Policy Update
Meenu Mohan
The recently released report, “Future Pandemic Preparedness and Emergency Response: A Framework for Action”, by the Expert Group constituted by NITI Aayog, offers a comprehensive roadmap for managing future public health crises. The Expert Group, tasked with drawing on both national and global experiences of COVID-19 to design an actionable framework for pandemic preparedness and emergency response, based its recommendations on the lessons learned from the challenges and successes encountered during the COVID-19 pandemic, as well as insights from other public health crises.
Pandemic and Response: A Historical Perspective
Pandemics have profoundly shaped human history, from the Black Death to the Spanish Flu, causing widespread suffering and disruption. Although pathogens are different, challenges in containment, treatment, and prevention are basically the same in most cases. Current phenomena such as globalization, urbanization, and climate change contribute to the fact that infectious diseases break out more often now than they did before.
Technological improvements are an example; fast pathogen sequencing and vaccines represent essential tools in combating pandemics. Conversely, the digital era presents a challenge; it contains misinformation and cyber attacks to health care. Social media disperses useful information and destructive conspiracy theories that make responses complicated.
Science and international cooperation are what is required to fight pandemics. Innovations in vaccines and diagnostics have already saved millions of lives, but without the global dimension, it would be difficult to go further than that. Coordination, guidance, sharing resources, and knowledge are some of the most important contributions made by the World Health Organization in the fight against pandemics. This will allow nations to address the issue and reduce its impact on society.
Lessons from the Past: Dealing with Epidemics in the Last Two Decades
Between 2009 and 2022, the World Health Organization (WHO) declared seven Public Health Emergencies of International Concern (PHEICs). A PHEIC refers to an event that occurs infrequently or without another similar precedent that constitutes a public health risk to other countries through international spread and does require a coordinated international response. In recent years, various infectious disease outbreaks have emerged, resulting in significant loss of lives, property, and economic repercussions.
Notable Outbreaks and Lessons Learned
- SARS (2003)
- Description: Originated in China, spreading to over 50 countries within months, causing approximately 850 deaths.
- Learnings:
- Need for international, legally binding regulations.
- Challenges in identifying novel pathogens
- Importance of timely diagnostic tests.
- Development of core capacities for screening and quarantine at international airports.
- Avian Flu (H5N1)
- Description: Repeated outbreaks in birds since 2005, with human cases reported, particularly in the US (2024).
- Learnings:
- Importance of surveillance of at-risk populations and culling infected birds to prevent spreading.
- Effectiveness of a standing committee on zoonosis to provide coordinated responses.
- H1N1 Pandemic (2009)
- Description: Originated in Mexico, it spread to 74 countries, resulting in nearly half a million lab-confirmed cases and 18,449 deaths. H1N1 was the first pandemic to be declared as PHEIC under the International Health Regulations (IHR, 2005).
- Learnings:
- Importance of the IHR (2005) and the development of core capacities for surveillance and response.
- Implementation of public health measures (e.g. screening, contact tracing) to mitigate the spread.
- Ebola Outbreaks (2014-2016; 2018-2021)
- Description: Major outbreaks in several countries in West Africa
- Learnings:
- Effectiveness of screening, surveillance, and health education in controlling outbreaks.
- Importance of protective measures (e.g. PPE) for healthcare workers.
- MERS-CoV (2012-Present)
- Description: Ongoing outbreak of zoonotic diseases in the Middle East, with the risk of international spread, as shown by the outbreak in South Korea in 2015 (186 cases, 34 deaths).
- Learnings:
- Challenges of preventing zoonotic diseases, especially those transmitted via respiratory droplets.
- Recognition of the dangers of novel zoonotic viruses.
- Zika Virus Disease
- Description: In 2015, a disease transmitted by an Aedes mosquito invaded more than 90 countries and identified in 12 US states.
- Learnings:
- High rates of asymptomatic cases complicate public health response.
- Need for proper vector surveillance and a multi-sectoral partnerships.
These lessons thus call for the necessary preparedness measures such as inter-cooperative work with other countries for comprehensive control of an infectious outbreak and measures to minimize the effects of future outbreaks.
The Future of Pandemics
The COVID-19 pandemic has highlighted the urgent need for preparedness and response to future pandemics. As the world continues to grapple with the challenges of globalization, climate change, and emerging infectious diseases, it is essential to invest in research, develop robust healthcare systems, and foster international cooperation.
Understanding the historical context of pandemics, recognizing the evolving landscape of threats, and leveraging technological advancements and international collaboration, helps in better preparing for and responding to future outbreaks. The future of pandemics depends on our ability to learn from the past, innovate for the present, and work together for a healthier and more resilient world.
