Building Two-Way Capacity: Pioneering a Multi-Country Epidemic Prevention, Control, and Management Program
N
atural disasters attract instant attention, and
its haemorrhagic or shock-syndrome form. Vaccines are
typically, an immediate and intensive response
said to be just round the corner, but until then, treatment
in support of relief and rehabilitation. A quick
is limited to ameliorating symptoms as the disease runs its
review of the major natural calamities in recent years brings
course.
to mind earthquakes in New Zealand (2011), Haiti (2010) or Kashmir (2005), which together claimed almost 350,000
Transmitted through the bite of a common strain of the
lives and affected 5 million. Storms and tsunamis in recent
domestic mosquito, Aedes, which among its particular
memory, such as the ones in Eastern Japan (2011), Bay of
characteristics, has the ability to survive for months with-
Bengal-Nargis (2008), United States-Katrina (2005, and the
out water, and lay eggs in less than 5 millilitres of liquid,
Indian Ocean (2004) caused another 300,000 deaths, with
dengue remains a major challenge to public health manag-
another 4 million people directly affected.
ers. It has continued to climb higher on the list of high-risk epidemic diseases, with prevalence rising 30-fold since
These are indeed enormous human tragedies. The suffer-
1960, and could expose almost 2 billion by 2080.
ing they caused still lingers, particularly the disease and disability that came in the wake. But disease and disability
Dengue epidemics have been recorded since the late
are not confined to post-disaster situations. They stalk vul-
1700s, with the disease presently placing an estimated 2.5
nerable populations relentlessly. In fact, disease outbreaks
billion people at risk for epidemic transmission. In Pakistan,
and epidemics kill and disable more people, and have dev-
dengue was first reported in 1994, but by 2005, the number
astated more communities than have natural calamities. A
of hospitalizations had gone from a mere 3 to just under
striking illustration comes from the First World War in which
4,000, and 40 deaths. In 2011, this number peaked at over
16 million soldiers and civilians perished between 1914 and
21,000 cases, taking 365 lives before it became apparent
1918. The Spanish Influenza pandemic between 1918 and
that the Punjab was in the midst of the world’s biggest ever
1919, meanwhile, extinguished 50 million lives between.
dengue epidemic.
History records waves of bubonic plague epidemics killing
The Punjab health department quickly realized how
half of China’s population, then rampaging through India
unprepared its departments were for tackling the epidemic,
and Central Asia to strike Europe, to annihilate a third of
trying to cope with panic referrals from an un-informed
continent’s denizens. Smallpox, known since Pharaonic
and under-equipped primary care system. Typically, media
Egypt, is said to have wiped out the Aztec and Inca civiliza-
coverage increased public hysteria, straining an already
tions, claiming 60 million lives only in the century before it
overloaded hospital system to breaking point. Fortunate-
was finally eradicated in 1977.
ly, health policymakers soon understood that controlling a ubiquitous vector-borne condition cannot depend on
Malaria and tuberculosis, known through history as killer
hospitalization alone, and that it is already too late to
diseases, continue to strike down huge populations. In
respond once symptoms appear.
2012 alone, Malaria attacked 200 million people of whom
Author:
Faiz Shah, M.D.
Director, Yunus Center at AIT Senior Program Specialist and Head of Development Management, AIT Extension, Asian Institute of Technology (AIT)
600,000 succumbed to it. During the same year, tubercu-
Traditional approaches to prevention, control and
losis infected 9 million, of which 1.3 million did not survive.
management are made even more challenging in the case
The H1N1 swine flu virus may have killed over 300,000
of Dengue because mass diagnostic screening methods
people during 2009-2010. Ebola in its most recent rage
remain non-specific and clinical assessment is often
through West Africa has taken at least 9,000 lives.
non-exclusive. The answer lies in designing and mounting a proactive public health initiative that is community-based,
Of the lesser known, but equally malicious public health
oriented to building mass awareness and behavior-change,
challenges, is dengue fever. Endemic in 110 countries,
and driven forward by inter-sectoral coordination, led by
dengue infects 100 to 400 million people annually, out
an effective disease surveillance apparatus. What stands
of which over half a million can require hospitalization.
in the way of this rather obvious solution is the manner
Dengue can be life-threatening, particularly if it appears in
in which healthcare service-delivery is administered. In a
Technology | February 2015
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