Public Health Bill aims to be extensive in scope

Soham D Bhaduri

Health Policy Expert

Anew National Public Health Bill is reportedly being drafted and finalised by the Union government, and is being contemplated to be introduced in Parliament’s Monsoon Session. It is supposed to replace the antiquated Epidemic Diseases Act, 1897. The new Public Health Bill is a sequel to the Public Health (Prevention, Control and Management of Epidemics, Bio-terrorism and Disasters) Bill, which was released for public consultation in February 2017 but couldn’t successfully get through then. While the new Bill and its provisions are yet to be officially promulgated, there is merit in examining those enshrined in the previous iteration, keeping in mind the sea change in attitudes caused by the coronavirus pandemic.

The need for revisiting the 125-year-old Epidemic Diseases Act is axiomatic. For obvious reasons, it fails to accord well with contemporary needs and demands and lacks in clarity on multiple crucial areas. The 2017 iteration of the Public Health Bill attempted to step up strongly on these. It accorded explicit powers to the local administration in addition to the state and Central governments, while prescribing clearer terms for division and supersession of power in case of conflict. It lists down epidemic-prone diseases and potential bio-terrorism agents; lays out clearer, more elaborate definitions that are contemporarily relevant; and makes provisions for appeals against orders passed under the Act. The proposed 2022 iteration would likely carry additional provisions for state and national-level public health cadres. The most stand-out difference, however, is the expansion of scope from merely epidemic diseases to public health (encompassing epidemics, bio-terrorism and disasters).

The 2017 iteration was heavily criticised by the experts for placing little emphasis on the rights of patients and people in general, while giving sweeping powers to the state. In this respect, it is hardly different from the old Act. It was also reproached with being unrealistically aspirational, given the then lacking institutional and technical capacity to counter high-order public health threats. Felicitously, the 2022 iteration shall follow a range of recent initiatives directed at strengthening public health capacity, namely, those announced under the Ayushman Bharat Health Infrastructure Mission and also the 15th Finance Commission grants for health. These include health and wellness centres, district and block level public health units and laboratories, critical care hospital blocks, new National Institutes of Virology and Biosafety labs, and others. It is only warranted that the new Public Health Bill brings in an explicit mandate for the creation and maintenance of such crucial public health infrastructure around which all public health response revolves.

Certain caveats accompany an attempt to be comprehensive in scope. The 2017 Public Health Bill embraces three different elements, viz. epidemics, disasters and bio-terrorism, all of which have differential scopes and cannot be straight-jacketed into a single response paradigm. For instance, the response strategy for bio-terrorism shall greatly contrast with that of an epidemic or disaster, and concomitantly, the roles and responsibilities of different state organs and departments shall change. Much foresight and definition will be called for in such areas. Also, multiple provisions of the potential Public Health Act would come to overlap with the Disaster Management Act, 2005, and it would be important to ensure complementarity and avoid conflict among these.

Furthermore, it is important to consider as to how comprehensive the new Public Health Bill would and should really be. Public health encompasses a diverse set of inter-related sub-domains, including medical-care provisioning, health financing, and so on. Despite being rechristened from an epidemic Act to a Public Health Act, the primary emphasis will likely continue to be on epidemics. This may suggest that it belies its name, but being overly comprehensive in scope, isn’t practical and wise either. It is important to know where to draw the line, and while the prime focus of the new Bill should continue to be public health emergencies, it must invariably appreciate the holistic nature of emergency responses and broaden its scope to embrace other closely-related topics. For instance, an integrated public health cadre created under the new Act would not only consist of public health professionals but also a clinical cadre which is not directly involved in public health work. Similarly, a true Public Health Act would be incomplete without provisions and mandates for regular disease surveillance, one health, and so on.

That infodemics can be as menacing as the epidemics themselves is one of the biggest learnings from the Covid-19 pandemic. Misinformation that spreads like wildfire can be one of the biggest impediments to the fruition of crucial public health measures. The new Public Health Bill should indispensably include provisions not just for investigations and penalties in cases of manifest misinformation but also suitable arrangements to prevent and deter them. Similar treatment is merited for sale and promotion of unproven, spurious therapies and drugs which opportunistically abound during public health emergencies. This is regardless of any legal provisions that might already be in place.

Distinct penal provisions for negligent and deliberate contravention of orders were rightly laid out in the 2017 iteration of the Bill. However, these are suited mainly for individual level transgressions, and are out of sync with the plethora of opportunistic malpractices that organisations and establishments can indulge in during public health emergencies. For instance, malpractices ranging from treatment denied in hospitals to unholy alliances between public and private entities have been commonplace, particularly during the peak days of the Covid-19 pandemic. Appropriate penal provisions for such transgressions, apart from a thorough apparatus for investigation and grievance redress must characterise the new Public Health Bill.

Last but not least, balancing provisions that impose restrictions and those that uphold rights during public health emergencies would be crucial. Disregard for rights and a very limited room for appeals drew sharp criticism for the 2017 iteration of the Public Health Bill. The same has not just a strong moral connotation, but is integral to the very success of public health responses. There cannot be a bigger testimony to this than the Covid-19 pandemic which still continues to linger.

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