Sustainable Management of Dengue Fever and Chikungunya: Policy Gaps and Responses in Kenya

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Thursday, January 28, 2021

By David Illah

Globally, countries are experiencing unprecedented cases of viruses such as HIV, Ebola, Covid-19, dengue fever, and Chikungunya. These viruses have affected socio-economic and political spheres of lives resulting in a massive loss of jobs, deaths, and decline in international trade and development.

An effective response to these viruses would possibly be a breakthrough in achieving sustainable development goals, Africa Union Agenda 2063, and Kenyan vision 2030 mild-term strategic plan. So far, progress has been made in research, policy, and programs to promote health, help prevent, treat and care for people, plants, and animals. Perfect examples include equipment, vaccines, clinical trials, funding, and awareness creation. This has brought about a notable decline in the spread of viruses and the longevity of lives.

Unfortunately, many gaps in policy and response still linger as there is no cure or vaccine, developed to eradicate these viruses. Sad still, the existing nontherapeutic interventions have not been given the correct attention in terms of policy and response especially in developing economies. Many countries including Kenya have neglected most tropical diseases. This neglect has affected public perception and response to viruses particularly Dengue Fever or Chikungunya, which are spread to people when they’re bitten by an infected mosquito or tick. Consequently, there has been an increase in the emergence and recurrence of these diseases in tropical Europe, Asia, America, and Africa.

Reports on Dengue Fever or Chikungunya reveal that an estimated 50 million people are affected annually and 2.5 billion people have already contracted the vector-borne disease. Significant variation exists between countries with Brazil having more than 1.4 million cases in 2016. Kenya’s caseload is also rising. The country recorded more than 200 cases between 2017 and 2018 in Coast province particularly Mombasa. These are not the first cases. In May 2016, World Health Organization data posits that 1,700 positive cases of Dengue Fever or Chikungunya have been recorded in the North Eastern region particularly Mandera County. Like HIV, Ebola, or Covid-19, mitigating the spread of these viruses has been met by various challenges, some of which include lack of vaccines and treatment. However, the good news is that controlling vector is the only sure bet to prevention, control, or both!

Before dwelling on the vector control, it would be nice to know what really happens when there are human, plant, and animal interactions. For decades, it was widely thought that tropical forests with the intact natural environment of plants and exotic wildlife threatened humans. They harbor viruses and pathogens that give rise to new diseases in human beings such as Ebola, HIV, and Dengue Fever. Today, many researchers hold that human destruction of environment creates the new conditions for new viruses and pathogens.

The new shift dubbed “Planetary Health” tries to connect the relation between human well-being and the natural environment consisting of plants and animals. Through this lens, human activities such as road construction, urbanization, mining, hunting of animals and plants have and will continue to fuels the spread of vector-borne viruses. In his book “Spillover” David Quammen wrote that human invasion of tropical forests and other wild landscapes, which harbor so many species of animals and plants makes them vulnerable to many viruses. He also wrote in New York Times and I quote “We cut trees, kill animals or cage and send them to markets. We disrupt ecosystems and we shake viruses loose from their natural hosts. When that happens, they need a new host. Often, we are it.”

According to the US Centers for Disease Control and Prevention (CDC), three-quarters of new and emerging diseases that infect humans originate from Animal. Also, Ecologist Kate Jones holds that animal-borne infectious diseases such as Dengue Fever are increasingly and significantly a threat to global health, security, and economies. Worrisome still, existing vector-borne viruses or diseases are just the tip of the iceberg. This means radical measures need to be put in place to mitigate possible spread or emergence of new viruses. As Ecologist Thomas Gillespie rightly puts it, “pathogens do not respect species boundaries. The majority of pathogens are still to be discovered. We are at the very tip of the iceberg.” Where do we go from here?

