Experiences and Lessons Learned from Public Health Risk Management in India: A Case of COVID-19 Pandemic
18 Jan 2024 . #2401
S. M. Vanmathi reviews India’s COVID-19 risk management and public health responses in a comprehensive manner, offering valuable insights into the country’s approach to handling the pandemic. Their analysis sheds light on the strategies employed, the challenges faced, and the outcomes experienced, providing a holistic view of India’s efforts in addressing the public health crisis.
Throughout history, pandemics have had a profound impact on human lives, the economy, and the affairs of states. Several new diseases, such as those caused by the Ebola virus, Zika virus, Nipah virus, and coronaviruses (CoVs), have emerged in different geographical areas. The emergence and spread of the 2019 novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first reported in Wuhan, Hubei province, China, in December 2019, significantly threaten the global public health and countries progress. First, with the presence of multiple mutant variants of the Covid-19 virus, including the South Africa, UK, and Brazil variants and Omicron variant, and currently with the HV.1, JN.1, and EG.5.
Given that the impact of the SARS-CoV-2 virus on individuals in the 30 to 69 age group has been particularly severe, it’s evident that a significant portion of the workforce has been affected by the virus. This has led to challenges in sustaining economic growth and productivity, as the working population plays a crucial role in driving these aspects of the economy. Additionally, this demographic trend has further implications for healthcare systems.
Meanwhile, with the shifting global climate and ecological landscapes, coupled with heightened instances of human-animal interaction, it is increasingly likely that new strains of coronaviruses will emerge in the future, posing significant risks to human health. Consequently, there is a pressing need for the implementation of sustained and enhanced public health interventions and strategies to mitigate emerging health hazards. In this context, examining the risk management strategy and public health responses of a nation will be beneficial in identifying deficiencies and extracting valuable insights from the experience.
India’s Public Health Security prior to COVID-19
India’s public health security status prior to the emergence of Covid-19 was characterized by a complex interplay of factors. The healthcare infrastructure and resources varied across the nation, posing challenges in ensuring comprehensive access to healthcare services for all citizens. According to the Global Health Security Index 2019, India was ranked 57th out of 100 countries in terms of preparedness for the outbreak of serious infectious diseases. The combination of densely populated cities, low awareness, and unhygienic conditions posed the risk of transforming such an outbreak into an epidemic within a matter of days. Besides, shortage of health facilities including hospital beds, rapid testing facilities, healthcare equipment, and quarantine facilities placed immense burden on an already over-stretched healthcare system.
Notably, India had two major challenges, the size of population and the limited resources.
Public Risk Management: Responses and Strategies
India, with a population exceeding 1.38 billion, executed meticulous action plans at various administrative levels, ranging from local wards to the state level. This encompassed rigorous monitoring, supervision, and continual assessment carried out by governmental, bureaucratic, and health authorities to combat the pandemic. To mitigate the spread of the virus, India implemented four comprehensive strategies. These entailed early detection and isolation, surveillance of clusters and containment zones, strengthening healthcare infrastructure such as intensive care units, and the procurement of critical medical equipment like ventilators and ECMO. Furthermore, nationwide lockdown measures were enforced. Individuals arriving from foreign countries underwent testing at the airport, and anyone in contact with a confirmed positive case was subject to testing as well.
Upon the identification of infected individuals, a three-tier approach was implemented. Individuals with mild or very mild symptoms were authorized to receive treatment at home or in temporary COVID Care Centers. Patients exhibiting moderate symptoms were hospitalized in regular medical facilities, while those with severe symptoms were accommodated in specialized isolated wards within health centers or hospitals.
The containment zones policy were implemented. The Cluster Containment Strategy includes containment of the pandemic within a defined region with high rate of infection, and thus, preventing its spread to new areas. Notably, the Bhilwara model of containment included a complete citywide curfew, an extensive follow-up and testing of its residents, and imposition of travel restrictions. Following the implementation of this approach, an extensive risk communication campaign was employed to encourage the citizens to stay in their homes for an initial period of 28 days, which was later extended after subsequent risk assessment. The Government of India classified the entire country into three regions: red, orange, and green, based on the severity of the infection rates. Subsequently, the restrictions were gradually eased in a staggered manner. This strategy contributed to India’s successful containment of the spread of virus to a great extent.
In the interim, the Indian government introduced a mobile application, ‘Aarogya Setu‘, on 2nd April 2020. This app serves as a means of contact tracing and providing medical advisories, forming a crucial component of the government’s comprehensive efforts to establish widespread surveillance, facilitate the sharing of epidemiological data, and monitor individuals affected by the virus.
