A disease surveillance system, for the future

Context:

In 1854, when a deadly outbreak of cholera affected London, John Snow (1813-1858), a British doctor and epidemiologist, used the health statistics and death registration data to say that cholera was a waterborne, contagious disease – resulting in the effective control of the cholera outbreak.

Hence, in the backdrop of the Covid-19 Pandemic, we can learn lessons on the importance of health statistics and data.

Relevance:

GS-II: Social Justice, Governance (Issues related to health, Government Policies and Initiatives)

Dimensions of the Article:

1. Epidemiology and data collection
2. Trends in increasing significance of epidemiology
3. Surveillance efforts in India
   1. About the Integrated Disease Surveillance Programme (IDSP)
4. Issues on Health related data in India highlighted recently
5. Way Forward

Epidemiology and data collection

• By definition, epidemiology is the study (scientific, systematic, and data-driven) of the distribution (frequency, pattern) and determinants (causes, risk factors) of health-related states and events (not just diseases) in specified populations (neighborhood, school, city, state, country, global).
• Epidemiology is the method used to find the causes of health outcomes and diseases in populations. In epidemiology, the patient is the community and individuals are viewed collectively.
• Epidemiologists help with study design, collection, and statistical analysis of data, amend interpretation and dissemination of results (including peer review and occasional systematic review).

Dependence of Epidemiology on Data and Statistics

• Epidemiologists depend on accurate collection of data and statistics to make efficient use of the data and draw appropriate conclusions.
• The application of principles of epidemiology is possible through systematic collection and timely analysis, and dissemination of data on the diseases.
• This is to initiate action to either prevent or stop the further spread, a process termed disease surveillance.

Trends in increasing significance of epidemiology

• In the late 19th century, with the emergence of understanding that germs cause diseases, and then in the early 20th century, with the discovery of antibiotics and advances in modern medicine, attention from epidemiology shifted.
• The high-income countries invested in disease surveillance systems but low- and middle-income countries used limited resources for medical care.
• In the second half of the twentieth century, as part of the global efforts for smallpox eradication many countries recognised the importance and started to invest in and strengthen the diseases surveillance system.
• These efforts received a further boost with the emergence of Avian flu in 1997 and the Severe Acute Respiratory Syndrome (SARS) outbreak in 2002-04.

History on emergence of epidemiology in the spotlight

• In 19^th century, John Snow (1813-1858) plotted the distribution of cholera cases and deaths on a map of the Soho area of London (where a deadly cholera outbreak was to be controlled).
• This was possible only with the use of health statistics and death registration data from the General Registrar Office (GRO) in London.
• John Snow convincingly proved his theory that cholera was a waterborne, contagious disease which was spreading in the areas with common water pumps, using data. Upon removal of the handle of the water pump, the cholera outbreak was controlled in a few weeks.
• John Snow was able to use data collected by the GRO effectively due to untiring efforts put in by another medical doctor, William Farr (1807-1883) – because of whom the collection of health data and vital statistics by the GRO had improved before the 1850s.
• John Snow is often referred to as the father of modern epidemiology and William Farr as founder of the modern concept of disease surveillance system.

Surveillance efforts in India

• India launched the National Surveillance Programme for Communicable Diseases in 1997.
• However, this initiative remained undeveloped till, in the wake of the SARS outbreak, in 2004, India launched the Integrated Disease Surveillance Project (IDSP).

About the Integrated Disease Surveillance Programme (IDSP)

• The Integrated Disease Surveillance Project was launched by the Ministry of Health and Family Welfare, in assistance with the World Bank, in 2004.
• It continued as the Integrated Disease Surveillance Programme (IDSP) during 12th Plan (2012–17) under the National Health Mission with a domestic budget.
• The primary objectives of the IDSP is to:
  • Strengthen/maintain decentralized laboratory based and IT enabled disease surveillance systems for epidemic prone diseases to monitor disease trends.
  • Detect and respond to outbreaks in the early rising phase through trained Rapid Response Teams (RRTs).
• Components of the IDSP are:
  • Integration and decentralization of surveillance activities through establishment of surveillance units at Centre, State and District level.
  • Human Resource Development – Training of State Surveillance Officers (SSOs), District Surveillance Officers (DSOs), RRT and other medical and paramedical staff on principles of disease surveillance.
  • Use of Information Communication Technology for collection, collation, compilation, analysis and dissemination of data.
  • Strengthening of public health laboratories.
  • Inter sectoral Coordination for zoonotic diseases.

• Under IDSP, a Central Surveillance Unit (CSU) at Delhi, State Surveillance Units (SSU) at all State/Union Territories (UTs) head quarters and District Surveillance Units (DSU) at all Districts have been established.
• The IDSP portal is a one stop portal which has facilities for data entry, view reports, outbreak reporting, data analysis, training modules and resources related to disease surveillance.

Issues on Health related data in India highlighted recently

• The disease surveillance system and health data recording and reporting systems are key tools in epidemiology; however, these have performed variably in the Indian states.
• This is evident from available analyses, be it seroprevalence survey findings or the analysis of excess COVID-19 deaths.
• The estimated excess deaths are also higher in those states which have weak disease surveillance systems and the civil registration and vital statistics (CRVS) systems.
• In a well-functioning disease surveillance system, an increase in cases of any illness would be identified very quickly.

Way Forward

• A review of the IDSP by joint monitoring mission in 2015, made a few concrete recommendations to strengthen disease surveillance systems. These included increasing financial resource allocation, ensuring an adequate number of trained human resources, strengthening laboratories, and zoonosis, influenza and vaccine-preventable diseases surveillance.
• These recommendations must be re-looked and acted upon. At a more specific level, the following should be considered by health policymakers.
• The government resources allocated to preventive and promotive health services and disease surveillance need to be increased by the Union and State governments.
• The workforce in the primary healthcare system in both rural and urban areas needs to be retrained in disease surveillance and public health actions.
• The vacancies of surveillance staff at all levels need to be urgently filled in.
• The laboratory capacity for COVID-19, developed in the last 18 months, needs to be planned and repurposed to increase the ability to conduct testing for other public health challenges and infections.
• The ‘One Health’ approach has to be promoted beyond policy discourses and made functional on the ground. The emerging outbreaks of zoonotic diseases, such as the Nipah virus, avian flu, scrub typhus in Uttar Pradesh are a reminder of the interconnectedness of human and animal health.
• There has to be a dedicated focus on strengthening the civil registration and vital statistics (CRVS) systems and medical certification of cause of deaths (MCCD). These are complementary to disease surveillance systems.
• It is also time to ensure coordinated actions between the State government and municipal corporations to develop joint action plans and assume responsibility for public health and disease surveillance. The allocation made by the 15th Finance Commission to corporations for health should be used to activate this process.

-Source: The Hindu