In order to see the road ahead clearly, we have to constantly look back and learn from past experiences. As India moves toward another important milestone of being an independent nation for seventy five years, the need of the hour is to protect and provide medical aid to its 1.37 billion people from the Novel Coronavirus Disease.
Plagues are not new to mankind and regrettably, the plague of the coronavirus may not be the last. India has been scarred by many plagues and epidemics in its history as a nation. One of the most devastating plagues in colonial India was the Bombay Plague of 1896. Starting with a major outbreak in south western China around 1855, the plague swept across the Chinese mainland and reached the port city of Hong Kong in 1894. From there it was imported to Bombay through naval commercial routes. The railways and shipping lanes established by the British acted as gateways for the plague pathogen and by March, 1897, it had found its way inland causing widespread devastation in many parts of the country. Between the plague’s arrival in 1896 and 1921, an estimated 12 million Indians lost their lives.
When the plague made its first appearance, there was reluctance to admit the severity of the problem. The Indian physician, Dr. A G Viegas discovered symptoms of bubonic plague on one of his patients, but when he made his diagnosis public, aspersions were cast on his findings and he was warned against “scaremongering”. Efforts to curb transmissions like identifying and isolating plague victims, disinfecting infected dwellings and inspecting travellers resulted in fear and panic and caused mass exodus of people from cities to rural areas thereby facilitating a speedier and further spread of the pathogen. Anti-plague measures introduced by the government were met with hostility. The implementation of the draconian Epidemic Diseases Act in 1897 which gave the authorities widespread powers to stop social and religious fairs and festivals, inspect male and female railway passengers, enter and investigate private homes, drag suspected cases to hospitals and burn their belongings inspired fear rather than security and reignited anti-colonial sentiments among all classes of Indians. Fearing a repetition of the 1857 Sepoy Mutiny, the government moderated some of the measures and eventually, people got used to them.
It was the Ukrainian bacteriologist, Dr. Waldemar Haffkine who developed a vaccine against the plague pathogen but this solution came with its own set of problems as people refused to be inoculated for religious and superstitious reasons. Although the vaccine was quite successful in protecting the inoculated against the plague, rumours and misinformation persisted and most of the time prevailed. The variety of cultures, religions and indigenous beliefs within the country also weakened faith in western methods.
Independent India witnessed many epidemics which were highly transmissible and were initially thought to be incurable and ineradicable. But India managed to eradicate these scourges and they are monumental achievements brought about by sheer commitment, dedication and sustained efforts. The country was riddled with recurring outbreaks of smallpox over centuries. It was a pestilence that claimed many lives. When the World Health Organisation (WHO) launched an Intensified Smallpox Eradication Programme in India in 1957, India had the most cases of smallpox in the world. The campaign was a massive effort of search – surveillance – containment. It requires management of logistics as health workers and doctors made house-to-house visits, community mobilisation as many victims were afraid of social stigma and isolation and the introduction of innovative methods like “ring-fencing” of smallpox hotspots or vaccinating people around these hotspots to interrupt the spread of the disease. The process was time-consuming and frustrating but the results were magnificent. Saiban Bibi became the last recorded smallpox case in the country in 1975 and two years later, the WHO declared India smallpox free and the campaign was hailed as one of the greatest public health successes globally.
Between 1970 and 1990, polio made its way to India. Until the early 1990s, India was hyper-endemic for polio, with an average of 500 to 1000 children getting paralysed daily. India rolled out the Pulse Polio Immunisation Programme on 2nd October 1994, when the country accounted for around 60 per cent of the global polio cases. Here too, commitment and sustained investments and efforts on the part of the authorities to provide equitable vaccine access to all, micro-planning to reach the remotest locations and community mobilisation to address concerns regarding vaccine hesitancy paid huge dividends and India has not had a case of polio since 2011 and was officially declared polio-free in 2014. These aggressive campaigns are legacies to an improved public health system in the country and they serve as examples that eradication of infectious diseases is possible when political will and commitment collaborate and cooperate with the community.
The Surat Plague in 1994 deserves mention because although it lasted for a little over two weeks, it was significant in the unprecedented panic and global repercussions it caused. It also demonstrated the disastrous effects of rumours and misinformation. When news of the plague broke out in September 1994, people were gripped by fear and hysteria. They fled the affected zones and headed in all directions instead of staying in quarantine to curb the spread. There was panic buying of medicines and surgical masks. The Union Health Ministry did not issue any statements to clarify the situation. Local press added to the confusion by exaggerating the death toll.
Lack of information on how to deal with the situation created panic and confusion and people with normal fever were labeled plague cases. Internationally, there was fear of the spread of the plague and the United Arab Emirates suspended all cargo from India, the share of value of agricultural products tumbled and several countries imposed restrictions on Indian travellers. In spite, of the initial confusion, the government successfully stemmed the spread and the actual number of suspected cases was registered at 698 and the death toll in Surat was 56. The Surat case taught India the necessity of preparedness and proactive response and the National Institute for Communicable Diseases’ plague research unit was modernised.