These studies point to the urgent need for total behavior change across the global population. For enhanced resilience against Dengue Fever or Chikungunya, both developed and developing worlds must reach a sustainable consensus, planetary healthy! For instance, it has been found that exploitation of natural resources by developed nations result in the destruction of the ecosystem and possible outbreak of vector-borne viruses including Dengue Fever. Kate Jones says demand for wood, minerals, and resources from the global north lead to the degraded landscapes and ecological disruption that drives diseases. She further notes that we must think about global biosecurity, find the weak points and bolster the provision of health care in developing countries or risk viruses.

These observations have been backed by many scholars including Brian Bird, a Virologist at the University of California. He submits that the world is at the pandemic status that calls for a total global investment and behavior change, “the risks are greater now. They were always present and have been there for generations. It is our interactions with the risk which must be changed. We are in an era now of chronic emergency. Diseases are more likely to travel further and faster than before, which means we must be faster in our responses. It needs investments, change in human behavior and it means we must listen to people at community levels. Getting the message about pathogens and diseases to hunters, loggers, market traders, and consumers is key.” These thinkers retaliate that the spillovers start with one or two people and that the solutions must start with education and awareness to make people who have the hunger and desire to have information aware of how things are!

For futurists, rethinking urban infrastructure is essential for under-resourced countries and communities, which requires long-term models. However, many of the current interventions are short-term goals pegged on containing the spread of Dengue Fever and viruses. Fevre and Tacoli recommend that policy entrepreneurs should consider urban planning and development as long term measures because new vector-borne viruses will likely continue to spread rapidly into and within cities. The bottom line, Bird says, is to be prepared. “We can’t predict where the next pandemic will come from, so we need mitigation plans to take into account worst possible scenarios, the only certain thing is that the next one will certainly come,” he says.

Modeling human risky behavior and its related consequences makes a perfect match for a sustainable Dengue Fever mitigation plan for any country. However, the Kenyan government has done very little in terms of policies and programs, especially on control. With respect to Malaria, several policies and programs have been put in place in the recent past and the fruits are overwhelming. For example, the National Malaria Control Programme through insecticide-treated nets and indoor spraying of homes has helped control the spread of malaria by over 72%.

For years now, a similar malaria vector approach has been adopted for Dengue Fever or Chikungunya, which is more unlikely to contain the vector spread. Explanations for this are so many. First, unlike malaria vectors that bite at night and can be controlled by sleeping under bed nets, Aedes aegypti, a vector that spreads dengue fever and chikungunya bites during the day. Sleeping under bed nets would therefore have minimal health outcomes in the control of the diseases. Second, spraying of insecticides is not advocated because it targets unintended organisms and has a detrimental effect on the environment. Last but not least, there is the challenge of insecticide resistance.

For a well-rounded approach, both national and county governments should adopt urban planning and land-use policies, which are easy, sustainable, and achievable solutions. A review on Aedes aegypti or black mosquito reveals that it prefers breeding in the garbage, water tanks, and shady areas, which is a true reflection of most residential premises in Kenya. As such, urban planning policies on proper solid and e-waste management, provision of enough fresh tap water, and education campaigns on the importance of covering, emptying, and cleaning their domestic water storage could help. Likewise, improved environmental management practices such as better drainage systems around residential areas, and clearing bushes and shady areas to help destroy the breeding sites for black mosquitos.

Research on land use policies suggests that attempts to intensify agricultural production, mining, logging, and various constructions could be linked to a high prevalence of dengue fever and chikungunya. In Kenya, this could be possible through the importation of seeds or weeds such as Parthenium hysterophorous, a source of sugar for black mosquitoes. Some of these agricultural lands could be turned into conservancies for growing Parthenium hysterophorous to offer an alternative ecological niche for black mosquitoes. With proper policies and programs, dengue and chikungunya can be managed and the government must take the first steps.

Mr. David is a sociologist, grant writer, and social entrepreneurs. He is the founder of SCORE CBO and current fundraising and development. He has a passion for social research, project development and management, and monitoring and evaluation. For feedback and partnership, write to him at okikidavid887@gmail.com

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