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When communication fails: the case of Indian dengue outbreak

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India is facing an aggressive outbreak of dengue fever – probably the worst in the last ten years – and risk communication from authorities proved to be very ineffective: the lack of proper strategies for both prevention and reaction to dengue outbreaks resulted in low levels of public awareness and poor coordination between different institutions. A series of mistakes for which India is now paying the price: so far, more than 38,000 cases have been reported by the Indian Ministry of Health across the country since January, with 109 deaths. Huge numbers, if compared with the over 50,000 of the whole 2012. Only in New Delhi, the disease has affected 2557 persons, three of whom have died, with more than 400 new cases reported in the last few days.

Dengue fever is an infectious tropical disease caused by a single positive-stranded RNA virus, transmitted by the mosquito Aedes aegypti and other species from the same family. The World Health Organization (WHO) estimated that the number of infections worldwide stood at 50-100 million a year, but a study published onNature in April raised this number to 390 million. One third of these cases comes from India, where the high rainfall that occurs during the monsoon season provides several areas for the insect vectors to breed. Usually, the monsoon season lasts from mid-June to mid-September but this year the period of heavy rains extended into October, thus prolonging the time window during which dengue hits.

But protracted monsoons are not the sole responsible for the outbreak that is shaking the country. Many voices rose to accuse government and institutions of negligence, saying that they failed in taking sufficient preventive measures even though India faces the same situation every year.

While the number of patients in hospitals is growing day after day, several healthcare operators have asked the state government to intensify the measures to check dengue's spread and increase the awareness campaigns. A meeting with state government and hospital authorities has been held, in order to ensure better coordination between institutions. However, the main impression is that authorities appeared to be waking up only now, while dengue has taken epidemic proportions.

Communication is a main component of an effective preventive strategy. For instance, the participation of the public is a key element to control the disease by restricting areas where dengue mosquitos could lurk in and around houses and residential colonies. It is thus fundamental to make people aware of the importance of cleaning the water storage areas in their houses, in order to prevent mosquitos to proliferate and propagate. This kind of approach leads to a higher public awareness, which help to contain the spread of the disease and to reduce panic within the population. On the contrary, a lack of communication causes a slower and disorganized reaction, which may result in a higher death toll.

But it seems that the Indian situation is not only due to a failure in elaborating an effective preventive strategy. Apparently, communication problems are also thwarting the interactions between local and federal institutions. On the one hand, some experts said that the official numbers underestimate the real situation, since the official system of recording is based on disclosure from local hospitals, some of which do not send reports. On the other hand, private hospitals have been criticized too, as they are apparently exaggerating the emergence. “Some private hospitals are spreading panic for commercial reasons,” said Dr Pushpa Bishnoi, civil surgeon of Gurgaon, to the Times of India.

In such a scenario, with local and federal authorities passing the buck amongst each other, there is also room for other kinds of suspects: according to some political opponents, the government would be scared by the epidemics because elections are close and this would be the reason behind the underreporting of dengue cases.

The lack of preparedness on one side, the slow and ineffective response on the other one; both issues are clearly due to a bad management of risk communication. The result? Inefficiency and distrust. As well as more victims, obviously.

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