|Year : 2018 | Volume
| Issue : 3 | Page : 193-196
Basis of science policies for infectious disease challenges in India
Kayzad Soli Nilgiriwala
Research Officer, Department of Tuberculosis, The Foundation for Medical Research, Mumbai, Maharashtra, India
|Date of Web Publication||12-Sep-2018|
Kayzad Soli Nilgiriwala
The Foundation for Medical Research, 84-A, R. G. Thadani Marg, Worli, Mumbai - 400 018, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
With increase in drug resistance and related challenges in infectious diseases globally, it has become more important for a country like India with a high population to develop strategies to deal with such challenges. The literature review was conducted using the Google search engine to explore the contemporary science policies in India (since 2012) which are designed for tackling infectious diseases challenges in the country. This review article gives an insight into the strengths and limitations of the basis of some of the contemporary science policies in India that are drafted and implemented to combat the challenges of infectious diseases. The new national plans for controlling infectious disease challenges with bold strategies for their rapid and effective implementation hold promise in India.
Keywords: Drug resistance, infectious diseases, science policies
|How to cite this article:|
Nilgiriwala KS. Basis of science policies for infectious disease challenges in India. Indian J Public Health 2018;62:193-6
|How to cite this URL:|
Nilgiriwala KS. Basis of science policies for infectious disease challenges in India. Indian J Public Health [serial online] 2018 [cited 2019 May 22];62:193-6. Available from: http://www.ijph.in/text.asp?2018/62/3/193/241097
| Introduction|| |
India is a country known for its diverse culture, rich history, and high population. Being a country with huge population, India bears increased challenges toward dealing and coping with the high burden of infectious diseases. In India, there have been many epidemics of emerging and re-emerging infectious diseases in the past; to mention a few of them – the smallpox epidemic (1974), the cholera outbreak (1992), the plague outbreak (1994), the dengue epidemic (2006) and the flu pandemic in India (2009). India, fortunately, survived through these infectious disease challenges due to timely support and action taken by the Indian government and the health department in the past. The emergence of multidrug resistance in bacteria causing infectious diseases such as tuberculosis (TB) and malaria is the new global challenge requiring concerted efforts.
| Materials and Methods|| |
The concept for this review originated from the need to extract insights from the contemporary national strategies/policies designed to tackle the challenges of infectious diseases in India. Literature review was conducted using Google search engine using the keywords “science policies in India on infectious diseases.” The inclusion criteria included the science strategies/policies in India since 2012. Data were extracted from five key national strategies for infectious diseases, namely, Strategic Plan for malaria control in India, National Biotechnology Development Strategy, National Action Plan on Antimicrobial Resistance (AMR), National Strategic Plan (NSP) for TB Elimination, and Swachh Bharat Mission (SBM).
Tackling the challenges of infectious diseases in India
To control infectious diseases in India, the Indian Council of Medical Research (ICMR) increased its funding during the 1990s to accelerate research for emerging infectious diseases. The ICMR has developed a network of institutes dedicated to specific infectious diseases which include regional centers that are strategically placed at locations with increased risk for new and emerging infections. The ICMR also provides support for establishing new laboratories, developing new rapid diagnostic tests, surveillance of drug resistance, and capacity building. The Indian government also initiated an Integrated Disease Surveillance Project in 1997–1998 to keep emerging infectious diseases under check. To equip the country to manage infectious diseases, the Indian government started the Institute of Epidemiology in Chennai and initiated training programs in the fields of epidemiology and public health. Moreover, in 2007, a new Department of health research (DHR) regulated by the Ministry of Health and Family Welfare (MoH&FW) was set up. The DHR is an effort by the Indian government to put the role of research at the center of health development. The DHR was expected to play a “conductor's role in orchestrating an effective health research response” for emerging infectious diseases.
