A Disease Surveillance System, For The Future

Context: Diseases and outbreaks are realities and a well-functioning system can help reduce their impact.

Disease surveillance system: Refers to application of principles of epidemiology, through systematic collection and timely analysis, and dissemination of data on the diseases to initiate action to either prevent or stop further spread of diseases.

Disease surveillance in India

• National Surveillance Programme for Communicable Diseases in 1997: On wake of a major cholera outbreak in Delhi in 1988 and Surat plague outbreak of 1994.
• Integrated Disease Surveillance Project (IDSP): After SARS outbreak in 2004. IDSP focused on increasing government funding for disease surveillance, strengthening laboratory capacity, training health workforce and have at least one trained epidemiologist in every district.
• Scale up during COVID-19 pandemic: It was on the foundation of IDSP on which, India could rapidly deploy teams of epidemiologists and public health experts to respond to and guide the response, coordinate the contact tracing and rapidly scale up testing capacity.

Issues associated with Indian disease surveillance system

• Capacity variability among states: As per data from fourth round of sero-survey,
  • Kerala and Maharashtra States could identify one in every six and 12 infections.
  • While in States such as Madhya Pradesh, Uttar Pradesh and Bihar, only one in every 100 COVID-19 infections could be detected, pointing towards a weak disease surveillance system.
  • Estimated excess deaths are also higher in those States which have weak disease surveillance systems.
• Poor traceability and responsiveness: Kerala’s best performing disease surveillance system helped in picking maximum COVID-19 cases and could pick the first case of Nipah virus in early September 2021.
  • On the contrary, cases of dengue, malaria, leptospirosis and scrub typhus received attention only when more than three dozen deaths were reported and health facilities in multiple districts of Uttar Pradesh, began to be overwhelmed.
  • Situation is same in Madhya Pradesh and Haryana, where viral illnesses, most likely dengue, are causing hospitalisation but not being correctly identified or are being reported as mystery fever.
• Administrative rigidity: Promises of strengthening disease surveillance and health systems still failed to take off despite 18 months into the COVID-19 pandemic.

Way forward

• Relook and act upon recommendations by 2015 review of ISDP by Ministry of Health and Family Welfare, the Government of India and World Health Organization India: It included increasing financial resource allocation, ensuring adequate number of trained human resources, strengthening laboratories, and zoonosis, influenza and vaccine-preventable diseases surveillance.
• Up resource allocation: Government resources allocated to preventive and promotive health services and disease surveillance need to be increased by the Union and State governments.
• Train workforce: Workforce in the primary health-care system in both rural and urban areas need to be retrained in disease surveillance and public health actions.
  • The vacancies of surveillance staff at all levels need to be urgently filled in.
• Technical capacity building: Laboratory capacity for COVID-19, developed in last 18 months, needs to be planned and repurposed to increase the ability to conduct testing for other public health challenges and infections.
  • This should be linked to create a system in which samples collected are quickly transported and tested and the reports are available in real time.
• ‘One Health’ approach has to be promoted beyond policy discourses and made functional on ground.
• Strengthening administrative system: Dedicated focus on strengthening the civil registration and vital statistics (CRVS) systems and medical certification of cause of deaths (MCCD).
• Ensure coordinated actions between State government and municipal corporation to develop joint action plans and assume responsibility for public health and disease surveillance.
  • The allocation made by the 15th Finance Commission to corporations for health should be used to activate this process.

Conclusion: The emergence and re-emergence of new and old diseases and an increase in cases of endemic diseases are partly unavoidable. But with a well-functioning disease surveillance system and with application of principles of epidemiology, we can reduce their impact.