Malaria vs. dengue

Responding to over 20,000 cases of dengue in the first six months of the year, the Health Ministry this week will be visiting people’s homes in a yearly tried but failed effort to reduce its spread. As a country Sri Lanka has done better than most, eradicating malaria and elephantiasis in one generation through impressive and sustained input of resources, but has failed to make a dent in dengue.  

The current numbers on dengue may be making headlines but in reality they are hardly unique. Sri Lanka appointed the Presidential Task Force on Dengue Prevention in 2010, following much public criticism as patient numbers soared. The outbreak hit hardest in the Western Province where rampant urbanisation has created the perfect breeding ground for dengue mosquitoes. Schools were closed and parents lived in daily fear of their children coming down with fever. Yet, the panic did not result in regulations that had long-term impact. 

Just two years later, the number of dengue victims hit 44,456 – the highest tally since 2010. Again, the Government responded to public pressure by introducing the National Dengue Prevention Act, which makes unwittingly creating dengue breeding grounds a punishable offense. It is likely 2016 will also close around the 40,000 number, clearly showing that knee-jerk policy reactions are not effective. 

Compare this against how successive Governments tackled malaria.  Sri Lanka went from about 5.5 million cases in 1934-1935 to fewer than 20% in the early 1960s, thanks to its aggressive malaria program. Prematurely assuming that the job was done, the government scaled the program back. By 1969, the country was battling a devastating and deadly resurgence of over half a million cases. 

Since 2000, Sri Lanka has again made malaria a priority, building a strong program to combat it. The country’s last recorded local malaria case was more than three years ago and is on the verge of being declared malaria free for good. Maintaining momentum is essential to realising a malaria-free world. Just as strong immunisation programs keep measles and other vaccine-preventable diseases at bay, strong, well-funded malaria programs are critical to ending the transmission of malaria and preventing its reintroduction.

Sri Lanka’s achievement in malaria is even more impressive given that about 80% of resources have to be supplied by local Governments and it has to be maintained for decades at a time. Sri Lanka has already provide it can do the job with malaria so why not dengue?   

In Sri Lanka, despite increased public awareness, dengue remains a serious and sometimes fatal urban health problem. With high yearly numbers, it is clear that efforts made thus far remain largely ineffectual. A frustrated Government has thrown many initiatives at the disease, including the Army, deploying patrols to frighten people into compliance, but these have all been stopgap measures.

People remain under the heel of the epidemic’s natural cycle with one year ending only to find fresh patients a few months later. Regardless of intense media coverage, there also seems to be little citizen interest in stemming the disease. There are no calls from the public at large for a sustained policy measure that reaches deep into all parts of the country, well-funded and long-term. In the absence of such sustained public pressure, dengue is unlikely to be tackled with the same ferocity and determination of malaria.