Unite to care (for dengue too) – 02/11/2024 – Marcia Castro

In 2015, 1,688,688 probable cases of dengue were reported in Brazil. This is the record number of cases considering the historical series since 2000. In the following year, 2016, there were 1,483,623 probable cases. It was the first time that Brazil had more than 1 million cases of dengue in two consecutive years.

In 2023, the number of probable cases was 1,658,816, the second highest in the historical series. This after more than 1.4 million cases in 2022, the second time that two years in a row have recorded more than 1 million cases.

In the first five weeks of 2024, 395 thousand probable cases have already been registered, 323% more than the same period in 2023. This increase is not a surprise. Last year, experts were already warning of an even more critical situation in 2024, and the estimate is that there could be up to 4.2 million cases of dengue this year.

This accelerated increase, anticipating the transmission curve in the first months of the year, is also observed in other Latin American countries.

If in 2022 there were a series of difficulties, including the effects related to the disruption of part of the routine vector control work, due to the Covid-19 pandemic and the previous government’s failures in the acquisition of insecticides, 2015 and 2023 have one characteristic in common : an intense El Niño.

However, it is not correct to attribute the current situation solely to El Niño. There is no doubt that the climate anomalies produced by El Niño worsen the situation. There are, however, structural problems that, despite government coming and going, remain unresolved.

Irregular access to water, irregular garbage collection, lack of health education since basic education and disorderly urban growth are determining factors in the expansion of Aedes aegypti. Furthermore, the National Guidelines for the Prevention and Control of Dengue Epidemics recommend bimonthly visits to 100% of properties and fortnightly visits to strategic points (for example, cemeteries, tire repair shops, scrapyards).

Considering issues of access, security and the number of vector control agents available, the frequency of these actions does not occur as recommended.

In other words, the conditions of cities favor the proliferation of Aedes, climate anomalies increase this proliferation, and vector control does not have enough personnel to meet the growing demand for actions. The account does not close.

Intensifying control actions in times of crisis, like now, helps to mitigate the situation, saves lives, but does not attack the root of the problem. To achieve this, other sectors of the government need to work in partnership with the Ministry of Health. The recently launched Healthy Brazil: Unite to Care program seeks to eliminate or reduce 14 socially determined diseases, however, it does not include dengue.

Brasil Saudável will be a joint effort between the Ministry of Health and 13 other ministries, initially aimed at 175 municipalities. The program has five guidelines. Among them, the fight against poverty, the reduction of inequalities and the expansion of access to basic sanitation — all crucial in the fight against dengue.

If, on the one hand, collaboration between different government sectors is a challenge in Brazil and around the world, on the other hand, finding ways for this collaboration to happen is absolutely fundamental for there to be sustainable solutions to public health challenges.

The mistakes, successes and challenges of implementing Healthy Brazil will bring lessons about how different sectors of the government must come together to create a form of governance that effectively makes Brazil healthier.

Uniting to care is also vital in the fight against dengue. And this union needs to be long-term, not emergency.

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