Dengue as a Human Security Challenge in Sri Lanka
July 26, 2023by Madhushi Sandamini
Published on Ceylon Today on 11th July 2023
Despite the fact that Sri Lanka has a victorious history of eradicating Malaria as the second nation in the Southeast Asian region, with the World Health Organization (WHO) declaration in 2016, the tragic situation is that the nation is still in the battle of dengue, a fatal vector borne-disease which the tropical and sub-tropical countries where the climatic conditions are favourable for mosquito breeding are experiencing worldwide in abundance. As per the WHO (2023), dengue disease has rapidly increased, with over half of the world’s population at risk and an estimated 100-400 million illnesses occurring each year. Hence, WHO has ranked Dengue as one of the top ten public health concerns in the globe. As a region, comprising numerous tropical countries, the WHO Southeast Asia region is home to 1.3 billion out of 3.5 billion people who live in Dengue endemic areas worldwide. WHO highlights that all member states in the SEARO (South-East Asia Regional Office), except for the Democratic People’s Republic of Korea, are endemic to dengue. And also, it contributes to more than half of the global burden of dengue, and countries such as India, Indonesia, Myanmar, Sri Lanka, and Thailand in the Asian region are among the top 30 most highly endemic nations in the world. The European Center for Disease Prevention and Control (ECDC) estimates, that Sri Lanka is among the top seven countries in the Asian region with a high risk of dengue while Sri Lanka ranks among the top three countries in South Asia according to WHO. However, these statistics demonstrate the gravity of the dengue situation worldwide and broader to the Asian region.
Sri Lankan Perspective on Dengue Incidence
Sri Lankan historical remarks on vector-borne diseases, particularly mosquito-borne diseases witness a variety of junctures, which the country was forced to battle periodically in a serious manner. In that scenario, dengue has been a persistent national health concern in Sri Lanka with high incidence for several decades, paving the way for human insecurity. According to the Epidemiology Unit in the Ministry of Health, the incidence of Dengue Fever (DF) and Dengue Haemorrhagic Fever (DHF) was declared as nationally notifiable diseases in Sri Lanka in 1996, and multiple dengue epidemics were reported island-wide between 1965 and 1988, as well as in the years 2002, 2004, 2017, and 2019. The most catastrophic dengue epidemic in recent history was in 2017 with 186,101 reported dengue cases and 440 deaths.
The WHO declaration of Sri Lanka as a hyper-endemic country in South Asia for Dengue has left a dark scar on sustainable disease prevention for the past few years albeit Sri Lankan health standards are at a high level. Notwithstanding the fact that Sri Lanka has a low case fatality rate relatively, the circumstances that emerge gradually as outbreaks and epidemics prove the severity of the dengue disease in Sri Lanka. When the dengue cases reported in Sri Lanka from 2010 to 2022 are considered, a fluctuating pattern of reporting dengue cases can be identified, with two outbreaks in 2017 and 2019. According to the reported dengue cases, there was a substantial spike following the 2017 outbreak compared to reported cases from 2010 to 2016, and a considerable decline in 2020 and 2021 in a comparable time period. However, health initiatives that restricted people’s movement in order to prevent Covid-19 transmission unexpectedly resulted in a considerable drop in the reported number of dengue cases in Sri Lanka during the Covid-19 pandemic period.
Due to the epidemics that occurred throughout Sri Lanka’s dengue history, as well as the considerable number of dengue cases that are typically reported, a variety of prevention efforts had been implemented and are ongoing to lower the risk of dengue disease. The National Action Plan on Prevention and Control 2019-2023 was initiated by National Dengue Control Unit (NDCU) as a strategy to control dengue disease and its major intention was to achieve case incidence below one hundred dengue cases per one lakh out of the total population in Sri Lanka by the year 2023. Accordingly, 22,000 dengue cases, approximately, should have been reported nationwide by 2023 to achieve the anticipated target of the action plan. However, data from the Epidemiology Unit show that 66,608 cases have been reported by December 2022. It was nearly a threefold increase over the expected situation of the action plan. Conversely, since the severe dengue epidemic in 2017, there has been a significant year-to-year increase, with the exception of the Covid-19 pandemic years rather than the years prior to 2017. Accordingly, it is obvious that Sri Lanka is extremely vulnerable to Dengue, which poses a public health emergency and jeopardizes human security.
