COVID-19: Lessons for disease Surveillance – Are we preparing for the future?

By Dr K Madan Gopal, 

The emergence and re-emergence of infectious diseases like plague, SARS, H1N1, avian influenza, Ebola, and ZIKA, and most recently the outbreak of COVID-19 viruses has emphasized the need for early detection, warning signs, and rapid outbreak containment. This is further challenged and amplified by trade expansions, globalization travel, as the infectious disease has no borders and goes beyond borders faster than ever, in past Spanish flu lasted from January 2018 till December 1920 and infected almost a third of the world population, and we are witnessing a similar, in fact, a faster spread during the current COVID-19 pandemic.

The COVID pandemic is progressing and has impacted human health, economy, and development, The United Nations had linked national security with pandemics. The European Centre for Disease Prevention and Control in 2016 alerted and warned regarding global monitoring of “SARS and related viruses and response capacities need to be maintained, but somehow, not much has been done. The ongoing COVID pandemic has overwhelmed the system and has highlighted the need to have a robust and unified Disease surveillance system which can respond to outbreaks that involve human, animals, and the environment. Over the years the Indian surveillance systems have evolved i.e human health, environment, and animals, but in silos and fragmented.

India has traditionally focused on Surveillance for Communicable/Infectious Diseases, and sustainable progress has been achieved viz. eradication of Smallpox (1977) Elimination of Polio in 2014. reduction in the incidence of HIV/TB and Malaria. India has substantially reduced the incidence of HIV infections by more than half in the last two decades and the system has shown its resilience during the times of COVID and earlier Nipah virus outbreak. Traditionally, the role of tracing outbreak of diseases has been performed by the Integrated Disease Surveillance Programme (IDSP), with assistance of both local state as well as the municipal governments. The IDSP monitors over 22 communicable diseases and reports on outbreaks across India every week, which somehow is hampered during the COVID times. This is marred with the shortage of trained manpower and finances and capacities. Despite capacity constraints, IDSP is responsible to track and trace multiple communicable diseases across the country, and now scope being increased to track other diseases as well.

Public Health Surveillance in India is often considered as a separate activity, not related directly to health care service delivery. It is an important public health function and cuts across primary, secondary, and tertiary levels of health care. It is often viewed as a stand-alone activity, with Many institutions responsible for different aspects. To raise the profile of Public Health Surveillance in India, it is important to position Public Health Surveillance as a tool for the public good. It is now recognized that data from effective surveillance systems are useful for targeting resources and evaluating the program.

This is the right time to build on the directions for enhanced disease surveillance and people-centric services in the National Health Policy 2017 and build on from the existing surveillance systems which is mainly data entry and upload to technology-driven with alignment with the national Digital health Mission and Ayusman Bharat.

Over the past many years most of the pathogens with epidemic risk have originated from the non-human host and this needs to be prevented by all means. In the aftermath of the COVID 19, we don’t know whether this opportunity to reimagine and build public health systems will translate to reality or not. Prompt identification of this interface will be crucial for breaking the chain of transmissions and suppressing the transmission and creating a technology enabling resilient surveillance systems based on the principle of one health i.e from the simpler to the complex system integration. Institutions like IDSP will have to take the lead and perform critical roles with similar structures at the state level which can bring uniformity in data collection, surveillance operations, and accuracy in the identification of diseases across states.

[The columnist is Senior Consultant (health) NITI Aayog. Views expressed are personal.]