Bangalore: Even as India tries to prevent terrorist attacks such as the one in Mumbai in November, security experts say that despite not facing a biological attack so far, the country musn’t ignore that threat.
The National Disaster Management Authority (NDMA) has begun preparedness, but concedes more cooperation is needed from companies and communities.
Early days: The biological disaster management guidelines has seen light of day under the guidance of Lt Gen (retd) J R Bhardwaj. Ramesh Pathania / Mint
India isn’t alone in worrying about a potential bioterror attack. Earlier in December, the US Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism released its
World at Risk report, which predicts the world is likely to experience a biological or nuclear weapons attack in the next five years, and calls for decisive global action.
NDMA had in July notified the biological disaster management guidelines, prepared under the chairmanship of Lt Gen (retd) J.R. Bhardwaj, former director general of the Armed Forces Medical Services.
“We are lucky that not a single incident has occurred in the continent because non-state actors haven’t tried the capabilities and they don’t have self-protection, but the day may not be far (of acquiring such capabilities),” says Dr Bhardwaj. The eight-member NDMA is chaired by Prime Minister Manmohan Singh.
NDMA has started the Integrated Disease Surveillance Programme (IDSP), which is funded by the World Health Organization, and for which the National Institute of Communicable Diseases is the nodal agency.
Modelled after a similar programme run by the Centers for Disease Control and Prevention in Atlanta, the IDSP has started taking shape, but will be a while before it reaches many of the 600 or so districts in India, says Dr Bhardwaj.
To strengthen the existing eight battalions of the National Disaster Response Force, each consisting of 1,000, two more battalions have been sanctioned. Half of the existing force is specifically trained to deal with chemical, biological, radiological and nuclear (CBRN) threats. NDMA has also asked the state governments to get part of the state forces trained in such areas.
At the time of the Sars (severe acute respiratory syndrome) outbreak in 2002-03, India had one BioSafety Level-4 (BSL) lab, but now it has two. Since such situations require BSL-3 labs, which can work with indigenous or exotic agents—dozens of these are coming up in medical colleges and defence institutions, according to Dr Bhardwaj.
Experts also say that funding hasn’t been a constraint so far. The 11th Plan has allocated Rs10,000 crore for medical preparedness. And 10% of all development plans can also be utilized for disaster mitigation. What is a constraint, though, is a “lack of participation from the people and private sector”, claims Dr Bhardwaj.
The fundamental structuring of medical care in the country is such that more than 70% of it falls in the private sector, which is not “committed to community health services” but is confined to “care of individual patients”, says Lt Gen (retd) D. Raghunath, principal executive of Sir Dorabji Tata Centre for Tropical Diseases in Bangalore, and lead author of the NDMA guidelines.
The private sector has to be more responsive to national needs and for which a complementary public health system needs to be put in place, notes Dr Raghunath. “Public health has been moribund for sometime and moving that is a challenge.”
His worry, for instance, is that if a patient turns up at a private hospital with fever and vesicles on his face, it’s important that it is diagnosed properly to rule out small pox. “Will a private clinic come forward to report it?” he wonders.
That’s a challenge NDMA is battling with, even though most big private hospitals have shown interest and offered three days of free treatment in case of an outbreak. “But we need a legal instrument that would ensure they (private hospitals) must do it,” says Dr Bhardwaj. He has written to the government to enact a law.
Meanwhile, NDMA has chosen Gurgaon as the model district to sign a memorandum of understanding with private hospitals, laying down clearly roles and responsibilities in the case of an eventuality. “All district collectors need to sign a mutually agreed upon MoU (memorandum of understanding) with their respective hospitals,” insists Dr Bharadwaj.
Private sector participation also falls short when it comes to detection readiness.
“We have a tough time attracting the companies to manufacture the kits we develop,” says R. Vijayraghavan, director, Defence Research and Development Establishment, in Gwalior. His lab, he claims, has “perfected the rapid detection” of CBRN and stocks 500-1,000 kits for emergencies but can produce more within 6-24 hours.
For the livestock, which have seen surprise outbreaks from time to time including bird flu, Venezuelan equine encephalitis and glanderous infection in horses, Indian Veterinary Research Institute in Izatnagar says it is diagnostically equipped to handle any emergency. “We are now stepping up action for vaccines,” says its director S.P.S. Ahlawat.
But no measure is effective if people don’t participate.
“People should know if their neighbour’s pressure cooker is on all night, it is suspicious…he could be making anthrax spores,” says Dr Bhardwaj. Hence, Rs200 crore has been allocated to bring civil defence into disaster management. NDMA is running a pilot programme in Nagpur, which can become a model for the rest of the country.
The Armed Forces have always prepared for biowarfare, but to galvanize government machinery and prepare civilians for bioterrorism is no mean task. “The delay happens, but we’ll do it; we’ve done it in the Army for 40 years,” says Dr Bhardwaj.