Pandemic preparedness: Learning from COVID-19 and Nipah to build a resilient future

For India to mitigate future pandemics effectively, it must expand the ‘One Health’ model nationally, creating a network of One Health centres dedicated to monitoring potential disease outbreaks, studying environmental factors, and tracking animal-human disease transmission patterns

As we observe International Epidemic Preparedness Day on December 27, India stands at a crucial juncture in its journey towards building robust health security systems. The COVID-19 pandemic and recurring Nipah outbreaks in Kerala have provided valuable insights that can shape our approach to future health emergencies. 

The Kerala model

Kerala’s successful management of Nipah outbreaks since 2018 offers a compelling blueprint for handling emerging infectious diseases. The State’s response demonstrates how local healthcare systems can effectively contain potential pandemic threats through rapid detection, systematic contact tracing, and coordinated public health measures. The Kerala model emphasises three critical elements: early detection through surveillance, swift response via established protocols, and proactive community engagement.

The State’s experience with the Nipah virus underscores that successful containment requires a multi-pronged approach. This includes strengthening healthcare infrastructure, establishing clear communication channels, and maintaining robust surveillance systems. Importantly, Kerala’s ability to detect and contain single-case spillovers demonstrates the necessity of vigilance, even during non-outbreak periods.

Engaging with communities

The Nipah virus outbreaks in Kerala have highlighted the critical importance of engaging with communities, particularly those living in close proximity to animals, in health surveillance and preventive measures. One key lesson is the necessity of proactive education about zoonotic diseases. Communities must be informed not only about the risks associated with animal-to-human transmission but also about practical steps they can take to reduce these risks. This involves teaching them about the signs of illnesses in animals, the importance of proper sanitation, and safe practices related to handling animals and their products. Open lines of communication ensure that community members feel empowered and motivated to participate in health initiatives, thus fostering a collaborative approach to outbreak prevention. 

Another vital lesson is the importance of building trust through consistent engagement and involvement. Establishing strong relationships with community leaders and local organisations can bridge gaps between health authorities and the public. These trusted figures can act as conduits to disseminate information and mobilise community action during health crises. Additionally, incorporating local knowledge, such as cultural practices and environmental connections to wildlife, can enhance disease prevention strategies. When communities feel their voices are heard and their input is valued, they are more likely to adhere to public health recommendations and cooperate with health authorities during outbreak responses, ultimately leading to more effective containment measures.

The significance of ‘One Health’

The emergence of zoonotic diseases like Nipah and COVID-19 highlights the critical importance of the ‘One Health’ approach. This framework recognizes the interconnectedness of human health, animal health, and environmental factors. Kerala’s establishment of the One Health Centre for Nipah Research and Resilience (KOHCNRR) represents a significant step toward implementing this approach.

For India to mitigate future pandemics effectively, it must expand this model nationally, creating a network of One Health centres dedicated to monitoring potential disease outbreaks, studying environmental factors, and tracking animal-human disease transmission patterns. This approach is particularly relevant in light of India’s diverse ecology and high population density, which create numerous opportunities for disease spillover events.

A key lesson from both COVID-19 and Nipah outbreaks is the importance of early detection through comprehensive surveillance systems. To enhance preparedness, India needs to strengthen its Integrated Disease Surveillance Programme (IDSP) in the following ways: establishing more diagnostic facilities with advanced testing capabilities; implementing real-time data-sharing systems across states; training healthcare workers in early detection of unusual disease patterns; creating networks of sentinel surveillance sites in high-risk areas and integrating human and animal health surveillance systems.

The path ahead

The pandemic exposed gaps in our healthcare infrastructure. Moving forward, India should focus on several key areas, critical among them: creating dedicated isolation facilities in major hospitals; establishing clear protocols for managing highly infectious diseases; maintaining stockpiles of essential medical supplies and protective equipment; training healthcare workers in infection control practices and developing surge capacity plans for emergency situations.

India’s experience with COVID-19 vaccine development demonstrates our capability to respond to health emergencies; however, we need sustained investment in research on emerging infectious diseases and development of diagnostic tools and therapeutics. In addition to paying attention to vaccine research and manufacturing capabilities and genomic surveillance infrastructure, collaborative research networks with international partners are absolutely essential.

Future preparedness plans should include a number of communication strategies that will help influence health-seeking behavior. This includes laying out clear communication strategies for health emergencies, in addition to continuing, steadily, all regular public health education programmes, besides engaging with community leaders and local organisations. More importantly, as witnessed during the COVID-19 pandemic we must put in place robust systems for countering misinformation, and additionally, exhibit cultural sensitivity while implementing control measures.

Given India’s geographical position and population mobility, cross-border disease surveillance and coordination are crucial. We need very strong international collaboration mechanisms and standardised protocols for information sharing. Joint response exercises with neighboring countries, on the lines of what happens with bilateral military exercises, and collaboration with regional disease surveillance networks are vital. Such sharing will be possible, we must remember, only if we have harmonised quarantine and testing procedures. The pandemic, as we know, accelerated digital health adoption. Thanks to this, we now know that future preparedness should include robust telemedicine systems, digital disease surveillance platforms and electronic health records. While AI-powered disease prediction systems are gaining ground, the value of mobile health applications were once again apparent during the pandemic. 

The economic impact of COVID-19 that we have already witnessed demonstrates the need for financial preparedness. This means ensuring dedicated funding mechanisms for emergency responses, readying insurance systems for pandemic-related healthcare and providing economic support systems for affected communities. If we are able to plan for supply chain resilience and public-private partnership frameworks, we are reasonably prepared for the future and we might be able to avert some of the economic fall-outs of a health crisis.

India needs a comprehensive pandemic preparedness policy framework that includes clear command and control structures, and standard operating procedures for different scenarios. Unless existing health systems keep up with regular mock drills and simulations, it is likely they will be out of touch at the time of a crisis. It is necessary to update public health laws and also ensure that inter-state coordination mechanisms work well. 

Learning from the past 

As we face an increasingly interconnected world with growing pandemic risks, India must build on these lessons to create a comprehensive preparedness system. This requires sustained investments in public health infrastructure, research capabilities, and human resources. The recurring Nipah outbreaks in Kerala serve as constant reminders that the next pandemic threat could emerge anywhere, anytime. Our preparedness systems must be agile enough to respond to known threats while being robust enough to handle unknown ones.

Success in pandemic preparedness requires a whole-of-society approach, bringing together government agencies, healthcare providers, research institutions, and communities. Only through such coordinated efforts can we build a resilient health system capable of protecting our population from future health emergencies.

The time to prepare is now. As we mark International Epidemic Preparedness Day, let it serve as a reminder that investing in preparedness today is far less costly than responding to pandemics tomorrow. India’s experience with COVID-19 and Nipah provides a valuable lesson: it’s crucial that we learn from them to build a safer, more prepared future. 

(Dr. Anoop Kumar A.S. is director, Critical Care Medicine, ASTER North Kerala Cluster, anoop.as@asterhospital.in

Dr. Anish T.S. Is Nodal Officer, Kerala One Health Centre for Nipah Research and Resilience, Kozhikode. doctrinets@gmail.com)

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Published - December 27, 2024 07:00 am IST