Why Did English Dailies In India Not Cover Zika Adequately?

According to Anita Kar, the head of the school of public health at the University of Pune, a Zika outbreak could lead to a microcephaly epidemic because “we have no policy about how to provide services to families that have children who have microcephaly.” YURI CORTEZ/AFP/Getty Images
05 August, 2017

On 10 July, India reported the diagnosis of its fourth case of the Zika virus, in Tamil Nadu’s Krishnagiri district. The patient first presented with symptoms—fever, headache, photophobia, among others—on 28 June. He visited a local primary healthcare centre, and was treated with paracetamol. When he returned to the health centre on the subsequent day with the same symptoms, the medical professionals sent his blood samples for further testing to the Manipal Centre for Virus Research in Karnataka. The test returned positive for the virus, and the result was then confirmed by two other medical institutes. Within 11 days of its detection, the state government released information of the case to the public.

The Tamil Nadu government’s response to the Zika virus in the state was significantly different from that of the central government as well as the government of Gujarat, where the first three Zika cases of the country were reported. Both the state and central government did not disclose the outbreak of the virus to the public. The ministry of health and family welfare informed the World Health Organisation about the cases on 15 May, more than five months after the first case was detected. It only became public knowledge after the WHO reported the case on its website, on 26 May. In the aftermath of its disclosure, there appeared to be a conspicuous silence on part of most national print media organisations about the government’s failure to intimate the public at the time of the Zika outbreak, and the circumstances surrounding the same.

Zika is a vector-borne virus transmitted through infected mosquitoes and sexual contact. The virus can lead to birth defects such as microcephaly, due to which a child is born with an abnormally small head and an underdeveloped brain. It has no vaccine or treatment, and because it is vector-borne, the virus is particularly dangerous in areas with high population density such as India. The recent Zika epidemic broke out in Brazil, in 2015—54 children were born with microcephaly between August and October that year. In February 2016, the WHO reported that Zika constituted a Public Health Emergency of International Concern (PHEIC) after the transmission of the infection had been reported from over 20 countries. The WHO’s International Health Regulations (IHR), which are binding on 194 countries including India, define a PHEIC as an “extraordinary event” that is a “public health risk to other States through the international spread of the disease” and “potentially require a coordinated international response.” On 18 November, the WHO declared the end of Zika as a PHEIC.

According to the WHO report on India’s Zika cases, the first patient to carry the Zika virus in India was a 34-year-old woman, who showed symptoms just after the delivery of her child, on 9 November 2016. The Zika diagnosis was confirmed at the National Institute of Virology in Pune, on 3 January 2017. The second case was of a 22-year-old pregnant woman, who tested positive for Zika during an antenatal clinic surveillance conducted from 6–12 January, and the third case was that of a 64-year-old man who was confirmed to be infected with the virus during an acute fever surveillance from 10–16 February.

Six days after the WHO disclosed the cases—and over four months after the first case was confirmed—the health ministry issued a press release confirming the three cases in the country. In an apparent defense of the government’s delay in releasing the information, the ministry stated that news of the virus was reported earlier, on 17 March, “as part of an answer to a Parliament question raised by Smt. Vanaroja R, MP [member of parliament] Loksabha.” It also stated that because Zika was no longer a PHEIC, “the case was handled as per our existing protocol.”

However, both these claims are questionable. In her answer to R Vanaroja’s question in parliament about Zika, Anupriya Patel, the minister of state in the health ministry, acknowledged “only one case of laboratory positive Zika,” even though all three cases had been detected by that time. Additionally, the IHR prescribe four yes-or-no questions for a national government to determine whether it must notify the WHO about any event in the country: whether the health impact of the disease is serious; whether the event is unusual; if there’s a risk of international spread; and if there is a risk to travel and trade.

