Prof. Dr. Humayun Rathore
THE country is already in the grips of COVID-19 epidemic, it is expected that epidemic will be eventually brought under control with the guidance from the medical expertise and the strategy of cautious optimism adopted by the present government. The authorities are trying to make the traders and religious communities see the medical sense.
It is feared that if misguided section of these communities are allowed to have their way, there may be (God forbids) no citizens left to do the shopping and pray in mosques. We hope that with proper sanitation, social distancing with responsible behavior by every citizens and all possible medical and financial support being provided by the authorities, the coronavirus epidemic will subside.
However, despite being fully engaged in the fight against corona, it will be unwise to ignore another looming health disaster by Dengue. Warmer season is approaching, it is feared that dengue may not further complicate the already overburdened national heath scenario. For Corona, people are advised to stay inside houses, the Dengue transmitter mosquito breed in and around the houses and Dengue transmission takes place in and around houses. The question is that where shall people go if dengue starts knocking people down inside houses. Therefore, preparations for prevention of Dengue must start immediately.
Dengue outbreaks and epidemics have been regular feature in Pakistan since the first reported death by dengue in1994 in Karachi. Every year Dengue causes morbidity and mortality, the same old story is repeated yearly with increasing intensity. It is known that present dengue problem is not the making of the recent one or two years, it is the outcome of negligence of last 20 years. This year twice as deadly dengue epidemic is predicted for this country.
In view of above, it is clear that despite good intensions of health authorities, presence of saner element in scientific community and availability of highest level of political will, during last year dengue continued to play havoc with human lives nationwide. It is obvious that something is wrong with the dengue control strategy. There is a lack of appreciation of well-known WHO strategic direction “Prevention is better than cure”. This is truer when dealing with a vector-borne viral disease like Dengue, against which, neither a specific drug nor a vaccine is available.
This kind of mind set leads to lack of emphasis on prevention. Another notable fact is that the virus lives in two hosts i.e. man and mosquito, the fight against dengue virus can better be fought in vector mosquito than in man. Innovative mosquito control tools and technology are available but effective and sustainable deployment of these tools requires appropriately trained and certified Medical Entomologists and allied technical staff. Unfortunately, such technical staff is scarce in this country; this makes another most important factor against prevention and control of Dengue.
Training of such experts is possible within this country but requires appropriate technical and material resources. A unique successful programme was initiated in 2009 (For details read the published article: Rathor, H.R. A. Mnzava, K.M. Bile, A. Hafeez and S. Zaman. Launching the first postgraduate diploma in medical entomology and disease vector control in Pakistan. Eastern Mediterranean Health Journal Vol. 16 Supplement 2010, S62-S67). The program started producing such expertise but was shelved on the basis of the shortage of funds. This programme can be re-launched without any delay.
In the absence of qualified staff, untrained seasonal laborers and paramedics are trusted for the job they are not trained for. During epidemics, in some situations, requires application of insecticides for mosquito control. Unfortunately, in most cases seasonal laborers, not trained in correct and safe use of insecticides, are used for spraying insecticides, they instead of controlling mosquitoes end up causing pollution and poisoning. In some cases unsafe fumigation resulted in deaths in school children. Such incidents have been reported by the media. For example, in recent past, as many as 107 students at school in Jhelum fainted after dengue spray and 50 school girls fell unconscious from dengue spray in Attok city.
This situation requires training of Medical Entomologists on priority basis. The main target of this technical capacity building shall be the public health staff and post-graduate students from all the Provinces. This specialized technical cadre is essential if we wish to address the public health needs of Pakistan. While searching for a solution for the predicted twice as deadly Dengue epidemic this year in this country, we need to keep in mind that Dengue problem was never brought under control during the previous three decades.
—Prof. Dr. Humayun Rathore Ph.D: former: WHO Regional Advisor & Country Rep.
