Shyamal Banerjee/Mint
Shyamal Banerjee/Mint

India’s vulnerability against Ebola

Our capacity for disease surveillance is extremely limited

The rapid spread of the Ebola virus over the past few weeks has finally made the world sit up and take notice, months after the World Health Organization (WHO) first declared the Ebola outbreak in West Africa as a public health emergency of international concern. Ebola was first discovered in 1976, and had recurred in several countries in the African continent over the past four decades. But the current outbreak has been far more deadly, and the death toll has been rising exponentially since the first case late last year.

The death toll from this outbreak has already surpassed the toll from all previous Ebola outbreaks, and threatens to land the West African region into a humanitarian crisis of epic proportions. It is also one of the most serious global health threats in recent history. A recent Lancet study based on air traffic data from the three worst affected countries: Guinea, Liberia and Sierra Leone, found that the top destinations for travellers from these countries were other countries in Africa and some in Europe. Within Asia, China and India, the two most populous countries, appear to be at the greatest risk. The 10th biggest destination for air travellers from these countries in the past few months was China. India ranked 13th among the top destinations, just below US and Mali, the West African country that reported its first Ebola outbreak last week.

The current crisis calls for immediate steps to improve medical facilities in West African nations and to put in place effective entry and exit screening protocol to limit the spread of the disease. But the crisis also calls for structural changes in the public health infrastructure of developing countries such as India, which have under-invested in public health systems for decades. The Ebola epidemic shows that communicable diseases can wreak havoc in the absence of a well-functioning public health system, and can spread very rapidly in an increasingly inter-connected world. Unless a country puts in place a well-designed public health apparatus in advance, its public health system will crumble precisely when it is direly needed. With some studies suggesting that the spread of infections will only grow with climate change, it is high time that developing countries started ramping up their defences against communicable diseases.

A dysfunctional public health system means India’s capacity for disease surveillance is extremely limited, and our ability to launch a timely response even lower. The absence of an effective public health network in a densely populated country such as ours not only makes India extremely vulnerable to global pandemics but also results in an extraordinarily high disease burden. The lack of investments in preventive health services such as water systems, waste management, and vector control makes India an ideal breeding ground for communicable diseases. Water-borne diarrhoeal diseases alone result in annual deaths of about 200,000 children below four years of age in the country, according to a 2013 Lancet study. Many more manage to survive the attacks from microbes but are stunted in early life, which has life-long impacts.

It should not take an extraordinary disaster for us to wake up to the importance of effective public health systems. Every time the world faces a major health threat, there are calls for strengthening public health systems but the moment the threat recedes, we seem to go back to business as usual. The global panic caused by the SARS outbreak in the early part of this century had led WHO to revise its international health regulations, making it obligatory of members to develop “core public health facilities". But this was not followed by any regulatory action, or independent monitoring of the effectiveness of health systems across the globe.

It will be a fitting tribute to the Ebola victims if we learn from the crisis this time, and make the world a safer place to live in.

Is India prepared to tackle global pandemics? Tell us at views@livemint.com

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