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Unless there is sustained investment in health budgets, we will again face a crisis in the next pandemic

All governments pledge to allocate resources for health during a pandemic but soon after it is over, our priorities go back to other sectors.


Updated: May 16, 2021 8:27:35 am
We only wake up to disease threats when there is an outbreak. In the intervening periods, we have selective amnesia to health-related issues. (Express Photo by Tashi Tobgyal)

Written BY Dr V Ravi

George Santayana (1863-1952) was a philosopher, essayist, poet, and novelist. He is known for his aphorisms such as “Those who cannot remember the past are condemned to repeat it”. He said this as early as 1905 in Reason in Common Sense, the first of the five volumes published under the heading ‘The Life of Reason’.

This profound philosophical statement has been proved right several times over the past century. Human history is chequered with episodes of infectious diseases caused by viruses such as smallpox, influenza, HIV and Ebola. Amongst these, the 1918 Spanish Flu was the first influenza pandemic in the 20th century and also the most lethal one. Following this, three more influenza pandemics occurred until 2020. Compared to the 1918 pandemic, the later influenza viruses showed lower morbidity and mortality. But 100 years down the line, we are confronted with a second severe pandemic, Covid-19. While some characterise Covid-19 as an unprecedented catastrophe, others are excavating the records of past plagues, certain that we must have learned something from them. It is therefore an opportune time for us to take stock of some of the lessons learnt from previous pandemics.

Tell the truth: As stated by American pandemic historian John Barry, the most important lesson from the 1918 influenza is to “tell the truth”. In 1918, under pressure to maintain wartime morale, neither national nor local government officials told the truth to the public. However, Spain was neutral in the First World War, and newspapers there could report on the disease. So it was generally perceived that the pandemic had originated from Spain and led to the misnaming of the disease as the “Spanish Flu”. In countries that silenced the press, trust in authority deteriorated as death toll increased. Suppression of true figures during pandemic times skews data and results in unreliable projections by modellers. It also leads to formulation of wrong policies.

Sustained surveillance: We only wake up to disease threats when there is an outbreak. In the intervening periods, we have selective amnesia to health-related issues. But it’s the intervening years between outbreaks that are important. It is in this period that surveillance is needed to pick up spillover events for viruses that might jump from animals and birds to humans. Most diseases that become epidemic start as endemic.

Adopting a ‘One Health Approach’: Over the past three decades or so, over 30 new human pathogens have been detected, three-quarters of which have originated in animals. This indicates that in zoonotic infections, spillover is common. Sometimes the consequences are serious for humans. Just as with influenza viruses, coronaviruses can cause human disease. As environments alter through climate change, intensification of agriculture or rapid urbanisation, we need to adopt a ‘One Health’ approach, which encourages cross-working between medical professionals, veterinarians and ecologists, together (sometimes) with social scientists. Identifying hotspots where spillover events are likely to occur and setting up surveillance at these sites would be the prime function of such groups.

Balance lives, livelihoods: Control measures adopted during pandemics can often be damaging to vulnerable populations. In the avian influenza outbreak, poultry was slaughtered in huge numbers. This caused devastating impacts on livelihoods across southeast Asia. Similarly, the lockdown and quarantine measures adopted in India during the first wave of Covid-19 laid emphasis on saving lives. This adversely impacted the livelihoods of the poor, who were the worst hit by the disease control efforts. However, after the first wave subsided, cases started rising sharply in March 2021, indicating that there would be a second wave. We continued to lay emphasis on livelihood and did not impose any restrictions until a huge surge. These lessons indicate that we need to learn to balance lives and livelihoods.

Allocation and management of resources: The allocation of resources for health is meagre in most nations across the world. Pandemics are wars of a different kind — biological wars, wherein we fight an unseen enemy, lose millions of lives. All governments pledge to allocate resources for health during a pandemic but soon after it is over, our priorities go back to other sectors. Unless there is sustained investment in health budgets, we will again face a crisis in the next pandemic.

This column first appeared in the print edition on May 16, 2021 under the title ‘Living with viruses: lessons from the past’. Dr Ravi, virologist and former NIMHANS professor, is nodal officer for Geneomic Confirmation of SARS-CoV-2 for Government of Karnataka

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