Director Communication and Publications INSSSL

 The INSSSL Threat Lens on The Current Dengue Trajectory: Framework and Paths to Minimize the Spread of the Epidemic with the participation of stakeholders and experts in the health sector was held at the Ministry of Defence in Colombo on 26th July. The current state for emergency in the country as a result of the rapid spread of dengue which has reached epidemic proportions is seen as a threat to national security. The impact on several sectors such as tourism, investments, education and the overall workforce has potential to cripple the economy. Therefore, the aim of this meeting was to bring together the relevant State and public health stakeholders to assess the current state of emergency in the country with regards to the dengue epidemic. Specifically, this threat lens aimed at looking at how the armed forces can be mobilized in aiding the mitigation process. The outcome hoped to ascertain from this roundtable discussion was that of proactive framework on how to minimize the threat of dengue and the paths needed to stop the epidemic from arising in the future. As the current state of the country warrants an immediate response, this round-table discussion also looked at the pervasive effects of the emergency action currently being adopted and their implications for the future of the country.

 Director General Asanga Abeyagoonasekera and researchers at INSSSL mapped the trajectory of dengue and the variant dengue viruses in the country which has been catalysed by floods and the garbage crisis. In their presentation which depicted a dengue update by epidemiologists in the country, it was disturbing to note that Sri Lanka is facing an “unprecedented” outbreak of deadly dengue fever, with 296 deaths recorded and over 100,000 cases reported in 2017 alone, according to the Red Cross with all state and private health experts stretched to their limits in terms of treating this epidemic which is now a national security concern with government and private hospitals ill equipped to treat the surging number of patients.

 In order to curb this crisis, the researchers pointed out the importance of eradicating the causative organism which is the virus rather than the mosquito which is the vector. As methods, they suggested to seek and destroy dengue breeding grounds; community-led clean up campaigns; legal action on the public; and equipping hospitals with adequate resources. Therein, attention was focused on how other countries combatted dengue, with examples from Brazil, Pakistan, Philippines, Singapore and Australia. They presented a very important case study of the discovery of the Wolbachia bacteria by Professor Scott O’Neill of the Institute of Vector Borne Diseases at Monash University, which was used in Queensland, Australia. In conclusion, dynamic solutions to combat dengue in Sri Lanka were expounded. ‘Veta’, the fight dengue mobile app; locally invented mosquito trap; ‘Oxitec’ re-engineered mosquitoes; release of dragonflies into the eco system and bacteria release by Debug were proposed together with the implementation of a 10-year comprehensive, sustainable dengue eradication plan. The tri forces, the office of the Chief of Defence Staff and Police whose tremendous contribution in this crisis is largely appreciated also made presentations on their operations in dengue affected areas.

 In the discussion that followed, gaps in communication with regard to breeding sites and community participation were disclosed with recommendations that relevant local authorities should coordinate with the armed forces for a more effective outcome with central level assistance in executing plans. The incessant garbage and waste management problem was brought to the fore as a contributory factor for the breeding of dengue mosquitoes. However, an interesting point to note is that the city of Negombo which depicts the highest number of dengue patients globally is not affected by garbage disposal problems.

 The significance of entomologists with a scientific approach to this problem and an action oriented task force monitored by a central location can prevent future crises of this proportion. It was suggested that the public could approach the committee with their proposals so that they will in turn come up with plans with practical solutions to be executed with relevant authorised powers. Medical experts in the forum provided some very useful information with regard to understanding and combating the problem. Recommendations were made wth regard to the need to maintain preventive activities when the crisis subsides as well as identifying areas that need strengthening. Reducing mortality is the challenge as the disease which has many dimensions and is one of the hardest to manage. Reducing breeding places, water management, solid waste management and building management are contributory factors in the prevention of future outbreaks. Most importantly, as the topic suggests, the trajectory should be identified in formulating an operational plan to identify and strengthen capacities to combat dengue.