Preparing India for a flu pandemic

The threat of an avian flu pandemic must galvanise India into improving its public health infrastructure?

In an article in the Economic and Political Weekly, T Jacob John outlines the state of preparedness against a potential flu pandemic. He argues that even as India considers specific measures to combat the H5N1 avian flu virus, there is a more fundamental need to put in place an efficient public health infrastructure.

Many rich countries are hogging and hoarding Tamiflu for defence against possible pandemic, paying the current high market prices, at least by Indian standards. What should India do? Even under the restrictions on patented drugs, agreed under the WTO, there are clauses to protect human health in times of emergency. Once a disease is declared a national emergency, drug(s) against it can be “compulsorily licensed” to bypass patent restriction. India could adopt this route and Indian drug industry is capable of manufacturing generic drugs at low cost. India must keep this option open and prepare for making Oseltamivir in case the situation warrants. The timing and the much needed diplomacy and bargaining power must be carefully orchestrated. Simultaneously India must also invest in developing new drugs against influenza viruses as a crash programme – without being stingy or penny wise but pound foolish. The global market for new drugs will be enormous.

Even if drugs are procured, how will it be given to prevent death or spread of infection? We do not have viral diagnostic facilities in most hospitals and medical colleges. If flu strikes as an epidemic, we need clear clinical criteria set for diagnosis and defined steps to give an antiviral drug. If misused or overused, the drug may soon become useless on account of the virus developing resistance to it. These exercises and simulation studies need not wait for the detection of the first H5N1 in India.

Without the foundation of a robust system, each vertical disease control programme is not only wasteful of resources – both personnel and funds, but also neglectful of major diseases not on the vertical list. An efficient and effective public health system must define clearly the functions of the central, state and local governments, and must be led by public health professionals. [EPW]

In the absence of compelling events, governing India is just about common minimums (even when the manifesto is not specifically called that). Even so, India has shown an ability to get things right in the face of, and immediately after compelling events. This was the case with the economic reforms of the 1990s, Kargil and Operation Parakram, and the post-tsunami investment in earthquake monitoring and disaster management. This suggests that greater public awareness of the avian flu threat can compel the government to act decisively to prepare the country for this contingency. India could do with more public debate on flu preparedness that is currently going on in America, Europe and east Asia.

Related Links: Posner and Becker on the economics, politics and psychology of avian flu; and a bird flu pandemic related prediction on the PublicGyan Exchange