DENGUE, a rapidly spreading disease fuelled by climate change and rapid urbanisation, has evolved into a global health crisis.
In recent months, unprecedented outbreaks have occurred in countries from Latin America to Southeast Asia, with new outbreaks reported for the first time in European countries such as Spain and France. Argentina, Bolivia, Peru, Ethiopia and Sri Lanka are reporting record numbers of cases.
And, it will get worse. By 2080, an estimated 60 per cent of the world's population will be at risk of so-called "breakbone fever". Surprisingly, despite the magnitude of the dengue crisis, there is still no specific treatment for the disease.
However, a new generation of researchers, many of whom are women based in dengue-endemic countries, is diligently working to change this narrative.
The leadership role assumed by women, including my esteemed colleagues Dr Ami Fazlin Syed Mohamed in Malaysia and Prof Panisadee Avirutnan in Thailand, in the pursuit of effective, safe and affordable dengue treatments is not merely anecdotal. It underscores the significance of gender in understanding and combating this disease.
As someone who has witnessed the devastating impact of dengue first-hand, I have seen the toll it takes on women. While many people experience dengue as a mild illness, it can lead to severe disease, life-threatening complications, and death in some cases. For pregnant women, dengue leads to a three-fold increase in the likelihood of maternal death.
Complications of dengue haemorrhagic fever (DHF), the most serious form of the disease, include severe vaginal bleeding. A study in Brazil found that DHF increased the risk of maternal death by 450 times, and another study in India recorded a 15.9 per cent maternal mortality rate associated with DHF.
The burden of caregiving also often falls disproportionately on women and girls, which impacts their careers, education and access to health services. Caregivers must miss work or school to care for children with dengue, who may be sick at home for two weeks.
If other children in the family then develop dengue, this can result in an extended leave from income-earning, career advancement and educational opportunities. This is an often-overlooked gender-specific burden due to the disease.
Like many other infectious diseases, when it comes to dengue the needs of women have long been ignored by medical research. Although studies show that pregnant women are more susceptible to developing severe disease and pregnancy-related complications, such as preterm delivery, foetal distress and miscarriages in early pregnancy, this is not well understood due to lack of research.
As well, pregnant women and women of reproductive age are often excluded from clinical trials that assess potential new medicines. As a result, crucial physiological data about women are often lacking.
This neglect is widespread in biomedical research. During the Covid-19 pandemic, for example, women were also routinely underrepresented in clinical trials. For dengue, this underrepresentation in clinical trials has also resulted in serious consequences.
Historically, research in tropical medicine has been predominantly led by men. Fortunately, a positive change is underway in the global effort to combat dengue.
Last year, we established the Dengue Alliance, a global partnership led by institutions from dengue-endemic countries in Asia and Latin America, with the objective of investigating potential treatments and implementing clinical trials of the most promising ones.
This alliance includes the Institute for Medical Research (IMR) in Malaysia, where Dr Ami Fazlin is heading the Herbal Medicine Research Centre, and the Mahidol University in Thailand, where Prof Panisadee is leading the dengue research unit.
Together with our partners, we are leading the charge in finding new treatments, conducting research in our respective countries, and tailoring interventions to meet the specific needs of our communities.
The South-South cooperation in this Alliance is crucial, as we have all witnessed the impact of dengue on our healthcare systems and communities. We have seen too often how hospitals can be overburdened and overwhelmed when severe outbreaks occur.
Dengue can be fatal, but even in those with less severe form of the disease its symptoms, including high fever, severe headaches, and vomiting, can be excruciating.
As affected people may miss work for weeks or even months, dengue imposes a heavy economic burden on families, communities, and countries. Of course, finding an effective treatment for dengue is an incredibly difficult task, compounded by the fact that the virus has four serotypes.
If someone who has previously had dengue caused by one serotype later contracts dengue caused by a different serotype, the risk of severe disease is much higher.
We urgently need to find a treatment that prevents progression to severe disease stage for everyone at risk, whether due to pregnancy, a previous dengue infection, or other risk factors.
Funding is another challenge. We have witnessed substantial funds dedicated to addressing the Covid-19 pandemic in the past two years, while only a fraction of that has been invested in finding treatments for dengue, a disease that has plagued communities for decades. This global effort to tackle dengue demands gender equality and inclusivity at its core.
Empowering women to lead and participate in research, clinical trials and policymaking will yield comprehensive and impactful solutions for everyone, regardless of gender or age.
By embracing a gender-responsive approach, we can address the unique threats to women with dengue and be better prepared for the big challenge we are all facing: a changing climate and the infectious diseases like dengue that go with it.
The writer is Head of Dengue Global Programme and Scientific Affairs, at the Drugs for Neglected Diseases Initiative (DNDi), a not-for-profit medical research organisation