Readiness framework for pandemics needed

Dinesh C Sharma

Journalist and Author

India has embarked upon an unprecedented experiment in the history of mankind. Never before a country of the size of India has been under complete lockdown, not even in times of wars, internal disturbances and the national emergency imposed in 1975. It is a medical and epidemiological experiment of an unthinkable scale. No scientist can afford or imagine to recruit this large number of subjects — 1.3 billion people — in any study. It is an experiment in inducing mass behaviour change and testing of health communication messages targeted at people. The lockdown has put the entire economy in an experimental mode — from service to manufacturing, all industries are going to test their resilience and emergency preparedness during the lockdown and beyond. It is also a challenge for law-enforcing agencies, which for the first time, are facing a situation when the whole country is under legally enforceable curfew. Most important, it is a new experiment in governance, civil liberties and human rights.

The turn of the century brought into public imagination the term — pandemic, a global epidemic. This was a result of a series of epidemics and pandemics which have unfolded in the past two decades — avian influenza, swine flu, severe acute respiratory syndrome (SARS), middle east respiratory syndrome, ebola, nipah and so on. Some of them caught led to a great loss to humanity and economy. A pandemic can swiftly turn into an economic contagion and cripple economies, resulting in massive losses for countries of their origin. SARS is a classic case where China suppressed information about the initial outbreak, resulting in its spread to dozens of countries. Data is now showing that a similar pattern has led to Covid-19 becoming a pandemic. Before containment measures like travel ban and lockdown really kicked in, thousands of infected people from Wuhan had carried the virus to many countries around the globe.

In response to the avian influenza pandemic, the global health community led by the World Health Organisation has been working on strategies to address the challenge. The WHO has been emphasising that new pandemics need a response not just from the health sector but also from an array of non-health ones. This approach has helped develop a ‘readiness framework’ based on five tenets — a whole-of-society approach; preparedness at all levels; attention to critical interdependencies; a scenario-based response; and respect for ethical norms. Every country can develop its own strategic response to a pandemic based on these broad principles.

For example, the whole-of-society approach means developing preparedness plans across government departments, and involving business and civil society so that economic impacts on the society can be minimised and mitigated. Industry should not be caught off guard when a pandemic occurs. Here, industry does not mean just those engaged in essential services, but also sectors like information technology outsourcing, which is worth $175 billion. Pandemic preparedness plans should include all such sectors so that they can switch to the emergency mode when the need arises. Each industry should have its own ‘business continuity management’ plan.

The preparedness plans have to work at all levels — national, state and district. Directing states to follow certain norms only after a heath emergency is declared does not yield the desired results. Disaster-preparedness in Odisha and epidemic-preparedness in Kerala (during the nipah outbreak) are excellent examples of proactive states taking a lead. Getting states ready in advance would also ensure more nuanced responses to emergencies based on the situation in every state. Again, Kerala, during the current pandemic, has been ahead of the curve announcing a health package (Rs 20,000 crore) bigger than that announced by the Prime Minister. Most states don’t have this level of preparedness capacity and simply look to the Centre for guidelines in case of emergencies. Attention to interdependencies means carefully mapping all inter-linkages in critical sectors. For instance, assuring essential medical supplies during lockdown would depend on the supply of raw materials and components from industries which by themselves may not qualify as essential.

The pandemic situations also require governments to enforce certain regulatory measures such as travel restrictions, visa bans, social distancing, quarantine, isolation and lockdowns through existing or new laws. This has implications for public order, personal liberties and livelihood. In the present situation, the Epidemic Diseases Act of 1897 was applied in some states to enforce a partial lockdown. The 21-day national lockdown has been imposed by invoking the provisions of the National Disaster Management Act under which Covid-19 has been declared a ‘notified disaster’. Some states have also used provisions of the Indian Penal Code to enforce a ban on gatherings and curfew conditions. The use of such provisions in times of a health emergency is untested and needs utmost caution. There are reports of stickers being posted on Covid-19 suspects and foreign returnees, leading to their social boycott and stigmatisation. People were also stamped on their hands at airports. All such steps are a violation of personal liberties and human rights. The preparedness plans must also take care of vulnerable groups of people — migrant labour, daily wage earners, the homeless, people in homes for the aged and so on. Civil society and community-based organisations have to be involved in reaching out to these groups.

While the government has implemented the lockdown and empowered the Ministry of Home Affairs to enforce it, health agencies like the Indian Council of Medical Research and the Ministry of Health need to be transparent about containment and mitigation measures being taken during this period. The government should also share with the nation steps it is taking to strengthen the health system to prepare it for a surge of cases, if it occurs. Lack of transparency can lead to lack of accountability and fuel rumours during the lockdown period. A grievance redress mechanism should also be developed to address complaints and accesses, if any, during the lockdown.