Bridging pandemic preparedness gaps in the Northeast

The Ministry of Health and Family Welfare has confirmed the first case of Mpox virus infection in the country but clarified that it is not linked to a World Health Organisation (WHO) reported public health emergency. This implies that there is no apprehension of widespread transmission of the virus in the country. There is no widespread risk to the public, but there is little scope for lowering the surveillance through contact tracing and monitoring to prevent outbreaks of any public health emergency. WHO cautions that Mpox, caused by the monkeypox virus, is a viral infection that can spread between people, mainly through close contact and occasionally from the environment via things and surfaces touched by infected persons. “In most cases, the symptoms of Mpox go away on their own within a few weeks with supportive care, such as medication for pain or fever. However, in some people, the illness can be severe or lead to complications and even death,” it adds. The COVID-19 catastrophe that left a cascading impact on the country’s economy and claimed more than 1.54 lakh lives keeps reminding us about the importance of remaining fully prepared for the outbreak of any new pandemic and associated public health emergency. A new Expert Group report titled ‘Future Pandemic Preparedness and Emergency Response—A Framework for Action’ released by the NITI Aayog provides the roadmap for the country to prepare for any such challenges in the future. The mandates for the Expert Group included, among others, recommending specific action to be taken for strengthening and creating a robust ecosystem for pandemic prediction and prevention, biomedical research, and new innovative, affordable, and accessible countermeasures; identifying gaps that exist in infrastructure, human resources, and systems; and suggesting mechanisms for focusing on surveillance taking a ‘one earth, one world’ approach to ensure that we are prepared for diseases of potentially unknown agents causing the outbreak of pandemic. Lessons learnt from the COVID-19 experience helped the experts understand that effective management of pandemics is determined by the capability to respond within the first 100 days of the outbreak of the pandemic. The Expert Group has recommended an action plan for a 100-day response to the outbreak of any pandemic in the country. The four pillars of this recommendation are: governance, legislation, finance, and management; data management; surveillance and early predictive warning; forecasting and modelling; research and innovation; manufacture; infrastructure; capacity building; risk communication; community engagement; private sector partnerships; and international collaborations. Enactment of a new Public Health Emergency Act, as recommended in the report, will be crucial to ensuring the legal architecture of the action framework. The expert group has suggested Creating an institutionalised empowered governance mechanism for public health emergencies through the setting up of an Empowered Group of Secretaries on Pandemic Preparedness and Emergency Response chaired by the Cabinet Secretary, a Continuous Monitoring Group to be constituted and co-chaired by the Secretary Health and Secretary Department of Health Research, and the preparation of a well-defined Standard Operating Procedure manual for rapid response. Regional disparities in health infrastructure and shortages of healthcare professionals adding to COVID-19 management challenges in regions like the Northeast call for strengthening emergency health response mechanisms and creating similar institutionalised structures in every state. The report acknowledges that seamless coordination between the State/Union Territories and the centre is an essential pre-requisite for effective pandemic preparedness and recommends designating a senior officer as the Nodal Officer for coordinating all activities related to pandemic preparedness and response. Northeastern states need special financial assistance to strengthen public health infrastructure, more particularly for diagnostics and affordable tertiary care. With 98% international borders, the region is poised to become a hub of economic activities for deepening trade, commerce, and people-to-people engagement under the Act East and Neighbourhood First policies of the country. This increases the vulnerability of the region to future pandemic risks, but because of huge gaps in health infrastructure and shortages of healthcare professionals, the region is ill prepared to mitigate such risks. Investment decisions based on recommendations made by the Expert Group prioritising the region will be crucial for the country to effectively manage future pandemic outbreaks in the country. The proximity of the region to ASEAN and South Asian nations also calls for strengthening pandemic surveillance to the maximum level. This task cannot be left alone for the cash-starved states in the region, and special central assistance is required to build a robust disease surveillance ecosystem. Challenges faced in the health sector in respect of disease prevalence, treatment, and care varying from state to state; more emphasis should be laid on funding research work to develop state-specific response systems on the line of the national action plan for 100-day response. Health awareness plays a crucial role in pandemic response, but in the digital age, misinformation poses a stumbling block. Educating every section of society on future pandemic risks will make the first 100-day response easier.