G20 Is An Opportunity To Reflect Upon Pandemic Preparedness And Global Health Security

With the crucial G20 conclave happening in Delhi this week when global leaders will deliberate upon several pertinent issues, including healthcare, it is time to reflect upon what India can offer. Pandemic preparedness and global health security should be on top of its health agenda. There are three major aspects that need to be talked about.

1. How G20 nations can collectively tackle the next health emergency or pandemic 

We have gone through tough periods personally and collectively. The Covid-19 pandemic, that brought the world on knees, followed a pattern of waves. Though China remained secretive, the world believes that the virus came from China. But we don’t know how the virus originated — by design or by accident? However, even China had to bear a heavy brunt.

Covid-related deaths were unevenly distributed during waves, throughout the world. The second wave orchestrated by the Delta variant of coronavirus taught us hard lessons, as we celebrated too early after the first wave with laxity in political, religious, social gatherings with detrimental results. Augmenting healthcare was the biggest challenge, with the worst-ever oxygen crisis.  

Collective lack of preparedness and an inability of the systems to defeat outcomes has thrown us to the “greatest failure” with major fallouts being in the areas of healthcare, economies, societal disruption and education. None from the world, even the most powerful economies, could claim any expertise in understanding the virus or handling the pandemic.  

While many countries globally had up to six waves, India had three of them and successfully postponed the fourth wave. I would profusely thank Omicron, the Variant of Support (VoS) for India rather than Variant of Concern (VoC). Some how its BA.2 sub-variant did not allow entry for BA.4, BA.5 and recombinant sub-variants. 

Despite having the institutions and frameworks like Disaster Management Act, 2005 and the Epidemic Diseases Act, 1897 in place, India surprisingly didn’t encompass pandemic preparedness. Pandemics will keep evolving and thus will attract frequent updates, but an epidemic preparedness with a formal structure, collective wisdom and collaborative approach among countries would always help.

Thankfully, we are lucky and somehow got out, but the stroke of luck may not be on our side the next time — for the next pandemics. Now we are wiser and much better prepared than earlier! G20 presidency may help India with its global leadership to orchestrate a better pandemic preparedness and the Global Health Security (GHS). 

Addressing the G20 Health Ministers' meeting last month, Prime Minister Narendra Modi said the pandemic reminded us that health should be at the centre of our decisions and we must be ready to prevent, prepare and respond to next health emergency, and that India aims to brings affordable healthcare to all as health is the very foundation of life.

2. Can the G20 nations ensure GHS for Global South? 

We all live in a global village and most good or bad experience in one part impacts the entire globe. If the virus doesn’t recognise any boundary, why providing health security should? When the rich countries were totally self-centred, procuring 500% of vaccine doses for their populations, India’s Vaccine-Maitri (Friendship) initiative helped poor countries. With the philosophy ‘Vasudhaiva Kutumbkam’, India did make a good beginning; which has received a lot of accolades. Similarly, during the Oxygen crisis in April-May 2021, India received global support by way of oxygen tanks, oxygenators and support to setting up oxygen plants from friendly as well as not so friendly countries. 

Most countries were China dependant, so took time for domestic manufacturing of PPE kits, masks, testing kits. But Covid-19 taught us to be self-reliant. India is a classic example of how an adversity can be turned into an opportunity. Vaccination of 1.4 billion wasn’t easy, but India has done it systematically and also helped and is helping other nations. However, many nations can’t be self-reliant for several reasons, which emphasises need for GHS. 

GHS should be linked to all the inventions in the health sector. The power-wielding multinational pharmaceutical companies do invest in research and development (R&D) and have their original global patents. But they also buy patents from researchers at pittance and make billions. They are interested in higher revenues so jack up prices manifold, under the guise of recovering R&D costs. They target ‘classes’, but generic manufacturers have to reach the ‘masses’. It is important to protect intellectual property, but more important to take the fruits of inventions to the masses. Without that, the ‘they’ and ‘we’ divide will remain wider, leading to a state of anarchy. There are legal instruments like the Trade Related Intellectual Property Rights (TRIPS) to override patents, supported by the World Intellectual Property Organization (WIPO). This comes handy for countries like India, which is described as the pharma and vaccine powerhouse of the globe. 