The National Centre for Disease Control (formerly known as National Institute of Communicable Diseases) which originally focused on malaria-related research now has a current mandate of disease outbreak investigations, to provide referral diagnostic services, quality control of biologicals, storage, and supply of vaccines, providing training for successful implementation of various health programs and to conduct applied research in aspects of communicable and noncommunicable diseases. Its mandate supports in dealing with infectious disease challenges in the country. The Centre for Infectious Disease Research (CIDR) at the Indian Institute of Science, Bengaluru, is another institute which provides intellectual and infrastructural support for infectious disease research and has a goal to better understand basic biology of infection and to explore new therapeutics. CIDR also has a Biosafety Level-3 facility, which allows researchers to work on highly pathogenic microorganisms.
Research on infectious diseases in India is at various stages of development – from basic to translational to operational research. India has some of the best infrastructural facilities in the world and has many talented scientists who can meet the challenges of infectious diseases in the country.
Science policies for infectious disease challenges in India
In order to understand the basis of the national science strategies and policies that deal with the challenges of infectious diseases in India, we need to have deeper insight into some of the contemporary national strategies/plans designed for handling infectious disease challenges in India. Following are some of the key ongoing national strategies for dealing with specific infectious diseases and/or challenges related to infectious diseases in the country.
Strategic plan for malaria control in India (2012–2017)
Malaria is one of the major public health issues in India and hence the Indian government has given special attention to malaria control. The Strategic Plan for Malaria Control mentions scaling up of interventions for malaria control and has a vision of reduction of the burden of the disease on health and economic development of people affected with malaria. The goals of the strategy are as follows: (a) to include screening all fever cases suspected for malaria (60% by microscopy and 40% by rapid diagnostic test), (b) to treat all Plasmodium falciparum and Plasmodium vivax cases with full course of effective treatment, (c) to equip health institutions (primary healthcare level and above) with microscopy facility/emergency facilities/injectable artemisinin derivatives, and (d) to strengthen facilities for management of severe malaria cases. The ultimate objective of the strategic plan is to achieve <1 annual parasite incidence in 1000 population by the end of 2017. The strategy systematically defines the outcome and impact indicators and is in line with the Regional Malaria Strategy of World Health Organization, South-East Asia Regional Office. A drug policy for rapid focused scale-up for Impact has also been suggested in order to increase the coverage of drugs in the range of 80% in high-risk areas which can result in substantial reduction (over 50%) in malaria illnesses, drugs and healthcare costs. The core interventions and target objectives are to reduce the burden of malaria by prevention (by using insecticide-treated mosquito nets and indoor residual spraying), accurate diagnosis, prompt and effective treatment of malaria, effective program management, empowering individuals/communities and commitment to performance monitoring and impact evaluation. The total budget for the strategic plan is Rs. 3976 crores for 5 years (2012–2017).
National biotechnology development strategy (2015–2020)
The National Biotechnology Development Strategy was announced by the Department of Biotechnology (DBT) in 2007 with a vision to bring connectivity between disciplines and enhance synergy in skills across various sectors. Although this strategy was not designed solely for tackling the challenges of infectious diseases, it also supports research in the fields of human genome, vaccines and infectious diseases as an integral part of biotechnology. In this strategy, DBT provides support to understand basic biology of infection and translational research. The strategy also encourages preclinical/clinical development of vaccines against various viruses (rotavirus, rabies, dengue and Japanese encephalitis) and bacteria/protozoa (cholera, typhoid, TB, and malaria). It also supports new approaches for affordable vaccine development against cancer (HPV), polio, pneumococcus and HIV. An inter-ministerial committee involving ICMR/DHR, DBT, and MoH&FW has also been formed under this strategy and a memorandum of understanding has been signed with the Centre for Policy Research on vaccines for preventable diseases for achieving disease prevention in the Indian population. The basic research initiatives in infectious diseases include understanding pathogenesis, virulence factors, transmission, host susceptibility, and developing new technologies for diagnosis and treatment. The translational research in this strategy focuses on host-targeted interventions as therapeutics, host/pathogen biomarkers for rapid diagnosis, and development of high-throughput screening assays for discovering new therapeutics.