In the 21st century, there has been a continuous evolution of new infectious threats to human health that emerge often without warning and countries all over the world remain vulnerable and India is no exception. In 2009, a novel influenza virus, H1N1, started to spread creating the first influenza pandemic of the 21st century. India reported its first swine flu (H1N1) case in 2009 and since then a huge number of cases were reported and by March 2015, with nearly 30,000 confirmed cases and almost 3000 deaths, swine flu led to significant morbidity and mortality. The worst affected states were Rajasthan, Gujarat and Delhi. The government of India issued guidelines suggesting people to maintain social distance, hand hygiene and coughing and sneezing etiquette and to avoid crowds. In a Covid-19 infested world, these measures are all too familiar and the WHO has also said that Covid-19 is at least ten times deadlier than swine flu.
Now, as Covid-19 rages across the country, the Indian Council of Medical Research (ICMR) credited the experience of the swine flu outbreak in shaping India’s Covid-19 testing strategy. With the lessons learnt from 2009, India could immediately scale up its testing facilities by adopting an “intelligent testing strategy” to trace and track the virus and anticipate areas where testing would be required and all possible institutions – public or private like laboratories, universities and private medical colleges were identified and roped in. Indian companies were also helped to develop and scale up indigenous production of testing kits while ensuring quality and standards were met.
While this worked out well during the first wave of the pandemic, the situation is now entirely different. The ferocity of the second wave has shocked and shaken the nation to its core. People gasping for breaths queuing outside hospitals only to be turned away, mass graves and cremation sites are grim sights that define the country’s struggle against Covid-19. A striking similarity to previous plagues and epidemics in the pattern of fear and anxiety is also noticed around the country. However, in spite of the many controversies around vaccine production and vaccine procurement and distribution, the vaccination drive has begun in earnest and the government asserts that India is on track to vaccinate its entire population by December.
India has always been the largest producer of vaccines in the world. As early as 1955, it was producing penicillin at Hindustan Antibiotics Limited, a public sector company. But its standing in this grand position is now being threatened because of a shortage of raw materials that are usually imported, stalling its vaccine production capacity. If India is to meet its set target and protectall its people from the coronavirus, it has to strike a balance between its domestic and foreign policies as far as vaccine production, procurement and distribution is concerned.
Epidemics and pandemics have the potential of infecting an ever-greater number of people. They have a catastrophe impact on the economy disrupting social life, trade and livelihood, more so in the 21st century where viruses are evolving and mutating into deadlierstrains and variations. Historically, vaccines have played a crucial role in halting the spread of infectious diseases. In India, there is widespread vaccine hesitancy that can put the country’s fragile gains against Covid-19 at risk. Given India’s vast geographical terrain, climate and lack of basic health infrastructure, vaccination drives in India have always been mammoth and challenging tasks, but the hesitation of people to cooperate makes it even harder. Fuelled by rumours, misinformation and mistrust, many people are refusing to take the vaccine in rural and urban areas as well.
A new word has entered the public health vocabulary: “infodemics”. It refers to the rapid spread of information of all kinds, including rumours, gossip and unreliable information through social media, the internet and other communication technologies. They produce diverse and often contradictory views which generate confusion, anxiety and panic causing reluctance of the public to adopt well-founded control measures by health authorities. Thus, apart from the need to prioritise surveillance, preparedness efforts and long term investments to strengthen health systems, risk communication has become an increasingly important skill that has to be inculcated in health professionals in order to maintain credibility and public trust.
Now more than ever, we have to remember that our survival depends on our cooperation. National as well as global health begins with the individual and we are only as strong as our weakest link. Unless we realise that the safety of our loved ones depends on our safety, we will always be at risk and we will always be complacent and complacency is one of our biggest enemies. We have to come out of the mindset that thinks only of the self and remember our responsibilities towards our fellow humans. Mahatma Gandhi had said that “Interdependence is and ought to be as much the ideal of man as self-sufficiency… [Man’s] social interdependence enables him to test his faith and to prove himself on the touchstone of reality” and the reality is that we are all connected to each other and no one is safe until everyone is safe.
The Covid-19 pandemic is wreaking havoc all over the world but on the flip side, humanity is in full bloom. The coronavirus has not managed to stamp out humanity. There are plenty of caring, brave and selfless people who are making life a little better. From a rickshaw driver who is offering free rides to those who need to get to hospitals, to people who are distributing free food and supplying free oxygen, from groups who are performing funeral rituals for Covid victims without discriminating on the basis of religions or castes to others who are opening the doors of their properties to help ease India’s Covid-19 burdens, the pandemic has seen Indians from all faiths and ethnicities coming together to save lives, on individual and community levels. Driven by sheer humanity, they exemplify that “the greatness of humanity is not in being human, but in being humane” (Mahatma Gandhi). These humane souls also give meaning to the phrase “Unity in Diversity” which celebrates what India is all about. (The author is an Assistant Professor, Department of English, Synod College, Shillong)
