Hundreds succumb to the deadly dengue virus each year. This is the heart-wrenching story that has its origin in the deplorable state of the Indian healthcare sector. While the deaths of two boys in Delhi caught the nation’s attention, what goes unreported is the significant spread of the disease in rural areas due to socio-economic and environmental changes.
Despite having 10 major institutes to tackle the incidence of dengue fever, why is the nation being called the epicentre of the disease? If one accepts the wisdom of the adage that prevention is better than cure, shouldn’t there be a solution in sight?
It is time to put the government in the dock as to what is the framework to tackle dengue. Are clinical guidelines sufficient to curb the disease? Why doesn’t the country have a specific plan like the malaria eradication programme to find a permanent cure or vaccine for dengue?
The 10 Centre-run institutes in the country deal with the epidemiology, clinical studies, diagnosis, vector control and vaccine research. They are as follows:
♦ National Institute of Virology, Pune, that provides anti-viral and diagnostic kits;
♦ International Centre For Genetic Engineering and Biotechnology (ICGEB) that does research on vaccines;
♦ National Institute of Cholera and Enteric Diseases in Kolkata focussing on diagnosis;
♦ National Centre for Disease Control for Epidemiology;
♦ All India Institute of Medical Sciences Delhi for diagnosis and epidemiology;
♦ Vector Control Research Centre in Puducherry to conduct studies on vector control;
♦ The Sanjay Gandhi Post Graduate Institute of Medical Sciences in Lucknow that does clinical studies;
♦ The Post-Graduate Institute of Medical Sciences, Chandigarh;
♦ Defence Research and Development and Establishment in Gwalior for vector control;
♦ Institute of Preventive Medicine, Hyderabad working on epidemiology.
Every year, crores of rupees are being allocated to these institutes to do their bit for suffering humanity. Still, no breakthrough in dengue research is on the horizon. When Tehelka contacted Dr AC Dhariwal, director, National Vector Borne Disease Control Programme under the Ministry of Health and Family Welfare (MOHFW), he said their job is to look for preventive measures and ensure clinical management. “Kya hum kisi cheez ki utpatti rok sakte hain? (Can we really stop the origin of anything?) It isn’t possible in the case of mosquitoes. Our job is to work on diagnostics and ensure prevention from the disease,” says Dhariwal.
Asked whether there is any research work on dengue vaccination in the country, the director cross-questioned the correspondent on her awareness about the vaccine and replied, “Please ask Indian Council of Medical Research and Department of Biotechnology what they are doing. It doesn’t come under our department.”
Tehelka then contacted Dr Ashutosh Biswas, Department of Medicine, AIIMS, who is one of the experts in framing the clinical guidelines for dengue. He says, “As per my knowledge, there isn’t any particular research work on dengue going on in India. Since the mortality rate is coming down, our focus is on clinical diagnosis and treatment in the current scenario. Also, controlling the mosquito population effectively is the major issue. There should be a very strict procedure to control the outbreak.”
To prove his point, he mentioned how the mortality rate has come down in years. Notably, the mortality rate has plunged from 3.3 percent in 1996 to 0.4 percent in 2010, further receding to 0.3 percent in 2013. However, in 2014, 137 deaths were reported.
Globally, there is no licensed vaccine or drug for dengue across the globe. Though Sanofi Pasteur has emerged as one of the leading companies in developing a vaccine (CYD-TDV), it is still struggling to get approval for conducting Phase iii trials in India. Phase iii trials are conducted on large populations. The government of India was forced to make stringent laws on clinical trials following deaths due to the pentavalent vaccine in 2011-12.
So far, the company has done trials in Latin American countries like Brazil, Colombia, Honduras, Mexico and Puerto Rico. Also, the survey has been done in Thailand.