According to India’s Ministry of Health, around 530,000 people died from the COVID-19 pandemic in the second wave, more than most people in India. The pandemic has exposed both the vulnerabilities and strengths of the nation’s health system, providing valuable lessons on preparedness, response and resilience. In an increasingly interconnected world, the threat of infectious diseases is crossing borders with unprecedented speed and impact. India’s huge and diverse population, as well as its unique socioeconomic dynamics, make it particularly vulnerable to the rapid spread of infectious diseases.
As the global community grows with the evolution of pathogens, from new viruses to antibiotic-resistant bacteria, India’s role is critical not only for its citizens but also for regional and global health security. According to experts, preparing for future contagions is not a mere reactive exercise but a proactive engagement. It requires an integrated approach that includes surveillance systems, improved health infrastructure, community engagement and proactive policies.
Microbiologist and virologist Dr. Gagandeep Kang | Photo credit: SPECIAL ARRANGEMENT
Devastating consequences
In a recent lecture entitled Outsmarting outbreaks: The future of contagionAt the Bangalore International Centre (BIC), microbiologist and virologist Gagandeep Kang spoke about the history and continued existence of infectious diseases with devastating consequences in India.
Dr. Kang spent three decades at the Christian Medical College (CMC), Vellore, building national surveillance networks for rotavirus and typhoid to estimate disease burden, test vaccines and inform policy decisions. Today, she is the Director of the Bill & Melinda Gates Foundation’s Global Health team, responsible for enterology, diagnostics, epidemiology and genomics. She is the first Indian woman to be elected a Fellow of the Royal Society, a 2016 Infosys Prize winner and co-author of the best-selling book “ Until we win: India’s fight against the COVID-19 pandemic.
In her talk, she explained that the extension of human lifespan in the 20th century was due to our ability to control the scourges of the past – smallpox, tuberculosis, plague and malaria – through cleaner water and sanitation, medicines and vaccines. Dr Kang, a physician and scientist who has worked on vaccines and public health, particularly children and intestinal infections in India, said that science has transformed society but with climate change, new threats could and would emerge. She explained why India, as the world’s most populous country, needs to be prepared for its people and the world with data and models for new technologies.
A healthcare worker and a Delhi Civil Defence volunteer collect swab samples from passengers for an RT-PCR test at Delhi Cantt railway station in New Delhi during the Covid-19 pandemic. | Image credit: Shiv Kumar Pushpakar
Pandemic and epidemic
Dr. Kang said the list of outbreaks has grown over the years to the point where there is now a virus named after all 26 letters of the English alphabet.
“Endemic diseases are diseases that are persistent in a population or region and spread relatively little. In contrast, an epidemic is a sudden increase in cases that spreads across a large population, while a pandemic is a sudden increase in cases across multiple countries, continents, or the world. Over the past 30 years, the number and variety of outbreaks have increased dramatically, from A to Z, from AIDS to Zika. This increase is due to factors such as growing trade, travel, population density, displacement, migration, deforestation, and climate change, and signals a new era of increased epidemic risks. In particular, most large outbreaks that spread easily are caused by viruses,” she added.
Dr Kang explained the epidemics and pandemics that India and the world have experienced in the past and how to identify a disease caused by an infectious agent. “When we had smallpox, people did not know the differences between bacteria, viruses or parasites. Even malaria was called ‘malaria’ or ‘bad air’ because people thought that malaria was transmitted through the air in swamps and did not understand that the disease was transmitted by mosquitoes. It was Robert Koch, popularly known as the father of microbiology, who came up with the ‘Koch’s postulate’, which was a set of rules to establish a relationship between a microorganism and a disease,” she said.
John Snow, father of epidemiology, was responsible for identifying a street pump as the cause of cholera in London. He made a map of all the cholera cases reported in London and used his map to identify the water sources of all the houses with cholera. He found that everyone got their water from the street pump and the households that did not have cholera had other water sources. “John Snow immediately removed the handle of the pump and the outbreak stopped. We still follow the principles he laid down and must continue to do so to be able to link disease to what is happening in the population and think about control methods,” explained Dr. Kang.
Health workers conduct door-to-door COVID-19 tests in Mukund Nagar, Dharavi slum area of Mumbai during the nationwide lockdown. | Photo: VIJAY BATE
Where is India?
When asked why some people are hesitant about vaccination even during a pandemic like COVID-19, Dr Karg said, “In India, hesitancy and lack of confidence in vaccines has been around for a long time. There are people who believe in vaccines, people who are a little hesitant but can be convinced, and some who are fanatical and cannot be convinced no matter what you do. The important part is to find out where on the spectrum most people are and whether it is worth investing time in them and convincing them to get vaccinated is the question.”
Dr. Kang said infectious diseases will continue to pose a threat. “In the future, there will still be endemic diseases, emerging and re-emerging diseases, and bioterrorism. Infectious diseases, especially those transmitted by healthy people, can spread rapidly around the globe. Antibiotics will pose a threat. The combination of infectious diseases and non-communicable diseases reduces the effectiveness of our means of preventing and treating disease. All of this is something we already know,” she said.
How, when and where?
“What we don’t know, however, is when, where and how big the next outbreak will be. How big will it be? What will it take for countries to work together and share data and resources? That’s something that both India and countries around the world need to work on,” Dr Kang said.
