A view from here
A man said to the universe, “Sir, I exist.”
“However”, replied the universe, “the fact has not created in me a sense of obligation.”
-Stephen Crane

Emerging new viral threats-How Prepared Are We?

If yellow fever were to strike India, how many of us would be in a situation to diagnose it?” Said one of our leading Infectious disease experts in a discourse on threat posed by emerging new infectious diseases. ‘Diagnosis’ would be an inappropriate word to use, given the state of health system and infrastructure in the country; I’d be surprised if someone even suspects it! The system comprising of medical professionals, public health experts and planners, medical institutions and investigating agencies, all are quite ill equipped to deal with the situation.
Thinking process and diagnosing acumen of most medical professionals are clouded today. They are not provided with the enough ‘ammunition’, skill and expertise to think laterally, to test new hypothesis and experimenting away from the routine right from their post graduation days where more emphasis is placed on providing the results and later restructuring them in accordance with what is already known and published in the literature. And any variation from the existing pattern usually finds the disapproval from their guides. So, the mindset of a fresh medical professional is tuned to follow a set pattern of evolution of an existing entity. They are indeed shut-off from thinking beyond what is already known on the subject. This is probably the bane rotting most medical institutions of our country, which is being further compounded by their inability to lure good faculty, of late. The faculty even in some reputed medical institutions and colleges is fast fading in to mediocrity. Hundreds of seats of faculty are either lying vacant across the country in most medical colleges or being filled up by the candidates not well equipped to do justice to the jobs! It is no more the most sought after job for an aspiring bright medical professional today who finds private sector far more lucrative. Even the medical curriculum is deficient on this count and you would hardly find a chapter fully devoted to intricacies of investigating and managing a new emerging illness, the threat of which is looming larger than ever given the population heterogeneity, ecologic changes, concomitant with increasing contact between humans and animals, global warming, and amount of mobility a modern man has acquired.
Blaming the medical institutions and professionals is only the insignificant part of the whole story. The major fault lays with the public health delivery system-its planners, experts, executers and the infrastructure, which is woefully ill equipped to deal with even the routine diseases prevailing in the country. And, what else can you expect from a country that spends merely 0.9% of its GDP on public health and placed right at the bottom of UN list of countries ranked on basis of public spending on health! But, perhaps, the most wanted sphere is the scarcity and poor state of most medical investigating agencies of the country. The good, reliable and competent of them can be counted on tips. Even these are badly affected by the excessive workload, poor infrastructure and lack of modernization, scarcity of funds, and high political interference. No wonder, all these factors contributed to undermining their credibility.
Hence, investigating a new, unknown disease has become a laughing stock in the country! Take the example of an epidemic of a deadly disease in Siliguri in 2001. Even after 3 years of excessive investigation and intense media coverage, we still do not know which bug provoked that lethal epidemic. From Hantavirus to Atypical Measles to Nipah virus- all were incriminated for the calamity that killed more than 40 people in no time! In a recent virological investigation of simple viral fever cases, few strains of West Nile virus were isolated in Maharastra. The annual introduction of new viral agents in to human’s environment and their acquisition of a new trait called, ‘interspecies jumping’, a new pool of ‘exotic viruses’ has emerged. Considering the abysmal state of microbial surveillance system in the country, and going by the number of epidemics being assigned the tag of ‘mysterious’, ‘unidentified’ illnesses, we do not know for sure how many members of this newly formed group are already doing rounds in our neighborhood.
Containing an emerging disease depends on rapidly designing and implementing a control strategy appropriate to the epidemiology of the disease. Interdisciplinary and international collaboration are the need of the hour to rapidly combat the offending pathogen and evolving epidemic. The success of NPSP has provided us a platform on which a competent disease surveillance system can be erected and use for tracking and cracking the new emerging infectious diseases in future. There is indeed an urgent need to reform the existing system at all the levels, from restructuring the medical curriculum and reorienting the medical professional to revamping and upgrading the medical institutes to overhauling the mindset of public health planners and experts! Establishment of more virological research labs that are capable of handling, isolating and containing the new microbial agents at peripheral level and networking them with other national and international investigating agencies is what sorely needed today. Provision of more funds and upgrading the technology to hone the skills of existing so-called ‘premiere national investigating agencies’ should take topmost priority.

-Vipin M. Vashishtha

Bottom-line
"The world began without man, and it will complete itself without him."
-Claude Levi-Strauss.