Why wait for an epidemic/pandemic when it is cheaper and less painful to prevent it?
Diwali had special significance this year, as we tried to re-capture the joy of a pre-pandemic Diwali. But for many families, the festive season was bitter-sweet, with memories of lost family members tempering the celebrations. And no one can be blamed for that quick crossing of fingers that our unmasked festive get-togethers in October will not result in COVID waves in December? Have our immune systems re-bounded and will our COVID-19 shots prevent a COVID-23?
Beyond COVID, there are concerns that the climate change is one of the factors leading to more disease outbreaks. As leaders meet in Egypt for COP27 climate summit, a recent WHO analysis of the seven countries in the greater Horn of Africa – Djibouti, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda – recorded 39 reported outbreaks, flooding and other acute public health events just between the first 10 months of 2022 (January 1 – October 30, 2022). This is reportedly already the highest annual reported number since 2000. The WHO report lists outbreaks of anthrax, measles, cholera, yellow fever, chikungunya, meningitis, and other infectious diseases as accounting for more than 80 per cent of the acute public health events reported, with drought, flooding and other disasters accounting for 18 per cent.
But as we near the third anniversary of the COVID-19 pandemic, there is also hope that the lessons of the COVID years are being translated into better implemented public health policies. Cautious hope comes from studies like the recently released second “Epidemics that Didn’t Happen” report where the non-profit Resolve to Save Lives features six disease outbreaks that public health authorities managed to contain in 2021, even as healthcare staff were coping with the worst of the COVID-19 waves. This report follows the inaugural “Epidemics that Didn’t Happen” report that featured nine examples of outbreaks that were contained quickly, ‘because of careful planning and swift strategic action.’
One of the six examples in the 2021 report details how Kerala took to heart the lessons from past Nipah outbreaks and succeeded in restricting the 2019 outbreak to just one case. The facts have learnings for all of us. On August 29, 2021, a 12-year old boy was bought to a clinic with headache and low-grade fever. In hindsight, the symptoms were obviously too general to be immediately linked to past Nipah outbreaks which delayed diagnosis by a few days. The boy’s health deteriorated as he was transferred from one hospital to another.
It was only on September 3 that his samples were sent to Pune’s National Institute of Virology. The samples tested positive for antibodies on September 4 but it was too late for the patient: the boy passed away on September 5. However, this was the only case in this outbreak, an indication of the state’s high preparedness and response levels.
These “Epidemics that Didn’t Happen” must serve as beacons of light to all policy makers and practitioners across the public health ecosystem. These success stories must be studied, to understand how they can be adapted and adopted to prevent, detect, contain and treat existing and future disease threats. The report discusses ‘how global and local investments in preparedness, combined with swift, strategic responses by public health authorities, can transform the trajectory of disease outbreaks, saving lives and preventing suffering.’
More importantly, these successful outbreak responses from around the world – from Brazil, Burkina Faso, Democratic Republic of Congo, Guinea, Indonesia, and Tanzania, besides India – ‘demonstrate the returns of investing in preparedness and response systems’ and ‘are a testament to the power of preparedness and a roadmap for future success in preventing epidemics.’
In other words, these stories prove that investment in public health infrastructure pay dividends many times over. Why wait for an epidemic/pandemic when it is cheaper and less painful to prevent it?
The report highlights four themes or learnings from these stories. Firstly, speed of response is essential. Secondly, local communities need to be part of the well-coordinated initial reporting of cases as well as containment measures. But this can only happen if there is trust between the community and the health authorities, which is the third observation. The fourth observation is that health care workers, especially community and frontline workers, need to be trained, supported and provided with access to resources and assistance to stop epidemics. As the report summarises, the bottom line is: when countries prepare consistently and act decisively, they can prevent epidemics.
How does India’s public health response fare on these four points? As the example from Kerala demonstrates, detecting and responding quickly to an outbreak, with cooperation of the community, is the difference between an outbreak that is contained and one that spreads unchecked.
Hopefully, these examples will silence critics who argue that health budgets need to be diverted to other sectors, now that COVID seems to be under control. Some states in India are already good examples with well-implemented tele-health schemes, closer monitoring of health budgets, successful systems to track beneficiaries of health subsidies to detect frauds.
But where are we on the tougher problems like matching disease burden with fund outlays to reach out to marginalised populations with special needs like tribals in hard-to-reach areas or TB/HIV patients who face a double burden of disease and social stigma? In future editions of Express Healthcare, we hope to delve deeper into how public health authorities have incorporated the learnings of the pandemic into various aspects. Do write in with suggestions.
VIVEKA ROYCHOWDHURY Editor
viveka.r@expressindia.com
viveka.roy3@gmail.com