Resilience In Action: NITI Aayog’s Vision For Pandemic Preparedness And Global Collaboration – IMPRI Impact And Policy Research Institute

Policy Update
Meenu Mohan

The recently released report, “Future Pandemic Preparedness and Emergency Response: A Framework for Action”, by the Expert Group constituted by NITI Aayog, offers a comprehensive roadmap for managing future public health crises. The Expert Group, tasked with drawing on both national and global experiences of COVID-19 to design an actionable framework for pandemic preparedness and emergency response, based its recommendations on the lessons learned from the challenges and successes encountered during the COVID-19 pandemic, as well as insights from other public health crises. 

Pandemic and Response: A Historical Perspective

Pandemics have profoundly shaped human history, from the Black Death to the Spanish Flu, causing widespread suffering and disruption. While pathogens differ, challenges in containment, treatment, and prevention remain consistent. Modern factors like globalization, urbanization, and climate change have increased the frequency and spread of infectious diseases.

Technological advances, such as rapid pathogen sequencing and vaccine development, offer crucial tools in combating pandemics. However, the digital age also introduces challenges, including misinformation and cyber threats to healthcare systems. Social media can spread both valuable information and harmful conspiracy theories, complicating responses.

Science and international cooperation are essential in addressing pandemics. Innovations in vaccines and diagnostics have saved lives, but their effectiveness depends on global collaboration. The World Health Organization (WHO) plays a vital role in coordinating efforts, providing guidance, and enabling the sharing of resources and knowledge. By working together, nations can better manage and mitigate the impact of pandemics.

Lessons from the Past: Dealing with Epidemics in the Last Two Decades

Between 2009 and 2022, the World Health Organization (WHO) declared seven Public Health Emergencies of International Concern (PHEICs). A PHEIC is defined as an extraordinary event that poses a public health risk to other countries through international spread and requires a coordinated international response. In recent years, various infectious disease outbreaks have emerged, resulting in significant loss of lives, property, and economic repercussions.

Notable Outbreaks and Lessons Learned

1. SARS (2003)
   • Description: Originated in China, spreading to over 50 countries within months, causing approximately 850 deaths.
   • Learnings:
     • The need for international legally binding regulations.
     • Challenges in identifying novel pathogens and the importance of timely diagnostic tests.
     • Development of core capacities for screening and quarantine at international airports.
2. Avian Flu (H5N1)
   • Description: Repeated outbreaks in birds since 2005, with human cases reported, particularly in the US (2024).
   • Learnings:
     • Importance of surveillance for at-risk populations and culling infected birds to prevent human infection.
     • Establishment of a standing committee on zoonosis to enhance coordinated response.
3. H1N1 Pandemic (2009)
   • Description: Originated in Mexico, spread to 74 countries, resulting in 491,000 lab-confirmed cases and 18,449 deaths; first pandemic declared as PHEIC under IHR (2005).
   • Learnings:
     • Importance of IHR (2005) and the development of core capacities for surveillance and response.
     • Implementation of public health measures (screening, contact tracing) to mitigate the spread.
4. Ebola Outbreaks (2014-2016; 2018-2021)
   • Description: Significant outbreaks in West Africa that spread to multiple countries.
   • Learnings:
     • Effectiveness of screening, surveillance, and health education in controlling outbreaks.
     • Importance of protective measures (e.g., PPE) for healthcare workers.
5. MERS-CoV (2012-Present)
   • Description: Ongoing outbreaks primarily in the Middle East, with international spread risk exemplified by the South Korea outbreak in 2015 (186 cases, 34 deaths).
   • Learnings:
     • The challenges of preventing zoonotic diseases, especially those transmitted via respiratory droplets.
     • Recognition that many pandemic threats arise from novel zoonotic viruses.
6. Zika Virus Disease
   • Description: Aedes mosquito-transmitted disease spread to over 90 countries; detected in 12 US states.
   • Learnings:
     • High rates of asymptomatic cases complicate public health response.
     • Necessity for effective vector surveillance and multi-sectoral collaborative efforts.

These lessons underscore the need for robust preparedness measures, international cooperation, and a coordinated response to effectively manage and mitigate the impact of future infectious disease outbreaks.

The Future of Pandemics

The COVID-19 pandemic has highlighted the urgent need for preparedness and response to future pandemics. As the world continues to grapple with the challenges of globalization, climate change, and emerging infectious diseases, it is essential to invest in research, develop robust healthcare systems, and foster international cooperation.

Understanding the historical context of pandemics, recognizing the evolving landscape of threats, and leveraging technological advancements and international collaboration, helps in better preparing for and responding to future outbreaks. The future of pandemics depends on our ability to learn from the past, innovate for the present, and work together for a healthier and more resilient world.

