Ministers call for regional initiative

François Fao and Christelle Lepers
In the last 30 years, more than 50 outbreaks of dengue fever have occurred in Pacific Islands countries and territories—some more devastating than others.

But every outbreak has had health impacts and resulted in economic losses, particularly for the tourism sector.
Recognising the level of the problem, Pacific health ministers called for a regional dengue initiative based on the Pacific Public Health Surveillance Network (PPHSN).

Their call was acted on by the Secretariat of the Pacific Community (SPC) and the Pasteur Institute of New Caledonia (IPNC) last year with the development of an innovative regional project on dengue vector surveillance and control. A key element of the project will be involvement of the private sector.

Impact of dengue fever outbreaks in the region

The first dengue epidemics in the Pacific were reported in 1844 in Hawaii, in 1852 in Tahiti and 1883 in Fiji and New Caledonia.

Between 1950 and 1970 only two outbreaks were reported, both in French Polynesia, but dengue activity markedly increased in the 1970s with six major region-wide outbreaks reported from 1970 to-date. The last such epidemic struck 16 countries and territories between 2000 and 2005 and was due to DEN1 virus.

It affected up to 20 percent of the population in some countries and had a major economic impact. For example, according to a report by health economist, Carol Beaver, the 2002 dengue epidemic in Cook Islands (which had a population of almost 20,000, including tourists) cost the government around NZ$1.2 million directly and the broader economy NZ$3.4 to NZ$4.5 million indirectly.

This year, dengue fever outbreaks have been reported in three Pacific Islands countries and territories, and sporadic cases have occurred in two others, according to information available through the PPHSN. Most information relating to dengue outbreaks in the region is circulated on PacNet, the PPHSN early-warning system that is maintained by SPC.

Before PPHSN was set up in 1996, SPC collected dengue data through the South Pacific Epidemiological and Health Information Services.

“Despite the numerous efforts of Pacific governments to control dengue, we’ve had regular outbreaks over the last 40 years.

“We need to try new approaches to change this situation,” said Dr Justus Benzler, Communicable Disease Surveillance Specialist at SPC.

“The SPC/IPNC project is aimed at protecting Pacific Island populations and local economies from the burden of vector-borne diseases, especially dengue fever, in a sustainable way.

But this can only be achieved with real involvement by the private sector and local communities and this will be the key to success.”

The project has been developed in close collaboration with PPHSN members, especially countries and territories that are the core members of the network. Other network partners, such as the World Health Organisation (WHO) are also contributing. In April, three internationally renowned experts on vector-borne diseases, Dr Kevin Palmer from WHO, Professor Brian Kay, deputy director of the Queensland Institute of Medical Research, and Dr Didier Fontenille, entomologist from the Institut de Recherche pour le Développement in France met at SPC to review the project.

They strongly recommended involving the private sector in the initiative—a view inspired by positive experiences in other dengue-affected regions, particularly Asia.

Involving private partners

Dengue fever outbreaks concern everybody. Addressing this scourge therefore requires a multi-sector approach with public health services, private sector partners and communities working together.

A survey was sent to all Pacific countries and territories in July to assess their potential for building such public/private sector partnerships.

The first step in the project will be to select five pilot sites that are economically important to the countries involved.

If we take the example of the tourism industry, a sentinel site could be a large resort and the surrounding area.

The project will help identify local people for recruitment by the private sector and train them, together with public health staff, in mosquito surveillance and control.

Activities will include detecting different types of mosquitoes, implementing control measures and communicating information to help change behaviour.

All of these efforts will help reduce the risk of local transmission of the disease. Increasing capacity in dengue vector surveillance and control will enable authorities to target problematic mosquito vector populations more selectively, thus avoiding indiscriminate spraying, minimising negative effects on the environment and making control measures more affordable.

Another important outcome of the project will be the development of community-based mobilisation strategies that will be tested and adapted to local realities.

The project has attracted the interest of the French Agency for Development. SPC is still looking for other interested partners to launch this ambitious project on a regional scale.


• François Fao is SPC’s Public Health Trainee and Christelle Lepers is Surveillance Information Officer.