Emerging Infectious Diseases: A Growing Threat
The Intensifying Risk
The world is facing a rising risk of emerging infectious diseases due to factors like globalization, urbanization, and climate change. These diseases, often zoonotic in origin, can pose significant public health challenges.
The WHO’s Priority Pathogens List
The WHO has categorized its priority pathogens in order to take on this emerging threat: such are those that pose a high likelihood of causing outbreaks or pandemics, and thereby underpin global investment in research and development.
The Importance of Collaborative Surveillance
Effective response to emerging infectious diseases requires collaborative surveillance. This involves early detection of warning signs, identification of new pathogens, and multi-disciplinary assessment.
Addressing the Challenges
Addressing these challenges necessitates a proactive approach, including:
- Strengthening surveillance systems
- Investing in research and development
- Promoting international collaboration
- Addressing underlying factors
Future Preparedness
To prepare for future pandemic threats, countries should:
- Align regional and global capacities for cross-border collaboration.
- Enhance coordination between public health authorities and other relevant sectors.
- Assess potential future risks and engage with communities.
- Ensure necessary funds and resources are available.
- Adopt a One Health Approach for coordinated surveillance and response.
By taking these steps, we can strengthen public health systems and response capabilities to mitigate the impact of future pandemics.
Framework: Components
The Expert Group aimed to distill key lessons from both successes and shortcomings while identifying essential gaps that need to be addressed for improved preparedness and response. To accomplish this, the Expert Group conducted extensive consultations with a diverse array of stakeholders, including national and international experts, policymakers, clinicians, epidemiologists, researchers, and representatives from funding agencies and international organizations.
The recommendations that emerged emphasize a comprehensive approach to pandemic preparedness, incorporating key components such as governance structures, rapid response protocols, and proactive planning for the critical early days of any public health emergency. This report is designed as a strategic framework to inform future efforts in building resilience against potential health threats, ensuring that the lessons learned from the COVID-19 experience contribute to more effective responses in the future.
Governance, Legislation, and Finance
Governance
- Empowered Governance Structures: Establish a Standing Empowered Group of Secretaries (EGoS) for Pandemic Preparedness and Emergency Response (PPER) to guide and monitor preparedness efforts.
- Institutionalized Systems: Develop Standard Operating Procedures (SOPs) to enable rapid response and expedite the coordination and operationalization process to serve.
- Centre-State Coordination: Strengthen coordination between the Centre and States for effective pandemic management.
Legislation
- Public Health Emergency Management Act (PHEMA): Enact a comprehensive legislation to address public health emergencies, including epidemic prevention, control, and disaster response.
- Specific Provisions: PHEMA should strengthen public health agencies, set up public health cadres, and offer readiness systems.
- Global Examples: Find out how the current legislation has been managed in other developed countries, including the United States and United Kingdom.
Finance
- Dedicated Fund: Establish a Pandemic Preparedness and Emergency Response Fund to ensure adequate financial resources for all activities.
- Emergency Deployment: Allocate funds as per the requirements assessed and approved by the EGoS.
Data Management, Early Predictive Warning, and Surveillance
Data Management
- Unified Data Platform: Integration of all data portals for seamless data sharing and analysis.
- Utilize IHIP and IDSP: Leverage existing data systems for outbreak management and strengthening.
- Data Management Systems: Implement robust systems for data collection, management, and archiving.
Early Predictive Warning and Surveillance
- Surveillance Network: Strengthen and connect all components of the existing surveillance system for early warning, response, and monitoring.
- One Health Approach: Incorporate biosecurity and surveillance at political borders.
- Community Surveillance: Establish a strong community surveillance system.
- Real-Time Surveillance: Utilize AI and emerging technologies for real-time surveillance.
- Genomic Surveillance: Strengthen the INSACOG network for genomic surveillance.
- Wildlife Surveillance: Enhance on wildlife surveillance for early-detection of zoonotic diseases.
- Regional Consortium for Molecular Surveillance: Establish a regional consortium for coordinated surveillance efforts.
Forecasting and Modeling
- Epidemiological Forecasting and Modeling Network: Develop a network of centers to create prediction models based on Indian data.
- AI and Emerging Technologies: Utilize AI and other technologies for modeling efforts.
- Data Integration: Integrate data from surveillance systems for accurate modeling.
- National Institute for Research in Digital Health and Data Science: Leverage it as a nodal institute for the network.
- Capacity Building: Create centers for mathematical modeling and train human resources.
Research and Innovation
Research and Development (R&D)
- High-Risk Innovation Research and Development Fund: Allocate funds for research and development of diagnostics, therapeutics, vaccines, capacity building, and cutting-edge technology development.
- Focus on Priority Pathogens: Prioritize research on pathogens identified by the WHO.
- Public-Private Partnerships: Foster collaborations between public and private sectors for research and innovation.
