Recently both WHO and the US have announced the establishment of centres to monitor the emergence and spread of new diseases. WHO’s new Hub for Pandemic and Epidemic Intelligence in Germany, and the US’ Center for Forecasting and Outbreak Analytics under the CDC system will gather data on emerging diseases and forecast their spread to prevent a repeat of the COVID-19 pandemic. These are going to be dedicated facilities in addition to the already robust system of centres, agencies, departments etc. employed in monitoring global health trends.
We argue that it is in India’s national interest to develop its own National Epidemic Intelligence System {NEIS}, instead of only depending on global agencies. The NEIS should incorporate existing domestic machinery for disease surveillance with newer technologies and analyse biological events with a strategic lens.
Epidemics and pandemics have featured at various instances in world history and have led to great upheaval. Factors like the size of the population, its density, the mobility of people and characteristics of the pathogen can influence the spread of an infectious disease.
The current global trends thus favour the rapid spread of infectious diseases given the huge global population, rising high-density urbanisation, and unfettered movement of people due to air travel. All these factors were at play during the current COVID-19 pandemic as well. In this context, the ability to detect early signs of an infection and to predict its spread becomes an important asset for any nation or the international community.
Global framework
The WHO coordinates many national and multi-governmental agencies that collect, analyse and provide inputs regarding emerging biological threats. The USA’s CDC, WHO’s ECO-NET and Strategic Health Operation Centre{SHOC}, the Global Outbreak Alert and Response Network{GOARN}, Canada’s Global Public Health Intelligence Network{GPHIN} etc. are some of the agencies involved in gathering data on the global scale.
These agencies rely on certain legal treaties and theoretical frameworks to allow them to monitor public health globally. For example, the International Health Regulation{IHR} treaty allows the WHO to be an international monitoring and advisory body for Public health for more than 190 countries. The Global Health Security Index{GSI}, Joint External Evaluation JEE scores, the US’s National Biodefense Strategy document{NBS} and Global Health Security Strategy{GHSS} document etc. provide the basis for contextualising the emerging threats on the basis of pre-assessments of the region.
Indian scenario
India relies on the inputs given by some of the above-mentioned organisations. Though these agencies and their data sharing arrangements have been successful in detecting and providing timely advisories for diseases like SARS, MERS, Ebola in the past and were active during the ongoing COVID-19 pandemic, there are certain limitations to the reach of the organizations. The major limitation is that they rely on the generosity of a ‘host’ country to carry out field surveys and use official statistics provided by it.
This might not be the most reliable method of collecting data as some countries are opaque when it comes to sharing data or granting access to field teams for an independent analysis. Moreover, some of these agencies are quasi-governmental and depend on their respective government funding. National issues may take priority for such agencies, leading to budget cuts, modification of original mandate etc. The failure of Canada’s GPHIN – an organisation with a high success rate in early detection – to detect COVID-19 early enough is one such instance. This makes the need for India to have its own national agency tasked with global monitoring of emerging epidemics apparent.
Currently, the National Centre for Disease Control{NCDC} oversees programmes that are involved in monitoring Public health and infectious diseases in India. NCDC falls under the Directorate General of Health Services{DGHS}, Ministry of Health and Family Welfare{MoHFW}. Two programmes that are implemented by NCDC are the Epidemic Intelligence Service{EIS} and Integrated Disease Surveillance Programme{IDSP}. EIS is a training programme in Applied Epidemiology for physicians, following which these physicians return to their respective organisations. Thus, the Indian EIS is training service and not an intelligence service with institutional memory.
The IDSP is focused on domestic disease surveillance and collects data from government hospitals from 97 percent of Indian districts. IDSP also gathers information about biological events from analysing news reports from the media. This is handled by its Media Scanning and Verification Cell{MSVC}.
The Indian system under its current framework has some lacunae that need to be addressed. Under the current IDSP format, data from private hospitals and government labs are not part of the regular analysis. The media scanning cell needs to expand its reach to global monitoring of news on the lines of GPHIN with capabilities to capture news from various languages and use big-data techniques to analyse the real-time nature of such digital data. Moreover, India needs to develop the capability to analyse data related to biological events through a strategic perspective and so needs a dedicated team of personnel trained in public health and strategic studies.
NEIS for India
We propose improvements and expansion of the current domestic disease monitoring systems present in India. We propose for it to have three levels of operation. The first is to be a global digital monitoring system that will monitor all forms of digital content related to biological events and employ technologies like auto-translation, sentiment analysis etc. to create a real-time picture of an emerging situation.
The second level would consist of a permanent staff of public health professionals, statisticians, epidemiologists, as well as analysts trained in strategic studies. At this level, any emerging biological event will be analysed using a threat matrix that takes into account biological as well as strategic inputs to safeguard India’s interests. The third level should have trained officers to collect samples from the field directly so as to cross-validate data coming from other sources. We also see the mandate of NEIS to expand beyond just biological events to chemical and nuclear events as well.
Thus, the proposed NEIS should be able to assess and analyze domestic and international events while keeping India’s interests at the forefront. Inputs of NEIS can greatly aid policymakers and various arms of the Indian government to prepare for future potential threats to public health in India.
This article has been written by Ruturaj Gowaikar, a researcher at the Health and Life Science unit at Takshashila Institution, and Shambhavi Naik, Head of Research, Takshashila Institution.