WHO Representative: “Dengue must be everyone’s priority”

Lao PDR, like many countries in Southeast Asia, is experiencing a large number of dengue cases. The virus is transmitted through mosquito bites and can cause high fever and flu-like symptoms, ranging from mild to severe, potentially requiring medical intervention or hospitalization. In some cases, dengue can be fatal. 

Since the beginning of 2023, the Mekong region has seen an upsurge in dengue cases and deaths. In Lao PDR, approximately 35 000 cases were reported by the Ministry of Health in 2023. 

In 2024, the Ministry of Health reported high numbers of cases in the dry season, outside the typical peak of cases in Lao PDR's rainy season of June-August. The impacts of climate change and rapid urbanisation, among other issues, may exacerbate dengue patterns, making this illness a year-round concern.

Unfortunately, dengue is a significant burden on public health and the healthcare system in Lao PDR. 

Alongside the Ministry of Health, with significant support from the United States Agency for International Development (USAID), and other partners, efforts are underway on enhancing clinical management, strengthening surveillance systems, elevating the prioritization of dengue in non-health sectors and raising community awareness, and increasing vector control. 

In support of raising the priority of dengue, the Ministry of Health recently hosted a meeting with all Provincial Governors, led by Deputy Prime Minister, HE Professor Kikeo Khaykhamphithoune, and Minister of Health HE Dr Bounfeng Phoummalysith. 

At it, WHO Representative Dr Tim Armstrong highlighted the priority actions required to address dengue in Lao PDR – and the consequences of failing to do so.

Remarks:

So far 2024 has been the world’s worst year for dengue cases. Over 10 million cases have been reported from 176 countries – that is more than one million cases every month, a horrifying figure.

It is important to remember this is not just a health issue. 

Dengue affects everyone, and as cases rise, the economic and social impacts are felt across society. Children miss school. Employees miss work. Businesses lose money. Families face spiralling costs and hospitals come under increasing burden. Tourism and foreign investment are impacted as people become reluctant to visit locations with high dengue cases – as one example, a recent study in Thailand found a 2019 outbreak led to a loss of almost two billion US dollars in tourism revenue. And, worst of all, dengue is a killer.

As I said – dengue is not just an issue for the health sector, it must be everyone’s priority.

Making the situation more challenging, dengue patterns in Lao PDR, and other countries, are changing. 

Climate change, increased and unplanned urban population growth, increasing travel, and the lack of an effective treatment, mean that instead of large outbreaks occurring every 3-4 years, we are now experiencing outbreaks almost annually.

Fortunately, there are things we can do. By working together, across all sectors and with all available resources, we can save lives. We can improve how we protect our communities.

From today’s meeting, I hope I can leave you with three key points, drawn from our regional perspective and expertise. 

First: dengue must be a priority - for everyone - this can range from ensuring dengue is a standing agenda item at a provincial and district governance level, to directing and regularly reminding naibans to conduct cleanup campaigns. I commend the Ministry for efforts such as this meeting.

Second: the primary focus must be reducing deaths, specifically the number of people who die from severe dengue, with good management of cases.

Third: any efforts to manage or control dengue mosquitos, must be sustainable and conducted year-round, as reactive vector control once an outbreak has begun, such as spraying programmes and cleanup, has little effect.

Keeping these objectives in mind, and based on evidence from other countries in the region and the latest research, WHO recommends:

• Improving the capacity of health staff to diagnose and effectively refer or treat and monitor dengue patients so that dengue deaths can be reduced, and even eventually eliminated. This is especially important at the provincial and lower levels of the health system, and is a step that will save lives.
• Regular and clear communication, including from Governors directly, that encourages people to access appropriate health care early if they have dengue symptoms, and to protect their families and communities by keeping villages clean and free from mosquito breeding sites.
• Community engagement in vector management throughout the year, with a particular emphasis before the dengue season. Providing affordable and effective solid waste management is an important part of this, as are health promotion activities focusing on behavioral change and how individuals can protect themselves from dengue mosquito bites.

At this National Dengue Advocacy Meeting, let us review achievements, but also discuss the challenges faced by all sectors. This is not an easy problem to solve in Lao PDR, or in any other country, particularly with the changing patterns of the disease. 

There is much work to be done but improvement is possible with the right prioritisation and commitment – Governors in particular have a crucial role to play. 

As WHO, we are confident that together we can identify ways to safeguard communities, reduce economic impacts, and save lives. We are happy to discuss this in more detail, and I wish you all a successful and fruitful meeting.