I refer to the media report that Malaysia is seeing a higher death toll from dengue fever this year. The Health Ministry's director of disease control Hasan Abdul Rahman said 44 people had died in the first four months of 2007 from 16,214 cases reported, compared to 21 deaths and 10,244 cases in the same period last year.

Even more disturbing is the statement that the disease has seen a rise of 16 percent in cases every year since 2003 with fatalities reaching record levels in 2004, when 102 people died. The ministry's deputy director-general Ramlee Rahmat further appears to have even identified the cause for the rise attributing it to unkempt construction sites, indifferent contractors and land owners, public complacency and ideal weather conditions for breeding of the aedes mosquito.

Primary healthcare officials, having already identified the problems, may need to do more if this plague is to be dealt with more effectively. The time is appropriate for them to speak to the deputy prime minister and ask for emergency powers for they may have no clout if some of these problems fall into the domain of the environmental authorities or local councils who may take a lackadaisical attitude to this endemic plague which can very well rapidly escalate to be an epidemic if these erratic weather conditions continue to facilitate the exponential breeding of the aedes aegypti. How indeed memories are short for authorities do not appear to remember the other great mosquito scourge that swamped this country in its early years malaria.

Malaria was first successfully shown to be controlled in Malaya by a government surgeon, Sir Malcolm Watson in 1901, who, faced with an epidemic of malaria, brought it under control by a programme of jungle clearing and drainage in the town of Klang. The rise of dengue in our current ecological circumstances is not dissimilar to Watson's analysis of the relationship between economic activity, landscape change, insect density and malaria.

Constant attention to the ecology of the local mosquito species in relation to control measures is critical if we are to curtail this rise in incidence and bring about its consequent reduction in mortality which is more related to reinfection rather then primary infection.

Our primary healthcare leaders need to demonstrate greater leadership qualities adopting more aggressive and proactive measures. They must be further equipped with adequate powers to rope in other departments such as the DID, JKR, local councils, the police and the environmental authorities to effect the necessary environmental changes so required to eradicate the vector. Fogging and fines are akin to treating the symptom unlike Watson who went down to the field to treat the disease.