Zika in India and Public Health Ethics

Chhanda Chakraborti argues for a more ethically aware public health response to Zika in India.

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On May 27, 2017, Indian newspapers reported that the World Health Organization (WHO) had confirmed three cases of Zika virus in Ahmedabad, Gujarat, India. The first case, in November 2016, involved a 34-year-old woman, who tested positive for Zika after she delivered a baby at B. J. Medical College. The second case, in January 2017, involved a a 22-year-old woman in her 37th week of her pregnancy. The third case, in February 2017, involved a 64-year-old man who was identified during a random monitoring and surveillance activity conducted by the B. J. Medical College.

In February 2016, the Minister of Health proclaimed that India’s Ministry of Health and Family Welfare had adopted several actions and countermeasures to prevent the spread of Zika. However, the alerts and guidelines about Zika, that were created in consultation with the WHO, only became publicly available on the Ministry’s website after media reports of Zika in India. In May 2017, the WHO asserted that India’s Ministry of Health has taken the necessary steps to address the situation. These steps include sharing national plan and guidelines on Zika with the States, setting up an Inter-Ministerial task force, displaying Zika- related information for travellers in the airports.

B. J. Medical College, Ahmedabad

Beyond the media reports and the statements issued by the Ministry and the WHO, there has been little public discussion about Zika in India. The local neighbourhood Ahmedabad, as well as the Ahmedabad Municipal Corporation (which is responsible for public health in the area) reportedly were unaware of the Zika cases until these were publicized by the media. In sharp contrast, there are regular public updates on Dengue and Chikangunya cases in India.

The media reports also indicated that the government officials have consistently tried to downplay the threat of Zika. For example, the Head of Indian Council of Medical Research is reported to have said that there is no reason to panic, as no new cases has been identified. Other top officials have also insisted that there have been only three “isolated” cases, and that none of them, including the pregnant woman who has since then delivered, had any complication.

India has a population of 1.34 billion people. Why should anyone be concerned about only three cases of Zika virus? We should be for the following reasons:

First, the number of detected cases does not always represent the true picture of the disease burden. The cases were identified at one institution—the B.J. Medical College—in one area, in just one state of a vast country. With known under-reporting, and without a much wider survey, it is possible (and likely) that the number of persons in India who are infected with Zika virus is much greater than three. Also, we may not yet know the extent of this disease burden in India. Even if the confirmed cases have not shown any complications,  such as microcephaly, future cases may be more serious. Of note, there have been 260 cases of microcephaly in India since February 2016. However, it was only earlier this month that the Ministry began testing such cases for a link to Zika.

Second, as reported by the media, none of the three people with confirmed Zika virus had a travel history to a Zika-affected country. This means that it is likely that the Zika cases in India are homegrown.  This should not come as a surprise because the Aedes Aegypti mosquito, which acts as vector for Zika, is known to exist in India. Its presence in India is confirmed by the annual recurrence of the Dengue, Haemorrhagic Dengue, and Chikangunya fevers.

Finally, India has history of poor performance with respect to the management of outbreaks and pandemics. For example, during the 2009 H1N1 Pandemic, many gaps, ad-hoc measures, and undesirable outcome were observed, despite the presences of a pandemic plan and guidelines.  Issues concerning the availability, accessibility, and affordability of vaccines, health infrastructure, medicines, and the disproportionate burden on the already disadvantaged population surfaced. H1N1 is endemic in India and preventable morbidity and mortality are annual occurrences. Unless we recognize that Zika as a potentially serious public health concern, history may repeat itself

We can best avoid a potentially dangerous situation with Zika by ensuring an ethically aware public health response that is both realistic and situated in the local context. For example, there must be more active and localized Zika awareness campaigns. Instead of downplaying the risk of Zika, at the very least, the Indian Government should be taking steps to minimize the risks and that includes ensuring that the public is informed about the virus.

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Chhanda Chakraborti is a Professor of Philosophy in the Department of Humanities and Social Sciences, at the Indian Institute of Technology Kharagur in India. @Chhandac