India’s pandemic failure

| July 26, 2015 | 0 Comments

In the early 1980s, doctors in California found that some patients were immuno-compromised for no known reason. Blood samples of the patients were sent to the Centre for Disease Control and Prevention (CDC) in Atlanta. The CDC wrote to Robert Gallo of National Institutes of Health (NIH) in Bethesda, to look at the problem. Gallo, who had earlier discovered the human leukemia-causing viruses, HTLV1and HTLV2, found that the blood of all the patients had another slow-growing virus which he called HTLV3, and which we now know as HIV that causes AIDS. A similar event took place in France; the lab was the famed Institut Pasteur and the scientist, Luc Montagnier. He discovered the same virus, actually before Bob Gallo and received a Nobel Prize last year.

If the cases referred to Montagnier and Gallo had occurred in India, the doctors would have first ignored it. Then, we have no labs like CDC or Institut Pasteur. The government would have initially denied that there was a problem. When they could not have done that any more, they would have said that the problem is not severe — and that they are doing everything to take care of it. So, don’t worry; it is now contained. After thousands were infected and destined to die, a foreign agency would have stepped in as happened with arsenic contamination of well water in eastern India.

Within a year of the discovery of HIV, I was invited to NIH as a consultant to Bob Gallo. He pointed out that the AIDS virus had reached Iran via the Atlantic and Thailand via the Pacific. India seemed to be the only land mass, fortunately isolated by mountains and sea, that was free of HIV. At a dinner in my honour hosted by Ted Becker, the associate director of NIH, the then director of NIH offered us a million HIV detection kits free of cost to test visitors arriving by sea or air.

I wrote to V Ramalingaswami, the director-general of Indian Council of Medical Research and a good friend, telling him about the new virus and the offer of the kit to detect it. But there was not even an acknowledgement. Reason: How can anyone living in a glorified village called Hyderabad know of something important that Delhi does not know?

We don’t even know how to do proper and honest epidemiology. The figure that NACO gave last year of number of people who are sero-positive for HIV, is a gross under-estimate. It took weeks for the National Institute of Communicable Diseases in Delhi to tell us that it was plague in Surat and no one was bothered to look into the possibility of its being a surreptitious act of biological warfare. In contrast to this, when a confirmed epidemic of measles occurred in the US a few years ago, they traced it to a Romanian who unwittingly brought the infection with her from Europe.

What has happened in India recently in respect of swine flu, is reminiscent of what happened with SARS some years ago. Today, the data on incidence provided to us is unreliable. What about the villages? Very few places in India have had facilities for testing for swine flu. Till recently, all the samples had to be sent to the National Institute of Virology in Pune. Interestingly, no government diagnostic laboratory in the country is accredited with the National Accreditation Board of Laboratories. Therefore, one is justified in questioning the reliability of most government labs.

There has been no flow of reliable information from the government. An unnecessary panic has been created in spite of the chance of death due to swine flu being less than one in a hundred. Compare this with malaria, tuberculosis or AIDS.

Professional organisations like the Medical Council of India, Indian Medical Association (IMA), and the Association of Physicians of India, have made no statements. There has not been enough supply of drugs used for swine flu. The quality of care in government hospitals has continuously declined over the last four decades. Most of the commercial hospitals are devoid of any code of ethics. Most doctors do not know how to differentially diagnose swine flu. The masks have not been appropriately certified.

Pandemics, today, are dealt by politicians and bureaucrats who know little about the problem and not by experts who would be free to express their expert opinion.   In the case of H1N1, shouldn’t the responsibility of handling the problem have been of the department of health research and Indian Council of Medical Research, without any undue pressure on them so that they could act professionally and not be obliged to do what is politically correct or expedient from the government’s point of view? Why didn’t the Centre put together a team of real experts and ask them to prepare an authoritative, professionally accurate and well-presented statement for public release in all languages using all forms of media, and professional communicators who were not  chosen on the basis of the lowest quotation?

To handle pandemics concerning humans, animals or plants, we should consider taking the following steps: Make it the responsibility of the government which would mean improving the standard of all government hospitals and setting up a workable system of rural medical and healthcare; have government-run diagnostic labs equipped and accredited, to do the tests required for controlling pandemics; the Centre and states should set up health advisory councils consisting of courageous, honest, professionally competent people with impeccable integrity and high public credibility — something on the lines of the economic advisory council.

The government should set up a centre for human disease control, a centre for animal disease control; and a centre for plant disease control, to take care of rare, new and exotic diseases, with appropriate linkages; our National Institute of Epidemiology must be totally reorganised and well-equipped to discharge its responsibility in case of a pandemic; an appropriate system to prevent, monitor, counter and react in real time to all acts of biological warfare against the country,  should be set up; our medical curriculae and syllabus should be appropriately revised to prepare  medical graduates to recognise and deal with new, rare and exotic diseases and pandemics; politicians and bureaucrats must refrain from making statements based on  inadequate knowledge and understanding, the government must establish linkages with professional organisations such as the IMA, whose advice and help should be sought through an organised structure in case of a pandemic; a similar interface should be set up with other relevant professional groups concerned with medical and healthcare and representing civil society; no vaccine for a pandemic should be adopted in the country without adequate scrutiny and trials, and; if a pandemic hasn’t reached India, a system of checking visitors arriving by air or sea at the point of arrival, must be put in place.

Reference: India’s pandemic failure. P.M. Bhargava. The New Indian Express, 11 August 2009.

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