An enemy that never sleeps

This is an enemy that never sleeps, knows no time, and recognises no boundaries. It is on the march, relentless, and mutating. “The global impact of COVID-19 has been profound, and the public health threat it represents is the most serious seen in a respiratory virus since the 1918 H1N1 influenza pandemic.” This is the sombre observation of the Imperial College, London, in its most recent report. In this backdrop, the response of the government – at the Centre and in the states — in a resource-constrained country like ours, has been commendable and deserves appreciation. The national strategy of containment — testing those with a travel history in the past two weeks, those that clinically present symptoms akin to the coronavirus, and those who have come in contact with the former two categories — has meant sharply targeted surveillance. This, followed by quarantining for observation, and isolation of those testing positive, have helped mitigate its scale and spread so far. That less than 200 cases have been reported so far in a country of India’s size is praise-worthy. There is a reason for cautious optimism as we head into the critical stage 3 of the outbreak.

In these extraordinary circumstances, it is time perhaps to think beyond this specific battle. The fact that in the first two decades of the 21st century alone, the world has seen four global zoonotic epidemics -- SARS, Avian Flu, Ebola, and now the SARS-CoV-2 coronavirus -- raises troubling questions about the unexpected vulnerability of post-modern societies. Societies, in which consumerism – production and consumption in ever-increasing quantities -- is ubiquitous and social connectedness and community, rare.

What should be troubling is the emerging and re-emerging zoonoses that are rapidly increasing in incidence and geographical spread. The unpredictability of the occurrence of these infections in human populations is because they originate from animals and are often caused by novel viruses detected only after outbreaks occur. In an increasingly inter-connected world, emerging zoonoses in one country can potentially constitute a threat to global health security, as is the case with the corona pandemic. Zoonoses matter not just because they spread like wildfire, but because they bring in their wake high mortality and morbidity.

The states constitute the theatre of public health action. Yet, the current strategies for the prevention and control of zoonotic diseases remain fragmented with no coherence between the animal and human health sectors. In the absence of a coherent policy and coordinated action at the state level, there has not been any focussed effort to develop a structured, scientific surveillance and response protocol for the management and control of zoonotic diseases and their public health risks. The scale of the problem and the rising public health risks associated with zoonotic infections point to the urgent need for a paradigm shift to ensure a better real-time public health response. The human, economic and social costs are far too high to not consider a step-change in our social and epidemiological response in the future. Central to such a step-change are three imperatives:

First, the social imperative as communities, to embrace a minimalist lifestyle that supports sustainable production and consumption. We must recognise that we cannot sustain the current levels and patterns of production and consumption. In an irony peculiar to our times, countries including India are pursuing two potentially conflicting goals -- to safeguard the environment and ecology and achieve high economic growth. In the growth versus sustainability dynamic, it is clear that sustainability is taking a hit. The poor water and sanitation and abysmal solid waste management in our unsustainable cities represent critical failures that have far-reaching and long-term consequences on public health and the capacity of the state apparatus to respond to epidemic crises. It is clear as day that the content of economic growth needs to change, relying less on finite resources, and the emphasis shift to human development from mere economic growth.

Second, adopting a strategic approach to predict, detect and control these infections through the application of data science that will enable an integrated and interdisciplinary engagement between the animal and human health sectors. It is perhaps time to adopt the ‘one health’ approach -- a collaborative, multisectoral and transdisciplinary approach -- integrating the local, state and national levels, with the goal of achieving optimal health outcomes. We must recognise the interconnectedness between people, animals, plants and their shared environment if we are to effectively address the challenges of antimicrobial resistance.

Third, and perhaps the most important over the medium to long term, is to develop the capacity in the states for rapid response and managing outbreaks and epidemics at scale. This will require a slew of reforms in every state: Strengthening preparedness, surveillance and response; capacity building and promoting research; enhancing Centre-state and inter-state cooperation and collaboration; and advancing health education, risk communication, and social mobilization.

Emerging zoonotic infections are unexpected and unpredictable events. What we have not faced, and hopefully will never have to face, is a full-blown community transmitted national outbreak that will be a health calamity. These novel diseases will continue to confront and challenge our resilience and ability to respond effectively. While the national efforts should continue to fill the current gaps in knowledge associated with the origin and transmission of many zoonotic infections, the corona pandemic provides the sense of urgency to establish a sustainable public health programme. The most important lesson that we might learn is that identifying the risk factors for a disease is important; but of greater consequence are the social determinants of disease -- poverty, education, livelihoods and access to basic civic amenities like water and sanitation. The single-minded focus demonstrated in defeating the coronavirus should pervade our action for overall health and wellbeing, especially of the vulnerable and the disadvantaged. That must remain the immutable public health goal that we address with indefatigable resolve.

(The writer is Director, Public Affairs Centre, Bengaluru)