It may well be said that the surveillance system put in place by the Health Ministry achieved a measure of success in identifying three adults who were infected with the Zika virus between November 2016 and February 2017 in Gujarat. Yet, the Ministry acted extremely irresponsibly by withholding the information from the local administration, doctors and the media. In fact, from everyone.
Shockingly, even the World Health Organisation was informed about the three cases as recently as May 15, more than five months after the first case was laboratory-confirmed. Information regarding the three cases came to light only when the WHO posted the information on its website on May 26.
By not disclosing the information in real time, India has behaved very much like China did in the case of the severe acute respiratory syndrome (SARS) outbreak in 2003. China was then widely criticised by the global community for covering-up the outbreak and desperately trying to downplay the extent of the outbreak. Indeed, by doing so, the Chinese government was partly responsible for SARS spreading to some other countries.
That none of the three Zika infected adults or their spouses or relatives had travelled to any country with Zika virus transmission indicates that the virus was locally transmitted in India. Based on the local circulation of the virus, the WHO has warned that “new cases may occur in the future”, particularly as the Aedes Aegypti mosquito which transmits the virus is widely found in India.
Over 34,000 human samples and nearly 13,000 mosquito samples were tested for the presence of the Zika virus, and there was monitoring for cases of microcephaly, a birth defect that has been connected to the mother being Zika-infected during the early stages of pregnancy. But it is not clear whether the person who brought the infection into the country (the index case) has been identified.
While the bite of an infected A. Aegypti mosquito is the main route of Zika virus transmission, it can also be sexually transmitted from an infected male. With the government choosing to remain silent about the spread of Zika infection in the community, the 64-year-old male and the index case, if it is a male, could have spread the virus through sex. As the virus remains present in the semen for a long time, the WHO recommends that couples abstain from sex, for at least six months after the onset of symptoms; the virus can also be transmitted by oral sex. Hence, secrecy about Zika outbreaks, even if seen only in isolated cases, can lead to a public health disaster.
Given that local transmission is already present, the A. Aegypti mosquitoes is commonly found, and many infected people exhibit no or only mild, non-specific symptoms, up-to-date health bulletins and advisories are vital. In a public health situation such as this, taking everybody into confidence, particularly the local administration, doctors and the people, especially the infected people, is imperative to prevent the spread of the infection and for doctors to be vigilant for any suspicious cases.
Any public health exercise, such as immunization, will turn out successful only when the public trusts the government and cooperates with it, as seen in the polio immunization programme. One of the reasons for the low measles-rubella immunisation coverage in Tamil Nadu was because the State government did not take school authorities and parents into confidence and inform them about the vaccination; it was the first time in the country that the immunisation was carried out in school premises. Therefore, by keeping everyone in the dark, the government has hugely dented its image, the repercussions of which may emerge in the coming days and years.
In any case, India has the responsibility to keep the WHO and the global community informed, especially in the case of dreaded infectious diseases, for both global risk assessment and risk preparedness. At a time when the government machinery should have been on an overdrive to educate and increase awareness about ways to avoid infection, the decision to keep the information under wraps to avoid creating “panic” is downright condemnable.