India and “zoonoses” and “emerging infectious diseases”

 In an increasingly interconnected world, emergence and spread of infectious diseases constitute grave health, economic, developmental and security challenges globally. Notably, Emerging Infectious Diseases (EIDs) are diseases of infectious origin whose incidence in humans has increased within the recent past or threatens to increase in the near future. These include new, previously undefined diseases as well as old diseases with new features e.g. Avian influenza, chikungunya, Nipah virus etc.

Over 30 new infectious agents have been detected worldwide in the last three decades; 60 per cent of these are linked to zoonoses i.e capable of being transmitted to humans from animals. In the recent past, India has seen outbreaks of at least eight organisms of emerging and re-emerging diseases in various parts of the country, six of these are of zoonotic origin.
The Indian subcontinent is a ‘hotspot’ for zoonotic, drug-resistant and vector-borne pathogens. India is especially vulnerable because of:

• High population density: With 1.34 billion people, 512 million livestock and 729 million poultry, the density and rates of human–animal, animal–animal and human–human contacts are high.
• Inadequacy of research: Threats from EIDs are inadequately understood because of poor domestic research and lack of international collaborations due to restrictive policies on sharing clinical and research materials. E.g. There are 460 medical colleges and 46 veterinary colleges in India, but most do little or no research.
• Coordination issues: The bureaucratic approach and lack of inter-sectoral coordination leads to fragmented response.
• Lack of policy focus: Recently approved National Health Policy has not mentioned “zoonosis” and “emerging infectious diseases”, thus, missing the opportunity to have a comprehensive strategy for it.
• Anthropogenic changes: Deforestation brings wildlife into direct contact with humans and domesticated animals, increasing the risk of zoonosis along with changed weather patterns which further escalates the spread of EIDs.
• Diverse animal population: For instance, India has an incredibly diverse bat population which harbours 10% of corona viruses. Further, little is known about the viruses in Indian bats and their disease potential.
• Changing lifestyles, patterns of behavior etc., for example, improper food handling and preparation in order to save time and for convenience.
• Lower latitudes: areas that lie in lower latitudes are at a greater risk of new and emerging EIDs.
• Poverty and social inequality; e.g. tuberculosis is primarily a problem in low-income areas.

Structures in Place

• National Apical Advisory Committee for National Disease Surveillance and Response System (NAAC) created in 1996
• National Surveillance Programme on Communicable Diseases (NSPCD) in 1997
• Integrated Disease Surveillance Programme (IDSP) established in 2004, as project, in 101 districts and later expanded to cover all States and districts. It involves Central Surveillance Unit (CSU), State Surveillance Units (SSUs) District Surveillance Units (DSUs) a surveillance unit and peripheral reportig units at block level.
• IT connectivity has been established with all the States, districts and medical colleges through 776 sites for rapid data transfer, video conferencing and distance learning activities.
• Commitment to International Health Regulations (IHR) 2005 of the WHO. This requires all countries to have the ability to detect, assess, report and respond to public health events and disease outbreaks.
• National Vector Borne Disease Control Programme (NVBDCP)
• National Surveillance Programme for Communicable Diseases
• National Centre for Disease Control (NCDC) has initiatives such as Division of Zoonosis dedicated to the control of zoonoses and Epidemic Intelligence Service (EIS)
• Indian Council of Medical Research (ICMR) signed MoU with Indian Council of Agricultural Research (ICAR) for cooperation in the area of zoonoses.
• First SAARC Epidemiology Networking Forum Meeting held primarily to operationalize a sustainable and functioning veterinary epidemiology network.

Structures and Measures required to combat these risks are:

• There is a need to move from being reactive to proactively understanding zoonotic pathogens before they cause human disease.
• Identifying the animal source of infection and intervene to stop further transmission. For example, setting up a district level emergency response team which acts swiftly on such incidents.
• Culture of safe health care practices for timely infection control to stop transmission within hospitals and healthcare facilities. Capacity augmentation in hospitals ( medical staff, supplies & equipments) to cope up with epidemics.
• Developing robust early warning, communication & surveillance system at ports, airports etc.
• A strategy should be evolved for the law enforcement/national defence structure as EID etc. promotes regional tension, mistrust and distort productive economic growth.
• An inter-ministerial task force should prepare a policy framework that enables preparedness by strengthening inter-sectoral research on zoonosis and health systems. There needs to be regular collection of data for unusual occurrences and of their origins. Also the National Health Policy should include specific section on how to deal with EIDs.
 

By: ABHISHEK KUMAR GARG