In its notification on the Indian cases, the WHO stated that there were no reasons to impose travel or trade restrictions. However, the IHR states that the a state must inform the WHO within 24 hours in all scenarios except when the answers to the first three questions are all in the negative, or if the answer to the first is in the affirmative, but those to the subsequent three questions are all in the negative. Article 9 of the IHR also states that any country in receipt of evidence of a public-health risk, which can spread internationally through means such as vectors carrying the infection, must inform the WHO within 24 hours.

That the Indian government was bound by these regulations that were not applicable solely to PHEIC cases, were not addressed by most media organisations that covered the issue. In India, the media’s coverage of Zika began after the WHO’s report was published on its website, and to a large extent, only reported the official government position on the virus. Barring some exceptions, the reportage on Zika failed to raise questions about several important aspects, such as the delay in informing the public and India’s compliance with WHO guidelines.

The media coverage of the issue has been inconsistent at best. The news website The Wire, in its second report of a three-part series on the Zika cases, discussed the “questionable loophole” that the government used to avoid disclosing the information to the WHO. The website for the WHO’s country officer for India notes that “Although Zika is no longer a Public Health Emergency of International Concern, WHO maintains that vigilance to Zika needs to remain high.” It further adds that a commitment to IHR requires “all member countries to report public health events to WHO.” However, three national English-language dailies—the Hindustan Times, Times of India and Indian Express—which  carried reports on the three cases of Zika published on the WHO website, did not report on India’s compliance with the IHR at all. I tried contacting health correspondents at all three dailies. They either declined to speak to me, or did not agree to come on the record.

All three dailies did not raise questions regarding the government’s failure to acknowledge the detections of the Zika virus in parliament. R Vanaroja, the MP from the All India Anna Dravida Munnetra Kazhagam, who had submitted the questions concerning the Zika virus, told me that she “was not aware of the three cases till the WHO and the government readdressed the issue in May.”

A senior correspondent at a national daily told me, “I will not be surprised if the government is concealing information on this deliberately, but there has to be a way to substantiate that claim.” According to her, there was a waning interest in pursuing the story because the government’s responses were opaque and sources in the ministry were unwilling to come on the record. She continued, “When I look at stories, I look at what I can substantiate and what I cannot.”

A report carried in The Hindu on 31 May stated that the Vibrant Gujarat summit, which was scheduled to take place from 10–13 January—a week after the first Zika case was confirmed—“was a factor” in the government’s omission to disclose the Zika outbreak in the country. The summit is a biennial investors’ summit held by the Gujarat government, which was launched by Narendra Modi during his tenure as chief minister of Gujarat, to invite foreign investment. The report stated, “A travel advisory at this time could have ruined the summit. Two independent sources, one of whom is highly placed in the Health Ministry, confirmed that the investment summit was the reason for covering up the Zika cases.”

However, Hindustan Times and Indian Express did not report on the circumstances surrounding the government’s failure to disclose the Zika cases in India. Both only quoted government sources stating that the decision not to disclose was pursuant to the WHO withdrawing Zika from the PHEIC cases. “There were a lot of conspiracy theories after that, but no one could substantiate these claims,” the senior correspondent said, referring to the Vibrant Gujarat summit and its relation to the non-disclosure of the Zika cases.

Another report in The Hindu, published on 2 June, states that after the confirmation of the first Zika case in January, the Ahmedabad Municipal Corporation sent a team of 250 entomologists to Bapunagar, where the virus was first detected. The report notes that the team was directed “to carry out intensive door-to-door work, including collecting blood samples of symptomatic patients and mosquito samples, and destroying breeding sites.” However, according to the report, neither the officials nor the six lakh residents of Bapunagar were informed that the tests were for the Zika virus. While this aspect found coverage with the Indian Express and the news website Scroll, both the Times of India and Hindustan Times did not report on the fact that even those people collecting blood and mosquito samples were kept in the dark about the virus.

The report in Scroll notes that there are inconsistencies between the responses of government health authorities. It states that JP Gupta, the Gujarat commissioner of health, said that it was the government’s prerogative to not inform patients or medical staff that the tests and samples are for the Zika virus. On the other hand, Dr AC Dhariwal, the director of the National Centre for Disease Control—which Patel identified as the nodal agency investigation the Zika outbreak in her answer before the parliament—said that it was “protocol” to inform patients in advance about the test.

