Chandrakant Lahariya | In 2023, let's try to make India a healthier nation
The year 2022 is behind us and so is hopefully Covid-19, which arguably has become endemic in India. Though China’s biggest Covid-19 wave is ongoing, the possibility of a fourth national wave in India is negligible. In fact, the epidemiological evidence points that the end of the ongoing Covid-19 wave in China would pave a path for the end of the pandemic globally. But while the pandemic will undoubtedly end, but Covid-19 will remain with humanity for a long time, possibly forever, as an “endemic” disease. Clearly, the start of the year 2023 is the time we in India must move on from Covid-19 and use the learnings for further strengthening our health services.
Since the start of the pandemic, all countries across the world started to pay more social and political attention to strengthening health services. In India, public health has become the subject of national discussion and terms like vaccines, genome sequencing and disease surveillance have become a part of daily conversations. There have been policy decisions such as the launch of Ayushman Bharat Health Infrastructure Mission to strengthen public health laboratory and disease surveillance up to the block level and in remote areas as well. This is a good start; but more will be needed. There is a need that in 2023 and ahead, these decisions are followed through to make a difference at the ground level. Also, the government funding for health continues to remain low and it is time that the promises to increase government allocation for health are fully implemented.
Covid-19 was the first pandemic in the era of social media. It has reminded us that misinformation is a major challenge in tackling disease outbreaks and epidemics. There are many examples from three years of the pandemic when rumours or misinformation derailed public health interventions. Vaccine hesitancy and refusal, and the resulting lower vaccine coverage in some sections of the population, has been some of the outcomes of misinformation. Learning from all this, timely, evidence informed and reliable communication has to be part of all government health initiatives. The mechanisms need to be established to dispel any health misinformation in real time.
In November 2022, there was a measles outbreak in a few Indian states with the deaths of a few children. Measles is a fully vaccine preventable disease targeted for elimination from India. There is no reason even a single child should die due to measles. However, during the Covid-19 pandemic, much of health system attention was diverted to the Covid response, which resulted in reduced availability of essential health services such as childhood vaccination. The measles outbreak was just a tracer of this situation, and many other health services would also have been affected. As Covid has become endemic, in 2023, more attention should be given to the restoration of all health services.
Covid-19 has also taught us that vaccination is not just for children, but many vaccines are also for adolescents and adults. Apart from Covid, a few other vaccines such as Hepatitis-B, meningococcal vaccine, pneumococcal vaccine can reduce diseases in adults. These are especially useful for select vulnerable adult populations. The year 2023 is the time the government should start to prioritise, paying special attention to vaccinating the at-risk adult population. India now has an indigenously developed and low-cost HPV (Human Papilloma Virus) vaccine, which can protect adolescent age groups from cervical cancer and other ailments. It is time this vaccine is made available through a government programme in India.
Covid-19 has once again emphasised the importance of stronger health services and that of well-functioning primary health care services. The PHC services should be built around the people, where it is not just the treatment of disease but attention is on preventive and promotive services as well. In this context, the special session of the United Nations General Assembly on Universal Health Coverage in September 2023 is an opportunity for all countries including India to recommit to strengthening primary healthcare.
In 2017, India’s third and latest National Health Policy was released. The year 2023 should be used as an opportunity when India conducts a mid-term review of the progress made against the targets set in the National Health Policy 2017. Such a mid-term review should focus upon assessing inter-state disparities. India has 11 diseases which are considered “neglected tropical diseases”, such as filariasis, etc, which need higher policy and programmatic attention. Due to the better facilities of some states, the average of the nation recovers, but the weaker states have to pay a big price for it. The strengthening of health services in poor- performing states and districts should be given priority. The year 2022 has also taught us the importance of timely, granular and accurate health data. Such data is useful for health decision-making as well as to dispel the myths and rumours. Learning from the Covid pandemic, India should accelerate the availability of health-related data for every Indian state.
India has assumed the presidency of G-20, a group of the world’s largest economies. This is India’s opportunity to bring health issues to the fore globally. In particular, we in India need to play a leadership role in bringing and sustaining attention on the challenges of “anti-microbial resistance”, the coordinated global response to epidemics and pandemics, neglected tropical diseases, and focus on “one health” (health of humans, animals and the environment is related to each other). Learning from the Covid epidemic, the G-20 should take such collective steps, so there are no vaccine-related inequities in the future, as we had witnessed in Covid-19 pandemic.
To make health a sustainable agenda, the Indian government needs to consider establishing a mechanism for regular engagement and partnership between the troika of the government and policy makers; technical subject experts including clinicians, and policy makers and the community members. A formal mechanism for their regular engagement to formulate strategies and policies need to be created.
Economist and Nobel laureate Angus Deaton, in his 2013 book The Great Escape, has argued that much of the growth and development in European nations in last two centuries can be attributed to their actions in the areas of public health and medicine after the cholera pandemic of the 19th century and influenza pandemic of the 20th century. It remains to be seen what concrete and sustainable steps are taken in India — in 2023 and later — for improving the health of its citizens. The question is: If not now, then when?
