Why a pandemic treaty is still hanging fire
THE havoc caused, the deaths and the social chaos witnessed during the Covid-19 pandemic are gradually fading from public memory. This ought not be. That pandemic was neither the first such health emergency nor will it be the last one that has the potential to engulf the entire world.
Any extraordinary event which constitutes a public health risk through the international spread of disease and requires a coordinated international response, implies a situation that is serious, sudden, unusual or unexpected. Since 2007, WHO has officially declared seven such public health emergencies of international concern. These were the influenza pandemic (2009), Ebola (2013-2015, and 2018-2020), poliomyelitis (2014 to present), Zika (2016), Covid-19 pandemic (2020) and mpox (2022 and 2024). Given their frequency and regularity of occurrence, it can be logically surmised that the next pandemic is knocking at our doors. The question is when it will appear with a potential to repeat or exceed the magnitude of previous pandemics.
What causes a pandemic? Most pandemics during the current millennium are caused by viruses of animal origin which have originated from wildlife where millions of viruses continue to circulate. Most of these viruses are transported by bats from wildlife into nearby animal and human habitation thus kicking an epidemiological cascade from local outbreak to massive epidemics and a possible pandemic. The degradation of the environment, especially deforestation, enhances the proximity of wildlife to domestic animals and human habitation thus enhancing the risk of emergence and transmission of novel viruses.
Recognising that these emergencies cannot be prevented but, with appropriate preparedness, can result in low-risk events for communities, WHO coordinated the development and promulgation of an instrument-based framework. The International Health Regulation of 2005 is a legally binding treaty between 193 member countries, and calls upon countries to share information on public health events in a transparent manner and build their national core capacity for the prevention, detection, and response to health emergencies.
What progress has been made to strengthen national core capacities? According to self-assessment in 2022, India scored 85 per cent against the global average of 66 per cent. However, the Global Health Security Index puts India at No 66 amongst 195 countries with a score of 42.8 against a global average of 28.4. According to this Global Health Security Index all countries remain dangerously unprepared for future epidemic and pandemic threats, including threats potentially more devastating than Covid-19, and no country is fully prepared for future pandemic or epidemic threats.
There is unquestionable need for an urgent and comprehensive enhancement of India’s capacity in alignment with international health regulations. Learning from the Covid-19 pandemic, the need for a comprehensive national public health law has been acutely felt. A recent NITI Aayog document on future pandemics has recommended the enactment of the Public Health Emergency Management Act to facilitate the response to any public health crisis including a holistic approach to health management, prevention, control and response.
At the global level, a pandemic treaty is hanging fire and being negotiated for last two years among 194 WHO member countries, but consensus remains elusive. The idea is to increase collaboration before and during pandemics after acknowledged failures during Covid-19.
Given the importance of multisectoral approach, the establishment of One Health Mission at the highest technical level in India augurs well. Implementation of this ambitious Mission has the potential to bring together all sectors and catalyse convergence for meeting common national objectives. India has started strengthening its infrastructure. Major challenges include strengthening of microbiological laboratories which are critical for early diagnosis and surveillance.
Progress has been made in surveillance through a web-based Integrated Disease Surveillance Programme that detects an average of 40-50 outbreaks every week. This is indicative of the national burden of infectious diseases. A strong and battle-ready epidemiological capacity especially trained workforce through the India epidemic intelligence service and field epidemiology training programme need to be expanded to cater to the urgent need for conducting effective outbreak investigation and taking action locally. We also need to build capacity for national surveillance and detection of novel pathogens from animals and wildlife.
The national surveillance programme should facilitate community and hospital data to flow seamlessly into a unified data portal for data access and sharing across all relevant sectors for mounting appropriate interventions. An efficient integrated surveillance at human-animal-wildlife interface is critical for early detection of such unusual events. There is a need to develop a country-specific forecasting and prediction modelling system by harnessing expertise available in non-health institutions of excellence.
Vaccines are the most cost-effective public health interventions. It was incredible how Indian scientists, industry and regulators rose to the occasion and developed and manufactured efficacious Covid-19 vaccines in a short period. Administering 2.2 billion doses to more than 1 billion people is indeed commendable. For new vaccines, diagnostics and medicines to combat future health emergencies, a focused National Mission on therapeutics and novel drug development should be established with a 100-day target to develop, produce and make these fit for use in the communities through networking of pharmaceutical industry, research institutes and regulatory authorities.
No public health programme can succeed unless institutions are built for the purpose and the public is actively collaborating through a systematic risk communication and community engagement strategy that incorporates locally relevant factors. With 1.2 billion mobile phones, 600 million of which are smartphones, 825 million people having access to the internet, 425 million people using WhatsApp, 897 television channels of which 350 provide news in addition to almost 80,000 newspapers in various languages, India has extensive electronic and print media reach. These resources can be utilised to convey reliable and doable health messages to almost the entire population of this country.
National capacity for early detection and comprehensive swift response to novel diseases are the keys to minimise the impact of future pandemics. These require strong political will and appropriate sustained financing to successfully implement the International Health Regulations 2005 framework to obviate health, economic and social chaos that are the hallmarks of any pandemic.