National action plan on antimicrobial resistance (2017–2021)
AMR in infectious agents is a major challenge and threat to public health in this era of antibiotic misuse. The MoH&FW have identified AMR as one of the top 10 priorities for collaborative work with WHO and the Prime Minister of India and the Union Minister for Health have committed to tackle AMR challenges in India. The goal of the National Action Plan on AMR is to effectively combat AMR in India and contribute towards the global efforts to tackle this public health threat. The objectives of the national action plan (in line with the global action plan for AMR) are based on national needs and priorities. A total of six priorities (based on the global action plan for AMR) have been included in this strategy which includes international, national and subnational collaborations on AMR. The six strategic priorities are as follows: (i) to improve awareness/understanding of AMR through effective communication/education/training; (ii) to strengthen knowledge/evidence through surveillance; (iii) to reduce incidence of infection by effective infection prevention/control; (iv) to optimize the use of antimicrobial agents in health, animals and food; (v) to promote investments for AMR activities, research and innovations; and (vi) to strengthen India's leadership on AMR. The successful implementation of the National Action Plan on AMR is essential for the country to deal with a major challenge (if not threat) in near future.
National strategic plan for tuberculosis elimination (2017–2025)
TB is an infectious disease which kills almost one person every minute in India. Control activities for TB in India have been active since over half a century. Although India is now better prepared for tackling TB, it is constantly battling with the challenges of transmission and drug resistance. The NSP for TB elimination has considered all stakeholders including national/state governments, development partners, civil society organizations, international agencies, research institutions, and the private sector. The vision of the strategy is to have TB-free India with zero deaths, and the goal is to achieve rapid decline in TB cases, morbidity and mortality in India by 2025. The NSP has proposed bold strategies in line with the global End-TB targets to rapidly decline TB incidence in the country. Some of the bold policy initiatives include the introduction of a national TB policy/bill, a national TB elimination board, strengthening of the Central TB Division, creating thematic resource groups, and institutionalization of surveillance/research/HRD. The categories defining the NSP are--Detect (laboratory systems and diagnosis, case finding and patients in private sector); Treat (treatment service, key affected populations, and patient support systems); Prevent (airborne infection control, contact tracing and latent TB infection treatment); Build (urban TB control systems, health system strengthening, advocacy/communication/social mobilization/TB campaign, surveillance/monitoring/evaluation, research and technical assistance); and Resourcing the NSP (procurement and supply chain management, costing, financing and implementation of NSP). The total cost of the strategic plan is expected to be Rs. 16,649 crores.
Swachh Bharat mission (2014–2019)
The SBM or Clean India Mission was launched in New Delhi, India on October 2, 2014 with the vision to create general cleanliness in the country. The Total Sanitation Campaign (TSC) trials in the villages of Madhya Pradesh concluded that with access to individual household latrines (to avoid open defecation), there was improved child health by reduction in gastrointestinal illnesses, parasitic infections, and anemia. Based on the success of the TSC, one of the primary objectives of SBM is to end open defecation by creating 12 million toilets in rural parts of the country at a cost of Rs. 1.96 lakh crores by 2019. Although SBM does not specifically focus on a particular infectious disease, it broadly provides a strategy for promotion of cleanliness and sanitation which will benefit the health of people in India and will be beneficial to reduce the spread of the superbugs, and ultimately in reducing the infectious disease challenges.
The basis of science policies for infectious disease challenges
Based on the present national strategies/policies, the basis of science policies in infectious disease challenges in India and some comments on the same are highlighted as follows:
- Science policies in India are mainly based on the priority and long history of the disease in the country (e.g. Strategic Plan for Malaria Control in India and NSP for TB Elimination). The basis of drafting policies based on disease history in the country undoubtedly strengthens the strategies, giving greater depth towards appropriate decision-making; although in addition, there is a need for policies that has provision for rapid response during an emergency situation such as an epidemic.
