Vibrant Gujarat summit forced silence on Zika?

Even health workers on prevention operations were not informed of incidence; WHO official expresses disappointment over Ministry response

A team of 250 health workers and entomologists carried out a week-long exercise to identify mosquito breeding spots and screen patients in Bapunagar.

For a week, the Union Health Ministry has maintained that the decision to not make cases of Zika public was to avoid panic. However, an investigation by The Hindu reveals that the Vibrant Gujarat Summit “was a factor” in the decision to keep the Zika incidence under wraps.

The cases in Ahmedabad district were confirmed by January 4, 2017. In just about a week, Prime Minister Narendra Modi’s flagship project to attract foreign investors, Vibrant Gujarat, was scheduled to take place. A travel advisory at this time could have ruined the summit. Two independent sources, one of whom is highly placed in the Health Ministry, confirmed that the investment summit was the reason for covering up the Zika cases.

Intense surveillance

Soon after a positive case was reported, a team of 250 health workers and entomologists (people who study insects) were summoned to Bapunagar, in the east of Ahmedabad, where the patient lived. The healthcare workers were divided into clusters of 20 to carry out intensified intra domestic (ID) work that involves identifying mosquito-breeding spots and symptomatic patients. The week-long exercise, however, did not mention the word Zika.

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Question of public trust

 

“We were told it was a special campaign for vector-borne diseases like malaria and dengue. The ID activities are carried out throughout the year so we simply followed the orders,” said Dr. Harish Sandariya, medical officer of the Bapunagar Urban Health Centre that was at the epicentre of the action.

“Even now, I have no idea who the Zika virus patients are. I am only told that two of them fall under my medical boundary,” he said, adding that the secrecy was probably to avoid spreading panic.

The health officials were not the only people in the dark. The entire district, with population of close to six lakh people, was told that the screenings were for malaria. “The health workers keep coming to put medication in the water tanks to prevent malaria and dengue. But we are not aware about any new disease spread by the mosquitoes,” said Gulshan Bano, 40, a resident of Garib Nagar inside Bapunagar.

Asked about how the government handled the news about the Zika cases, Dr. Soumya Swaminathan, Director General of the Indian Council of Medical Research (ICMR), said: “In general, for public health interventions, it is best to take the community into confidence. We need to educate people about the risks and present a factual and balanced view.”

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Answer in Parliament

The Health Ministry had submitted in Parliament that, “representative[s] of the State Governments/UTs have been briefed on the action plan. Advisories have been issued to the States for intensification of vector control measures. Travel advisory has been issued,” after confirming one of the three cases reported.

However, last week, J.N. Singh, Chief Secretary of Gujarat, informed the media that the government, “Consciously did not go public with the cases” as the numbers did not rise.

Further, the Health Ministry delayed giving data on the Zika cases in Gujarat to WHO’s South East Asia Office (SEARO) for nearly two months. WHO’s SEARO had reached out to the Ministry in March whereas the data was given to them on May 15, and eventually published last Saturday.

“Going in, the government could not have known that the cases won’t rise. We reached out to the Health Ministry the day that question was raised in Parliament. It took two months to get the data from the government,” said a senior official in WHO SEARO.

The WHO official added that when the ICMR eventually handed over the information, the facts were out of place. “Their document said that one case each was reported in February 2016, November 2016 and then January 2017. When we published this information last week, the Ministry informed us that the first case in February 2016 was a typo. The handling of information by the Ministry has been disappointing,” the official said.

Precautions ignored

According to notification requirements of WHO’s International Health Regulations (2005), member states are to brief the international organisation within 24 hours of identifying a case. “The four decision criteria to be used... in assessment of a public health event are: (1) the seriousness of the event’s public health impact; (2) the unusual or unexpected nature of the event; (3) the risk of international disease spread; and (4) or the risk that travel or trade restrictions will be imposed by other countries.”

We now know that none of these precautions was taken by the Health Ministry as the State-level health officials were also kept out of the loop.