Why Nepal needs a powerful disease control agency

Although it has been about two months since Kathmandu began reporting its first dengue fever cases this season, the Kathmandu Health Bureau has no plans yet to launch a campaign to contain the infections.

Experts say a search-and-destroy campaign is an effective way to eliminate mosquito breeding sites, the vector, and raise awareness about protective measures.

“Dengue fever cases have been on the rise, mainly in the metropolitan city of Kathmandu,” said Basanta Adhikari, head of the Kathmandu health bureau. “But a plan to launch a search-and-destroy campaign for dengue virus has yet to be worked out.”

Like the Kathmandu Health Bureau, most local units have taken no action, as hospitals see large numbers of dengue patients daily, citing a lack of budget.

Officials from the Division of Epidemiology and Disease Control said they can only ask 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 dealing with all kinds of epidemics and epidemics in the country. The division deals with neglected tropical diseases, vector-borne diseases, and zoonotic and communicable diseases. It is also responsible for developing necessary policies and conducting research in the country.

The division, however, is not an enforcement agency, unlike other countries like the United States where the Centers for Disease Control and Prevention plays a key role in epidemic control and advises the government on issues. health.

“While the focus is on the coronavirus, there are other deadly diseases like dengue fever, scrub typhus, cholera and kala-azar, among others, circulating in the country,” said Dr Prabhat Adhikari, an infectious disease expert. “The problem is that we don’t have a central agency, which can make quick decisions and enforce them.”

Experts say delay in making and implementing decisions multiplies the risks and by the time agencies spring into action, the disease has already penetrated society, affecting large numbers of people.

Dengue fever 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 Organization.

Cases of dengue infection have increased exponentially due to the apathy of affected agencies to take measures to control infections.

So far this year, 2,108 cases of dengue infection have been reported in 69 districts.

In 2019, at least six people died and more than 16,000 were hospitalized after dengue fever spread in 68 districts.

Meanwhile, 69 people have tested positive for cholera since June 21.

The threat of the coronavirus is not over either, with active cases rising to 3,612 on 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 burden on the country.

“Thousands of people are dying from Covid infections and thousands are infected with dengue virus,” Adhikari said. “But our response to control the spread of infection is not effective.”

The government had formed the Covid-19 Crisis Management Coordination Center for coordination among agencies concerned with the prevention and control of coronavirus infection. However, questions have been raised about the success of the High-Level Center in coordinating between agencies tasked with preventing the spread of infections.

Many local governments across the country have even refused to conduct contact tracing, placing suspects in quarantine and those infected in isolation centers.

The infection spread rampantly across the country, especially during the second, third and fourth waves of the pandemic.

And experts say that even if the high-level committee worked effectively in a particular incident, it is not always possible to form such a committee.

“It is not possible to form a high-level committee to contain the spread of all diseases,” said epidemiologist Dr Biraj Karmacharya, who is also the community program manager at Dhulikhel Hospital. “We need a powerful body that includes experts from various sectors – public health, epidemiology, infectious diseases, communication, animal health, among others. Such a mechanism should have the power to take quick decisions and enforce them.

In the United States, the Centers for Disease Control and Prevention (CDC) is the federal agency responsible for protecting the health of Americans. It is among the most important health agencies in the world and plays a crucial role in protecting public health and safety through the control and prevention of disease, injury and disability in the United States and around the world. .

The CDC has a broad mandate to address health, safety, and security threats both at home and abroad. It has a particular focus on infectious diseases, foodborne pathogens, environmental health, occupational safety and health, health promotion, injury prevention, and educational activities designed to improve the health of American citizens.

In India, there is National Center for Disease Control, which plays a leading role in conducting nationwide outbreak investigation using epidemiological and diagnostic tools. The agency organizes meetings for the formulation of guidelines for the surveillance, management, prevention and control of various communicable and non-communicable diseases.

The meetings are attended by experts in the respective fields, senior administrators from state health departments, program managers from medical, veterinary, agricultural and animal husbandry departments.

The doctors also stress the need for a strong disease control mechanism in Nepal with representation from all three levels of government.

The Ministry of Health and Population said it was working to set up a powerful center for disease control, which will deal with all existing and emerging infectious diseases.

For this, the ministry had prepared a draft law, which has already been approved by the seven provinces. The ministry sent the bill to the Ministry of Finance for suggestions.

“We are working to form a strong body, something like the CDC, to meet the challenge of existing and emerging diseases that threaten human health,” said Dr Roshan Pokhrel, secretary at the Ministry of Health.

Pokhrel, however, said he cannot say how long it will take for such an agency to come into being.

Ministry officials said the bill will be forwarded to the Ministry of Law, Justice and Parliamentary Affairs once the Ministry of Finance makes its suggestions.

The bill must be approved by the Cabinet and both Houses of Parliament to enter into force.

Officials said the new bill will replace the Infectious Diseases Act of 1964, and through the act, a powerful CDC-like body will be formed.

“Agencies at all three levels of government – local, provincial and federal – will have to follow the decisions made by the powerful new body,” said Dr Guna Nidhi Sharma, an official with the Ministry of Health and Population. “All agencies under the Department of Health Services and other ministries, tasked with dealing with disease outbreaks will report to the powerful agency.”

Doctors say most countries have dedicated agencies like the CDC to control existing and emerging diseases and Nepal also needs a similar mechanism to fight the ongoing Covid pandemic and outbreaks of dengue fever, cholera and scrub typhus, among other diseases.

“The existing mechanism of government cannot deal with all the health problems we face,” said Karmacharya, who is also a member of an expert group formed by the Ministry of Health to prepare a health bill. the CDCs. “We shouldn’t take a long time to set up a CDC-like body.”