a diagnosis.
“It can’t be dengue” she said. “You’re right,” I replied, “he’s had dengue already. So this time it must be chikungunya.” And although we were right, playing tic-tac-toe with fatal vector diseases in our nation’s biggest cities seemed very, very wrong.
I spoke to my father later that day and in a weak voice, he said, “You can exercise everyday and eat healthy but at the end of the day, what do you do if a buggering mosquito gets you?”
Although he has a vector disease, I don’t think he is the victim of a mosquito bite; he, along with millions of other Indians, is a victim of appalling apathy and government dysfunction.
India’s healthcare system is currently in the ICU – the nation itself is in critical condition and it will take more than doctors to get us back on our feet. Maybe we can begin by acknowledging the scale of the issue. When it comes to communicable infections, official data in India is simply unreliable.
Let’s take the case of dengue. Official statistics put the number of dengue cases at 20,000 annually. However, a research conducted by independent researchers and published in the American Journal of Tropical Medicine and Hygiene, estimates that almost 6 million Indians suffer from dengue every year. I’ll help you do the math – the independent estimate of dengue is a staggering 282 times higher than the official data. Similarly, highly communicable infections like malaria and TB go under-reported which means that as citizens we are often unaware of the danger to our everyday lives.
Adding to our disease burden is the latest wild card entry – chikungunya, which means ‘to bend backward’ referencing the terrifying pain that causes patients’ bodies to contort in agony.
But while scores of Indians writhe in pain, the authorities are conspicuous either by their absence or by their absurd remarks. When the top health authority in the national capital, Health Minister Satyendra Jain, starts to quote Dr. Google for medical information, it’s clear that mosquitoes aren’t the only unwelcome elements in town.
Agreed, some city corporations have commenced fogging and breeding ‘inspections’ but these seem more like marketing gimmicks; as evidenced by rising numbers of cases, these knee-jerk reactions are unable to curb the disease. And so while the government literally creates a smoke screen to hide its failure, vector diseases strike like clockwork.
My daughter recently had some friends over and despite all the mosquito patches coupled with repellent creams, the parents had agreed that they shouldn’t play outdoors. I was given the task of communicating this to the children.
“Its dengue season, kids. You can’t play outside,” I insisted, to which a four-year-old asked, “What is dengue season? Is it like summer season and winter season?”
That’s when it hit me. We grew up learning about summer and winter but the next generation may end up knowing the seasons as ‘dengue season’ and ‘swine flu season’. And, as a result, our children will lose their most basic rights – to be safe and to play.
But maybe lost childhoods aren’t convincing enough for authorities, so let’s talk cash. India spends approximately one per cent of its GDP on healthcare. I’ll help put that figure in perspective: Rwanda and Tajikistan spend more money per capita on healthcare than India.
To make matters worse, most of the allocated money goes towards treatment with only a pittance leftover to actually prevent disease. Independent reports conclude that dengue already costs India over $1.1 billion each year (including medical costs and lost income while off work). The Central Government collects almost 18 per cent of GDP in taxes which means that dengue alone must cost the exchequer $190 million every year in taxes.
It is plausible then that we should spend at least that much to prevent dengue since anything less puts us in a financial loss. According to a report on India Spend, the government only spends $50 million on dengue (of which only a fraction goes towards preventing the disease) versus $190 million that it is losing in taxes.
Money matters because as funding increases, cases decrease. But instead of increasing the budget of the National Vector-Borne Disease Control Programme (which covers malaria, dengue, chikungunya and Japanese encephalitis), the allocation to the programme has actually seen a decline from 2011-2012 to 2015-2016. It’s simple – if no one else is paying for it, the people have to pay. And we are paying for it with our lives.
Apart from a scarcity of funding, we also have a drought of a vision. The lack of vision reminded me of the recent Rio Olympics – in the moment of truth, we expected our athletes to perform despite the fact that we had invested very little in them in the years leading up to the Games.
Dengue ‘season’ arrives more often than the Olympics and we cannot expect our health care system to perform if we haven’t invested in it prior to game time. Services like sanitation, waste water management and urban crowding solutions need a long-term vision that extend beyond short political tenures. Visible marketing exercises like fogging and inspections may be politically appealing but ultimately, if we are to bring India’s healthcare out of the ICU we will have to think big.
Viruses won’t wait as we announce one more scheme and pretend to have our act together. The vector population has increased and the dengue and chikungunya viruses see dangerous mutations every year. Moreover, those aren’t our only time bombs – India has the world’s largest epidemic of tuberculosis including the most drug-resistant patients, in which even the two most powerful TB medicines do not work.
We seem to be waiting for a messiah to arrive and dig us out of our disease. But the world is not going to prioritize our disease burden; diseases like dengue, chikungunya and TB are endemic to India but they are not prevalent in the West. We have to prioritize them by investing in research including out of the box solutions like genetically modified mosquitoes. And we can succeed.
In fact, success has been demonstrated by countries that have smaller resources than us: Sri Lanka has been declared malaria free, Indonesia has eradicated tetanus and Brazil is experimenting with genetically modified mosquitoes to eliminate dengue.
India is also capable of success. In 2011, we eliminated polio against tremendous odds. This success was possible because the nation was truly united against the disease and government leaders, small and big, at the central, state and district levels cooperated on the issue.
To see a break in transmission by next dengue ‘season’, governments at all levels have to start working together today. The #OneDelhi hashtag sounds good but it now needs to be more than a fogging smokescreen.