Mumbai: The outbreak of bird flu at a poultry farm in a village outside Imphal in Manipur has brought into focus India’s preparedness - or lack of it - in dealing with a pandemic.
The current episode of avian influenza is local and there have been no reports of human infection yet, but health-care experts are worried that the country’s hospitals are ill-prepared to grapple with any future epidemic-like situation.
For the record, the government has stocks of nearly 950,000 capsules of oseltamivir, a generic copy of Roche’s Tamiflu, the only drug available for treating bird flu, from a purchase it made last year when the bird flu virus appeared in parts of central and western India. That stockpile is enough to treat about 100,000 patients. (Roche is the pharmaceuticals division of F. Hoffman-La Roche Ltd.)
In addition, each of the three drug firms approved to manufacture oseltamivir in India - Ranbaxy Laboratories Ltd, Cipla Ltd and Hyderabad’s Hetero Drugs Ltd - have an inventory of a few million dosages, estimates Amar Lulla, managing director of Cipla.
This amount lags global preparedness benchmarks, such as those set out by the World Health Organization, which recommends countries prepare to deal with as much as a quarter of their population affected by the virus.
Several countries, including the US, UK, Belgium, Germany, France, Italy, Poland, Russia, Spain, Turkey, China, Kazakhstan and Thailand, have already stockpiled at least 10-14 million courses of anti-viral drugs.
The three Indian companies could be asked to produce more capsules, maintains Drug Controller General of India M. Venkateswarlu, adding that “we can approve more manufacturers now as the patent restriction has been removed for this drug now”.
Health-care experts still say that India’s preparedness to face a bird flu outbreak is grossly inadequate as the government is yet to act in some of the key areas such as crisis management, medicines and vaccines procurement and distribution, technology upgradation for instant identification of the virus.
The government, for instance, is yet to set up emergency-care cells manned with trained medical and para-medical staff in all health care and local administration departments despite global alerts.
For instance, it took almost three weeks for the High Security Animal Disease Laboratory at Bhopal to confirm the virus after the outbreak was first reported in Manipur on 7 July. Following which, the Centre deputed its rapid response team to review and firm up preparedness measures on 26 July. The Union health ministry airlifted drugs and protective gear the same day.
The Bhopal lab and a similar facility at Pune are not equipped with state-of-the-art virus recognition software that is used by the US Food and Drug Administration and other regulators worldwide, which can immediately detect the presence of the bird flu virus. Compare this to the one month it takes Indian labs to confirm the exact strain, “which is crucial for readying precautions and treatments”, said a senior official at the drug controller’s office, who did not want to be identified because he is not authorized to speak to the media.
Such delays could prove expensive as India has more than a million farms and poultry. “We should have learned from instances like the plague disaster in Surat and neighbouring towns in Gujarat (in 1994), when hundreds of people died like rats with no diagnostics, medical facilities and preventive measures readily available,” says A.S. Gandhar, a health-care expert with PeopleCare, a non-governmental organization.
“Though the authorities have now stockpiled the drug and equipment expecting a bird flu outbreak, a delay in diagnosis and proper medical care at the spot will make this inventory useless.”
More recently, Kerala witnessed more than 100 deaths in the last couple of months primarily over delays in medical care when thousands in the seven southern districts in the coastal state were affected by mosquito-borne viral fevers dengue and chikungunya. With the hospitals not equipped to handle the situation, the Army Medical Corps was called in. Gandhar points to the irony of the loss of life over an inadequate health care system in a state that boasts the highest health and education metrics in the country.
The Union health ministry, which has been planning to set up a high-level committee to chalk out a bird flu strategy, is yet to act on recommendations by the drug control department, submitted in May by officials who were trained by the US Food and Drug Administration on crisis management in the?event of a bird flu outbreak.
The report had suggested technology upgradation in testing laboratories to instantly identify and diagnose H5N1, as the bird flu virus is called, training medical and para-medical staff, and preparing various departments including drug control, health and local administrations, as also hospitals and distributors, with a checklist to handle the situation at the time of a medical emergency.
In contrast, the government action in India, which declared itself bird flu free last August after two major outbreaks of the H5N1 virus, has been mostly reactive. In Imphal, the Union health ministry said in a statement, the 21 family members and nine veterinary staff who got exposed to the infected birds have been put on oseltamivir, but only last week.
All the other preparations, such as orientation training to state medical rapid response teams, hospital staff and field staff were also late. An isolation ward in the Jawaharlal Nehru Hospital, Imphal, to manage suspected human cases of avian influenza also came up just last week.
“For active human surveillance, 20 medical teams have been constituted, each team having one medical officer, three supervisory staff and 30 health workers,” said a senior medical officer at the health ministry in charge of monitoring the situation in Imphal, preferring anonymity.
“One health worker would cover 100 households doing house to house search for influenza-like illness. Daily reports would be generated.”
Still, medical teams have checked more than 235,000 people living within 5km of Chingmeirong village on the outskirts of Imphal, Manipur health minister Ph Parijat Singh said on Monday.
In addition, following confirmation of bird flu strain, some 200,000 poultry have been slaughtered in a 5km radius around the affected farm in Manipur, which lies on the border with Myanmar.
Chief minister Okram Ibobi Singh told state legislators on Tuesday that his government had asked the Centre to take steps to prevent the import of poultry and poultry products from Myanmar and Bangladesh.
Health workers are checking for any signs of flu among some thousands of people around the poultry farm in Chingmeirong.
Government officials say they are still investigating the source of the virus’ outbreak after some 132 chickens died at the farm in a period of six days from 7 July.
India has also lagged on regulatory action needed on a vaccine being developed for avian influenza. A bird flu vaccine developed by French multinational drug firm Sanofi-Pasteur SA is in its final stages of trials and is being touted as being effective in preventing infection of the H5N1 virus, which is airborne and spread mainly through poultry and migratory birds.
Unless the country immediately allows such trials here, it will be at least three-four years behind other countries such as the US, the UK, Germany, France Russia, Greece and China to be able to use it.
Bhuma Shrivastava of Mint, and PTI and Reuters contributed to this story.