The death of 129 children of acute encephalitis syndrome in Muzaffarpur, Bihar, is as painful as it is sickening for the sheer incompetence with which the State government has handled the situation. Not so long ago in 2017, the entire media world was questioning the administration of Yogi Adityanath when similar Japanese encephalitis had hit Gorakhpur, Uttar Pradesh, claiming the lives of many children. But the larger State, with a marginally better reputation than Bihar, also had to bear with the extra burden on its health infrastructure, for patients from as far away as Nepal and large parts of Bihar sought the treatment of the near-incurable disease at the BRD Hospital in Gorakhpur. Alarmed by the death of over 500 children, the Yogi government launched a mega health project in collaboration with the WHO and UNICEF, focussing primarily on sanitation and secondarily on vaccination. The instances of deaths due to Japanese encephalitis dropped by 66% the next year to nil this year so far. The situation is similar in Bihar, where the AES recurs annually. But there is no mission mode visible in the health administration led by minister Mangal Pandey.

Death of any human being due to the negligence of the state must merit punitive measures. Ministers and officers supposed to man the health infrastructure, which includes prevention of diseases, who did not do their jobs properly either in supplying potable water through the right means or in segregating vectors (germ-carrying animals like pigs or poultry birds) of the herpes simplex virus, rabies virus, poliovirus, enterovirus, West Nile virus, Japanese encephalitis, Eastern equine virus and measles virus, or those who did not make households aware of the hygiene hazards must lose their jobs. If vaccination against tick-borne and Japanese encephalitis could be administered to at-risk patients, but it was not, the heads of health officers responsible for this negligence must roll. Wondering whether consumption of litchi is bringing the disease to children via hypoglycin A and methylenecyclopropylglycine could be understood if this were the first outbreak of the ‘Chamki fever’ in the State; it is not. If five years ago, a medical team saved 74% of sick children through a simple intervention by infusing 10% dextrose within 4 h of the onset of illness, Bihar is certainly not alien to the disease. Even a simple measure like not letting children go to sleep with empty stomachs was not ensured in this world of ignorance.

The Bihar administration is suffering also due to coalition politics of convenience. Neighbouring Jharkhand, not saddled by alliances, is already prepared with preventive measures, just in case. While the law-and-order in Bihar is remarkably better than what was witnessed under the Lalu Prasad Yadav raj, there is no palpable change in the lives of the people under an extra-cautious, socialist chief minister who tends to believe sanctioning projects may attract allegations of corruption. In the case of fighting a disease, the issue is how to fix the responsibility. As the seat sharing arrangement in Bihar for the Lok Sabha election showed, the balance between the BJP, JD(U), LJP and other constituents of the NDA is delicately balanced. No wonder then that one litigious person got so frustrated by the lack of accountability that he sued Union Health Minister Dr Harsh Vardhan, his counterpart in the State Mangal Pandey as well as Chief Minister Nitish Kumar — all in one go. On Tuesday, the chief minister was greeted with boos as he approached the Sri Krishna Medical College and Hospital, the unfortunate venue that witnessed the largest number of AES deaths this year. But neither litigation nor hooting will address the issue in hand.

A silver lining to the cloud of backwardness in Bihar: Vast swathes of undeveloped land that must attract investment without drawing the ire of farmers as these large plots are not cultivable. Bihar needs a lot of money and that cannot arrive without private investment. While a section of the investment must uplift the poor, the other must keep them healthy. Small towns like Muzaffarpur and villages, where not much human displacement would be needed, could be developed into smart cities rather than targeting Patna that entails displacing the heritage Gole Market. It’s a simple logic that even the Modi government has not appreciated since it hit upon the idea of transforming cityscapes of the nation more than five years ago. ‘Smart cities’ is one of the few dreams of the prime minister that never quite materialised. What is developed as a city can be called smart when it is clean and hygienic, too, while the inhabitants are not so indigent that their children remain malnourished, the easiest target for viruses and bacteria that causes diseases like variations of encephalitis.