- Network of Centers of Excellence: Establish a network of centers focused on research on priority pathogens.
Countermeasures
- Diagnostics: Develop novel diagnostic procedures and tools for rapid identification of emerging infections.
- Drugs and Therapeutics: Launch a National Mission on Therapeutics and push for novel drug development.
- Vaccines: Establish an Innovation and Vaccine Science & Development Institute to develop vaccines for priority pathogens.
Regulatory Reforms
- Harmonized Regulatory System: Develop the system for mutual acceptance of regulatory data.
- Accelerated Approvals: Establish accelerated pathways and protocols for swift response.
- Strengthen SECs: Enhance the technical competence of Subject Expert Committees (SECs).
- Clinical Trial Network: Develop a strong clinical trial network for expedited development of drugs, devices, and diagnostics.
Capacity and Competency Building
- Assess Training Needs: Identify training needs for healthcare professionals involved in pandemic preparedness.
- Develop Roadmap: Create a roadmap for training and capacity building in mission mode.
- Collaborate with Partners: Collaborate with private public health institutes, international bodies, and partner agencies for training and capacity building.
- National Programs: Develop national programs for technical competencies in areas like IDSP surveillance, IHIP data portal, epidemiological intelligence, and One Health.
Partnership, Community Engagement, and International Collaborations
Community Engagement
- Risk Assessment and Community Engagement: Conduct comprehensive assessments and engage with communities at the local level for effective planning and response. Develop strategies and guidelines for managing public health emergencies, including implementing public health and social measures, restricting movement, information dissemination, and managing infodemics.
- Community Partnerships: Link with health NGOs and CSOs for last-mile connectivity and engage with communities transparently to empower them for public health efforts.
- Infodemic Management: Establish structures for community involvement, SOPs, and HR for Risk Communication and Community Engagement (RCCE) to address infodemics and rumors.
Private Sector Partnerships
- Data Sharing: Collaborate with the private sector to share data on outbreak-prone diseases and other public health events.
- Community Awareness: Collaborate with the private sector for community awareness and IEC activities.
- Public-Private Partnerships: Partner with private sector research centers for developing diagnostics, therapeutics, and vaccines. Engage the private sector for clinical care, testing, and other services during pandemics. Develop clear guidelines and mechanisms for private sector involvement in clinical care, quarantine, isolation, and intensive care services.
International Collaborations
- Pre-Agreed Protocols and MoUs: Establish agreements for data sharing, knowledge transfer, technology transfer, and intellectual property management.
- Institutionalized Collaborations: Foster collaborations between institutes and agencies for pandemic preparedness and response.
- Global Partnerships and Regulatory Approvals: Strengthen partnerships with WHO, CDC, and other international organizations for mutual acceptance of regulatory data and expedited approvals.
- South-South Cooperation: Focus on self-sufficiency while cultivating South-South cooperative partnerships.
Continuous Monitoring and Evaluation
Monitoring Mechanism
- EGoS Working Group: Establish a Working Group for Monitoring Progress within the EGoS for Pandemic Preparedness and Emergency Response.
- Scorecard System: Develop a scorecard with well-defined priority targets and collect data through an online portal.
- Regular Tracking: Track defined and quantifiable parameters, including research pipeline, human resources, funding systems, and surveillance systems, and foster participation in WHO peer review systems.
Scorecard Parameters
- R&D Ecosystem Readiness: Periodic assessments on the readiness for pandemic response.
- Funding: Evaluate the availability and allocation of funds for diagnostics, therapeutics, and vaccines.
- Research Priorities: Monitor research on the WHO List of priority pathogens. Assess the progress of establishing and maintaining international collaborations.
- Capacities: Assess capacities for surveillance, forecasting, modeling, AI, new technologies, and clinical trials.
- Data Management: Evaluate the effectiveness of the unified data portal and data analysis unit.
- Forecasting and Modeling: Assess the accuracy and effectiveness of forecasting and modeling simulations.
- SOPs and Protocols: Evaluate the availability and implementation of SOPs for data sharing, communication, and accelerated regulatory approvals.
Testing the Framework
- Pilot Pathogens: Test the framework on existing priority pathogens like Nipah, Zika, Monkey pox, and H5N1.
- Timeframe: Implement the preparatory phase within 3-6 months and monitor the system’s readiness to deliver in 100 days.
Fig : 100 Days Mission for Future Pandemics
Operationalizing the components of this framework and using a comprehensive scorecard can ensure that the PPER framework is implemented effectively and that we are prepared to respond to future pandemics.
Indicative Timelines for Implementation
Short Term (3-6 Months)
- Establish Key Structures: Set up the EGoS for Pandemic Preparedness and Emergency Response, approve the special fund, and prepare the monitoring framework.
