Shambhavi NaikApril 7, 2021 2:54:39 PM IST
COVID-19 has renewed the focus on threats to public health, causing countries to review their public health systems and healthcare infrastructure. Some countries, such as New Zealand and Vietnam, have fared better than others, including the US and the UK, but the underlying reasons for this result are unknown. However, there are important lessons to be learned from global and national health responses. World Health Day is celebrated on April 7 and is the perfect occasion to review India’s response to COVID-19 and identify threats to our health security that can be rectified in a war step. These threats go beyond the biological causes of well-being and include health policies and responses that, when not aligned, can exacerbate a low-level threat into a serious one.
The best characterized threat are the biological causes of poor health, such as infectious diseases, malnutrition and obesity, poor sanitation, tobacco use, etc. These threats are well recognized and are often discussed from a preparedness perspective. Once identified, steps can be taken to counter these threats through increased vigilance, targeted health programs, and effective biocontainment policies.
However, this response to biological threats is based on the availability of adequate health capacity. COVID-19 has demonstrated a shortage in the infrastructure and capacity of India’s healthcare professionals. A major capacity gap is the surveillance of data on lifestyle and infectious diseases that can drive viable evidence-based policy action. Ongoing deficiencies in infrastructure, healthcare workers, and administrators will compound even minor causes in threats to public health. Therefore, addressing these deficits must be our top priority in our preparation to prevent future outbreaks.
Solving the deficit and responding effectively to developing threats depend on effective decision-making by policy makers. The COVID-19 response has shown multiple problems in this process. Early in the pandemic, when testing should have intensified, the policy of limiting testing to only government centers wasted existing private sector capacity. The Indian Council of Medical Research (ICMR) found itself in a conflict of interest in creating, purchasing and approving test kits, while approving test laboratories and prices for kits and tests. There were also overlapping roles between ICMR and the Central Drug Standard Control Organization (CDSCO). In one incident, an imported kit that had been approved by CDSCO was blacklisted by ICMR and ended up causing confusion about the usefulness of the kit.
Such incidents of conflict of interest and overlapping roles reduce the credibility of the response and hinder accountability within government agencies. A robust public health response requires clear, accountable, and accountable policymaking. Unless India’s public health governance is streamlined, ineffective policy will continue to hamper the health response.
Similarly, India needs to pass strong new public health legislation that upholds the principles of clarity, accountability and transparency and instills the rights of Indian citizens. The 2009 National Health Bill needs to be reviewed in this regard. It is critical that new public health legislation focuses on improving public health in general and is not just driven by pandemic preparedness. In addition, public health legislation should allow for decentralized decision-making, to allow first responders to make decisions tailored to base conditions.
Engage with the world
In addition to national governance, India must also take a leading role in key bilateral and multilateral international organizations to enable global health security. Multilateral organizations such as the WHO, the BWC or the Australia Group need to be more proactive in assessing health threats and taking preventive measures. India must also play a bigger role in its neighboring region to improve public health measures, as infectious diseases can easily cross national borders. Therefore, improving regional health security is in the national interest of India and ignoring this aspect would endanger the public health of India.
Interact with the public
A critical public health threat highlighted in the COVID-19 pandemic has been the lack of effective public participation. For example, fear of lockdown caused migrants to walk hundreds of miles, and a lack of clarity about vaccine approvals fueled skepticism about vaccines. Establishing effective mechanisms for public participation will be critical to better address future outbreaks and promote health-seeking behaviors.
Data Drive Actions
Finally, India needs to learn lessons from the COVID-19 pandemic and take data-driven action. This applies to both the state and society. We are already seeing a second wave of COVID-19 in several states in India, accompanied by inappropriate COVID-19 behavior, the politicization of vaccine approvals, and an ineffective political response. For example, despite problems caused by low testing capacity early in the pandemic, vaccine distribution was also limited to government centers early in the vaccine launch. Clearly, the lessons of increasing capacity (manufacturing and distribution) could have been better applied, facilitating more vaccinations in India.
In short, India must think beyond the obvious biological threats and remedy the other policy issues that may threaten India’s public health security. The starting point would be to increase investment in data collection and primary health infrastructure, simplify public health governance, and take a leadership role in the neighborhood.
The author is a researcher in the Takshashila Policy and Technology program. She tweets on @TheNaikMic.