Drones fly over the Han river showing messages to support the country as measures to avoid the spread of COVID-19 continue, in Seoul, July 2020. Photo: Yonhap via Reuters.
For a lot of us, the COVID-19 pandemic came out of the blue. Given the utter confusion that reigned government response across countries developed and developing, it could be safely assumed that the pandemic caught even the most tech-forward nations unprepared.
Yet history bears witness to disease outbreaks existing almost as long as humanity itself. In the last decade alone, we faced six public health emergencies: the 2009 H1N1 swine flu; polio setback in 2014; Zika virus in 2016; the Ebola epidemics of 2014 and 2018. Widespread disruptions in the human-animal-environment interface in recent times have exacerbated such emerging infectious disease (EID) risk. Two-thirds of new diseases affecting humans in last ten years have been zoonotic infections, caused by pathogens originating in animals or animal products and spilling-over to humans.
The rise in international trade of exotic animals, intensive and unhygienic live-stock farming, urbanisation and agro-industry fuelled encroachment into wildlife habitats, and large-scale exploitation of the environment, among others, have provided hitherto unknown pathogens with numerous opportunities to emerge anew, invade new hosts and engender new pandemics.
The next pandemic
While everything from bacteria to ticks can cause the next pandemic, the most disruptive health emergencies in recent memory – HIV, H1N1 and H5H1 influenza, SARS coronavirus, Lassa virus, Ebola – were caused by viruses. The Global Virome Project estimates that there are some 1.67 million unknown viral species in the world, of which 827,000 can pose a potential risk to humans. While pathogens to cause pandemics are aplenty, our preventive efforts remain suspect at best, and counterproductive at worst.
Take the fact that while the country reeled under the pandemic and experts exhausted reels of paper emphasising links between ecological degradation and EID, government bodies went on an environmental clearance giving spree, which seemed to lack due diligence and will adversely impact eco-sensitive areas such as tiger reserves and designated wildlife corridors. Then came the controversy around the dilution of environmental impact assessments. These clearly signal the government’s failure to learn from past mistakes, even amidst the death and distress unleashed by the pandemic.
Its yearning for the pre-pandemic status quo exposes a dangerous ignorance of the fact that the ‘normalcy’ it seeks gave birth to this scourge in the first place. Such negligence of environmental concerns for short-term gains may cost the country heavily in the long haul; especially when India, burning an ominous shade of green, indicates maximum potential risk of EID in the 2017 global disease hotspots map.
COVID-19 is unlikely to be the last pandemic or even the worst; that is if we pay no heed to the warning bells now. Despite the unavoidable uncertainty around complex phenomena like pandemics, we have credible ideas about the threat landscape of infectious diseases: the likely pathogens; potential hotspots; probable mechanisms of spread; and preparedness required to avert such threats – nearly enough to get us going. But are we doing enough?
Preparedness is key
Soon after the SARS outbreak in 2002-2003, countries – including India – signed on the revamped International Health Regulations (IHR) 2005, a legally binding instrument that seeks to enhance country competence to prevent, detect and respond to public health risks and emergencies. Ensuring adequate stockpiles of PPE, instituting systems to timely track and report disease or death, rapid control measures to prevent disease transmission, and strengthening core public health capacity for supporting these, are some of its key elements.
Yet the 2019 Global Health Security Index – a comprehensive score to assess countries’ ability to deal with health emergencies – could find not even a single country adequately prepared for epidemics or pandemics. India ranked an unremarkable 57th out of the 195 countries. Its score, spread across the six categories of prevention, detection and reporting, rapid response, health system, compliance with international norms, and risk environment, was uniformly mediocre, with preventive efforts graded the least. Disaggregated further, India fared even worse across indicators such as zoonotic disease prevention; emergency preparedness and response planning; health system capacity and healthcare access.
All of us, but the poor disproportionately, continue to pay a heavy price in this pandemic because of the government’s total lack of preparedness or empathy for its people. Preparedness is key to averting such health and humanitarian crises in future.
Pandemic preparedness, typically involving surveillance, risk reduction and capacity building, demands considerable effort and commitment. Strengthened surveillance capacity across the district-state-national level, inclusive of the private sector, and strategically intensified in potential hotspots, with capable support from sufficient human resources and diagnostic infrastructure, would be critical to timely identify and respond to outbreaks.
Adopting a ‘One Health’ approach, which recognises sustainable interrelation between people, animals and their shared environment as key to optimising health outcomes, would boost risk reduction and preventive efforts further. A national OneHealth policy will be necessary to maximise synergies between the different sectors dealing with human, animal and environmental health and provide a framework for collaborative action. Some immediate measures may include ensuring health and hygiene standards in food-animal farming, preventing antibiotic misuse therein and strategic integration between human and animal disease surveillance.
The recently announced National Mission on Biodiversity and Human Well-being, with a multi-sectoral presence and a declared component to examine the connection between biodiversity loss and EID, is uniquely positioned to leverage the OneHealth approach in pandemic prevention. The upcoming zoonotic research centre in Nagpur is also a step in the right direction. Investing in health research, formulating protocols for developing medical countermeasures during a pandemic; R&D preparedness against priority pathogens; building health solidarity networks across countries, could further assist future-proofing against pandemics.
However, given the society-wide ramifications of COVID-19, a whole-of-society response involving everyone from social scientists to social activists, and many others, as a recent editorial in The Lancet noted, would be vital to mounting a coordinated front against future pandemics. Further, recognising the right to health as a fundamental right would legally guarantee healthcare to everyone and for every need, even during a crisis. Making the promise substantive would require the government to first acknowledge the failures, identify the challenges and ‘build back better.’
Building back better
According to the 2019 annual report on IHR capacities needed to counter public health risks, the main challenges facing India are health service provisioning, zoonotic events, food safety and laboratory services, in that priority order. While all capacities average score of India is a respectable 78%, health service capacity cuts the sorriest figure at 33%, a repeating trend across different indices. This is hardly surprising given India’s abysmal spending on public healthcare – one of the lowest in the world.
The exact what, where and how of the next pandemic may be less clear, but who it will overwhelmingly affect is almost certain: the poor and the marginalised, dependent most on public healthcare. Absent any tangible benefit from the private sector or the Ayushman Bharat scheme during the pandemic, a robust and universal public health system remains the sine qua non for the health of the public. Strengthening the public health system, building surge capacity to meet health emergency needs and improving the overall social determinants of health will be essential for building back better health systems that are equitable, resilient, and sustainable.
Lest we forget, the dominant, unequal and unsustainable development paradigm lies at the centre of our current predicament. A critical rethink of our existing way of life, and a renewed thrust towards building healthy and lasting eco-social relationships, hence, would be much needed.
Past evidence and present experience leave us in no doubt that the country needs to get its act together, pronto. In the thick of the pandemic when awareness/panic is high and even otherwise sluggish government machinery moves swiftly, it may be difficult to imagine that as soon as the dust settles, things will become business as usual. Except our lives and histories are living testimonies to such errors of judgement, repeated ad nauseam.
Nevertheless, when our very existence is at stake, the margin for error is slim to none. It is thus crucial that we break the vicious cycle of ‘panic and neglect’ to act now, and act decisively. To err may be human, but when preparing for future pandemics, to delay would be deadly.
Sayan Das is a medical doctor and public health researcher.