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Fifty years ago, Alvin Toffler wrote a book called Future Shock, introducing the idea that social paralysis is induced by rapid technological change. A widespread feeling of “too much change in too short a period of time" is a perfect description of 2020, induced not by technology, but a strand of RNA wrapped up in a layer of protein and fat.

Could this happen again? Absolutely. With our warming planet, future outbreaks caused by known and unknown pathogens are a near certainty; just the location and timing are unpredictable. Increasing urbanization, characterized in India by slums, rapid ecological changes and unpredictable weather patterns, apart from increased internal migration and international travel, will make epidemics more frequent, complicated to handle, and very hard to prevent and control. Preparedness is essential and we must ensure that the learnings of the current pandemic are not forgotten.

With the severe acute respiratory syndrome coronavirus 2, or SARS-CoV2, perhaps we have been lucky. Despite the very large number of cases, India and other countries in Asia and Africa have seen many asymptomatic- infection cases, and much lower levels of severe disease and mortality than in the West. Although some of this low mortality might be attributable to lower testing levels and reporting, there does seem to be a discrepancy in severity and survival here that is not completely explained by data inadequacies.

What then prepares us for the future? How do we build better defences? For the control of infectious diseases, particularly epidemics, we must move from crisis response for each outbreak as a separate event, to an integrated cycle of preparation, response and recovery. This can only happen if we move from a fragmented and still-siloed approach to facility-based care in our federal structure for healthcare delivery, and to a universal system that places the person most affected at its centre and is well geared for integrated, preventive and curative care.

From communities, through local and regional health authorities, all the way to national public health institutes and international organizations (including many essential partners in sectors beyond public health), an integrated approach to developing systems that deliver, irrespective of the provider, must be supported. And not just for infectious diseases, but all aspects of health.

The long-standing need for universal health coverage in India has been brought into sharp focus by the pandemic. The enormous toll on routine healthcare services, particularly for chronic diseases, the impact on the nutritional and immunization status of children, and the consequences for women and their babies because of decreased services, fear and stigma only serve to emphasize the urgent need for a strong and resilient healthcare system that provides services to all Indians, not just the wealthy who can afford to quality services.

With challenges come opportunities for reconstruction and growth. Given India’s capacity for manufacturing and technology, there is no reason why we cannot take a new approach to establish systems that strengthen participatory planning and delivery of healthcare. In preparing for future epidemics, we now have an opportunity to combine knowledge and skills from all over the world. We must integrate not only the discipline of epidemiology, but also social sciences, research and development, diplomacy, logistics and crisis management. Surveillance and monitoring are the backbone of infectious-disease preparedness, particularly with a one-health approach that calls for tracking animal, avian and human disease in tandem. Building trusted systems for the provision of primary healthcare and referrals for advanced care is India’s greatest challenge, given that quality healthcare for the poor is often either inaccessible or unaffordable.

In addition, governance mechanisms will need to have policies drafted in advance, ensure a structure and willingness to implement them in a federal set-up, and institute systems for monitoring outcomes to identify gaps in performance. To enable the rapid development and approval of vaccines and drugs, India will need to enhance its regulatory capacity.

The country already has large-scale production capacity for vaccines. Because of domestic manufacturing and a government that has committed itself to buying vaccines, I am not worried about the availability of covid vaccines in the country. But the most important component that we need to build is vaccine-safety monitoring after the vaccines are licensed and put to use in the country. The government is strengthening the national Adverse Events Following Immunization (AEFI) programme to monitor any hazards that may arise on account of vaccines or the vaccination process.

Coordinated systems, expertise and resources will provide the country insurance against pandemics of the future. Given the health and economic damage suffered in 2020, can we afford not to have them?

Gagandeep Kang is a professor at Christian Medical College and board member of Coalition for Epidemic Preparedness Innovations

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