Over the last 72 hours, the Gujarat health department has received flak from both its citizens and the public health community for hiding the presence of the Zika virus in Ahmedabad. Blood samples of three residents – a 64-year-old man and two new mothers aged 34 and 22 – from the Bapunagar and Gopalnagar localities of the Ahmedabad district were found to be positive for the Zika virus.
In the first week of January, the Indian Council of Medical Research and the Government of India intimated senior officials of Gujarat’s health department about the possibility of Zika virus transmission in the area. But, the health department did not make the information public.
The Zika virus generally causes a mild and temporary infection in adults with symptoms like fever and rashes. But infections in pregnant women can lead to congenital defects in newborns such as microcephaly, in which the brain of the infant is small and underdeveloped. The infection is also linked to neurological impairment in adults.
In January, Gujarat hosted its high-profile biennial international investor summit called Vibrant Gujarat. At the same time, an army of outreach workers were looking for fever cases in Bapunagar and Gopalnagar. They were told that the exercise is to control malaria because the Gujarat government has committed to end malaria by 2022. Only the national agencies and the Gujarat health department knew the real purpose of the mega surveillance exercise – to look for patients with Zika among those with fever.
The covert operation, however, has raised serious ethical questions of whether the government is allowed or even justified in hiding such news of national and international concern from its own people and the world.
JP Gupta, commissioner of health, medical services and medical education in Gujarat and ex-officio principal secretary to the government in the department of health and family welfare spoke to Scroll.in. Here are excerpts from the interview.
Why did the Gujarat government keep its people and its own health machinery in the dark about Zika cases?
The decision on whether to make the information about Zika virus presence in Gujarat public was of Indian Council of Medical Research or the Government of India. We were told about the cases and asked to take some surveillance which we did.
The staff which conducted the surveillance need not know what diseases they are collecting the blood samples for. It is our decision, what we test the blood samples for – dengue, malaria, chikungunya or Zika. The patients or the health staff has nothing to do with it.
Isn’t it the right of the people to know that a new disease has entered India and understand what precautions they can take?
There is no secrecy. This is not a public health crisis. After the cases were detected in January and February, we collected blood samples of more than 1,000 people from these localities (Bapunagar and Gopalnagar) and none of them had Zika virus infection. Some samples were tested in National Institute of Virology and others were tested in BJ Medical College. As there were no further cases, we did not feel the need to inform [anyone]. Also, informing the people and international agencies is to be done by Government of India, not my office.
People need not worry. Gujarat has declared a war against mosquitoes.
How did these three residents of Gujarat contract Zika infection?
Indian Council for Medical Research has not been able to establish the source of infection for these three patients. All three cases are unrelated and random cases. They have never travelled to any foreign countries. If they had travelled abroad, we could have said that they have contracted the infection abroad. But we haven’t got any confirmation either that they must have contracted the infection in Gujarat. We have sent more than 300 mosquito samples from the areas where they live to look if they are infected with Zika. Not a single mosquito was carrying the Zika virus. So we cannot say anything conclusively.
Apart from the mosquito route, there is also a possibility that they must have contracted the cases sexually. Zika is known to transmit sexually too.
In that case people need to know the different precautions they need to take?
There is no need for any new precautions. If people don’t allow mosquitoes to breed in their homes and surrounding, there will be none of the vector control diseases including Zika. Also, there is no need to take any special precautions to stop sexual transmission of Zika virus. It is the same as HIV. We don’t need additional advisory for Zika. There is no need.
What are these patients doing now? Is the health department still monitoring them?
Yes. We along with the Indian Counci of Medical Research monitored them closely and even tested their families and neighbourhoods to check for Zika virus. We are purposely not mentioning any more details about them because we want to protect their privacy. They would feel stigmatised if their status of Zika virus infection is out as the disease is known to spread through the sexual route. It can be traumatic for them.
Have the patients been informed and made aware that they are suffering from Zika?
I would not like to spell out any more details about it.