A case of the Zika virus has been recently reported in Chennai, India. This comes on the heels of three Zika cases reported in Ahmedabad in May 2017 by the World Health Organization (WHO). Indian government authorities have so far disregarded these as sporadic cases as not warranting high alert action, while the public in general is indifferent. It is this apathy that is worrisome.
Zika is a new addition to the growing number of vector-borne diseases that are moving rapidly across continents, causing public health scares. First detected in the Zika forests of Uganda in 1947, the virus, which mostly affected Africa and Asia until the 1980s, has now traveled across the globe. The world sat up and took note in February 2016, when WHO declared Zika to be a Public Health Emergency of International Concern (PHEIC), as there is growing evidence that Zika is associated with microcephaly (a birth defect in newborn babies) and other neurological disorders.
Though the WHO has since lifted the “emergency” alert on Zika, it is still a global threat and low-level transmission is said to be underway in India. The WHO has warned that apart from mosquito vectors, Zika infections were expected to be carried worldwide by international travelers. All the four Zika patients in India lack a history of travelling abroad but were still infected. In a world so extensively connected, how immune can any country be to life threatening vector-borne diseases?
In 2015, more than 52 percent of all deaths in low-income countries were caused due to communicable diseases, poor maternal health, and nutritional deficiencies. By comparison, only 7 percent of deaths in high-income countries were due to these causes. This clearly indicates that no matter where in the world an infection originates, it is the poor countries that are more vulnerable to the risks of communicable diseases. In the case of Zika, India has special reasons to be cautious. The main vector for Zika the A. aegypti mosquito, is the same vector that causes dengue, and chikungunya. With the alarmingly high number of deaths due to dengue and chikungunya that were reported last year, there’s no question that the vector A. aegypti is established in India.
Zika transmission in India may also occur because India shares a boundary with Bangladesh, a Category 2 country according to WHO, where the virus either existed before 2015 or the transmission is ongoing, or there is evidence of uninterrupted transmission. India also shares the same ecological zone and evidence of dengue virus transmission as Bangladesh.
Zika is generally reported to have very mild external symptoms but is potentially debilitating for a fetus should a pregnant woman contract the virus. The babies thus born are affected with microcephaly. With 64 percent of the population of India in the child-bearing age, and a fertility rate of 2.3 births per woman, the stealthy spread of the virus can cause havoc if India sees Zika babies in the future. That detection is often only possible after the fact, in the next generation, is itself a cause of huge concern.
Vector-borne diseases cause the highest devastation in densely populated areas. With a population density of 452 people per square kilometer, India provides a grand platform for the spread of such diseases. The situation becomes graver in urban areas, where a dense population is combined with poor sanitation. The World Bank reported the economic impact of poor sanitation to cost 6.4 percent of India’s total GDP in 2006, with 72 percent of the damage coming in the form of health-related impacts. With such bleak scenarios, what chance does India stand against a future Zika outbreak?
A global threat like Zika requires robust preparedness on a universal scale, especially for vulnerable countries like India. This cannot be achieved without global collaboration. Still developing countries like India are seen grappling with such emergencies on a local scale at a very micro level, only after an outbreak. Though the number of deaths happening around the world due to terrorism is miniscule compared to the number of deaths caused due to communicable diseases, we see global collaboration in countering terrorism but no such efforts seem forthcoming for emergencies like Zika. At best, alerts are raised and travel advisories to affected countries are issued. Locally, governments use piecemeal curative strategies to cope with the outbreaks till humanitarian aid from international organizations arrive. In the meantime, thousands of innocent people die.
Outbreaks of Zika, Ebola, SARS, and Avian influenza etc. in recent years have proved that vector-borne diseases are on the rise in the 21st century. Unfortunately, the developing world still looks to developed countries for post hoc solutions, like providing humanitarian aid, disaster relief, and emergency assistance, when it comes to healthcare emergencies. However, vector-borne diseases are best mitigated by preventive rather than remedial measures. The fact that these diseases do not recognize international boundaries should itself disconcert the collective conscience of the developed world. This is one world and there is one health. No country, rich or poor, can claim impunity from an impending epidemic on the grounds of ignorance or indifference.
Combating threats like Zika requires a broader understanding of public health epidemiology. Cross-sectoral and inter-disciplinary approaches on a global level are needed to find viable and sustainable solutions for to prevent, monitor, and control of outbreaks of such diseases. Currently, there are more questions than there are answers for the control of Zika. For developing countries like Uganda, Brazil, and India, where poverty, population, illiteracy, and lack of funds worsen the impact of disease outbreaks, resorting to preventive measures is the only viable solution.
Worldwide, a lot of research is being carried out to find solutions for preventing vector-borne diseases. Apart from technical research on developing vaccines, a lot of researchers are now focusing on the behavioral aspects of prevention, such as encouraging pregnant women to use insecticide-treated mosquito nets, indoor residential spraying, and preventative therapy for pregnant women (steps supported by the WHO). Researchers at MIT are also looking at simple solutions such as leveling the land to fill up low spots where water may stagnate, plowing the land so that water may percolate down into the soil, and spreading grounded neem (Azadirachta Indica) seeds in ponds and other stagnant water bodies. These modest methods have proven effective in eradicating 50 percent of the vector population at the research sites. This proves that unlike post hoc humanitarian aids, preventive measures do not need to be expensive. They only need to be collaborative and inclusive.
Since Zika has already reached India, there is an immediate need for Indian policymakers to invoke an international consensus for collaborating on evidence-based preventive measures, to control the impending public health catastrophe that Zika may unleash. At the same time, policymakers from developed countries need to realize that the world might be sitting on a Zika time bomb. The WHO has clearly warned that the transmission of Zika is in progress in India and that the virus is already in circulation in Southeast Asia. The threat is thus global; preparedness will need to be undertaken on the same scale. The developing countries that may become the source of origin and spread such diseases, need to be equipped to prevent them from becoming hot spots. Inter-sectoral partnerships from international and national research organizations (involved in public health policy and research), civil society organizations, and local communities from the developing countries will help achieve this in a robust manner. Being in denial mode can prove catastrophic for the future generations of humankind. India is no exception.
Nayan Chakravarty is Associate Director for Policy and Outreach at IFMR LEAD.
Kavita Tatwadi is a public policy analyst.