Emerging Infectious Diseases: A Growing Threat

The Intensifying Risk

The world is facing a rising risk of emerging infectious diseases due to factors like globalization, urbanization, and climate change. These diseases, often zoonotic in origin, can pose significant public health challenges.

The WHO’s Priority Pathogens List

To address this growing threat, the World Health Organization (WHO) has established a list of priority pathogens. This list includes agents that can cause outbreaks or pandemics, guiding global investment in research and development (R&D).

The Importance of Collaborative Surveillance

Effective response to emerging infectious diseases requires collaborative surveillance. This involves early detection of warning signs, identification of new pathogens, and multi-disciplinary assessment.

Addressing the Challenges

Addressing these challenges necessitates a proactive approach, including:

• Strengthening surveillance systems
• Investing in research and development
• Promoting international collaboration
• Addressing underlying factors

Future Preparedness

To prepare for future pandemic threats, countries should:

• Align regional and global capacities for cross-border collaboration.
• Enhance coordination between public health authorities and other relevant sectors.
• Assess potential future risks and engage with communities.
• Ensure necessary funds and resources are available.
• Adopt a One Health Approach for coordinated surveillance and response.

By taking these steps, we can strengthen public health systems and response capabilities to mitigate the impact of future pandemics.

Framework: Components

The Expert Group aimed to distill key lessons from both successes and shortcomings while identifying essential gaps that need to be addressed for improved preparedness and response. To accomplish this, the Expert Group conducted extensive consultations with a diverse array of stakeholders, including national and international experts, policymakers, clinicians, epidemiologists, researchers, and representatives from funding agencies and international organizations.

The recommendations that emerged emphasize a comprehensive approach to pandemic preparedness, incorporating key components such as governance structures, rapid response protocols, and proactive planning for the critical early days of any public health emergency. This report is designed as a strategic framework to inform future efforts in building resilience against potential health threats, ensuring that the lessons learned from the COVID-19 experience contribute to more effective responses in the future.

Governance, Legislation, and Finance

Governance

• Empowered Governance Structures: Establish a Standing Empowered Group of Secretaries (EGoS) for Pandemic Preparedness and Emergency Response (PPER) to guide and monitor preparedness efforts.
• Institutionalized Systems: Develop and implement Standard Operating Procedures (SOPs) for rapid response and ensure effective collaboration and operationalization.
• Centre-State Coordination: Strengthen coordination between the Centre and States for effective pandemic management.

Legislation

• Public Health Emergency Management Act (PHEMA): Enact a comprehensive law to address public health emergencies, including epidemic prevention, control, and disaster response.
• Specific Provisions: The PHEMA should empower public health agencies, establish public health cadres, and provide for rapid response mechanisms.
• Global Examples: Learn from existing legislation in countries like the United States and United Kingdom.

Finance

• Dedicated Fund: Establish a Pandemic Preparedness and Emergency Response Fund to ensure adequate financial resources for all activities.
• Emergency Deployment: Allocate funds as per the requirements assessed and approved by the EGoS.

By strengthening governance, enacting appropriate legislation, and ensuring adequate financial resources, we can build a robust framework for effective pandemic preparedness and response.

Data Management, Early Predictive Warning, and Surveillance

Data Management

• Unified Data Platform: Integrate all data portals for seamless data sharing and analysis.
• Utilize IHIP and IDSP: Leverage existing data systems for outbreak management and strengthening.
• Data Management Systems: Implement robust systems for data collection, management, and archiving.

Early Predictive Warning and Surveillance

• Surveillance Network: Strengthen and connect all components of the existing surveillance system for early warning and response.
• One Health Approach: Incorporate biosecurity and surveillance at borders.
• Community Surveillance: Establish a strong community surveillance system.
• Real-Time Surveillance: Utilize AI and new technologies for real-time surveillance.
• Genomic Surveillance: Strengthen the INSACOG network for genomic surveillance.
• Wildlife Surveillance: Focus on wildlife surveillance for zoonotic diseases.
• Regional Consortium for Molecular Surveillance: Establish a regional consortium for collaborative surveillance.

Forecasting and Modeling

• Epidemiological Forecasting and Modeling Network: Develop a network of centers to create prediction models based on Indian data.
• AI and Emerging Technologies: Utilize AI and other technologies for modeling efforts.
• Data Integration: Integrate data from surveillance systems for accurate modeling.
• National Institute for Research in Digital Health and Data Science: Leverage this institute as a nodal institute for the network.
• Capacity Building: Create centers for mathematical modeling and train human resources.

By strengthening data management, surveillance, and forecasting capabilities, we can improve our ability to predict, monitor, and respond to future pandemics.

