COVID-19: Disruptions And Response

• As per National Disaster Management Act (2005), Biological Disasters are “causative of process or phenomenon of organic origin or conveyed by biological vectors, including exposure to pathogenic micro-organisms, toxins and bioactive substances that may cause loss of life, injury, illness or other health impacts, property damage, loss of livelihoods and services, social and economic disruption, or environmental damage.
• Examples of biological disasters include outbreaks of epidemic diseases, plant or animal contagion, insect or other animal plagues and infestation. Biological disasters may be in the form of – Epidemic and Pandemic.

Constitutionally health is a state subject and the primary responsibility of dealing with a biological disaster rests with the state government. There are a number of legislations that control and govern the nation’s health. Government can enforce these legislations to contain the spread of disease. Some of the commonly used legal instruments are:

• Epidemic Diseases Act of 1897: It is a colonial act, still in force, which provides the states to authorize any of its officers or agency to take such measures for prevention and control of epidemics.
• Civil Procedure Code (CPC) and Criminal Procedure Code (CrPC): Relevant provisions under the Civil Procedure Code (CPC) and Criminal Procedure Code (CrPC) can be invoked to detain and question persons involved in criminal acts which in its ambit includes bio-terrorism. Other provisions under this act can be applied for establishing law and order, for enforcing quarantine etc.
• Public Health Emergencies Act (Draft) being drafted by Ministry of Health and Family Welfare intends to replace the Epidemic diseases Act 1897 and provides for effective management of public health emergencies including bio terrorism. The draft is presently being modified after seeking comments of the states.
• Environmental Protection Act 1986 and the rules (1986): This act also provides for the Bio Medical Waste (management and handling) Rules of 1998 with a view to control the indiscriminate disposal of hospital / bio-medical waste. These rules apply to hospitals, nursing homes, veterinary hospitals, animal houses, pathological laboratories and blood banks generating bio medical waste.
• National Disaster Management Act: The Disaster Management Act of 2005 is the most important legal measure to deal with bio-defence. This Act provides for effective management of disasters and for all matters connected therewith or incidental thereto. It provides for an institutional and operational framework at all levels for disaster prevention, mitigation, preparedness, response, recovery and rehabilitation. This includes setting up of NDMA, SDMA, DDMA, NEC, NDRF and NIDM. It also clearly spells out the role of central ministries, state government and district administration.

At National level various institutions which are responsible to deal with biological disaster are following:

• National Disaster Management Authority: The National Disaster Management Authority (NDMA) is responsible to-
  • Lay down policies on Disaster Management;
  • Approve the National Plan;
  • Approve plans prepared by the Ministries or Departments of the Govt. of India in accordance with the National Plan;
  • Lay down guidelines to be followed by State Authorities in drawing up the State Plan; and
  • Lay down guidelines to be followed by the different Ministries or Departments of the Govt. of India for the purpose of integrating the measures for prevention of disaster or the mitigation of its effects in their development plans and projects.
• National Executive Committee: The NDMA is assisted by a National Executive Committee consisting of secretaries of 14 ministries as provided under the Disaster Management Act.
• National Crisis Management Committee: National Crisis Management Committee under the Cabinet Secretary is mandated to coordinate and monitor response to crisis situations which include disasters. The NCMC provides effective coordination and implementation of response and relief measures in the wake of disasters.
• Security Forces: Armed forces by their inherent organization, infrastructure, training, leadership, communications etc. are ideally suited as “First Responders” in any natural and manmade disaster. Since this type of “Disaster” would be more towards the management of providing immediate medical assistance, the nodal agency to co-ordinate and provide assistance as “First Responders” would be orchestrated by the Director General Armed Forces Medical Services (DG AFMS), who should include certain additional points in the existing SOPs for providing aid to civil authorities. These would be in the form of earmarking Command wise response, relating to assigned areas of responsibilities.
• Various Ministries and Scientific Institutions: Various Ministries and Scientific Institutions include,
• Ministry of Home Affairs: Ministry of Home Affairs is the nodal ministry for bio terrorism, biological disaster and partners with Ministry of Health and Family Welfare (MoHFW) in its management.
• Ministry of Health and Family Welfare: MoHFW is the nodal ministry for epidemics. The decision-making body is the Crisis Management Group under Secretary (H&FW) which is advised by Technical Advisory Committee under Director General of Health Services.
• National Centre of Communicable Disease: The Centre has three technical centres, viz., “Centre for Epidemiology and Parasitic Diseases”, “Advanced Centre for HIV/AIDS & related diseases” and “Centre for Medical Entomology & Vector Management”. The functions of the Centre broadly cover three areas, viz., trained health manpower development, outbreak investigations, specialized services and operational/ applied research. It also provides training in field epidemiology.
• National Institute of Epidemiology: It focusses on goal-oriented programs of national relevance, operational research, health systems research, teaching and field epidemiology training.

