Why India needs to worry about communicable diseases like dengue

A new multinational study suggests that the dengue virus will find its way into cities that have no prior history of infection thanks to the unplanned way urban areas have come up in India. The global mapping study which was done by Oxford University found that India had 33 million dengue cases which accounts for one-third of the infections across the world every year. India's climate and huge population have both been favourable for the spread of the disease.

'With globalisation and the constant march of urbanisation, the virus may enter areas that previously were not at risk, and number of infections may increase in areas that are currently affected,' said Professor Simon Hay, a Wellcome Trust Senior Research Fellow at the University of Oxford. The effect of urbanisation on dengue is apparent with a significant jump in the number of dengue cases in Mumbai in the last three years from 115 in 2010 to 1,008 last year. At present, there is no treatment or vaccine to treat the infection.

Experts also stated that they're witnessing a change in the behaviour of the virus on the account of change in the global climate that has increased the life cycle of mosquitoes from 12 to 15 days. Crowded urban areas with stagnant water, low lying areas and various other overcrowding factors are responsible for spread of communicable diseases.

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Why is India so ill-equipped to deal with communicable diseases?

We never seem to learn from our mistakes. Every year during the monsoon season there's an outbreak of dengue and malaria which the authorities fail to contain, irrespective of the state where the problem occurs. Since, the outbreak of H1N1 the winters too have swine flu season in many states. It's extremely shocking that despite the same diseases afflicting a particular area at a particular time of the year, the authorities are unable to contain it. We talked to Dr Gulrez Azhar, a senior lecturer at the Indian Institute of Public Health in Gandhinagar, Gujarat. Excerpts from the interview:

Q: Why are people more vulnerable to communicable diseases these days? Is the urban population (with people living and interacting much closely in a city like Mumbai) or a rural population with less access to healthcare services more at risk?

Dr Azhar: Urbanisation and high population density is a reason that cities are reeling under communicable diseases. Now there are more forced man environmental interaction and with people travelling more they are 'taking' diseases to new places. Also people are living more closely, which is allowing diseases to spread more easily.

Q: What are the biggest challenges to eradicating communicable diseases like tuberculosis, malaria, dengue, encephalitis or swine flu (they all seem to have become seasonal now)? Is it because that these diseases aren't present in the Western world that we don't have a vaccine for them yet?

Dr Azhar: There are various reasons for this. We as a country have various shortages. We have a healthcare system based more on treatment than prevention, a system which lacks the capacity to deal with the healthcare needs of its people and a serious lack of human resources. There's also the point that since these 'neglected tropical diseases' aren't present in developed countries there hasn't been enough research to find vaccines for them. Though there have been attempts to fund research into these, much more needs to be done.

Q:Do you see any solution on the cards in the near future or even distant future? What would it take to eliminate a disease like malaria like we have done with polio - universal vaccines? Is it the lack of funds?

Dr Azhar: It's hard to say. I believe the solution instead of focussing on individual diseases one-by-one through vertical programs, there needs to be a systemic change in shift of healthcare services. Vertical programs for particular diseases are extremely resource intensive and can end up having negative effects on the general healthcare services. This is of course an opinion I have and would need to conduct thorough research to justify them.

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