Research and Innovation

Research and Development (R&D)

• High-Risk Innovation Research and Development Fund: Allocate funds for research and development of diagnostics, therapeutics, vaccines, capacity building, and cutting-edge technology development.
• Focus on Priority Pathogens: Prioritize research on pathogens identified by the WHO.
• Public-Private Partnerships: Foster collaborations between public and private sectors for research and innovation.
• Network of Centers of Excellence: Establish a network of centers focused on research on priority pathogens.

Countermeasures

• Diagnostics: Develop novel diagnostics for rapid identification of emerging infections.
• Drugs and Therapeutics: Launch a National Mission on Therapeutics and novel drug development.
• Vaccines: Establish an Innovation and Vaccine Science & Development Institute to develop vaccines for priority pathogens.

Regulatory Reforms

• Harmonized Regulatory System: Develop a harmonized regulatory system for mutual acceptance of regulatory data.
• Accelerated Approvals: Establish accelerated approval pathways and protocols.
• Strengthen SECs: Enhance the technical competence of Subject Expert Committees (SECs).
• Clinical Trial Network: Develop a strong clinical trial network for expedited development of drugs, devices, and diagnostics.

Capacity and Competency Building

• Assess Training Needs: Identify training needs for healthcare professionals involved in pandemic preparedness.
• Develop Roadmap: Create a roadmap for training and capacity building in mission mode.
• Collaborate with Partners: Collaborate with private public health institutes, international bodies, and partner agencies for training and capacity building.
• National Programs: Develop national programs for technical competencies in areas like IDSP surveillance, IHIP data portal, epidemiological intelligence, and One Health.

By investing in research and innovation, strengthening regulatory frameworks, and building capacity, we can enhance our ability to develop and deploy effective countermeasures against future pandemics.

Partnership, Community Engagement, and International Collaborations

Community Engagement

• Risk Assessment and Community Engagement: Conduct comprehensive assessments and engage with communities at the local level for effective planning and response. Develop strategies and guidelines for managing public health emergencies, including implementing public health and social measures, restricting movement, information dissemination, and managing infodemics.
• Community Partnerships: Link with health NGOs and CSOs for last-mile connectivity and engage with communities transparently to empower them for public health efforts.
• Infodemic Management: Establish structures for community involvement, SOPs, and HR for Risk Communication and Community Engagement (RCCE) to address infodemics and rumors.

Private Sector Partnerships

• Data Sharing: Collaborate with the private sector to share data on outbreak-prone diseases and other public health events.
• Clinical Services: Engage the private sector for clinical care, testing, and other services during pandemics. Develop clear guidelines and mechanisms for private sector involvement in clinical care, quarantine, isolation, and intensive care services.
• Research and Development: Partner with private sector research centers for developing diagnostics, therapeutics, and vaccines.
• Community Awareness: Collaborate with the private sector for community awareness and IEC activities.
• Public-Private Partnerships: Foster partnerships for drug and therapeutic development, vaccine candidates and platform technologies, and PPEs.

International Collaborations

• Pre-Agreed Protocols and MoUs: Establish agreements for data sharing, knowledge transfer, technology transfer, and intellectual property management.
• Institutionalized Collaborations: Foster collaborations between institutes and agencies for pandemic preparedness and response.
• Global Partnerships: Strengthen partnerships with WHO, CDC, and other international organizations.
• South-South Cooperation: Focus on self-sufficiency while cultivating South-South cooperative partnerships.
• Global Regulatory Approvals: Collaborate with international regulatory authorities for mutual acceptance of regulatory data and expedited approvals.

Strengthening community engagement, partnering with the private sector, and fostering international collaborations can enhance preparedness and response capabilities for future pandemics.

Continuous Monitoring and Evaluation

Monitoring Mechanism

• EGoS Working Group: Establish a Working Group for Monitoring Progress within the EGoS for Pandemic Preparedness and Emergency Response.
• Scorecard System: Develop a scorecard with well-defined priority targets and collect data through an online portal.
• Regular Tracking: Track defined parameters, including research pipeline, human resources, funding systems, surveillance systems, and participation in WHO peer review systems.

Scorecard Parameters

• R&D Ecosystem Readiness: Assess the readiness of the R&D ecosystem for pandemic response.
• Funding: Evaluate the availability and allocation of funds for diagnostics, therapeutics, and vaccines.
• Research Priorities: Monitor research on the WHO List of priority pathogens.
• Capacities: Assess capacities for surveillance, forecasting, modeling, AI, new technologies, and clinical trials.
• Data Management: Evaluate the effectiveness of the unified data portal and data analysis unit.
• Forecasting and Modeling: Assess the accuracy and effectiveness of forecasting and modeling simulations.
• SOPs and Protocols: Evaluate the availability and implementation of SOPs for data sharing, communication, and accelerated regulatory approvals.
• International Collaborations: Assess the progress of establishing and maintaining international collaborations.

