His career began in the Municipal Corporation of Delhi in 1994, the year of two outbreaks — a new strain of cholera, followed by the plague in September.of the Centre of Social Medicine and Community Health in JNU has since been part of efforts to control several other disease outbreaks such as dengue in 1996 and SARS in 2001. In the context of the delayed revelation that three cases of Zika were detected in Ahmedabad last year, he tells Rema Nagarajan why secrecy in public health is problematicIt is not clear whether Zika existed in an indigenous form or if it was imported. However, sero surveys for Zika have been on in India since 1950 after the virus was discovered in Uganda in 1947. It was done by the Virus Research Centre, as the National Institute of Virology in Pune was then known. The centre did appear to have detected Zika in 1954 but since it belongs to the same family of viruses as dengue and chikungunya , there could have been a mix-up. In an outbreak form it surfaced first in 2007 in Yap state of Micronesia from where it spread to other countries like Cambodia and Brazil due to increased international travel. Following the Zika scare, as a part of the global response, Zika labs and screening mechanisms in airports were set up. The cases at Ahmedabad are a testimony to the fact that the surveillance system worked. However, sometimes initial cases may not be picked up by the surveillance system. Since those infected with Zika in Ahmedabad have no history of travel, either a primary case was imported and remains undetected and caused local transmission, or these are indigenous cases as is being presumed. Recent indigenous infections are unknown. However, we may have detected it now because we are testing for it.The government says it has done all the right things except announcing the diagnosis, which they say was a well thought out strategy. With no new cases so far, it appears to have worked. But something that has spread globally can also be expected to spread across the country. So when such a disease is detected the first time, it is important to alert surveillance networks across the country, so that they can be on high alert. After all, Zika is spread by the Aedes aegypti and Aedes albopicti mosquitoes that cause dengue and chikungunya. Information needs to be shared locally too as it can be spread from a pregnant woman to her newborn or through the sexual route, and so counselling of patients is necessary.Plague, SARS, dengue and H1N1 have mortality. We have handled those outbreaks. Zika has virtually zero mortality and till the outbreak in Brazil, it was considered a mild infection. This time, most of the scare is about microcephaly in the newborn. Disease and panic go hand in hand. Informing without panic is done through sound public health practices and appropriate communication techniques. It is not sound public health practice to conceal. Only the government can answer why the diagnosis of Zika was not revealed.Zika created a dilemma during the Rio Olympics. But to the best of my knowledge, diagnosis was shared with patients and local authorities even during the Olympics. The processes were carried out as per public health requirements. Again, dengue was raging in the run up to the Commonwealth Games. But the National Vector Borne Disease Control Programme (NVDCP) and the Municipal Corporation of Delhi collaborated and strengthened measures. There was not a single case of dengue in the Commonwealth sports community. It was commendable. So it is possible.Public health includes everything from high-end research institutes and technology to frontline health workers and communities. You have to share information and carry everyone along. Zika spreads through multiple routes, through mosquitoes, for which there are implications for protective practices at individual and household level, as well as through the sexual route that requires counselling to patients and their contacts. So it is imperative that we share information and get all-round support for limiting the spread. If we don’t do that, we can’t limit the transmission by breaking the transmission chain. We have the example of HIV, which was stigmatised and so patients tried to hide it. So we need to share and support. We have learnt this in practice in the HIV pandemic. You unwittingly stigmatise a disease if you start hiding it. If a disease carries stigma, people tend to hide it. Secrecy is quite unnecessary. It leads to a trust deficit, which could have been totally avoided.