India’s response to the global health challenges
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In the popular American TV series The Walking Dead, the protagonists who had survived a zombie apocalypse are shown to briefly take shelter at the Centers for Disease Control (CDC) in Atlanta, Georgia—a touch of morbid irony given that the CDC is responsible for protecting public health. By the end of the season, it’s incinerated, the protagonists’ hopes of finding a cure dashed. In real life, the CDC, thankfully, still stands—fighting the good fight against infectious diseases less telegenic than a zombie apocalypse, but dangerous for all of that as pathogens old and new travel at a faster pace across countries and continents, spreading health crises.
Take, for example, the Japanese encephalitis (JE) outbreak in Odisha’s backward, tribal-dominated Malkangiri district that has already claimed about 100 lives. While JE is not uncommon in this part of the world, it is not endemic to Odisha either. The first outbreak in Odisha was in 1989 in Rourkela city. After that, sporadic cases were reported between 1992 and 1995, and it wasn’t until 2012, when there was another major outbreak in Malkangiri, that JE cases were reported again in the state. JE traditionally attacks children but in recent years the number of adults who have died from the viral brain infection, for which there is no cure yet, has also soared.
JE is not the only viral infection following this pattern which has emerged in response to changing weather conditions, shifting agricultural patterns and ever-increasing man-animal conflicts. Dengue and chikungunya both are on a similar path. Today, dengue epidemics have become so common that they barely raise an eyebrow. It is true that the disease is not new and was recorded even in China under the Jin dynasty, but keep in mind that until 1970, it was limited to about half-a-dozen countries. Today, severe dengue outbreaks have been reported by more than 100 countries.
Similarly, chikungunya, which was first isolated in Tanzania in the early 1950s, has in the past decade or so spread across Africa and Asia with a worrying number of outbreaks being recorded since 2005. In India, chikungunya was initially reported in Barshi, Maharashtra, in 1973 and then it disappeared for the next 30 years. In 2006, just two years after the virus had reappeared in east Africa, India suffered a major chikungunya outbreak affecting more than a million people. This year, Delhi was the epicentre of the chikungunya outbreak with more than 12,250 cases from across the country.
Globally, we are seeing a similar trend with the Zika virus, which until last year was a little-known entity but is now a household concern across the world. A Lancet report published last year suggests that Zika may spread globally much like dengue and chikungunya. The virus was first isolated in Uganda in 1947 and for many years after that, only sporadic human infections were reported. In 2007, the virus caused an epidemic in Micronesia, followed by another epidemic in French Polynesia in 2013-14. The Zika virus is yet to reach India, thankfully, but as the Lancet report notes, “With more than half of the world’s human population living in areas infested with these mosquitoes, the potential for major urban epidemics…is overwhelming”.
Traditionally, the World Health Organization has been the leader in global public health issues but a funding crunch has tied its hands for many years now. Steadily, the US’ CDC (among a few other organizations) is rising to the challenge. A good example here is the US government-funded HIV prevention programme, the world’s largest state-sponsored global health programme. Notably, India too has played its part in the global fight against HIV by providing cheap antiretroviral treatment. This is just one small indication of the role that India can and should play in dealing with the health challenges emerging, simultaneously, at home and across the world.
Of course, given how the country’s public healthcare system is currently struggling to provide even basic primary care to all its citizens, this may seem like pie in the sky for now. But there is enough scope to convert this enormous burden of disease into an opportunity for innovation and global leadership.
For starters, apart from the cost-effective quality care that it provides to urban elites, India has had some major successes such as containing HIV infections and leprosy and eradicating polio, which offer valuable lessons in public health management, particularly in poor countries with inadequate healthcare infrastructure. At the same time, there are also limitations—particularly with the vertical model for disease control (specific programmes for specific diseases)—which do not allow for an integrated approach.
Only the anti-malaria programme has been converted into a more broad-based National Vector Borne Disease Control Programme, which includes interventions against other vector-borne infectious diseases such as dengue and chikungunya. This is a step in the right direction. It must be followed by comprehensive review and restructuring of the healthcare system with a focus on upgrading primary healthcare centres, manned by a well-trained cadre of health professionals.
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