Testing the Framework

• Pilot Pathogens: Test the framework on priority pathogens like Nipah, Zika, Monkey pox, and H5N1.
• Timeframe: Implement the preparatory phase within 3-6 months and monitor the system’s readiness to deliver in 100 days.

Fig : 100 Days Mission for Future Pandemics

By establishing a continuous monitoring mechanism and using a comprehensive scorecard, we can ensure that the PPER framework is implemented effectively and that we are prepared to respond to future pandemics.

Indicative Timelines for Implementation

Short Term (3-6 Months)

• Establish Key Structures: Set up the EGoS for Pandemic Preparedness and Emergency Response, approve the special fund, and prepare the monitoring framework.
• Operationalize One Health Institute: Initiate coordinated collaborative surveillance and research.
• Strengthen Existing Systems: Institutionalize the Epidemiological and INSACOG framework and SOPs for regional expansion.
• Develop SOPs: Develop SOPs for data sharing, risk communication, and capacity building.

Medium Term (6-12 Months)

• Engage with Stakeholders: Collaborate with states, other ministries, and international partners.
• Develop Frameworks: Establish frameworks for collaboration and partnership with MoUs and protocols.
• Integrate Data: Integrate data portals and coordinate data sharing across agencies.
• Allocate Funds: Approve the High-Risk Innovation Research Fund.
• Establish Institutes: Establish the Vaccine Science & Development Institute and initiate research through the Center of Excellence Network.

Long Term (12-24 Months)

• Enact Legislation: Approve the New Public Health Emergency Management Act.
• Establish Networks: Set up the Epidemiological Forecasting and Modeling Network and the National Biosecurity Biorepository Network.
• Regulatory Reforms: Grant autonomy to the regulatory body with well-developed SOPs for accelerated emergency use authorization.
• Capacity Building: Implement a comprehensive capacity-building training program at all levels.

Conclusion and Critical Analysis

The report’s emphasis on governance, data management, research, and community engagement aligns with global best practices in pandemic preparedness. However, a comparative analysis with international frameworks reveals both strengths and areas for improvement.

Governance and Collaboration

India’s proposed Standing Empowered Group of Secretaries (EGoS) mirrors the international trend towards centralized coordination bodies. However, the effectiveness of such structures depends on their ability to foster inter-ministerial collaboration and ensure timely decision-making. International examples, such as the World Health Organization’s Emergency Committee, demonstrate the importance of transparent communication and accountability in these bodies.

Data Management and Surveillance

India’s focus on a unified data platform is in line with global efforts to enhance data sharing and analysis. International organizations like the Global Health Security Agenda have emphasized the need for robust surveillance systems and data-driven decision-making. However, India must address the challenges of data privacy and security, particularly in the context of emerging technologies like artificial intelligence.

Research and Innovation

India’s commitment to research and innovation aligns with international best practices. The global response to COVID-19 highlighted the importance of rapid development of diagnostics, therapeutics, and vaccines. International collaborations, such as the COVAX initiative, have been instrumental in ensuring equitable access to these innovations. India’s participation in such initiatives can strengthen its research capabilities and contribute to global health security.

Community Engagement and Partnerships

The report’s emphasis on community engagement is a crucial aspect of pandemic preparedness. International examples, such as the community-based surveillance networks in many African countries, demonstrate the effectiveness of local involvement in disease prevention and control. India’s diverse population and decentralized healthcare system make community engagement particularly important.

Key Areas for Improvement

While India’s framework offers a solid foundation, several areas require further attention:

• Funding: Adequate funding is essential for implementing the proposed measures. International examples, such as the Global Health Security Financing Initiative, can provide guidance on sustainable funding mechanisms.
• Equity: Ensuring equitable access to healthcare services, particularly in rural and marginalized communities, is a critical challenge. India’s experience with the COVID-19 pandemic highlighted the disparities in access to healthcare.
• Human Resources: Building a resilient healthcare workforce, including sufficient numbers of public health professionals and laboratory technicians, is essential for effective pandemic response.

In conclusion, India’s pandemic preparedness framework aligns with international best practices in many respects. By addressing the identified areas for improvement, India can strengthen its capacity to respond to future public health emergencies and contribute to global health security.

References

About the Contributor: Meenu Mohan is a Research Intern at the Impact and Policy Research Institute, and holds a BSMS Degree in Mathematics from IISER, Bhopal. Her research interests include Data Analytics, Foreign Policy and Geopolitics, and Disarmament.

Acknowledgement: The author extends sincere thanks to Dr. Arjun Kumar for the invaluable opportunity, and to Deepa Baghel and Geetam Acharya for their informative inputs.

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