Ige must step up actions against dengue outbreak

With the spread of mosquito-borne dengue fever on Hawaii island, pressure is building on Gov. David Ige to issue an emergency declaration to trigger a more intensive effort to control and defeat the disease.

So far Ige has resisted. When Hawaii County Mayor Billy Kenoi issued a county emergency proclamation on Feb. 8, the governor responded with a list of five criteria that must be met before he declares one of his own:

>> More resources to combat dengue must be required.

>> Dengue has spread to other islands.

>> The outbreak includes Zika and other vector-borne diseases.

>> It becomes necessary to waive “certain laws and regulations.”

>> Federal assistance becomes needed.

Some would characterize Ige’s response as dangerously passive. This is an exaggeration; behind the scenes, the administration says, it is lining up resources that could be deployed immediately upon an emergency declaration.

Furthermore, the Ige administration’s measured, step-by-step approach to the outbreak has yielded some positive results: There have been 252 confirmed past and present cases as of Wednesday, but the rate of reported cases has declined.

Nonetheless, with dengue on Hawaii island and the troubling appearance of Zika elsewhere, the state remains ill-prepared to fight another outbreak.

An initial assessment by a federal Centers for Disease Control and Prevention expert praised the “excellent” coordination between state Department of Health and Hawaii County, noting that all the facets for dealing with the outbreak have been addressed.

Ige released $250,000 to help DOH respond to the initial outbreak.

Nonetheless, the Dec. 8 assessment warned that “current resources are taxed, and there is limited surge capacity if another significant health event arises in the State.”

In other words, county and state officials are holding the line against dengue, but the defenses could easily fall without serious reinforcements.

The state expects to release within a week another $250,000 to fund eight vector control positions, one entomologist and one communications position. This would answer the CDC’s critique that DOH had “critical deficiencies in communications and medical entomologic capacities” that “should be urgently addressed.”

That the Ige administration is still working on this “urgent” and “critical” need, a full two months after the CDC’s recommendations, does not bode well if another serious outbreak occurs in the near future.

It would behoove the Ige administration to adopt a more aggressive role to protect the state against these vector-borne diseases — not just for now, but in anticipation of the future.

Controlling disease-bearing mosquitos is notoriously difficult — insecticides must be applied in labor-intensive ways that don’t harm the larger environment and agricultural assets, such as organic crops and bees. More manpower would greatly enhance county-led efforts.

So would more resources, such as insecticide sprayers and other supplies, delivered to more places. Also, teaching people to protect themselves through public education campaigns must be expanded beyond the current “Fight the Bite” campaign.

Most important, rebuilding DOH’s Vector Control Branch, which lost half its staff due to budget cuts in 2009, should be a top priority. Legislation has been introduced to correct this problem, and deserves swift consideration.

With Hawaii’s tropical weather, the large number of international visitors and the right kind of mosquito, another serious disease outbreak is entirely possible. The Zika virus, deemed a global health threat by the World Health Organization and a top-level threat by the CDC, is carried by the same mosquitoe s that transmit dengue in Hawaii.

Our long-term ability to control these outbreaks does not depend on an emergency proclamation, although it could help. Rather, it depends on a firm commitment to maintain our defenses.