Could it be quietly present among us, lurking in various animal hosts, or perhaps it has already made its subtle presence felt in ways we have yet to uncover? The mysteries of our microbial cohabitants beckon us to delve deeper into the world of infectious diseases.
Worldwide, scientists are working to find solutions and connect the dots, all in a collective effort to forestall the emergence of Disease X or the impending pandemic.
Amid the evolving climate change landscape, the spectre of zoonotic diseases looms ever larger. Bats, guardians of an astonishing trove of some 40 viruses, have unveiled just a handful to us, including the notorious Coronavirus and Nipah — leaving countless mysteries yet to be unravelled by the world of humans.
While some believe that pandemics happen every 100 years, scientists disagree, saying there is no discernible pattern or established trend.
As we engage in ongoing conversations about the next potential pandemic, here are the four key focal points that India should promptly initiate action on to pre-empt the emergence of Disease X.
1. Intensify “One Health Surveillance”
One Health Surveillance often appears to be more of a buzzword than a dedicated programme.
The concept of One Health promotes the de-compartmentalisation of human, animal, and ecosystem health. It involves the gathering, interpretation, and sharing of data gathered not only on humans but also on animals and the environment. In India, the programme suffers from a lack of financial assistance and seriousness.
The interplay among humans, animals, and ecosystems is inescapable, and it is a well-established reality that the interconnectedness of these three entities is vital for survival.
As we talk about the possibility of zoonosis — a disease that has jumped from animal to human — the need to intensify efforts to strengthen One Health is more than ever.
2. Drive community engagement
Many health experts believe that one of the key reasons behind Kerala’s success stories in dealing with health emergencies is “community involvement”.
Dr Raman Gangakhedkar, the country’s top epidemiologist and former head of the communicable disease wing at the Indian Council of Medical Research (ICMR), once told me that one of the crucial things he did while heading the effort to curb the spread of the Nipah outbreak in 2018 was to drive community involvement in Kerala.
“Kerala is a unique state. We must prepare such an environment across the country where the community should know how to come together in times of adversity and act in an intelligent manner,” he told me earlier.
There exists a significant lack of awareness about zoonotic diseases among the general population. Hence, it is imperative to target communities, including school children, to create awareness.
Involving diverse community health workers or training the on-ground cadre such as ASHA workers is essential to promote community engagement. The goal of this cadre should be to cultivate an informed public which is capable of responding effectively to health emergencies.
3. Find effective antivirals
While India proudly boasts of being the world’s pharmacy, it should channel all its efforts towards the challenging yet very significant task of developing a range of effective antiviral drugs or line of newly emerging segment of monoclonal antibodies.
This mission has the potential to save numerous lives worldwide during pandemics.
The Union government recently rolled out the national policy to boost Research & Development and Innovation in the Pharma-MedTech Sector and the Scheme for Promotion of Research and Innovation in Pharma-MedTech (PRIP).
The scheme — which has a total outlay of Rs 5,000 crore for a period of five years till 2028 — has the capability of providing financial support to top Indian pharma companies to enter new categories of drug development.
From mRNA, DNA to inactivated, protein, subunit or more — India already has mastered the vaccine platforms. The focus should be on fixing the challenges faced during the vaccine manufacturing drive apart from expanding the high-security BSL-4 labs and centres similar to the National Institute of Virology in Pune.
4. Expand genomic surveillance & act swiftly
Top government official Dr NK Arora told News18 last week that India is planning to expand the scope of its genomic surveillance body INSACOG with the aim of preventing the outbreak of Disease X.
Arora is co-chair of INSACOG (Indian SARS-CoV-2 Genomics Consortium) which is a national multi-agency consortium of Genome Sequencing Laboratories (RGSLs). The plan is to expand its scope beyond Covid-19 so that it could look for more pathogens.
Dr Vishal Rao, a member of the Genomic Surveillance Committee of Karnataka’s Covid-19 Task Force, told me that a team at the Indian Institute of Science (IISc), in collaboration with the Bengaluru Bio-innovation Centre, the Department of Biotechnology, the government of Karnataka and the state department of health, has identified 32 potential pathogens. In order to monitor these pathogens at the district level and enhance surveillance, the team will collaborate with various state departments, including urban development, rural and panchayat raj, and other agencies.
The state is building the programme for future applications.
For instance: Rao told me that the initiative will help in understanding the public health burden caused by pathogens in South Karnataka. It will provide estimates of prevalence and herd immunity that can be used for disease forecasting and analytics apart from assisting in the development of vaccines and in determining which candidate vaccines to prioritise. Also, it will facilitate the creation of a Karnataka Serology Bank to measure and identify the immunity landscape of many infectious diseases.
Similar to Karnataka, India should encourage additional states to formulate and begin implementing plans. Over time, successful models can be adopted by other states too.
Overall, India is making comprehensive preparations in anticipation of the next pandemic. The key is to maintain the momentum and keep the ball rolling.
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