Why Nepal needs a powerful disease control agencyDoctors say Nepal needs a body comprising experts with authority to take prompt decisions and enforce them.
Although it has been around two months since Kathmandu started reporting its first dengue cases of this season, the Health Office Kathmandu has not yet made any plan to launch a drive to contain the infections.
A search and destroy drive is an effective means to eliminate breeding sites of mosquitoes, the vector, and raise awareness among the people about protection measures, according to experts.
“Dengue cases have been rising, mostly in the Kathmandu Metropolitan City,” said Basanta Adhikari, chief of the Health Office, Kathmandu. “But a plan to launch a dengue virus search and destroy campaign has not yet been made.”
Like the Health Office, Kathmandu, most of the local units have not taken any measures, just as hospitals are seeing a large number of dengue patients on a daily basis, citing a lack of budget.
Officials at the Epidemiology and Disease Control Division said that they can only request the local units and cannot enforce the decision, as provincial governments and local units can make their own decisions independently.
The Epidemiology and Disease Control Division (EDCD) is an agency under the Ministry of Health and Population, which is responsible for tackling all kinds of epidemics, and outbreaks in the country. The division deals with neglected tropical diseases, vector-borne diseases, and zoonotic and communicable diseases. It is also responsible for making necessary policies and conducting research in the country.
The division, however, is not an enforcement agency, unlike in other countries like the United States where the Centers for Disease Control and Prevention plays a key role in controlling the outbreaks and advises the government on health issues.
“While the focus is on the coronavirus, there are other deadly diseases like dengue, scrub typhus, cholera and kala-azar, among others, circulating in the country,” said Dr Prabhat Adhikari, an infectious disease expert. “The problem is we do not have a central agency, which can take prompt decisions and enforce them.”
Experts say the delay in taking decisions and implementing them multiplies the risk and by the time agencies swing into action, the disease has already penetrated society affecting a large number of people.
Dengue is a mosquito-borne disease transmitted by female Aedes aegypti and Aedes albopictus mosquitoes. The same vector also transmits chikungunya, yellow fever, and Zika viruses, according to the World Health Organisation.
Cases of dengue infection have been increasing exponentially due to the apathy of agencies concerned to take measures to control the infections.
So far this year, 2,108 cases of dengue infection have been reported from 69 districts.
In 2019, at least six people died and over 16,000 were hospitalised after dengue fever spread in 68 districts.
Meanwhile, 69 people have tested positive for cholera since June 21.
The coronavirus threat is also not over yet, with active cases standing at 3,612 as of Saturday. On Saturday, 173 people tested positive for Covid—65 in 643 polymerase chain reaction tests and 108 in 2,196 antigen tests.
Experts say a lackadaisical approach to containing the spread of infections can add to the country’s burden.
“Thousands die due to Covid infections and thousands are getting infected with the dengue virus,” said Adhikari. “But our response in controlling the spread of infection is not being effective.”
The government had formed the Covid-19 Crisis Management Coordination Center for coordination among agencies concerned for the prevention and control of coronavirus infection. However, questions were raised about the success of the high-level Center in coordinating among the agencies responsible for preventing the spread of infections.
Many local governments throughout the country even refused to carry out contact tracing, placing the suspects into quarantine and infected persons in isolation centers.
The infection spread rampantly throughout the country, especially in the second, third, and fourth waves of the pandemic.
And experts say even if the high-level committee worked effectively in any particular incident, it is not possible to form such a committee always.
“It is not possible to form a high-level committee to contain the spread of every disease,” said Dr Biraj Karmacharya, an epidemiologist, who is also the head of the Community Programme at the Dhulikhel Hospital. “We need a powerful body that comprises experts from various sectors—public health, epidemiology, infectious disease, communication, animal health among others. Such a mechanism should have authority to take quick decisions and enforce them.”
In the US, the Centers for Disease Control and Prevention (CDC) is the federal agency mandated with protecting the health of Americans. It is among the world’s preeminent health agencies and plays a crucial role in the protection of public health and safety through the control and prevention of disease, injury, and disability in the US and across the world.
The CDC has a broad mandate to address health, safety, and security threats both at home and abroad. It especially focuses its attention on infectious diseases, food-borne pathogens, environmental health, occupational safety and health, health promotion, injury prevention, and educational activities designed to improve the health of US citizens.
In India, there is the National Center for Disease Control, which takes a leading role in undertaking an investigation of disease outbreaks all over the country by employing epidemiological and diagnostic tools. The agency organises meetings for the formulation of guidelines for surveillance, management, prevention and control of various communicable and non-communicable diseases.
The meetings are attended by experts in the respective fields, senior administrators of health services of the states, programme managers from medical, veterinary, agriculture, and animal husbandry departments.
Doctors stress the need for a strong disease control mechanism in Nepal too with the representation of all three tiers of government.
The Ministry of Health and Population said that it has been working to set up a powerful centre for disease control, which will deal with all existing and emerging infectious diseases.
For this, the ministry had prepared a bill, which has already been approved by all seven provinces. The ministry has sent the bill to the Ministry of Finance for suggestions.
“We are working to form a strong body, something like the CDC, to address the challenge of existing and emerging diseases which are threats to human health,” said Dr Roshan Pokhrel, secretary at the Health Ministry.
Pokhrel, however, said that he cannot say how long it will take for such an agency to come into being.
Officials at the Ministry said that the bill will be forwarded to the Ministry of Law, Justice, and Parliamentary Affairs once the Ministry of Finance gives its suggestions.
The bill needs to be endorsed by the Cabinet and both houses of Parliament for it to come into force.
Officials said that the new bill will replace the Infectious Disease Act of 1964 and through the Act, a powerful CDC like body will be formed.
“Agencies under all three tiers of government—local, provincial, and federal—will have to follow the decisions taken by the new powerful body,” said Dr Guna Nidhi Sharma, an official at the Ministry of Health and Population. “All agencies under the Department of Health Services and other ministries, responsible for dealing with epidemic outbreaks will come under the powerful agency.”
Doctors say most countries have dedicated agencies like the CDC for controlling existing and all emerging diseases and Nepal also needs a similar mechanism to tackle the ongoing Covid pandemic, and outbreaks of dengue, cholera and scrub typhus among other diseases.
“Existing mechanism of the government cannot deal with all the health problems that we are facing,” said Karmacharya, who is also a member of an expert panel formed by the Health Ministry for preparing a draft of the CDC bill. “We should not take much time to set up a CDC-like body.”