Preparing for the Next Pandemic – Explained, pointwise

Introduction

Several experts and leaders like Bill Gates have announced that the threat of COVID-19 has receded. However, others, including the Center for Forecasting and Outbreak Analytics in the US, have warned that the world will see another pandemic—only that the pathogen will be different. In such a scenario every country should take proactive measures to develop a high degree of resilience against a future pandemic. Failure to do so would increase the vulnerability of the whole world to a pandemic similar to COVID-19.

Why is it imperative to be prepared for the next pandemic?

In recent history, and noticeably after the Second World War, pandemics have surfaced regularly almost every 10 years like the Asian flu, the Hong Kong flu, cholera, Severe Acute Respiratory Syndrome (SARS), HIV/AIDS, swine flu, middle east respiratory syndrome (MERS), ebola and then the deadly COVID-19. Given the frequency and the almost predictable return of strange new pathogens, pandemics have been fairly regular events (and not rare events). Therefore, the health systems must be prepared for the next pandemic.

Similarly, the recent outbreaks in Shanghai and a suspected case of a new variant in Mumbai are concerning events. Thus, it is important for us to keep track of the ‘variants of interest’ and the ‘variants of concern’.

What have been the learnings from the COVID-19 Pandemic?

First, developing herd immunity is crucial for duly tackling the pandemic. There is a need of upwards of 70%, preferably 80%, of the population to be fully vaccinated for herd immunity to set in.

Second, shortage of doctors, along with stock-outs and lack of hospital beds led to the enormous loss of life across the country. The WHO stated that India accounted for over 31% of all ‘excess deaths’ globally in the two covid-19 years of 2020 and 2021.

Third, countries also learnt that wide-spread lockdowns can never be the solution. They are draconian and only provide a feel-good factor by flattening the curve for a while. The number flares up eventually and become unmanageable. Lockdowns also cause enormous economic hardships, reverse migration, and stock-outs of essential drugs, including lifesaving oxygen cylinders.

Fourth, animal to human transmission is now seen as a major threat. It is estimated that 75% of new infections come from animals and that there are upwards of 5 lakh animal viruses lurking around. Only 250 of those have yet made the lethal jump to human populations.

What are the vulnerabilities faced by India in tackling the next pandemic?

Poor Vaccine Coverage: India has only managed to fully vaccinate just under 63% of its population. The speed of vaccination has decreased considerably. The sense of urgency seems to be missing in the Government as well as the public. Raising the coverage to 70% seems difficult and therefore the vulnerability to another wave remains high. Further, the world wide average for those who have taken a booster shot is 24%. However, in India, not even 2% of the population has been given a booster shot.

Vaccine hesitancy is also one of the prominent reasons behind low vaccine coverage in India.

Broken Healthcare Systems: The World Health Organization (WHO) has recommended 44.5 skilled healthcare workers per 10,000 people. India’s health workforce is less than 11 per 10,000. Further, there is shortage of hospitals and medicines in many parts of the country.

Even after opening all the 157 medical colleges and 50 nursing colleges that the government has promised, experts believe that there will be a woeful shortage of the healthcare workers in 2030.

Data Discrepancies: The Medical Council of India says that India has close to 1.2 million doctors. However, the Periodic Labor Force Survey data (2018-19) released by Government shows that there are only 9 lakh doctors, including the Ayurveda and Unani practitioners. Similarly, the Nursing Council of India claims that there are 2.3 million nurses and midwives. However, PLFS puts this figure to 8 Lakh only.

The lack of data has also resulted in the recent controversy related to the actual number of deaths due to COVID-19 in India. Lack of surveillance and quality data is major bottleneck in predicting the onset of a next pandemic.

Why is India facing a shortage of Healthcare personnel?

First, not all medical graduates join the workforce. Some graduates go on to study further, while some just drop out to pursue other careers. 

Second, a large number of women medical graduates opt out in a patriarchal society because of the difficulty in juggling between careers and responsibilities at home. More than 50% of students in medical colleges today are women, but only about 17% of practicing allopathic doctors are female. 

Third, a significant number of Indian graduates find their way to other markets, both in the developing and the developed parts of the world.

What should be the approach going ahead?

First, Governments, everywhere, and at all levels, must enable data registers and notifications that can quickly aggregate information and send to central databases.

Second, countries should focus on developing robust surveillance, testing, distancing and quarantining facilities to contain the virus spread. For instance, constant tracking, tracing and surveillance allowed Wuhan to contain the COVID-19 spread within 100 days in 2019-2020.

Third, the health gap i.e the differential access to health care between the rich and the poor must be reduced. With the enormous attention that health systems have received during the last two years, it is very much possible for states and governments to ramp up expenditure on healthcare.

Fourth, comparing genome sequences from across continents should be facilitated. Active and passive surveillance must be carried out, especially in border settlements where human beings come in contact with animals from the wild. WHO has for long been maintaining and encouraging cross border cooperation in this regard.

Fifth, governments need to work diligently on communication programmes that educate the public on the need for sanitation, distancing and hygiene. The importance of heeding warnings and alarms when they are sounded needs to be stressed as well.

Sixth, there is need for enhanced global cooperation in tackling the pandemic. The politics over TRIPS waiver has resulted in huge vaccination gap, which makes the whole world vulnerable to a future outbreak.

Source: Asia Pacific Economic Cooperation

What are India specific steps?

First, it is important to keep a ready account of the dead and the causes of their deaths. Real time data would enable government to bring in masking and distancing norms. If the threat becomes bigger, testing and quarantining can be made mandatory.

Second, coordination across States is essential to ease out the burden on hospital beds and intensive care units (ICUs).

Third, Imports and procurement orders for life saving equipment and vaccines must be streamlined in anticipation of a possible fourth wave.

Fourth, the Government must also provide immediate data on vaccine efficacy, new outbreaks, number of vacant ICU beds, and guide people on when to get booster doses. 

Fifth, public awareness need to be enhanced to ensure that there is no stigma attached to getting infected. It is also necessary to ensure that adequate care taken for a large number of people who have suffered on account of mental health issues.

Conclusion

A fourth wave looks unlikely as the new strains and variants after Delta have been benign. The mortality levels of new variants have been low. However, the possibility of a new different pandemic is very real. In fact, some experts have predicted the next major pandemic within next one and half decade. Therefore, India should be duly prepared to mitigate the impact of the next pandemic.

Source: Mint