Are we losing the war to the mosquitoes?

While the Caribbean region grapples with the rising scourge of non-communicable diseases – the leading cause of morbidity and mortality – communicable diseases, in particular vector-borne diseases, continue to pose a serious public health threat to the health security of our small island developing states.{{more}}

In 2014, an outbreak of Chikungunya (CHIKV) swept through Latin America and the Caribbean. Almost all countries in the region were affected resulting in significant health and economic consequences. As countries try to recover from the CHIKV outbreak, another vector-borne disease Zika (ZIKV) has appeared.

ZIKV has now spread to almost all countries in the region, with more and more countries reporting locally transmitted infections. ZIKV was initially thought to be mild and less painful than CHIKV and of a shorter duration. It was also said that the majority of persons who contract the infection would be asymptomatic and so there was no need to fear the disease, as it was not as painful and debilitating as CHIKV.

As the scientific knowledge about ZIKV increased and as more research evidence came to light, it was realized that the complications of this once thought to be “benign” disease pose huge challenges not only to public health officials, but to the overall development of the region, affecting vulnerable industries such as tourism.

For years to come, the region will have to deal with the complications of ZIKV, namely congenital neurological syndromes (microcephaly) and Guillain-Barré Syndrome (GBS). Immediate planning and action must be instituted in the region if we are to confront this epidemic before it spirals out of proportion and we unfortunately lose the war to these small creatures.

Not only is an immediate response needed, but also long-term planning and sustainability strategies must be put in place to care for, treat and rehabilitate children who will suffer from neurological disorders caused by Zika. It therefore means that an ‘all of society’ approach is needed in the planning process. Not only is a multisectoral approach needed in planning, but also this is critical in responding and sustaining response. The state therefore has a legal and a moral obligation to ensure that those affected are cared for and so the public health system must be ready to take on this added burden. Our schools must be equipped with the necessary resources, including teachers trained in special education to work with these children who may develop some sort of neurological deficit. Society must be able to understand and cope with them and provide the necessary resources to foster their integration and function.

Where GBS is concerned, most countries have limited Intensive Care Unit (ICU) bed capacity, so therefore it would mean that alternative arrangements must be looked into to facilitate any increase in the number of cases of patients with GBS. Treatment options and protocols must be developed and resources, including medical personnel and the availability of appropriate medication, easily accessible. Psychosocial support must be put in place to support individuals, families and the society as a whole.

As we know, the region has overcome the peak of the CHIKV outbreak with a drastic decrease in the number of cases of CHIKV being reported in 2016, compared to the same period for last two years. One would expect that we would have learned valuable lessons that would allow us to mitigate the impact of another similar vector borne disease. This clearly is not the case. We continue to struggle and fight against the aedes aegypti the vector responsible for the transmission of Dengue, CHIKV and ZIKV.

Vector control response plans must be revised. Vector control must take an integral and central position on the agendas of our Ministries of Health. Vector control activities need not be heightened only when there is an epidemic, but must be continuous throughout the year to keep the mosquito indices at a low, where they cannot spread diseases and cause an epidemic. The traditional vector control units that function as a “by the side” department must be fully funded with suitable resources and well-trained personnel including entomologists and environmental health workers.

Health promotion is also an important and critical tool to take to the war against the aedes aegypti. The key to overcoming these mosquitoes is not to unleash a chemical warfare by spraying and fogging, but to teach our people to be responsible. While spraying and fogging do have a place in the integrated vector control plan, they must not be the main activity. Being responsible is the key. We must be responsible for ourselves, our homes, our workplace and our communities. We are the ones who live in and around our communities and know the nooks and crannies where the mosquitoes live and breed. Therefore, the source reduction actions should start with us.

Behaviour change is needed. We have to move away from the seasonal clean-up campaign, where we react when there is an outbreak, to habitually cleaning up and maintaining a clean environment free of breeding sites. Also, we are to take the necessary precautions as outlined by public health officials to protect ourselves from being bitten.

The consequences of Zika can be grave not only to the health sector, but also to other sectors of the economy, such as tourism. It is therefore important that we all join together in this mosquito war and ensure that we are successful in eliminating the aedes aegypti.

Dr Rosmond Adams

MD is a medical doctor and a public health specialist with training in bioethics and ethical issues in medicine, the life sciences and research. He is the head of Health Information, Communicable Diseases and Emergency Response at the Caribbean Public Health Agency (CARPHA). (The views expressed here are not written on behalf of CARPHA).

Dr Rosmond Adams is a medical doctor and a public health specialist.