While India was diligently working to control the pandemic, a second wave hit the country in March 2021. According to data from the Indian government’s Ministry of Health and Family Welfare, over 80% of new Covid-19 cases originated from six states: Maharashtra, Punjab, Gujarat, Chhattisgarh, Karnataka, and Kerala. This surge was partially attributed to the increased testing levels in certain states. The Government of India took proactive measures to ramp up the manufacturing of Covid-19 vaccines within the country and expedite the vaccination process to combat the second wave.
On the 7th of August 2020, India promptly established a National Expert Group on Vaccine Administration for COVID-19 under the Cabinet Secretariat. This group was mandated to identify suitable vaccines for use in the country, manage finances for procurement on a large scale, and prioritize the population groups to receive the initial vaccine dose. Furthermore, the Indian Council for Medical Research (ICMR) and the National AIDS Research Institute (NARI) in Pune oversaw the trials. The ICMR and the Drugs Controller General of India (DCGI) granted first authorization for the production of the Covishield vaccine to the Serum Institute of India Pvt. Ltd and subsequently, the Covaxin, manufactured by Bharat Biotech.
Lesson Learnt
From the management of the COVID-19 pandemic in India, numerous lessons can be learned for the future. Firstly, the government needs to act quickly to stop the spread of false information during the Covid-19 pandemic. It’s important to take strong action to fight the spread of wrong or deceptive information, which can seriously affect public health and safety. By dealing with this problem in advance, the government can make sure that people have access to correct and trustworthy information, which will help them make good decisions and reduce the impact of false stories. One way to tackle false information is by using public health campaigns, targeted communication, and transparent reporting to counter false stories. Also, it’s vital for the government to work with technology companies and social media platforms to create and enforce rules that stop the spread of false information. This could include making sure community rules are followed, promoting fact-checking efforts, and using technology to identify and flag false content.
Second, it is crucial to establish clear whistle-blowing policies for potential global health emergencies. This will promote transparency and encourage clinicians to promptly bring important information to light. Once high-risk areas have been identified, travel restrictions and quarantines should be put in place to contain the spread of the virus. Furthermore, a framework should be developed to escalate the threat status earlier for fast-spreading diseases. Subsequently, it is crucial to promptly implement population-based interventions, including social distancing, quarantine, and isolation measures.
Thirdly, it is crucial to ensure that all district-level hospitals develop thorough disaster and emergency plans. These plans should include identifying areas within the hospital to expand into during emergency situations, implementing strategies to increase capacity for accommodating a large influx of patients, and establishing protocols for promptly securing additional staff support through adequate training of peripheral staff.
Fourth, ensuring the readiness of district hospitals is crucial in enhancing the overall healthcare system. By maintaining caches of supplies, these hospitals can mitigate the risk of shortages during emergencies or unforeseen circumstances. This proactive approach allows them to promptly attend to emergencies time without disruptions. Additionally, diversifying supply chains enables hospitals to access a wide range of resources from various sources. This not only reduces dependency on a single supplier but also promotes resilience in the face of supply chain disruptions. Therefore, embracing these strategies fortifies the district hospitals, ultimately bolstering the quality and efficiency of healthcare services provided to the community.
Fifth, maintaining public hygiene is of utmost importance in ensuring the health and well-being of the community. By keeping public spaces clean and properly sanitized, we can significantly reduce the spread of diseases and create a safer environment for everyone. Additionally, access to clean water and sanitation facilities is crucial for maintaining public hygiene, as it directly impacts overall health and disease prevention. By prioritizing public hygiene, we contribute to a healthier and more sustainable environment for current and future generations.
Conclusion
Pandemics pose a significant challenge to public health, healthcare systems, and global economic security. The escalation of human-animal interaction due to modern agricultural practices increases the likelihood of new zoonotic coronaviruses spilling over from animals to humans, leading to future outbreaks. With a global population of 7.8 billion people, it is imperative for countries to maintain a state of emergency preparedness to effectively address emerging infectious diseases. This necessitates a vigorous and targeted response, necessitating coordination across all government departments, including health, security, finance, commerce, transport, trade, information, and diplomacy.
Gaining insight into every aspect of corona viruses is crucial to implement proper control measures to help prevent these outbreaks or lessen their impact on humans and society if they were to still happen. Special focus should be placed on understanding their pathophysiology to help better tailor and generate effective drug therapies and vaccinations. Nevertheless, our ability to handle future outbreaks will rely on the actions we take based on the lessons we have learned from previous pandemics.
Dr. S. M. Vanmathi, Pharm D, is Assistant Professor at Shri Venkateshwara College of Pharmacy, Puducherry, India.
Views expressed are of the authors and do not necessarily reflect the views of the CHSIA.