Towards a multi-stakeholder dengue preparedness strategy

This article is authored by Madhavika Bajoria, executive director, AVPN (health and nutrition platform).

Dengue, often mistaken for a seasonal affliction, is increasingly showing signs of becoming a year-round concern. According to Environmental Health Perspectives, dengue transmission occurs for an average of 5.6 months in a year--making it a recurrent, near-perennial threat in many parts of India.

Dengue is a viral infection that spreads from mosquitoes and is common in tropical climates(unsplash)

National dengue data reveals that India had 2,33,519 dengue cases and 297 deaths in 2024, as compared to a mere 12,043 cases and 6 deaths in 2005. As the number of dengue cases keep rising, it is important to take a look into the manifestation of dengue in communities.

To tackle this, the government has made significant strides in dengue control through the Integrated Disease Surveillance Programme (IDSP) and the National Vector Borne Disease Control Programme (NVBDCP), which coordinate outbreak monitoring and rapid response across states. Dengue Case Fatality Rate has decreased from 3.3% in 1996 to 0.17% in 2023. These systems enable timely detection, data collection, and public awareness campaigns, contributing to improved early warning and case reporting. However, as transmission patterns shift and vulnerabilities deepen, there is a pressing need to strengthen health care infrastructure further and ensure that outbreak response mechanisms are resilient, inclusive, and responsive to evolving needs.

Dengue transmission occurs with high frequency in informal settlements and migrant housing clusters. Open drains, crowded shelters, erratic water supply (that forces water storage) create fertile breeding grounds for the Aedes aegypti mosquitoes. Studies conducted across India mirror the same results – be it Gujarat, Delhi or Kerala. The knowledge and practices relating to dengue among marginalised sections remain fraught with inconsistencies. A study in Delhi showed that 77% of the population was worried about mosquitoes, but only 43% monitored their environment. An observational study conducted among factory workers in Jammu presented that although a majority of workers (92.56%) were aware about dengue about 81.81% did not know about its nature, symptoms and complications.

For marginalised communities, the barriers to health care access are deeply entrenched and often intersectional. Women, trans and gender-diverse (TGD) individuals, persons with disabilities, and those from economically or socially disadvantaged backgrounds frequently face systemic exclusions. Women, particularly from low-income households, often encounter gendered barriers to mobility, autonomy, and decision-making in health care. For persons with disabilities, the challenges range from inaccessible infrastructure to communication. When routine health care remains difficult to access for these populations, outbreak-specific care—such as during dengue surges—becomes even more limited and inequitable.

Health care infrastructure, especially in densely populated urban areas, can come under immense strain during outbreak seasons. Addressing this challenge requires recognising that dengue is not merely a health issue--it is also closely tied to civil infrastructure, including water management, sanitation, housing, and urban planning. Ensuring adequate beds, medical staff, and supplies is only one part of the equation. Preventive action must be woven into the design of our cities and neighbourhoods. Strengthening dengue preparedness will therefore benefit from coordinated action between health departments, municipal bodies, and community-based organisations to build resilient, responsive systems that reduce disease vulnerability while improving overall well-being.

Moreover, disaggregated official data is critical in understanding why dengue appears in communities, what can be done to curb its inception and how it can be treated in a context-sensitive manner. This is why India’s dengue strategy may need to consider a shift--from a reactive, monsoon-driven containment to a more year-round, community-informed care. Context focused, inclusive interventions must take the centre stage.

As transmission patterns shift and vulnerability deepens, tackling dengue’s structural inequities can involve collaborative, year-round interventions—like those led by the EquiHealth Alliance, which unites public, private, and community actors to co-create context-sensitive, inclusive solutions.

EquiHealth Alliance is also supporting these efforts through state level convenings in Tamil Nadu and Karnataka, including integrated community outreach in prevention, proactive and data-backed surveillance, and financing innovation as the elements of a comprehensive dengue response, cognisant of the innovations in therapeutics and the future of dengue management. While India is in the final stages of clinical trials and approvals for dengue vaccines, access will depend on delivery strategies that prioritise vulnerable communities rather than urban centres alone.

Dengue may be vector-borne, but its burden is deeply human. An effective response demands care models that are accessible, affordable, and equitable—built not just to treat illness, but to prevent it where it starts.

This article is authored by Madhavika Bajoria, executive director, AVPN (health and nutrition platform).