The death of several people in Delhi linked to an outbreak of dengue, chikungunya and malaria has once again exposed the inadequacy of national public health programmes that aim to eliminate vector-borne diseases. There was a sharp increase in the incidence of chikungunya in the country in 2015 over the previous year, although official data do not attribute any deaths to the infection. Dengue cases have also steadily risen, from 75,808 in 2013 to 99,913 last year, with the death toll rising from 193 to 220 during this period. The footprint for malaria has grown, with over 1.1 million cases last year, although the number of people dying from the infection has shown a recent decline, going by official statistics. It must, of course, be borne in mind that there is some evidence of under-reporting of malaria, leading to the criticism that the full impact of the disease is not captured by government data. Delhi’s residents are, of course, not alone in suffering from the failures of long-running vector control programmes, although they are justified in feeling disgusted at the politicisation of the problem. The irony is that India, with its focus on rapid economic growth and prosperity, is nowhere near victory in the battle against productivity-sapping infections spread by mosquitoes and other insects, while a nimble neighbour like Sri Lanka could declare itself malaria-free.
There are several aspects to the Sri Lankan experience that could help evaluate the efforts of India’s States in their battle to control disease-spreading vectors. Better results were achieved by the island nation through integration of different approaches. This includes focussing on mosquito control in irrigation and agriculture, introducing new classes of insecticides for residual spraying within houses, and scaling up distribution of insecticide-treated bed nets even in areas caught up in conflict. Mobile centres for access to diagnostics and treatment also helped halt disease transmission. For India to achieve its goal of eliminating malaria by 2030, and curb other vector-borne diseases, there has to be sustained effort and political will. The dengue map for 2015 shows that Delhi, Punjab, Haryana, West Bengal and Gujarat were the worst-affected. On chikungunya, Karnataka needs special help, as it has a disproportionately higher incidence compared to other States. Evidently, it will take active surveillance and close collaboration with local governments to eliminate the hotspots. Mobilising the community to participate in sanitation campaigns holds the key, although families that live in deprived neighbourhoods will need generous municipal assistance, improved civic facilities and access to free health care.
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