100 years on, India is still seen as vulnerable to influenza pandemic

India remains as vulnerable to death and devastation caused by influenza viruses as it was during the global influenza pandemic in 1918-19, despite medical advancements and improved diagnostics.

The World Health Organization (WHO) last month released a list of 10 major threats to global health in 2019, which includes another global influenza pandemic. “The world will face another influenza pandemic. The only thing we don’t know is when it will hit and how severe it will be. Global defences are only as effective as the weakest link in any country’s health emergency preparedness and response system,” WHO said.

Health experts claim that India’s vulnerability in the last 100 years has remained unchanged and the country is yet not prepared to handle an influenza pandemic. WHO, in its latest global update on influenza released earlier this month, has highlighted that the cases in Europe, North Africa, Western Asia, East Asia, and southern Asia continue to increase.

India has recorded a total of 6,701 H1N1 (also called as swine flu or seasonal influenza) cases and 226 deaths across the country, according to National Centre for Disease Control (NCDC). The maximum number of cases has been reported from Rajasthan (2,363) followed by Delhi (1,011) and Gujarat (898). Rajasthan reported the highest number of deaths (85), followed by Gujarat (43) and Punjab (30). During the 1918 pandemic, India had the largest number of deaths in any country (10-20 million), as well as highest percentage of overall deaths in the world (4.39%). During the 2009 pandemic, India reported 27,236 cases with 981 deaths.

“Today we are more interconnected and the cities are denser. The speed of travel has increased. Conditions that favoured the spread of influenza in 1918 are still prevalent. Given the widespread presence of the influenza virus in nature, the probability of emergence of a reassortant flu virus that adapts to start human to human transmission is high,” said Lalit Kant, senior adviser, infectious diseases, Public Health Foundation of India.

Vaccination is the most effective way of preventing infection and severe outcomes caused by influenza viruses, according to WHO. Despite India’s successful immunization programme Mission Indradhanush, the country does not have a seasonal flu immunization/vaccination policy.

“India has also made recommendations for vaccination against influenza. However, only a limited number of states have implemented them. Introducing influenza vaccination in the National Immunisation Programme is a necessity, especially to protect those at higher risks such as pregnant women, young children, healthcare workers, and people with chronic conditions,” said Jean-Pierre Baylet, country head, Sanofi Pasteur India and South Asia.

Public health experts explained why India faces several challenges in vaccines and vaccination. “India is not eligible for receiving donated vaccines because of its better economic condition. The country needs to have its own vaccine. In case of a pandemic situation, no foreign country vaccine manufacturer will sell vaccines to India before fulfilling its own domestic requirements. Even if we pay for the vaccine, it may arrive too late to have an impact on the raging pandemic. Moreover, our health systems are not geared to deliver the flu vaccine,” said Kant.