A disease surveillance system, for the future

Synopsis Diseases and outbreaks are realities and a well-functioning system can help reduce their impact.

Introduction

The article highlights the importance of epidemiology in preventing and controlling infectious diseases.

What is epidemiology and disease surveillance?

Epidemiology is the study and analysis of the distribution, patterns and determinants of health and disease conditions in defined populations. This is done either to prevent or stop the further spread, a process termed as disease surveillance.

However, in the last 19^th or early 20^th Century, with the advancement of medical science and discovery of antibiotics, the focus on disease surveillance system has been shifted especially in development countries.

It is again in the late 20^th Century, with focus on eradicating smallpox and tackling re-emerging diseases, countries started to strengthen their disease surveillance system.

What is the status of disease surveillance in India?

India launched the National Surveillance Programme for Communicable Diseases in 1997. This programme was launched in the purview of the Delhi cholera outbreak and Surat Plague outbreak in 1988 and 1994 respectively.

Integrated Disease Surveillance Project (IDSP): It was launched in 2004. The focus of this programme was to increase government funding, strengthen laboratory capacity, train the health workforce and have at least one trained epidemiologist in every district of India.

It was on IDSP foundation that India tracked all the Covid related activity from deploying a team of epidemiologists to contact tracing, rapid testing etc.

What are the challenges?

The key tools in epidemiology are disease surveillance system and health data. However, in the ICMR Serological Survey , it was found that states have performed variably.

In a good disease surveillance system, any increase in the case of diseases can be identified quickly. For eg: Kerala, one of the best Disease surveillance systems in identifying covid and recently Nipah Cases in India.

Whereas states like UP and MP cases of dengue, malaria, leptospirosis etc received attention only when more than three dozen deaths were reported.

What should be done?

Ministry of Health and Family Welfare, the Government of India and World Health Organization jointly reviewed IDSP in 2015. They jointly gave the following recommendations to strengthen the disease surveillance system in India:

Financial resource allocation: Focus should be on promoting health services and disease surveillance. For this, required resources should be allocated to the concerned department.

Trained human resources: Proper training should be given to the workforce in the primary healthcare system in both rural and urban areas.

 Strengthening laboratories: Labs should be strengthened to increase the ability to conduct testing for public health challenges and infections. A system should be designed where samples collected are quickly transported and tested, and the reports are available in real-time.

Emerging Outbreaks: Study of animal and human health should be linked to control the outbreak of various diseases like Nipah, avian flu etc. For this “One Health Policy” approach should be implemented.

Strengthening the system: Focus should be on strengthening the civil registration and vital statistics (CRVS) systems and medical certification of cause of deaths (MCCD).

Coordination: Proper collaboration should be there between the Centre, State government and Municipal Corporation to develop joint action plans.

Although, we cannot avoid the emergence of new and old diseases, but with the well-designed surveillance system we can control the impact of these diseases.

Source: This post is based on the following articles “A disease surveillance system, for the future “published in The Hindu on 24^th September 2021.