At State level various institutions which are responsible to deal with biological disaster are as follows:

• State Disaster Management Authority: The State Disaster Management Authority is vested with the powers for planning, preparedness, mitigation and response to disaster events in the concerned states including biological disasters.
• Various Labs, Medical Colleges and State Departments: Health being the state matter, there is wide inter and intra state differential in terms of public health assets, functioning of the public health departments, teaching training institutions and public health research.

At District level various institutions which are responsible to deal with biological disaster are as follows:

• District Disaster Management Authority (DDMA): It is the focal point for planning for the disasters in their respective districts.
  • The District Head Officer (DHO)/Chief Medical Officer (CMO) of the district is a member of the DDMA.
  • Under the CMO/ DHO, there are program officers for immunization, tuberculosis and malaria. Under the Integrated Disease Surveillance Program (IDSP), a surveillance/ IDSP officer at district level is envisaged.
  • The peripheral units that provide preventive and promotive health care are the primary health centres and the sub-centres spread across the district established on population norms [of one PHC for 30,000 thousand population and one sub centre for 5000 population (3000 in hilly areas)].
  • These are the basic units from where public health information is generated and public health service delivery takes place.
• Local Disaster Management Committee: It is expected to be trained and empowered as first responders. The ASHA / ANM/ MPW of the village/ sub-centre are the peripheral most health service delivery points keeping a watch on the disease outbreaks and notifying the Village Health and Sanitation committee and the Primary Health Centre.

• Nongovernmental organizations form an important part of civil society. Mostly consisting of people who are socially aware and have lot of flair for public service, they try to supplement the effort of the government delivery system.
• Though these NGOs are quite forthcoming for extending help to the government agencies during natural calamities, their help in case of biological disaster is not guaranteed because of the fear factor associated with such emergencies. It is therefore important to have periodic liaison with such groups and train them so that they can act as force multipliers towards government effort of disaster mitigation.

Managing biological disasters could be tricky due to various issues acting as a constraint which includes:

• No Separate Policy on Biological Disasters: At the national level, there is no policy on biological disasters. The existing contingency plan of MoHFW is about 10 years old and needs extensive revision. All components related to public health, namely apex institutions, field epidemiology, surveillance, teaching, training, research, etc., need to be strengthened.
• Shortage of Medical and Paramedical Staff: There is a shortage of medical and paramedical staff at the district and sub-district levels. There is also an acute shortage of public health specialists, epidemiologists, clinical microbiologists and virologists.
• Limited Medical Supplies: State-run hospitals have limited medical supplies. Even in normal situations, a patient must buy medicines. There is a lack of stockpile of drugs, important vaccines like anthrax vaccine, Personal Protective Equipment’s or diagnostics for surge capacity. In a crisis there is further incapacitation due to tedious procurement procedures.
• Bio-safety Laboratories: Biosafety laboratories are required for the prompt diagnosis of the agents for effective management of biological disasters. There is no BSL-4 laboratory in the human health sector. BSL- 3 laboratories are also limited. Major issues remain regarding biosecurity, the indigenous capability of preparing diagnostic reagents and quality assurance.
• Colonial Relic and Outdated laws: Until proclamation of National Disaster Management Act, the measures to counter COVID-19 were taken as per an 1897 statute (Epidemic Diseases Act).
• Inadequate R&D: The most important aspect to counter biological disaster is – preparedness. Low Research and Development in biotechnology and bio-medics results into lack of preparedness.

Following measures can be adopted to counter biological disaster like COVID-19:

• Adopting Appropriate Approach
  • ‘Prevention-Mitigation-Rehabilitation’ approach must be properly implemented.
  • In biological disasters, preparedness includes – proper environment management i.e. Safe water supply, proper maintenance of sewage pipelines and Awareness of personal hygiene and provision for washing, cleaning, bathing, avoiding overcrowding; R&D in bio-medics, biotechnology etc.
  • Mitigation includes proper disease surveillance systems (for detection and containment of disease), institutional co-ordination, adequate medical resources etc.
• Rehabilitation would include post disaster activities like resettling displaced communities and ensuring their sustenance.
• National Policy on Biological Disaster: A national policy specific to biological disaster would help to address technicalities involved and define proper role of institutions involved in management.
• More Budgetary Allocation: Enhance budgetary allocation to increase spending in areas like R&D in bio-medics, improving doctor per population ratio, enhancing number of paramedics etc.
• Ensuring Institutional Co-ordination: Facilitate vertical and horizontal linkages between government departments, scientific and technical institutions, NGOs, CSOs and local bodies.

• In terms of bio-defence preparedness, India has taken the basic precautions and has an elementary structure in place. Not only legal structures, India has also established a vast network of institutions from civil defence at the local bodies level to the military and para-military forces at the national level.
• The problem in India’s bio-defence mechanism is in terms of coordination between the various agencies, lack of medical resources and proper action plan. This inadequate state of bio-defence preparedness needs to be overhauled on a war footing to deal with any future exigency because time and tide will wait for none.