After 2009, India is once again reeling under the grip of swine flu. It has killed close to 500 people and infected more than 10 times that number. Although it is a less lethal disease than ebola, which broke out in West Africa in mid-2014 and killed a much higher proportion of infected people, swine flu has created a panic in some parts of India, particularly where the winter has dragged on. But the authorities cannot afford to wait for a change of weather to do its bit. The worst-hit States are Rajasthan, Gujarat, Madhya Pradesh, Maharashtra and Telangana. Delhi has reported six deaths in over 1,100 cases, which shows that awareness and early treatment are half the battle won. The Centre has reportedly ordered 60,000 Oseltamivir (Tamiflu) pills and 10,000 diagnostic kits. This may fall short if there is a spike in infections. The Centre has erred in not placing sufficient orders for the flu vaccine manufactured by three Indian companies, priced at ₹100 a vial. As a result, vaccine shots in Hyderabad are selling at ₹450-1,000 a shot. The vaccine is essential for health workers who are most vulnerable to contracting the disease and becoming carriers. If the crisis persists, India should seek the WHO’s active support and, if necessary, use compulsory licensing to procure the necessary quantities of Tamiflu or Relenza.
It is surprising that the Draft National Health Policy (and the Twelfth Plan document of the UPA) has virtually nothing to say about tackling avian flu and swine flu. Therefore, the Centre has no policy template to fall back on and is unable to formulate a coherent response. This could be in the form of information dissemination, reinforcement of personnel and material in major hospitals, and creating a PPP mechanism to reimburse private players for subsidised testing and treatment. The last becomes important to ensure that patients are not turned away at the hospital gate.
Such epidemics also point to the failure of India’s urbanisation project, besides reminding us that Swachh Bharat has yet to show concrete gains. Poor sanitation, overcrowding and creaky public health systems — in India and West Africa — create the right conditions for swine flu, malaria, encephalitis and ebola to thrive. Public health spending, at just above 1 per cent of the GDP, must at least be doubled to break out of this disease trap. What is forgotten in the discourse on public health — focused on countering disease vectors — is the nutritional profile of the population, a critical factor in building immunity. Swine flu is particularly dangerous for those with poor resistance to respiratory tract problems. A holistic approach to well-being is called for — where policies on nutrition, public health, pharma, sanitation and urban planning come together. This should be a core concern of the new health policy.