Effective anti-encephalitis programme could have saved lives

Japanese Encephalitis (JE), a mosquito-borne arboviral infection and a leading cause of viral encephalitis in Asia, has killed hundreds in Nepal since July, but many of the deaths could have been avoided if both public and private bodies had done more to combat the preventable disease, health experts say. According to the Ministry of Health, in the past two and a half months alone, 270 people have been reported dead and 1,775 infected, with the number of deaths by 21 September exceeding the usual annual mortality figure of 200. JE is transmitted in a cycle between mosquitoes and certain animals (chiefly domesticated pigs and wading birds); humans are an incidental host. The transmission is at its worst during the monsoon season and particularly affects impoverished families living near rice fields. One reason behind the high death toll is poor distribution of vaccines, costing as little as US $1, health experts say. They allege that distribution was delayed due to a lengthy government purchase process. Local media reports cite corruption and irregularities inside the related units of the health ministry to find the most lucrative deal from pharmaceutical retailers. However, according to the government, just last week they had managed to distribute 5,000 vaccines in the western districts of Banke and Dang districts, which remain the most affected areas. “Even this amount was done by discarding the lengthy [purchase] process and was initiated by our senior official,” Ministry of Health spokesman, Hari Nath Sharma, said, although he conceded that the purchase of vaccines had been delayed due to tender bidding problems. But vaccine distribution is only one of a number of problems, health experts maintain. “This is no longer a mysterious disease. We can always predict how many will die and also how we can prevent it but we are not doing much at all,” public health expert Dr Sharad Onta, an associate professor of the quasi-governmental Institute of Medicine, said. At the same time, the health ministry spokesman defended the government’s position while hitting out at the non-governmental sector. “It’s not just the government’s responsibility. What have the NGOs and international NGOs ever done to combat this disease besides just criticise the government for not doing much?” Sharma asked, noting they [the ministry] had already taken preventive measures like spraying insecticides and distributing mosquito-block nets. In order to prevent such a disaster in future, the ministry had already planned to distribute 245,000 vaccines in 2006 worth nearly $1.7 million, he added. “The question is why aren’t the NGOs and INGOs coming up with any kind of support to help the patients?” Sharma wondered. Those who become infected and survive the disease often suffer from a series of disabilities including paralysis and mental retardation, requiring long-term rehabilitation but this has so far been lacking. “We have been failing to effectively manage this problem. This clearly indicates weakness in our public health system,” Onta said. Experts explained that while NGOs lacked priority in this issue, the government had also failed to mobilise the private sector, especially in diverting their resources to deal with the disease head on. “The consequences of such failure are becoming costly, both in human and financial terms,” Onta added. Meanwhile, health workers in the JE-affected districts of Banke and Dang report that the number of deaths has slowed somewhat as temperatures cool and the monsoon comes to an end. However, doctors at the state-run hospitals in Nepalganj and Dhangadi in far western Nepal remain concerned that fresh rains could result in more deaths.