In the third part of its series, The Wire reported that before the WHO disclosed India’s Zika cases, it moved India from category 4—the least-risk category of WHO’s classification of Zika-affected countries across the world—to category 2. Again, the same three national dailies did not have any report on the change. When I asked the senior correspondent about the omission, she said: “To a normal person these categories do not matter as such.” The WHO’s description for category 2 notes that “Countries in this category may have seasonal variations in transmission. These countries may also experience outbreaks of ZIKV disease.”

I spoke to Vidya Krishnan, the health and science editor at The Hindu about the visible lack of outrage in the media. She told me, “If only, like any other technical beat, social sector [beat] got the respect they deserved in newsrooms, the first question would have been, ‘how did our parliament reporter and health reporters miss this during the budget session?’”

According to Menaka Rao, a health reporter with Scroll, the issue was that there was limited interest among reporters on the health beat to take Zika seriously and follow up. “Once officials from the ministry began to answer questions concerning Zika with the same rhetoric that they used in the release, maybe reporters felt like there was nothing more that could be reported,” she said. Rao also referred to a press conference that the Health Minister JP Nadda called on 15 June to discuss the three-year achievements of the ministry. “When we asked them about the handling of the news about Zika, they told us that if they answered Zika questions, the whole conference would only be about that.” Another health reporter at a national daily echoed Rao’s analysis and told me on the condition of anonymity that, “once the answers began to sound the same, the newsroom was also showing a lack of interest in the issue.”

The reporter added that, “the fact that the WHO had some positive remarks to make about the in-depth investigations of the agencies may have contributed to the loss of interest in newsrooms in general.” In its report of India’s cases, the WHO had noted the measures taken by the Indian government in response and stated that it “does not recommend any travel or trade restrictions to India based on the current information available.” However, the report also noted that the “WHO encourages Member states to report similar findings.”

Krishnan said that the government had taken “a series of questionable steps” in the aftermath of news of the three cases. “For the first full week, the government has defended itself by saying this decision was taken so as to not spread panic,” she said. Comparing the response of the Indian government to that of Brazil she continued, “Brazil desperately required Rio Olympics to be a success, after having poured in money to organise the mega event. Yet, the country kept the world informed, issued travel advisories—that was against its economic interest.”

The senior correspondent had a differing perspective on the matter. “We usually do not follow up such stories because it was not an emergency at the time,” she said. She added that there was no clustering—a concentration of several cases in a particular area—which would have been a cause for greater concern. “Even the babies [of the first two patients diagnosed with the Zika virus] were born were fine,” she added. However, the senior correspondent added, “For all you know we have several babies with microcephaly that has been caused by Zika, but no one from the labs will confirm any of this to you.”

According to Anita Kar, the head of the school of public health at the University of Pune, the media’s biggest failure was to highlight the lack of existing infrastructure available to children born with disabilities such as microcephaly. She said: “As compared to other diseases, Zika is a real threat because it has a direct and dangerous impact on newborn health.” Kar said a Zika outbreak could lead to a microcephaly epidemic because “we have no policy about how to provide services to families that have children who have microcephaly.” “If we let the Zika virus go on undetected, we are leaving our population vulnerable to a disorder for which the government does not have any supporting policy or services,” she continued. “Remember one thing, we do not have a child-health service as such in the country,” Kar said. “The quality of life of families with disabled children is so poor that it is a crime to let something like this just go by.”

This article is part of The Caravan’s short series on Zika. The series includes a photo essay on the lingering effects of the virus in Recife, Brazil, and an excerptthat discusses two ways to examine an epidemic.

A previous version of this article erroneously described microcephaly as a birth effect due to which a child is born with an abnormally large head. The birth defect causes babies to be born with smaller heads than is usual. The Caravan regrets the error.