Knowing well that emotion-based medicine is more popular compared to evidence-based medicine, we must strategise health-science communication. Filter-in, filter-out mechanism has to be in place by appropriately wording scientific developments in lay language. Specifics of treatments should never be discussed on media, as we have seen how that sets in public frenzy creating artificial shortage and racketeering. Immediate corrective measures must be taken when needed.

3. How India's pharma can play a role in prevention and treatment of infections

Among essential components of healthcare — medical infrastructure, human resource and medicines — the last is crucial where India’s role is laudable. One of the lessons from the global public health emergency is that profiteering from illness has to end. It’s an essential cog in the wheel of sustainable development, where no one is left behind that all healthcare services reach every human being in a rights-based manner and not dependent on her/his capacity to pay. This global village requires symbiosis. 

Offering low-cost generic medicines is must for survival of millions of gullible, un-affording people globally. The world recognised the Indian pharma strength in saving millions for decades from range of health issues. In patents versus patients, the balance tilts towards patients. It’s a Herculean task and will only be possible by intensive joint efforts of all including innovators. India continues humanitarian missions to make life-saving medicines affordable and accessible. India invented the fixed-dose combination (FDC) for TB and HIV treatment, with the WHO making it standard-of-care for their global programme.

India has been saviour to the Lower and Middle Income Countries (LMIC). Having widely travelled between 2000 and 2005, for providing medical training to healthcare professions in Africa, I have seen how people were dying of HIV and related illnesses for want of medicines. There is a sea of change now, as they widely embraced Indian medicines. Same is true for vaccines. India meets 82% of the global requirements for vaccines as well as treatment of infectious diseases. One cannot even imagine the global health issues minus India! The G20 organisors have rightly decided inclusion of the African Union as special invitee.  

We can’t remain Covid-centric and have to move forward. We should expect other health emergencies, natural and man-made catastrophes. Out-of-the-box thinking, planning for short, medium and long term are required with robust policies and standard operating procedures (SOP) in place. The agenda of Sustainable Development Goals (SDG) aims to eradicate tuberculosis by 2030 and PM Modi has advanced that date to 2025 for India.  

EXPLAINED | ‘Global South’ That India Looks To Be The Voice Of As G20 President

Future Challenges

Antimicrobial Resistance (AMR) will be one of the biggest, man-made pandemics, and it is not far. This is a result of indiscriminate use of antibiotics, like Azithromycin and Doxicyclin among others were used during the Covid pandemic.
 
Hepatitis B viral (HBV) infection, which causes cirrhosis and cancer of liver, will be the biggest forthcoming pandemics, killing more people than HIV, TB and malaria killing together, according to a scientific estimate. Fortunately, the vaccine to prevent HBV is made in abundance in India and is cheap, but not popularised. It is included in childhood immunisation since 2011, but what about those born earlier? 

A recent Lancet Global Health publication shows that a third of males globally are infected with Human Papilloma Virus (HPV), whereas 21% of males have High Risk HPV that can cause cancer. Among men who have sex with men (MSM), who visit my clinic, HPV prevalence is similar, but there are hardly any clinics in India that test men for HPV. Cervical Cancer, the most common cancer among females, is caused by HPV. 

Studies by the Tata Cancer Hospital in Mumbai suggest around 50% of oro-pharyngeal cancers are due to HPV. HPV vaccine that can prevent anal, genital, oral and cervical cancers are exorbitantly priced due to monopoly of an MNC pharma. HPV vaccine is also developed by the Serum Institute. At primary look, it will cost Rs 200 per dose to government, which is 5% of the innovator’s cost. The Indian government has decided to include HPV vaccination for girls. This needs to be extended to boys as well. We need to make HBV and HPV vaccines affordable and accessible for the Global South.

(The author is Consultant in HIV and Infectious Diseases, President Emeritus of AIDS Society of India, Secretary General of Organised Medicine Academic Guild-OMAG and Governing Council Member of International AIDS Society)

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