VULNERABILITY TO DENGUE FEVER IN JAMAICA

1. VULNERABILITY TO DENGUE FEVER IN JAMAICA Charmaine Heslop-Thomas, Wilma Bailey, Dharmaratne Amarakoon, Anthony Chen, Samuel Rawlins, David Chadee, Rainaldo Crossbourne, Albert Owino, Karen Polson, Cassandra Rhoden, Roxanne Stennett, Michael Taylor.

2. HISTORY • Virological evidence of the presence of dengue in the Caribbean in the 1950s. • The disease has been appearing with increasing frequency. • All four viruses are circulating. • The appearance of dengue 1 in Jamaica in 1977 resulted in 60,000 cases. • The last large epidemic appeared about 10 years ago.Increase in temperature will shorten the incubation period of the virus. .

3. RISK • Increase in temperature will shorten the incubation period of the virus. • The vector may become more infective more quickly. • Reproduce more rapidly. • Bite more frequently. • There may also be the increased risk of DHF. EVIDENCE • A.aegypti is already appearing at higher elevations. • Simulations suggest a potential to spread into higher latitudes. • A link between El Nino and the incidence in some Pacific islands.

4. OBJECTIVES • To assess the vulnerability of the population of Jamaica to dengue. • To identify specific factors that put communities at risk. BACKGROUND • An upward (but not significant) trend in rainfall indices. • An increase in the incidence of dengue in the corresponding period. • The increase particularly marked in El Nino and El Nino +1 years. • A seasonal peak in occurrence in the latter part of the year, after a few months of warming and when the rainfall is receding. • A lag between climatic parameters, especially temperatures and the epidemics. • In the Caribbean the association of the disease with temperature is stronger and the lag with temperature is greater than that with rainfall

5. DISTRIBUTION OF EPIDEMICS PEAKS AMONG ENSO PHASES 1981-2001

7. PROJECTIONS Projections for Jamaica for the years 2020, 2050, 2080 using statistical downscaling methods and two scenarios (SRES A2 AND B2) indicate the possibility of increased warming in the next century.

8. TO SUMMARISE • Changing climatic conditions may enhance dengue transmission. • Immunity is low. • But individual and contextual circumstances could modify vulnerability.

9. TWO LEVELS OF ANALYSISGeneric and Specific Adaptive Capacity • Macro level – current social and economic trends. Expert interviews in public sector organisations and NGOs. How do they interpret their roles? How prepared are they? • Local level study in communities that had experienced an outbreak. How vulnerable are they to an outbreak?

10. The Survey

11. THE MACRO LEVEL • The ending of the bauxite/alumina inspired boom in the 1970s. • IMF and its conditionalities. Their effect felt most keenly by the poor: -Job loss. -Devaluation and price increases. -Removal of subsidies on basic food items. • No real economic growth in more than 30 years.

12. THE INTERVIEWS A – THE MINISTRY OF HEALTH • Most saw the possibility of increasing transmission. • No long term strategies are in place. • A resource constraint necessitates prioritising: HIV/AIDS is the priority. • The cost of surveillance, and control, public education is too high. • Environmental sanitation is the responsibility of communities. The positives: • a well organised system of primary health care built on interlocking system of clinics. • a long tradition of involvement in policy oriented research eg. their involvement in the current climate change project. • A decentralised system of health care.

13. THE INTERVIEWS B. OTHER ORGANISATIONS • Office of Disaster Preparedness and Emergency Management; National Environment and Planning Agency; Water Resources Authority; National Meteorological Service. -Health was not a part of their mandate -Sea level rise posed a greater threat. The NGOs • Long term considerations such as climate change were not on their agenda.

14. Vulnerability of Communities Based on indicators identified in the literature: • Immunity, knowledge of symptoms and vectors of disease. Use of protective measures. • Measures of resilience and stress – education, employment, income, female household headship, room densities, coping strategies, integration into the community. • Source of water, water storage. • Distance from the nearest health facility Community Ranking • Most Vulnerable: Johns Hall - 44 • Least Vulnerable: Granville/Pitfour - 26

15. Vulnerable Groups

16. CONCLUSIONS • Substantial number of people living in informal settlements is vulnerable. • Between 55,000 and 60,000 persons in Montego Bay (over 25 %) live in such settlements. • The poor are vulnerable and many of the poor work. • If communities must take responsibility for environmental sanitation they must be given the tools – education. • Access to water must be tackled on two fronts - the provision of low-cost, secure drums. -the granting of security of tenure to those who, because of their status, are denied access to running water. • Public sector organisations must be persuaded that: -The threat of an outbreak of disease is not incompatible with a mandate to mitigate disaster or sustain development. -Healthy lifestyle is an outcome of sustainable development -They can incorporate disease control into their education programme.

17. THANK YOU