Dengue as a Human Security Challenge in Sri Lanka
Although most of the national security disclosures are focused on traditional security threats such as military warfare, their priorities have shifted at present to non-traditional security threats related to human security as every nation around the world combats unprecedented security threats such as pandemics, natural hazards, drugs, crimes, etc. In this case, disasters caused by infectious diseases play a crucial role in the modern world, putting human security at risk. The United Nations Development Programme (UNDP) defines human security as safety from chronic threats such as hunger, disease, and repression, as well as protection from unexpected and harmful disruptions in the patterns of daily life. According to the United Nations Development Programme’s Human Development Report in 1994, human security comprises several significant components: economic security, food security, health security, environmental security, personal security, community security, and political security. However, dengue has an adverse impact on human security components within the domestic setting in multiple manners.
Dengue is indeed a human security challenge in Sri Lanka due to a variety of significant reasons. Although the majority of the literature on the incidence of dengue in Sri Lanka specifically attempts to portray dengue as a medical concern, however, it is also a serious issue that needs to be discussed from a human security perspective since there are numerous drivers and consequences that go beyond the medical point of view. When considering dengue in the case of Sri Lanka, the Western province is at the forefront of the high prevalence of dengue, accounting for half of all incidence across the country, with the majority of cases occurring in Colombo and Gampaha. Data from the National Dengue Control Unit show that by the month of June 2023, 48,505 dengue cases had been reported in Sri Lanka, with 24,171 of those cases coming from the western province. Accordingly, it is obvious that dengue disease is an urban dilemma in Sri Lanka. Due to rapid urbanisation, which has contributed to an ideal environment for dengue breeding, and urban challenges such as urban density, urban agglomeration, underserved settlements, and informal drainage system, etc. that grown up with it have accelerated its graveness more and more. However, as a result of high case incidence and considerable fatality rate, dengue has prompted the spread of fear and triggered unrest among populations that live in hotspots falling human security down in urban contexts.
A high dengue burden, on the other hand, has contributed to the development of economic insecurity in the county. Due to treatments and dengue prevention efforts, the high incidence of dengue has brought additional financial strain amidst Sri Lanka’s acute economic crisis, which has adversely engulfed every aspect of society and it has caused a burden on the healthcare system by raising the demand for hospitals and medical services as well. In such a circumstance, if Sri Lanka has to encounter catastrophic dengue outbreaks similar to those that occurred in the years 2017, and even 2019, the damage will be grievous, wreaking havoc on human security, especially health security as a result of the effects such as drug shortages and lack of infrastructure facilities that are required to combat the situation. Dengue also significantly impacts the economic well-being of individuals. The disease severely affects those who are already financially disadvantaged while also disrupting the livelihoods of people across all socioeconomic backgrounds.
The impact of dengue on health security is a significant aspect of its human security implications. The disease directly endangers the physical health of individuals, presenting a range of symptoms that can vary from mild fever to severe complications and even fatalities. Therefore, a country’s workforce being weakened has a direct impact on its productivity. On the other hand, dengue hits certain groups in various manners, and children, pregnant women, and the elderly are among the most vulnerable groups in the country who are more at risk from dengue than other groups because of the life-threatening effects it has mostly on them. As NDCU reveals that school children represent almost 25% of all dengue cases in Sri Lanka. Furthermore, Sri Lanka encounters occasional dengue epidemics, despite the disease remaining year-round endemic in general with thousands of cases reported each year. Therefore, due to the disease management strategies such as vector control campaigns have forced to people to adopt some measures such as applying mosquito repellents, special cloths which will add additional financial expense for them. However, the question of whether every individual from different economic origins, meanwhile, is able to survive with it is also challenging while the moment people have exposed to more vulnerable to economic hardships at the micro level in the face of the economic crisis.
Way forward...
In Sri Lanka, dengue poses a significant challenge to human security in addition to being a health issue. Although there is a number of preventive interventions employed by Government officials with high-cost burden, those efforts have been the failure to mitigate it to a sustainable level. Therefore, high-capacity domestic prevention approaches must be improved to reduce the prevalence of dengue from the grass-root level. Despite being a natural disaster, dengue has turned into a man-made disaster as a result of the favourable environment for dengue breeding that people’s lifestyles have brought about. Accordingly, the pursuit of a dengue-free nation also necessitates community involvement, which is just as important as medical initiatives. The government is therefore required to concentrate on initiatives that assist people to develop their knowledge, attitudes, and behaviours regarding Dengue in Sri Lanka.
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* Ms. Madhushi Sandamini is a Research Assistant at the Institute of National Security Studies (INSS), the premier think tank on National Security established under the Ministry of Defence. The opinion expressed is her own and not necessarily reflective of the institute or the Ministry of Defence.
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