Role of GIS in management of Vector Borne Diseases

By Agendra Kumar

How often do we realize that infections transmitted by pesky little insects (Referred to as Vectors in Epidemiology), have been killing more than 7 Lakh people silently across the globe every year. As per World Health Organization (WHO), Vector-borne diseases (VBD) account for more than 17% of all infectious diseases across the world. The burden of these are highest in tropical and subtropical areas, affecting disproportionately the poorest populations. These also leave a trail of chronic suffering, lifelong morbidity, disability, and occasional stigmatization on people who survive the infections.

Traditionally associated with rural transmission, Vector Borne Diseases (VBD’s) are making their presence increasingly felt in urban and semi-urban areas in recent years, notwithstanding their continued threat to the rural and poor population. Environment, climate, urbanization, socio-economic conditions, population, and mobility are playing a major role in this shift of vector behaviour and spread of the diseases, which is hard to ignore. With its tropical and subtropical climates and 27.5% of population multidimensionally poor (undernourished, lack of safe drinking water, adequate sanitation and clean fuel), and 8.6% living in severe poverty (Global MPI 2018 Report), a large part of Indian population continues to be highly vulnerable to VBD’s. During 2015-2019, India reported 46.98 Lakhs cases of VBD including Malaria, Chikunguniya, Dengue, Kala-Azhar, Acute Encephalitis Syndrome (AES), Japanese Encephalitis (JE) and Kala-Azhar. (Source National Vector Borne Disease Control Programme (NVBDCP), MoHFW, Govt of India). 15 states account for more than 90% of the cases reported.

Given the role of multiple factors and their dynamic interactions in prevalence of VBD’s, each state faces unique challenges at the ground level to deal with prevention and control. Amongst others evidence-based decision making and implementation are two main reasons that have been undermining the effectiveness of vector control efforts over last many years. Inadequate surveillance and lack of epidemiological vector data prevent effective prediction of emergence patterns of the VBD’s. This results in choice of myopic intervention approaches and waste of valuable resources.

Situational analysis with real-time data in a spatial context is critical to understanding Vector diseases, causative factors and their interrelationships for effective planning, response, decisions and actions for vector control programs. GIS tools have been used for years to understand the VBD’s, but unfortunately much of this work happens in siloes and fail to deliver results in today’s context. Need of the hour is intervention approaches that are broad based and holistic in nature. A technology transformation which can drive better understanding, enable efficiency, multi-stakeholder collaboration and rapid decision making. Given the federal framework of our governance, it is important that national, state and district level healthcare resources, systems, and information are brought together on a single platform which can connect gaps and dots through digital highways and talk to each other. Spatial tools offer significant advantage in deploying tailor made intervention strategies that are customized to address local challenges. This will be instrumental in furthering WHO’s Integrated Vector Management Strategies which call for evidence-based decision making, collaboration with stakeholders, advocacy, social mobilization and legislation and capacity building.

Esri’s ArcGIS offers capabilities of aggregating, fusing, processing, and integrating different types of data and systems including biological information, local determinants, risks, control methods, past interventions, climatic – demographic –environmental factors in a single environment. Playing a central role, a GIS based Vector Management platform brings together complementary areas of expertise among epidemiologists, entomologists, health officials, bureaucrats, research institutions, academia, NGO’s, and other stakeholders. By providing a bird’s eye view along with a capability to drill down to details with spatial and temporal perspectives, analytics can facilitate comprehensive assessment of the situations with actionable intelligence and generate evidence that is backed with rigour.

Advanced geospatial technologies are uniquely positioned to play a pivotal role in addressing the complex challenges, by bringing together spatially and temporally diverse touchpoints for timely predictions of vector behaviour and spread patterns. Spatial Modelling and Predictive Analysis using artificial intelligence, machine learning and big data can provide enhanced situational analysis and comprehensive health impact assessments, thereby helping with accurate assessment of likely impact of VBD’s, their geographic spread, hot spots, priority areas, appropriateness and efficacies of interventions. Advanced capabilities for intuitive visualizations, sharing and collaboration and anywhere, anytime access to required information, facilitate seamless intra and inter sectorial interactions between central, state, district administrations, healthcare professionals, services providers, NGO’s, civil society, and other stakeholders. While this fosters inclusiveness it also promotes multi-fold increase in the efficacy of control program outcomes.

For a large and diverse country like ours, easy to use, friendly mobile tools customized in local languages, with their ability to be tailored with little effort, and ability to synchronize with centralized systems in real-time, will be extremely useful for vector surveillance programs by ensuring availability of accurate and updated information at all times. ArcGIS, with its ability to integrate with other digital systems is uniquely positioned to build a GIS based Vector Management platform that can play an important role in building robust operational research, monitoring and evaluation frameworks which are critical to the success of Integrated Vector Management Programs. This can further strengthen the planning, design, and development of targeted surveillance strategies for early detection of outbreaks and cost-effective implementation at the ground level.

Strategic oversight, Predictive analytics for disease behaviour, evidence-based decision support and interventions, advocacy for strengthening regulatory and legislative controls; and Empowerment of the communities are some of the unmatched benefits spatial technologies offer which can aid in transforming Indian healthcare ecosystem. With multiple advantages spatial technologies are uniquely positioned to address the complex challenges posed by vector borne diseases and their holistic management including success of NVBDCP’s ambitious Integrated Vector Management (IVM) initiatives. This will be complementary to recently launched National Digital Health Mission (NDHM) by Government of India, which aims to develop the backbone necessary to support the integrated digital health infrastructure of the country.

(The author is President Esri India. Views expressed are personal.)