New Delhi: A separate Public Health Emergency Management Act (PHEMA) is proposed by an Expert Group constituted by NITI Aayog to facilitate the management of any public health crisis in India. “The PHEMA can address various aspects beyond epidemics, including non-communicable diseases, disasters and bioterrorism, and should be in place for a developed country. It will allow a holistic approach to health management, covering prevention, control and disaster response. The Act would also provide for the creation of skilled public health cadres at national and state levels,” the expert group said in its blueprint submitted to the government to counter all possible health emergencies and pandemic.
The terms of reference of the group were to draw lessons and experiences, both national and global, on how Covid was managed and visualise preparedness elements and future pathways for fighting any infectious public health crisis. The Expert Group, which was chaired by Dr Renu Swarup, former secretary to the Government of India, Department of Biotechnology also included three other members. They were Dr Soumya Swaminathan, former chief scientist of WHO & former DG ICMR, Dr Sujeet Singh, former director of NCDC and Rajib Kumar Sen, senior advisor of Health, NITI Aayog.
Stating that responding in the first 100 days of an outbreak is crucial for effective management, the Expert Group has prepared a framework for action for future pandemic preparedness and emergency response. It also outlines the detailed roadmap for preparedness and an implementation phase, indicating the steps on how the outbreak can be tracked, tested, treated and managed through a well-developed framework in a 100-day time frame.
During Covid-19, there was an effort to plug the gaps and build those components that supplemented the existing strengths.“The effective management of Covid-19 was possible due to a robust governance system through the Empowered Groups (EGs) with a whole-of-government approach. It is proposed that an Empowered Group of Secretaries (EGoS) chaired by the Cabinet Secretary be established for Pandemic Preparedness and Emergency Response and a well-oiled machinery is put into action, which prepares and readies itself before any emergency,” the expert group suggested in its report “Framework for Action for Future Pandemic Preparedness and Emergency Response.”
The COVID-19 contagion is undoubtedly not the last pandemic. Given the unpredictably changing planetary ecology, climate and human-animal-plant dynamics, new large-scale infectious threats to human health are inevitable. The WHO has warned the world that 75% of future public health threats are likely to be zoonotic threats (which could be due to emerging, re-emerging and new pathogens).
It said that a well-structured scorecard mechanism should regularly monitor the progress of key targets. “The priority targets would be the development of capacities for both human resource and infrastructure, the development of innovative countermeasures, appropriate high-risk financing for getting high returns, in terms of saving lives and minimising economic loss, a well-developed robust, responsive regulatory framework, and a strong surveillance network connecting epidemiological data with genomic, laboratory and clinical data,” the expert groups stated.
There is a need to connect the epidemiological surveillance data with the genomic data and develop clinical correlations using hospital and lab data. According to the expert group, a strong surveillance network is proposed, which allows community and hospital data to flow seamlessly to a unified data portal for data access and sharing across all relevant sectors.
“This will need a well-articulated data sharing and communication policy and assigning authority to key persons for decision-making,” it said. Challenges faced during COVID-19 regarding an India-based forecasting and prediction modelling system, therapeutic development and platform technologies for developing prototype vaccine candidates need to be addressed through new missions and centres which have been suggested in the report.
“To take effective, timely action, a Pandemic Preparedness and Emergency Response Fund needs to be established. During COVID, need-based finance packages were made available for some of the emergency response activities like genomic surveillance, vaccine and diagnostic development, research resources and shared infrastructure. However, adequate finances are also required to be made available for pandemic preparation,” the report suggested.
It also said that the research ecosystem needs strengthening. The special high-risk innovation research fund announced by the Government as a special package —‘Mission COVID Suraksha’, gave the country the capability to develop indigenous vaccines for the world’s most extensive vaccination programme.
The private sector could successfully develop a portfolio of vaccines including the world’s first DNA vaccine, the first thermostable mRNA vaccine, the first nasal vaccine and other vaccine candidates, using different platform technologies. The high-risk fund also helped to scale up vaccine manufacturing capacities.
“This experience highlights the need for continued support for developing platform technologies and vaccine candidate libraries. A new Institute of Innovation for new platform technologies and vaccine research, development and manufacture, and Centres of Excellence (CoEs) for research on priority pathogens (including the development of countermeasures) should get special financial allocation to prepare for future threats and be ready to deliver in 100 days of detection of a new pathogen,” the expert groups suggested.
Stating that the Indian regulatory system needs special attention, the expert groups said, “There is a need for global harmonisation of regulatory norms to allow acceptance of regulatory data across the world’s recognised regulatory authorities and a common framework for innovative technologies and accelerated response for emergency approval,” it said.
The need for a clinical trial network for global multi-locational trials has been suggested to facilitate speedy access to globally developed countermeasures. “The regulatory authority (CDSCO) needs special powers through legislation and requires technical competence strengthening and autonomy in functioning to meet these requirements,” it said.
Partnerships and coordination play a significant role in implementing an effective response during an emergency, especially centre-state partnerships and community engagement. “Strengthening the existing system and developing a strong institutionalised framework is needed,” the expert group suggested.
Over the last two decades, seven Public Health Emergencies of International Concern (PHEICs) have been declared by the World Health Organisation (WHO). These include the H1N1 influenza (2009), Ebola Virus Disease (EVD) (2014-16, 2018- 2020), Zika Virus Disease (ZVD) (2016), Poliomyelitis (2014), COVID-19 (2020), and Monkeypox (2022). In addition, the world has tackled public health threats of SARS, Avian influenza (bird flu), MERS-CoV, and Nipah virus outbreak which have challenged health systems across countries.
Read more: Niti Aayog Group Pitches For Separate Law To Tackle Future Public Health Crisis
