Context

A well-functioning system can reduce the impact of diseases and outbreaks.

Importance of disease surveillance system

• Successful tackling of cholera in 1854 in London by use of the health statistics and death registration data from the General Registrar Office (GRO) started the beginning of a new era in epidemiology.
• Importance of data: The application of principles of epidemiology is possible through systematic collection and timely analysis, and dissemination of data on the diseases.
• This is to initiate action to either prevent or stop further spread, a process termed as disease surveillance.
• Subsequently, the high-income countries invested in disease surveillance systems but low- and middle-income countries used limited resources for medical care.
• Then, in the second half of the Twentieth century, as part of the global efforts for smallpox eradication and then to tackle many emerging and re-emerging diseases, many countries recognised the importance and started to invest in and strengthen the diseases surveillance system.
• These efforts received a further boost with the emergence of Avian flu in 1997 and the Severe Acute Respiratory Syndrome (SARS) outbreak in 2002-04.

Surveillance in India

• The Government of India launched the National Surveillance Programme for Communicable Diseases in 1997.
• However, this initiative remained rudimentary.
• In wake of the SARS outbreak, in 2004, India launched the Integrated Disease Surveillance Project (IDSP).
• The focus under the IDSP was to increase government funding for disease surveillance, strengthen laboratory capacity, train the health workforce and have at least one trained epidemiologist in every district of India.

Issues with surveillance: Interstate variation

• Variation among states: The disease surveillance system and health data recording and reporting systems are key tools in epidemiology.
• In the fourth round of serosurvey, Kerala and Maharashtra States could identify one in every six and 12 infections, respectively; while in States such as Madhya Pradesh, Uttar Pradesh and Bihar, only one in every 100 COVID-19 infections could be detected.
• This points towards a weak disease surveillance system.
• In a well-functioning disease surveillance system, an increase in cases of any illness would be identified very quickly.
• While Kerala is picking the maximum COVID-19 cases; it could pick the first case of the Nipah virus in early September 2021. 
• On the contrary, cases of dengue, malaria, leptospirosis and scrub typhus received attention only when more than three dozen deaths were reported and health facilities in multiple districts of Uttar Pradesh, began to be overwhelmed.

Way forward

• A review of the IDSP in 2015, conducted jointly by the Ministry of Health and Family Welfare, the Government of India and World Health Organization India had made a few concrete recommendations to strengthen disease surveillance systems.
• These included increasing financial resource allocation, ensuring an adequate number of trained human resources, strengthening laboratories, and zoonosis, influenza and vaccine-preventable diseases surveillance.
• Increase allocation: The government resources allocated to preventive and promotive health services and disease surveillance need to be increased by the Union and State governments.
• Trained workforce: The workforce in the primary healthcare system in both rural and urban areas needs to be retrained in disease surveillance and public health actions.
• The vacancies of surveillance staff at all levels need to be urgently filled in.
• Capacity increase: The laboratory capacity for COVID-19 needs to be planned and repurposed to increase the ability to conduct testing for other public health challenges and infections.
• The interconnectedness of human and animal health: The emerging outbreaks of zoonotic diseases, be it the Nipah virus in Kerala or avian flu in other States as well as scrub typhus in Uttar Pradesh, are a reminder of the interconnectedness of human and animal health.
• The ‘One Health’ approach has to be promoted beyond policy discourses and made functional on the ground.
• Strengthening registration system: There has to be a dedicated focus on strengthening the civil registration and vital statistics (CRVS) systems and medical certification of cause of death (MCCD).
• Coordination: It is also time to ensure coordinated actions between the State government and municipal corporation to develop joint action plans and assume responsibility for public health and disease surveillance.
• The allocation made by the 15th Finance Commission to corporations for health should be used to activate this process.

Consider the question “Examine the measure for disease surveillance in India? How it can help reduce the impact of the diseases?”

Conclusion

We cannot prevent every single outbreak but with a well-functioning disease surveillance system and with the application of principles of epidemiology, we can reduce their impact.

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