Uttar Pradesh health minister Sidharth Nath Singh said it to defend his government in the Baba Raghav Das (BRD) Medical College Hospital tragedy where 63 children have already died of Japanese encephalitis (JE) and Acute Encephalitis Syndrome (AES) but if, as he says, BRD has been recording 20 deaths every day during August for the last 4-5 years, it is clear the health system in the state—and Gorakhpur in particular—is all but non-existent. The jury is still out on whether it was the lack of oxygen—due to Rs 68 lakh owed to the supplier for months—that killed the children. But the real problem starts long before the patients get admitted; and in August, their numbers swell, and that is where the government’s responsibility first comes in.
Vector-borne encephalitis like JE is preventable through vaccines (85-90% efficacy) and, if managed right, patients can make a full recovery. A 2015 study published by the US’s National Center for Biotechnology Information (NCBI) found the JE virus in 27%, 10% and 15% of the total encephalitis cases reported in UP in 2011, 2012 and 2013, respectively, with cases peaking in the monsoon months.
The sustained prevalence of JE and AES—that is caused by other viral, fungal and bacterial pathogens and certain toxins—makes it clear successive state governments have failed public health in the state. A 2017 study on the missed opportunity for JE vaccination in 2015 in Gorakhpur, published by NCBI, found that a quarter of the children aged 25-36 months who were surveyed had not received a single dose of the vaccine while 44% of those who had received the first dose, did not receive the second dose. The UP government did flag off a vaccination drive for JE in 38 districts in late-May this year—aiming to cover 4.6 million children—but for Gorakhpur, it perhaps amounted to little more than fire-fighting given how close it came to the monsoon. Worse, Gorakhpur’s problem—and that of all of UP—is that the low level of sanitation helps AES’s bacterial and fungal pathogens spread in the monsoons.
Open defecation in Gorakhpur and adjoining districts Kushinagar and Deoria is high with household toilet coverage at 37%, 51% and 46%, respectively. This means rainwater mixed with pathogen-carrying faeces runs off and contaminates drinking water sources, and increases the risks of contracting AES.
While Gorakhpur is in the news, an IndiaSpend analysis shows that UP contributed to the largest share of almost all communicable and non-communicable disease deaths across India. The state must add over 31,000 health sub-centres (it is short by 33% of the requirement), over 5,000 primary health centres and 1,300 community health centres (a 40% shortfall from its overall requirement). In the 25-year period to 2015, the number of sub-centres grew by just 1.8% even as its population rose by 51%. It is true the rot goes back several decades, but fixing this is now Adityanath’s problem—the last thing he can afford is to fritter his scarce resources on farm-loan waivers.