Preparing India for tomorrow’s pandemics
Early detection is key to minimising health and economic burdens
The history of mankind is replete with ravaging pandemics that have wiped out civilisations. Now Covid-19 has spread to more than 180 countries, infected upwards of 83 million, and killed 1.8 million people in just one year. In India, in 1918 the Spanish Flu killed more than 13 million in just three months. And within the last year the country has reported more than 10 million Covid cases and 1.48 lakh deaths.
Insights provided by Pasteur’s germ theory of disease, rapid advances in the development of new anti-microbial drugs and vaccines, improved housing, sanitation, and clean drinking water have dramatically reduced the burden of infectious diseases over time. Life expectancy in India increased from 32 years in 1947 to 69 years in 2020 leading to the illusion that the scourge of infectious diseases has been conquered. Nothing could be further from the truth. Increasing drug resistance, newly emerging infectious diseases like AIDS, SARS, H1N1, Covid and other zoonoses have turned out to be equally devastating and disruptive. The future could see more pandemics, not less.
Early detection, timely containment, and prevention of spread are key to containing infectious disease outbreaks and minimising their health and economic burdens. India needs an ‘epidemic early warning system’ with real-time surveillance of epidemic-prone diseases. Deploying computational epidemiology that uses big data, artificial intelligence, and algorithms makes for early detection of unusual patterns or clusters of illness. These patterns help assess the risk of an outbreak, forecast the disease trajectory, and provide inputs for issuing warnings about possible outbreaks. Governments will get much-needed time to prepare for and take appropriate preventive and curative measures.
The Covid pandemic and its debilitating impact have exposed the inadequacy of existing public health and institutional mechanisms to respond to health emergencies of this scale. Its containment necessitated multi-lateral cooperation across nations and multi-sectoral involvement within countries. In India the emergency medical relief division of the Directorate General of Health Services found itself without the heft or the authority to reach out and mobilise different stakeholders. The constitution of a statutory Indian health emergency response authority (IHERA) therefore becomes a sine qua non for ensuring seamless coordination and deployment of resources across multiple sectors in diverse situations.
IHERA will strategise and lead the containment effort. It will marshal and deploy necessary resources to rapidly detect, respond to, prevent and recover from any health emergency. The authority will prepare, maintain and update an integrated system of medical countermeasures for all possible public health emergencies. Such measures will include but not be limited to diagnostic tests, anti-microbial drugs and protocols for prevention including vaccines. It will inform decision-making, enabling governments to craft and mount multi-pronged responses under an integrated incident management system. Synergies created by leveraging the strengths of partners and sharing resources will avoid duplication and provide more people with access to life-saving health services.
The National Centre for Disease Control (NCDC) in Delhi monitors communicable disease outbreaks in the country, investigates them and recommends control measures. It collects data about diseases from villages of the country through its integrated disease surveillance programme (IDSP). The Covid pandemic overwhelmed existing surveillance systems and exposed their inadequacies. Public health systems struggled to investigate outbreaks, trace contacts, quarantine suspects and contain outbreaks. Healthcare facilities were overstretched and saw shortages of beds, PPE, drugs and manpower.
NCDC needs to be urgently strengthened to address these issues. It should be recast as the repository of technical knowledge for IHERA. Its current repertoire of disease monitoring must be expanded by including more diseases. Though IDSP is present at state and district levels, it struggles to collect outpatient data because of capacity limitations. Real-time surveillance needs to be enabled by deploying adequate numbers of male health workers in all primary health centres and advanced computing methods. Public health laboratories at state and district levels need real strengthening.
A massive expansion and upgradation of India’s healthcare facilities is an urgent priority. Of the 554 medical colleges in India, only four have teaching programmes in infectious diseases. The case for starting infectious disease specialities in all medical colleges is urgent and compelling. At MBBS/ MD levels the teaching hours for infectious diseases need to increase. Public health systems at the district and sub-district levels need to be professionally staffed and managed. The Tamil Nadu model of public health services delivery has stood the test of time and can provide a good template for replication.
A robust surveillance system, early warning protocols, a vigilant health emergency response, and a well-equipped healthcare system are indispensable for crafting an appropriate response to epidemics. We cannot be sure of what new outbreaks the future will bring, but we can be sure that if we do not prepare for them today, our tomorrows could be catastrophic.
The writer is an IAS officer and member of the Tamil Nadu government team for epidemic monitoring. Views are personal.