How to make India pandemic proof
By Mamta Murthi
As Covid-19 abates, the question everyone is asking is: How ready is the country for the next pandemic? The virus spread exposed the weaknesses in the world’s health systems, including those of countries ranked high in the Global Health Security Index.
Covid has also created a chance to build stronger health systems. Climate change is giving rise to new pathogens, and zoonotic diseases are spilling over from animals to humans, causing over a million deaths each year. A silent pandemic is also lurking — antibiotic resistance. The world realises that the cost of preventing a pandemic is far lower than the cost of managing one. The need of the hour is a holistic “One Health” approach that addresses the health of people, animals and ecosystems together.
India is one of the world’s first countries to frame a game plan in this regard. In October 2021, India launched its flagship programme to prevent, prepare and respond to pandemics. Since one of the key weaknesses during the Covid crisis was the inadequacy of institutions and systems, the programme — the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) — seeks to fill the gaps at both the national and state level. It will need to be overseen at the highest levels.
India has also brought several ministries — including health, animal husbandry, forests, and biotechnology — under the Principal Scientific Advisor. This was one of the major shortcomings during the pandemic. In most countries, the Covid response was hampered by overlapping mandates and weak coordination between key institutions. More recently, the foundation for the National Institute for One Health in Nagpur was laid. The institute will identify hotspots for endemic and emerging zoonotic diseases to contain their spread early on. Its success will depend on how well these strategies are implemented on the ground.
The fact that 30 cities accounted for almost 80 per cent of India’s reported Covid cases shows how vulnerable urban populations are to the spread of disease. India is now augmenting surveillance in 20 cities, both large and small, with municipal corporations being mandated to identify the most vulnerable areas and provide early alerts. For this to be successful, private hospitals and clinics, which provide over 60 per cent of India’s health care, will need to be brought under a common platform and data placed in the public domain. The Ayushman Bharat Digital Health Mission can facilitate this. In villages, where people and livestock live in proximity, the risk of cross-infections is greater. Here, strong partnerships will be needed with communities, dairy cooperatives, and the poultry industry to identify new infections.
The rise of new pathogens has highlighted the importance of genomic surveillance. During the pandemic, India was able to create, in a short time, a formidable network of institutions that can identify new pathogens. This can now be complemented with wider testing of wastewater and samples from incoming ships and aircraft. These surveillance systems will also need to be extended to other South Asian countries, as no country is safe unless its neighbours are safe. India is also expanding its network of research laboratories, which primarily focused on influenza, to cover all respiratory viruses of unknown origin. Antibiotic resistance will have to be tracked and powerful awareness campaigns are needed to promote their rational use.
After the 2015 MERS outbreak, South Korea used mobile technology and Big Data to trace contacts and built a strong capacity for diagnosis. The government also started semi-annual training sessions that simulated the spread of viral disease. India has also begun these exercises.
During the pandemic, Indian manufacturers produced vaccines, test kits, therapeutics, masks and other items at very competitive prices, both for India and other countries. The partnerships between research bodies and manufacturers will need to be sustained and enhanced to make India a global hub in the biopharma sector. The clinical trial network set up under the National Biopharma Mission is a positive step toward improving access to affordable new vaccines and drugs in India and around the world. Similarly, the ICMR’s initiative to establish a biorepository for clinical samples will be a national and global asset.
The World Bank has recently augmented its support to the country’s health sector to $3.5 billion. We are working with PM-ABHIM to build institutions and systems for preventing and responding to future pandemics. We are also helping improve the provision of primary health care by supporting the Ayushman Bharat Health and Wellness Centres under the National Health Mission at the Centre and in seven states.
The success of India’s efforts will be critical. For it is no longer a matter of “if” there is another pandemic, but “when”.
The writer is the World Bank Group’s Vice-President for Human Development