Shambhavi NaikApr 07, 2021 14:54:39 IST
COVID-19 has renewed the focus on public health threats – making countries review their public health systems and healthcare infrastructure. Some countries, such as New Zealand and Vietnam have done better than others including the US, UK, but the underlying reasons for this outcome remain unknown. However, there are important lessons to be learnt from global and domestic health responses. World Health Day is celebrated on 7 April and it is the perfect occasion to review India’s response to COVID-19 and identify threats to our health security that can be rectified on a warfooting. These threats go beyond the biological causes of well-being and include policy and health responses that, when misaligned, can exacerbate an otherwise low-level threat into a serious one.
The most well-characterised threat are biological causes of poor health, such as infectious diseases, malnutrition and obesity, lack of sanitation, tobacco consumption, etc. These threats are well-recognised and oft-discussed from a preparedness perspective. Once identified, steps can be taken to counter these threats through increased surveillance, targeted health programmes and effective biocontainment policies.
However, this response to biological threats is underpinned by the availability of adequate health capacity. COVID-19 has demonstrated a paucity in India’s infrastructural and healthcare professional’s capacity. An important capacity deficit is in data surveillance of lifestyle and infectious diseases that can drive evidence-based actionable policy actions. Continued deficiencies in infrastructure, healthcare workers, and administrators will aggravate even minor causes into public health threats. Thus, fixing these deficits have to be our top priority in our preparation to prevent future outbreaks.
Deficit-fixing and effective response to developing threats depend on effective decision-making by policymakers. The COVID-19 response has showcased multiple issues in this process. Early on in the pandemic, when testing should have been ramped up, the policy of limiting testing to only government centres wasted the existing capacity of the private sector. The Indian Council of Medical Research (ICMR) found itself in a conflict-of-interest situation creating, procuring and approving testing kits, whilst also approving testing laboratories and kit and test pricing. There was also overlapping functions between ICMR and Central Drugs Standard Control Organisation (CDSCO). In one incident, an imported kit that had been approved by CDSCO has been blacklisted by ICMR and ended up causing confusion on the kit’s utility.
Such incidents of conflict-of-interest and overlapping functions reduce the credibility of the response and make accountability within the government agencies difficult. A robust public health response requires clear, responsible and accountable policymaking. Unless India’s public health governance is streamlined, the ineffective policy will continue to hamper the health response.
Similarly, India needs to pass a new, robust public health legislation that espouses the principles of clarity, accountability and transparency and inculcates the rights of Indian citizens. The National Health Bill 2009 needs to be revisited in this regard. It is critical that new public health legislation focuses on improving general public health and not be only driven by pandemic preparedness. Further, public health legislation needs to allow for decentralised decision making, to allow early responders to make decisions tailored to grass-root conditions.
Engage with the world
In addition to domestic governance, India also needs to take up a leadership role at key bi-lateral and multi-lateral international organisations to enable global health security. Multi-lateral organisations such as WHO, BWC or Australia Group need to be more proactive in assessing health threats and take preventive measures. India also needs to play a stronger role in its neighbourhood region in improving public health measures, since infectious diseases can easily cross national borders. Thus, improving regional health security is in India’s own national interest and ignoring this aspect, would jeopardise public health in India.
Engage with the public
A critical threat to public health highlighted in the COVID-19 pandemic has been the lack of effective public engagement. For example, fear over lockdown saw migrants walk hundreds of kilometres and lack of clarity over vaccine approvals fuelled vaccine scepticism. Setting up effective public engagement mechanisms will be critical to better tackle future outbreaks and promote health-seeking behaviour.
Data drive actions
Finally, India needs to learn lessons from the COVID-19 pandemic and take data-driven steps. This applies to both state and society. We are already seeing a COVID-19 second wave in several Indian states, accompanied by inappropriate COVID-19 behaviour, the politicisation of vaccine approvals and ineffective policy response. For example, despite the issues caused by low testing capacity early in the pandemic, vaccine distribution was also limited to government centres early in the vaccine rollout. Clearly, the lessons of ramping up capacity – manufacture and distribution – could have applied better, facilitating more vaccinations within India.
In summary, India needs to think beyond the obvious biological threats and remedy the other policy issues that can threaten India’s public health security. The starting point would be to increase investment in data collection and primary health infrastructure, streamline public health governance and take a leadership role in the neighbourhood.
The author is a research fellow with Takshashila’s Technology and Policy programme. She tweets at @TheNaikMic.