What inequalities exist in the global health issue of dengue?

Global Inequalities in Dengue as an Emerging Disease

The most profound inequalities in dengue exist along socioeconomic and geographic lines, with populations in resource-poor settings, Least Developed Countries, and small island developing states bearing disproportionately higher disease burden, mortality, and limited access to prevention and control measures. 1

Geographic and Economic Disparities

Disease Burden Distribution

• Dengue causes an estimated 100 million human cases and 10,000 deaths per year across more than 125 countries, with the highest disease burden concentrated in tropical and subtropical regions of developing nations 1
• The true global incidence is likely closer to 400 million infections annually, but inadequate disease surveillance, misdiagnosis, and low reporting levels in resource-limited settings grossly underestimate the actual burden 2
• Populations at disproportionately higher risk include those living in small island developing states and Least Developed Countries, where climate change impacts are most severe 1

Climate Change Amplification of Inequities

• Climate change impacts on dengue transmission are exacerbated by poverty and existing health inequities, creating a vicious cycle where the most vulnerable populations face the greatest risk 1
• The largest impacts of climate-driven dengue expansion will be experienced by populations living in resource-poor settings, particularly as warming temperatures enable spread into highland regions of sub-Saharan Africa, Latin America, and the Western Pacific 1
• Evidence for climate change impacts on dengue is greatest in the Southeast Asian region, where many resource-limited countries struggle with inadequate health infrastructure 1

Healthcare System and Resource Inequalities

Diagnostic and Surveillance Gaps

• Imprecise morbidity and mortality statistics in developing countries underestimate dengue's magnitude as a regional health problem, resulting in it being considered low priority by health sectors with no timely steps for effective control 3
• Inadequate disease surveillance systems, misdiagnosis, and low levels of reporting in resource-limited settings prevent accurate assessment of the true disease burden 2
• Without precise risk indicators, there is little opportunity for timely diagnoses, treatment, health interventions, or vector control in developing nations 3

Treatment and Prevention Access

• No specific antiviral therapy currently exists, and vaccine access remains limited, with the illness imposing the greatest economic and human burden on developing countries that have limited resources to deal with the scale of the problem 2, 4
• Vector control strategies prove relatively ineffective in resource-poor settings due to insufficient political commitment and inadequate resources 3, 4
• Many validated prevention and control tools exist—including surveillance, chemical vector control, water, sanitation and hygiene (WASH), environmental modification, and housing improvements—but lack sufficient political will and funding for scale-up in developing regions 1

Institutional and Political Inequalities

Responsibility and Accountability Gaps

• Dengue is perceived as a problem of 'others' (individually, collectively, and institutionally), with responsibility for control passed between neighbors, communities, municipalities, health institutions, and governmental agencies, resulting in fragmented and ineffective responses 3
• Without political commitment, there are insufficient resources to face the problem adequately in developing nations 3
• Solutions targeting only the vector reduce intervention impact, and there is no sustainable control without addressing broader social determinants of health 1, 3

Capacity and Infrastructure Deficits

• Challenges in scaling-up, financing, and institutionalizing community empowerment approaches to dengue control remain major barriers, as demonstrated by Cuba's experience where top-down structures resisted organizational change despite evidence of effectiveness 1
• The structure, practices, and organizational culture of national control programmes in resource-limited settings often lack the flexibility needed for effective community-based adaptation 1
• Insufficient dissemination of effective approaches to government decision-makers and resistance to organizational change at management levels perpetuate inequalities in dengue control 1

Future Risk Inequalities

Climate-Driven Expansion

• Changes in geographic range and intensity of dengue transmission under future climate change conditions, including spread into regions with immunologically naïve populations, will greatly increase the global population at risk, with the poorest populations least equipped to respond 1
• A northward shift of the dengue-epidemic belt into parts of Europe and northern USA is predicted, but developing tropical regions will continue to bear the highest burden 1
• In sub-Saharan Africa, warming temperatures may result in a shift in disease burden from malaria to dengue, creating new challenges for already strained health systems 1

Adaptation Capacity Gaps

• Multi-sectoral climate change adaptation strategies are needed to enhance health system capacity and resilience, especially in regions with predicted climatic suitability for future dengue emergence, but these are least available in resource-poor settings 1
• Enhanced surveillance, early warning systems, predictive models, and enhanced vector control are suggested adaptation strategies, but implementation remains concentrated in wealthier nations 1