- Operationalize One Health Institute: Initiate coordinated collaborative surveillance and research.
- Strengthen Existing Systems: Institutionalize the Epidemiological and INSACOG framework and SOPs for regional expansion.
- Devise Standard Operating Procedures: Develop SOPs for data sharing, risk communication, and capacity building.
Medium Term (6-12 Months)
- Engage with Stakeholders: Collaborate with local governments, states, other ministries, and international partners.
- Develop Frameworks: Establish frameworks for collaboration and partnership with MoUs and protocols.
- Integrate Data: Integrate data portals and coordinate data sharing across agencies.
- Allocate Funds: Approve the High-Risk Innovation Research Fund.
- Establish Institutes: Establish the Vaccine Science & Development Institute and initiate research through the Center of Excellence Network.
Long Term (12-24 Months)
- Enact Legislation: Approve the New PHEMA.
- Establish Networks: Set up the Epidemiological Forecasting and Modeling Network and the National Biosecurity Biorepository Network.
- Regulatory Reforms: Grant autonomy to the regulatory body with well-developed SOPs for accelerated emergency use authorization.
- Capacity Building: Implement a comprehensive capacity-building training program at all levels.
Conclusion and Critical Analysis
The report maintains a focus on governance, data management, research, and community engagement that essentially copes with the best global practices in preparedness for pandemics, but there still are strength and weaknesses if comparative analysis is done with international frameworks.
Governance and Collaboration
The proposed EGoS of India, like other countries, has adopted the worldwide trend of more centralized coordination bodies. However, such structures would be successful only if inter-ministerial collaboration within such structures could be facilitated, along with smooth decision making culminating into timely results. In fact, the examples of this kind of international coordination, like the World Health Organization’s Emergency Committee, show that communication and accountability are the prime requirements of such coordination bodies.
Data Management and Surveillance
The unity of focus on a unified data platform in India is consistent with international efforts to advance the sharing and analysis of data. International efforts have concentrated efforts on health security through surveillance and data-driven decisions. However, there are still significant hurdles in this agenda; first, data privacy and security in the current emerging scope of artificial intelligence.
Research and Innovation
India adheres to research and innovation in compliance with best international practices. It was the need for the world to accelerate diagnostics, therapeutics, and vaccines against COVID-19. International collaborations, such as those initiated through the COVAX initiative, advocate for equitable access to innovations of this nature. Contributions of India in this area can further bolster its research ability to work towards achieving global health security.
Community Engagement and Partnerships
The report’s emphasis on community engagement is a crucial aspect of pandemic preparedness. International examples of successful community-based surveillance networks in many African countries demonstrate local involvement that is successfully promoting prevention and control in those diseases. Diversity of people and a decentralized health-care system in India make community engagement all the more important.
Key Areas for Improvement
While India’s framework offers a solid foundation, several areas require further attention:
- Funding: All the proposed measures require adequate funding. For instance, through international examples, such as that of the Global Health Security Financing Initiative for sustainable sources of funding.
- Equity: Health equity is also a challenge in ensuring that healthcare services are accessible; it tends to neglect and discriminate more towards people in rural and marginalized areas. Through experience from India during the COVID-19 pandemic, inequity concerning the access to health was shown.
- Human Resources: A resilient health workforce, adequate number of public health professionals and laboratory technicians can respond effectively to a pandemic.
Conclusion: In many ways the pandemic preparedness framework of India seems to align international best practices. By addressing those areas that have been identified for improvement, India strengthens its response capacity to future public health emergencies and contributes to global health security.
In conclusion, India’s pandemic preparedness framework aligns with international best practices in many respects. By addressing the identified areas for improvement, India can strengthen its capacity to respond to future public health emergencies and contribute to global health security.
References
- Future Pandemic Preparedness and Emergency Response: A Framework for Action. (2024). In NITI Aayog. Retrieved September 26, 2024, from https://www.niti.gov.in/sites/default/files/2024-09/Report-of-the-Exper-Group–Future-Pandemic-preparedness-and-emergency-response_0.pdf
- Equity in pandemic preparedness: Bridging divides for a safer world. (2024). Global Preparedness Monitoring Board. Retrieved September 26, 2024, from https://www.gpmb.org/reports/m/item/equity-in-pandemic-preparedness
About the Contributor: Meenu Mohan is a Research Intern at the Impact and Policy Research Institute, and holds a BSMS Degree in Mathematics from IISER, Bhopal. Her research interests include Data Analytics, Foreign Policy and Geopolitics, and Disarmament.
Acknowledgement: The author extends sincere thanks to Dr. Arjun Kumar for the invaluable opportunity, and to Deepa Baghel and Geetam Acharya for their informative inputs.
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