Mumbai, August 16: In May, the WHO had termed swine flu a level 6 pandemic, and warned that it could not be contained, advising governments to focus on treatment instead. But our health ministry slept over it. Nor did it learn from the experiences of the US and UK. It’s only now, after the chaos and neglect, that it has announced a change of strategy.Agency spoke to experts in India and abroad to pin down the health minister, Ghulam Nabi Azad’s goof-ups.
The swine flu pandemicAlthough the World Health Organisation (WHO) had declared that swine flu had become a level 6 pandemic and its spread could not be contained, and that one-third of the people in the world will get it over the next two years, why did the Indian government waste precious time and resources on screening and testing instead of focusing on making treatment available immediately to those with the symptoms?
Professor Hugh Pennington, professor emeritus of microbiology at the University of Aberdeen, Scotland: The UK, too, had started off with screening thousands of people. But after a month, we realised there was no point in wasting resources over the inevitable — there is no stopping the H1N1 virus and the sooner a nation’s government accepts that, the more capable it will be in dispensing treatment. By then, there had been three large outbreaks in the UK — Scotland, West Midlands and London.
The UK government then woke up to the fact that containment is futile and directed all its attention to treatment to avoid fatalities. The US government has dealt with swine flu in the same manner. In fact, our current policy is to discourage people from turning up at hospitals, because that’s a great way to spread the virus! We have realised that the need of the hour is to set up treatment facilities for high-risk groups like pregnant women, patients with medical complications and children. You will barely spot an individual waiting to be screened for swine flu. In fact, a majority of the UK’s infected patients have been children and teenagers — a high-risk group. However, most of them are healthy thanks to the thrust on timely treatment.
Dr T John Jacob, former head, department of virology, Christian Medical College, Vellore: We were forewarned way back in May by the WHO that Phase 6 of the pandemic would hit the country. We had the time to formulate a strategic response, but did we do that? What did our system do these three months when we had the advantage of time? Did we in May set up a war room to tackle the flu? Wasn’t that the time for strategic intervention?
I think the government mixed up public health — where the community is important, not the individual — where you study the disease by tracking it, and individual health, where a single patient is primary. No wonder the crisis got out of hand. For the individual, the approach would be to start treatment and wait for the test results. You stop treatment if he is not affected, and if he is, you continue with it.
It is terrible to be left without leadership at a time when we are dealing with an issue of such immense visibility.
What lessons could the Indian government have learnt from the US and UK in dealing with swine flu?
Prof Pennington: The Indian government had a very big advantage over the US and UK who had to deal with severe cases of swine flu months before India did. I fail to see why there is so much focus on containment even now as we speak, when the WHO declared long ago that trying to control the virus from spreading is futile. Today, it is so easy to gather information on the policies of other countries – news on every strategy, its successes and failures were out there for the Indian government to exploit. The US and UK have relatively experienced health set-ups and everything the Indian government needed to know in the time it had, was available at hand. Why did it not build up on it and have resources ready to deal with the virus meanwhile? Why were regional offices not set up to give out timely advice?
Dr Jacob: Leave alone the experience of other countries, in India itself the Department of Medical Research had started work three years ago on a study of the flu virus across Chennai, Vellore, Lucknow, Delhi, Chandigarh and Kolkata. But the results of the study – that looked at the previous pandemic to hit India – have not yet been analysed.
Why did the Indian government not include private hospitals from the very outset in dealing with swine flu, whether in quarantining or treatment?
Dr Jacob: The WHO warning had said that the disease would spread fast. Given the numbers projected, a child of ten could have told you that we need the private sector to be involved in combating the disease.
Prof Pennington: I cannot stress enough what an important resource private hospitals are. At a time when the Indian government needed to gather all the resources it could, why did it isolate such a force? The government should have focussed on delivering the best healthcare it could – and that is just not possible if you keep private hospitals out.
Was the Indian government justified in restricting the use of Tamiflu initially, with the health minister, Ghulam Nabi Azad, claiming that it would make the virus mutate?
Prof Pennington: The UK too was unfortunately restrictive when the virus broke out, but the Indian government could have got wiser from our experience and moved straightaway to a treatment regime that is not so limiting – this includes its approach towards Tamilfu.
The UK set up pandemic planning departments and a part of the plan was to stock Tamiflu in large quantities. We now have helplines wherein a patient can list his symptoms and if the medically trained operator feels the case is serious enough, the patient is given another helpline number where he can avail of Tamiflu without any medical prescription. All efforts are simply on the need of the hour – that those with certain symptoms must get Tamiflu immediately.
We aren’t sure if the virus can mutate further with the use of Tamiflu. No links between the two have been found yet. Tamilfu is the only known treatment for those suffering because of the H1N1 virus, and we’d rather hand out the medicine than rely on unproven theories. The US is following the same policy. I am not sure what difference India can make to the spread of the virus in the world by withholding Tamiflu from the public.
—Agencies