DOES INDIA NEED A PANDEMIC CONTROL AUTHORITY?

THE CONTEXT: During the COVID-19 second wave, the government’s efforts to tackle this unprecedented crisis have all but collapsed. Only a proper institutional design will ensure that we are equipped better to tackle future similar disasters.

PRESENT INSTITUTIONAL FRAMEWORK

• The Disaster Management Act, 2005, and Epidemic Diseases Act, 1897 are used to tackle the Covid-19 Pandemic.
• As public health is a state subject under the Indian Constitution, State Governments have issued orders under the Epidemic Diseases Act, 1897 (EDA)
• The National Disaster Management Authority (NDMA) issued guidelines considering the “coronavirus pandemic” as a “disaster” within the meaning of the Disaster Management Act, 2005 (DMA).
• The Disaster Management Act, 2005 provides those powers which the Epidemic Diseases Act, 1897 does not provide and allows the Central Government to take the necessary steps for a functional response.
• On the health advice side, there are bodies like the National Center for Disease Control (NCDC) and Indian Council for Medical Research (ICMR).

 NEED FOR A SEPARATE AUTHORITY

Limitations of Epidemics Disease Act, 1897:

• The EDA was enacted in the wake of the bubonic plague epidemic in 1896, in Bombay and it has just four sections. It doesn’t define “epidemic disease”. Its concise nature gives wide powers to the executive.
• The Central government’s power under this law only seems to be restricted to controlling the movement and detention of vessels at ports.

Disaster Management Act: 

• Disasters are normally geographically-localized catastrophic events, disrupting normal life for a few hours or days, but unlike a public health epidemic, do not last over a long period of time.
• While the DMA offers effective and aggressive measures to combat any kind of disaster, including epidemics, it may be inadequate due to two issues.

1. While the definition of a “disaster” under the DMA may be wide enough to include an epidemic, it does not contain any specific provisions or the graded approach to deal with the unique problems created by an epidemic.
2. Even the aggressive measures provided for in the DMA may be inadequate due to the exponential growth rate of the pandemic.

Others:

• The use of such an ad-hoc institutional architecture with a multiplicity of statues has resulted in a patchwork response against the epidemic in several areas.
• As the frequency of pandemics is expected to increase in the future due to factors like climate change and global warming, an empowered Central authority may be constituted with a clear mandate to control pandemics.

EXAMPLE OF DISASTER MANAGEMENT

• Looking at a parallel example, India has done well in its institutional design for tackling natural disasters other than pandemics.
• Through the Disaster Management Act 2005, the Union government set up multi-disciplinary Disaster Management authorities from the national to the state, district, and local levels.
• These authorities were assigned clear functions and responsibilities. A separate fiscal window was carved out to deal with natural disasters.
• The purpose of such a design was to create a rapid response structure free of bureaucratization.
• The success of this approach has been seen in the way India has since handled natural disasters such as floods, cyclones, and earthquakes.

DESIGNING AN EFFECTIVE SYSTEM FOR PANDEMICS

Basic Rules:

• First, functions ought to be carefully allocated to different levels as exclusively as possible. Some concurrency of action is inevitable, but too much overlap between the functions of different levels can create confusion and dilute accountability.
• Second, finance must follow function. No mandates must be given to institutions without giving them recourse to adequate resources for execution; if unfunded mandates exist, sooner than later, they will not be carried out.
• Third, every institution that is given a mandate must be given command and control over the staff and other capacities required to deliver that mandate effectively.

Pandemic Response Authority:

• There is a need to establish a high-powered Pandemic Response Authority at the national level and mimic the structure of the Disaster Management System.
• A Pandemic Response Unit should be established on the lines of NDMA like authority or body, having representation from both the Centre and states, responsible for designing and implementing well-coordinated surveillance, identification, contact-tracing, quarantine, isolation, testing strategy, and treatment.
• While establishing a new Pandemic Response Unit, care must be taken to avoid the danger of over-centralization. It is quite possible that a Pandemic Response Unit becomes a super-ministry, exercising unnecessary discretion and hampering effective response rather than aiding it.
• Ideally, what can be done at a lower level ought not to move upward. Only those residual matters that cannot be handled at a state or local government level need to be handled by an apex unit.
• Matters that have wide repercussions across jurisdictions are best centralized. So also are matters that enjoy scales of economy.

Functions:

• Four important matters in which a Pandemic Response Unit would add value would be in strategic medium-term and long-term planning, promoting research, international cooperation, and capacity-building.
• Develop, exercise, and periodically revise national and state pandemic preparedness and response plans in close collaboration with human and animal health sectors and other relevant public and private partners with reference to current WHO guidance.
• Anticipate and address the resources required to implement proposed interventions at national and sub-national levels, including working with humanitarian, community-based, and non-governmental organizations.
• Develop national surveillance systems to collect up-to-date clinical, virological, and epidemiological information on trends in human infection with seasonal influenza viruses, which will also help to estimate additional needs during a pandemic.
• Identify, regularly brief, and train key personnel to be mobilized as part of a multisectoral expert response team for animal or human influenza outbreaks of pandemic potential.

CONCLUSION:

Public health planning should have been strengthened, taking into account the experiences and lessons learned from the current crisis. Handling of the Covid pandemic in Indian states, in spite of scientific and public health advances, demands honest and critical reflections by policymakers and health experts alike. Political accountability has to be fixed and there is a need to get the management response right. It is priorities to set up systems that can work are set up, and they work right. If that is not done, we will continue to suffer far into the future.