- One of the basis of science policies in India is to establish new institutes dedicated to specific infectious diseases in the country which would act as a constant workforce against a long-standing disease. The basis of this is to develop a long-term vision which is beneficial for the control and eradication of a disease.
- Recent national policies (e.g. National Action Plan on AMR and NSP for TB Elimination) have initiated taking bold strategies and policy initiatives into consideration with a goal of combating antibiotic resistance and rapid reduction in disease incidence. This creates a strong basis for the national strategies to take urgent measures and to implement strategies in case of epidemics. Such considerations in national strategies/plans are very much needed and require increased budget and rapid government approval.
- Many strategies designed to handle the challenges of infectious diseases in India are broad and designed to tackle with multiple diseases (e.g. National Biotechnology Development Strategy and National Action Plan on AMR). Although broad strategies are useful and are impactful in the long-run, they may not necessarily provide with immediate action in case of an infectious disease emergency in the short run.
- Most of the national strategies/policies for infectious disease challenges in India involve the component of monitoring and evaluation in the form of surveillance as an integral part of the plan and is helpful in measuring the success of the strategy. Surveillance should continue to be a part of all future strategies since it can substantially help in fine-tuning and directing the strategies for its successful implementation.
Considerations for future science policies
Although the Indian Science policies/strategies are getting bold with time, there are still issues in the policies drafted for addressing the infectious disease challenges in the country. A recent editorial paper commenting on the NSP to eliminate TB from India by 2025 aptly summarizes some of the major hurdles in achieving such bold targets which also holds true for national strategies/policies in general. The key issues (including the ones highlighted in the above-mentioned editorial) which need to be addressed to create strong basis for science policies for infectious disease challenges in India are mentioned as follows:
- At present, only 1.4% of GDP of India has been allotted for health which is too low an amount to deal with the challenges of infectious diseases (an additional 2.5% of GDP is required to suffice the health needs of the nation). Moreover, a recent decision by the central government to curb half of CSIR's budget in order to self-finance most of its research, has jolted the scientific community in India. This government decision has received a lot of criticism from many scientists. Such kind of budgetary curbs can provide limitations for conducting quality research and for drafting and successful implementation of national science policies.
- There is an urgent need for development and validation of newer, cost-effective and rapid tools for diagnosis of diseases which can have a major role in success of the strategies.
- India being a country with a large population needs accessibility to the latest drugs for which the government should expedite the process for approving newer drugs and should ensure that there is adequate supply of drugs for the diseased so that there is no delay in initiation of the treatment.
- Private provider interface agencies (PPIAs) should be considered for increased notification in future national strategies/policies since many patients at various locations in India primarily approach private doctors and have inhibitions approaching public health systems. With the PPIAs included in the strategies, patients can be correctly guided towards successful diagnosis and treatment of the disease under consideration.
- Increased investment in research should be planned to successfully implement strategies/policies.
- Investment in surveillance and periodic surveys need to be considered for gauging the success of combating infectious diseases.
- The strategies should always include a component of health monitoring and should help to identify new, potentially zoonotic pathogens present in wild-life to forecast measures for emerging infectious diseases.
| Conclusion|| |
The national strategies/policies for infectious disease challenges in India have a strong basis with detailed structure for effectively combating diseases from their roots in the long run. These strategies may lack in connectivity of their objectives and may sometimes be affected due to budgetary constraints and delays in approval. With new national plans for infectious diseases having bold strategies for its rapid and effective implementation and with the promise of support by the India government, India now sees some light at the end of the tunnel.
The author would like to thank Dr. Nerges Mistry, The Foundation for Medical Research, Mumbai, Dr. Shubhada Chiplunkar, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar and Dr. Ragini Macaden, St. John's Medical College, Bangalore for critical reading of this review and discussion.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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