No lessons learnt: Why Delhi is staring at dengue, chikungunya outbreaks yet again this year

“Mosquitoes don’t wait for meetings,” the Delhi High Court remarked on May 16 as it pulled up Delhi’s government and municipal corporations as well as the Centre for holding meetings instead of implementing preventive measures against vector-borne diseases.

At least 90 cases of chikungunya and 36 of dengue have been reported in Delhi so far this year even though monsoon is still weeks away.

While the national capital has long been familiar with dengue, an outbreak of chikungunya nearly collapsed its healthcare system last year. It was Delhi’s first chikungunya outbreak, and it affected at least 9,661 people. In 2015, nearly 16,000 dengue cases were reported in the city and 60 people lost their lives to the disease, according to the Hindustan Times.

The High Court bench hearing the matter delivered this response on being told that Delhi Chief Minister Arvind Kejriwal and Lieutenant Governor Anil Baijal were holding high-level meetings on the issue.

On May 13, Kejriwal held a review meeting to discuss the level of preparedness for dealing with vector-borne diseases with the city’s civic bodies, medical superintendents and his ministers. This was the first such meeting chaired by Kejriwal since he took over as chief minister in February 2015.

“All stakeholders, Delhi government, civic agencies and all concerned, need to work in close coordination to ensure a Mosquito Free Delhi this year,” said a press note after the meeting, attributing the statement to Kejriwal. “Steps are taken every year to provide treatment to those who suffer from vector-borne diseases but this year the stress has to be on prevention of breeding of mosquitoes.” The chief minister has also directed that a control room be set up to deal with calls inquiring about the availability of hospital beds during the peak disease season, the note said.

While the task of making arrangements for medical assistance lies with the Delhi government, the civic agencies are responsible for checking the breeding of Aedes aegypti mosquito, which is responsible for spreading both dengue and chikungunya.

In April, the South Delhi Municipal Corporation had sent six senior officials to Surat for training in vector-borne disease control. In the aftermath of the 1994 plague in the city, the Surat Municipal Corporation is credited with taking effective measure to keep it relatively free of vector-borne diseases.

“The officers received training in a wide range of operations and in setting up a computerised system to monitor those operations,” said an official of the South Delhi Municipal Corporation who asked not to be identified. “But the training could not be put into use so far because of the municipal elections in the city [held on April 23]. It will be implemented once the elected councillors of South Delhi take oath and join their offices.”

Too little, too late

According to Rakesh Mehta, the last chief of Delhi’s municipal corporation before it was trifurcated in 2012, it is already too late for civic agencies to launch preventive measures for vector-borne diseases. “Ideally it should start latest by April,” he said.

Ashish K Naik, Surat Municipal Corporation’s health officer, confirmed as much. “Fighting vector-borne diseases is a round the year process,” he said. “Civic agencies should be active in the non-breeding months from November to April, which usually does not happen. Surveillance workers should be active 12 months and there should be intensive drives at places that usually happen to be hot spots for mosquito breeding such as construction sites.”

SM Raheja, additional director general in Delhi’s health department, echoed this view. “It is a round-the-year process,” he said. “But I fail to understand why only the civic agencies in Delhi are to be blamed. Nearly one-third of the dengue and chikungunya patients come from other parts of NCR [National Capital Region], such as Noida, Ghaziabad, Faridabad and Gurgaon.”

According to the National institute of Malaria Research, Domestic Breeding Checkers should conduct breeding surveys throughout the year rather than just from April to November. The institute, in fact, had pointed this out to the Municipal Corporation of Delhi two years ago, stating it to be a critical measure to control the breeding of Aedes aegypti, according to a report in The Indian Express.

There is consensus among experts that eliminating vector-borne infections as a public health burden can only be achieved by integrating vector control and vaccination. This means denying the mosquito breeding places such as open drains and sewers, stagnant water pools. The municipal corporation accepted the findings of the study and the Indian Council of Medical Research too “appreciated” it and circulated it to the National Vector Borne Disease Control Programme and other institutes under the council working on dengue and chikungunya. All this, however, does not appear to have translated into action on the ground.