This is festival time in India. The festivities for Ganesh chaturthi and Eid barely over, this weekend is the culmination of Vijaydashami, celebrated across India in various forms. Whether it is Dussehra, Dasara, Dashahara, Navaratri or Durgotdsav, the common theme is victory of good over evil. Large crowds gather every day in temples and puja pandals across India.
In times of a flu outbreak, this is a public health nightmare. This year’s Ravana is the microscopic influenza A H1N1 (2009) virus. Will the arrows of public health preparedness be able to slay this new age Ravana? This unlikely in India, if you listen to what experts have to say.
I wrote earlier about the 3.1% mortality among swine flu cases in India. The latest Ministry of Health and Family Welfare (MoHFW) release is for September 24, 2009; it reports 8979 cases and 277 deaths – 3.08% mortality.
Prof. T. Jacob John, unarguably India’s most prominent public health scientist, thinks this high mortality could be due to a selection bias – those with more severe illness are being tested. So, what has been India’s testing policy? A larger question is how has India dealt with this outbreak from a public health perspective.
An editorial in the August issue of the Indian Journal of Medical Research (IJMR) written by Prof. Jacob John and Prof. Jayaprakash Muliyil, provides a very frank and analytical assessment. It also provides sagacious advice to the Government on what it should and should not be doing.
The editorial can be read at http://www.icmr.nic.in/ijmr/2009/august/editorial1.pdf (I am grateful to the authors and the Editor, IJMR for their permission to post this link).
They say, and I quote – “At the request of the World Health Organization (WHO), many countries including India had made a detailed Pandemic Preparedness and Response Plan (PPRP). Many experts believed that India would, for the first time in our history, be well prepared to face an epidemic.-------- The events that took place in June, July and up to mid-August (as we write this) are still fresh in our memory. The expectation that India would face the pandemic with confidence and competence gradually gave way to disappointment and dismay. While the virus is reaching many places and spreading among the population, as anticipated, India does not have a public health infrastructure that could put into practice the PPRP”.
Prof. Jacob John agreed with my call in an earlier post and adds – “Science must guide policy. Policy must drive public health. So public health interventions must be evidence-based”.
Those who matter at the MoHFW and Indian Council of Medical Research will do well to read this editorial (which is in their own journal), and to ensure that policy is driven by science and not the other way around.
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