On Friday, the World Health Organisation said in a release that the Indian government had informed them of three laboratory confirmed cases of Zika virus in Ahmedabad. The first case was detected on January 4 and two more cases were confirmed by end of March. However, only a handful of people at the Indian Council of Medical Research and the Ministry of Health and Family Welfare were privy to the information.
It needs to be acknowledged that the surveillance of Zika virus in the country has been good. It is particularly commendable that the Ahmedabad hospital suspected that the cases may have been caused by the Zika virus and then diagnosed them. In a large country like ours, this is remarkable.
All the good work was however, compromised by the attitude of the health officials. Not revealing information to the concerned civic authorities and the public is both a technical and an ethical problem.
Zika virus is a global concern and can have long-term implications for the population, as we have seen in Brazil. Children are born with microcephaly (a birth defect where the baby’s brain is less developed) and Guillain-Barré syndrome (nervous system disorder).
This is not just a breach of scientific protocol. This lack of transparency has consequences in public health action.
Need to inform local health authorities
When an authority diagnoses a disease under global surveillance like Zika, it needs to institute a wide range action at two levels – at the scientific and academic level and to the public health authorities involved in disease control at the local level. The detection of the Zika infection should have been disseminated widely to the academic community and to clinical and research facilities. This information would help alert the states to strengthen and/or set up surveillance and diagnostic systems.
Zika virus is spread by the Aedes mosquito which is widely present in the country, and has been responsible for transmission of dengue and chikungunya in most states. Local health authorities including urban local bodies are vested with the responsibility of field operations to control breeding of mosquitoes. It is inconceivable why the highest public health authorities did not disseminate information to states and districts to be used by local health authorities.
There is a need for integrated vector management that includes information campaigns to reach out to communities to strengthen the practice of personal prophylaxis. Personal prophylaxis involves use of mosquito nets, repellants, long-sleeved clothes to name a few measures.
In its own guidelines issued last year before these cases were diagnosed, the union health ministry said that the states would create increased awareness among clinicians including obstetricians, paediatricians and neurologists about Zika virus disease and its possible link with adverse pregnancy outcomes like foetal loss and microcephaly.
Moreover, the guidelines said, “The public needs to be reassured that there is no cause for undue concern. The Central/ State Government shall take all necessary steps to address the challenge of this infection working closely with technical institutions, professionals and global health partners.”
The question now is whether there was adequate and appropriate risk communication after the diagnosis of these cases.
Violation of ethics
While India has not adopted any code of ethics for the practice of public health, the code of ethics of the American Public Health Association underscores two relevant points:
- Public health institutions should provide communities with the information they have that is needed for decisions on policies or programs and should obtain the community’s consent for their implementation; and,
- Public health institutions should act in a timely manner on the information they have within the resources and the mandate given to them by the public.
The management of an emerging disease in a large and diverse country as ours requires coordinated action at all levels and taking the people into confidence. The lack of sharing of information is an ethical violation too.
As told to Menaka Rao.