he World Health Organisation (WHO) documented 53,498 cases and 95 deaths in Pakistan in the last quarter of 2019. This was the last notable outbreak in the country, which has been suffering with a dengue endemic for the last 30 years. The National Institute of Health (NIH) has reported 24,967 dengue virus cases and 67 deaths this year. The numbers from the first three quarters of the year compared to the last quarter of 2019 are enough to convince a layman that the situation is under control.

Health policymakers may relish the numbers, which seem to indicate that the government is making progress in its war against the viral disease. However, it is pertinent to analyse the virus, its peak infection time and the mortality rates before making any claims of progress. The government’s focus has been on branding dengue as a by-product of the unprecedented floods in the country. However, the country’s first dengue outbreak was in 1994, and cases have appeared consistently and increasingly in the post-monsoon season over the years.

The most affected province in the country currently is Sindh, with 7,951 dengue-positive cases and 33 reported deaths this year. Following the 2019 outbreak, the Health Department had introduced the Provincial Implementation Committee on Dengue (PIC). It has been over two years since the inception of this body, yet the number of positive dengue cases in the province still presents a perturbing picture.

This year the overall case fatality ratio (CFR) in the country is 0.26 per cent. In the 2019 outbreak, the CFR was 0.17 per cent. Although the number of cases this year is fewer than the 2019 outbreak, there is a drastic increase in the mortality rate. In Sindh, the CFR is 0.4 per cent. This is almost 60 per cent more than the country’s average. The province needs immediate attention from the provincial government before the situation escalates during the peak infection period.

The WHO has reported three areas of focus in effective dengue management: 1) vector (mosquito) control, 2) case management, and 3) community awareness. To control the vector, timely mass-scale fumigation drives must be carried out. In Pakistan, the provincial governments carry out space spray activities only after an outbreak has begun after the peak monsoon time. Although a dengue fever outbreak in post-monsoon season is expected, the governments remain unprepared and act surprised every year. Local institutions work at a glacial pace and typically wait for an outbreak before addressing any threat.

The record-breaking floods in the country have had a severe trickle-down effect. Many people are left fending for their lives. The National Disaster Management Authority has recorded the displacement of 33 million people. These individuals are at higher risk of dengue fever infection as many of them are forced to sleep next to stagnant water under the open skies.

Pakistan, on average, has a median level of positive dengue cases compared to other countries in the same hemisphere. The federal government must ensure that the provinces with a CFR level above the country’s average are in prime focus for remedial action.

The World Health Organisation has emphasised the need to enhance vector and human surveillance in the affected areas. According to independent researchers, Sindh has one diagnostic unit hosting and analysing roughly 1,000 suspected cases daily.

The WHO reports the prevalence of dengue-causing mosquitos in tropical and sub-tropical climates worldwide. Governments are always keen to use the numbers to claim improvement in local conditions. Pakistan is in the northern hemisphere and has a CFR of 0.26 per cent. Other countries located in the northern hemisphere are Cambodia, Malaysia, the Philippines and Vietnam. They have CFRs of 0.2, 0.06, 0.3 and 0.04 per cent, respectively.

Pakistan, on average, has a median level of positive dengue cases compared to other countries in the same hemisphere. The federal government must ensure that provinces with a CFR level above the country’s average are in prime focus for remedial action. It is clear that provincial bodies have not performed up to mark thus far.

The WHO prepared a comprehensive report for Pakistan and suggested re-aligning the government initiatives with the Integrated Vector Management (IVM) approach for dengue management. This approach ensures that potential breeding sites are removed, and individual exposure is reduced through active intervention.

In Pakistan, only the Punjab government focuses on the IVM approach. Sindh has vector control activities that are carried out on an ad hoc basis. With one of the country’s highest CFRs, Sindh’s provincial government needs to be more strategic and adopt the IVM approach. The Sindh local government cannot blame the changing political environment, as one ruling party has been in power in the province for more than two decades. There has been no well-rounded effort on the part of the local governments to prevent an outbreak.

The Center for Disease Control and Prevention has reported that Pakistan is one of the few countries that have a range of risk levels inherent in different parts of the country. It is clear that the provincial governments must create a need-based strategy for the control of dengue fever. Sindh is clearly lagging behind other provinces in its dengue prevention initiatives.

The Finance Division has reported an expenditure of Rs 31 billion in FY 2022 for health sector projects. Despite the lack of historical data on the clinical characteristics of dengue fever patients, the report does not contain any project proposals for studying clinical characteristics of dengue fever. This lack of interest in dengue-related research at the federal level is a bad message for the provincial governments.

Health policy makers have little local research-based data to make informed decisions on preventive and remedial policies to control the rising mortality rates in dengue fever patients. The unprecedented flooding in the country has only increased the burden on healthcare practitioners. There has also been a rise in other infectious diseases, including malaria and water-borne diseases. With the country’s growing economic and social pressures, it is once again expected that dengue fever will not make it to the priority list of the governments. Despite its yearly outbreak and rising threat to the citizens, it remains a mystery as to why dengue fever is taken with such little regard. It is high time for both provincial and federal governments to give dengue fever the attention it urgently needs.

The writer is a risk analyst currently working for the IT Governance department at a leading bank in Pakistan. She is a public policy graduate from the Suleman Dawood School of Business, LUMS.