In the 21st century, dengue should not be a disease which infects hundreds and sometimes thousands of persons in Trinidad and Tobago every year. Four months into 2014, however, Health Minister Fuad Khan is reporting a 34 per cent rise in dengue infections.
Dr Khan has taken the right step in sounding this early warning. His predecessor under the Patrick Manning administration, Jerry Narace, expended great effort in 2008 to deny that there was a dengue outbreak. Such official denial, although treated with public scepticism, may have undermined measures to prevent breeding of the Aedes Aegypti mosquito, which spreads the dengue virus.
This, in fact, is why eradicating the disease has proved so problematic in T&T. Dengue can be contained only by a combination of efficient official responses and responsible citizens. The Government can provide the medication, but too many home-owners provide the breeding grounds in the form of water barrels, old tyres, and plant pots. As a result, the mosquito flourishes and so does dengue.
As measured by fatalities, official response seems reasonably effective. This country has had dengue outbreaks in 1990, 1996, 1997, 1998, 2002, and 2008. An “outbreak” means that there were higher-than-average infections—which, in T&T, means between 50 to 100 cases per year—in specific areas. Fourteen persons died from dengue in 2002, one in 2004, six in 2008 and, in 2013, seven.
Reports from the Pan American Health Organisation (PAHO) record 6,246 registered dengue cases in T&T in 2002, and 2,289 reported cases in 2003. The 2008 dengue report notes that water barrels are the main breeding ground for the mosquitoes, saying: “It is clear that the Aedes Aegypti problem relates directly to two main factors—water storage and inappropriate disposal of water-holding containers within the environment.”
So here we find the perfect nexus between official inefficiency and citizen irresponsibility. After all, if more people were assured of a regular pipe-borne water supply, households in T&T would not need to have water barrels. That alone would reduce the number of mosquitoes. At the same time, householders are clearly not ensuring that their barrels are properly covered or even cleaned.
Dengue infections, then, are an expression of our Third World mentality. Given the private property infrastructure which facilitates the breeding and spread of mosquitoes, and the limitations of medical treatment, the first step toward eradication must be a change in attitude. A public education programme, properly formulated and targeted, can help persuade citizens to cover or remove containers that mosquitoes use to breed.
If such a programme is effective, there need be no dengue deaths in 2014.