Opinion - Editorials

The plague within

THE TRAGIC RECURRENCE OF the plague should jolt the country's public health authorities into action. The Union Health Minister, C.P. Thakur's assertion that the plague in Rhoru, Himachal Pradesh, is now contained does not undo the damage caused by the failure to prevent the outbreak of this known epidemic. Given the medical advances and the knowledge available on the plague — considered a scourge a few centuries ago — the traumatic deaths come as a rude throwback to an ugly past. That it should revisit India within a decade of the shocking Surat epidemic is a sad commentary on the nation's approach to basic healthcare. The neglect by the public health authorities is evident as the chilling deaths took place in one of the four areas identified as focal points for the origin of the plague. Little comfort can be drawn from the lower severity of the epidemic in Rhoru, as the well-documented disease — which snuffed out the lives of Europeans by the million centuries ago — has no place in a scientifically and medically equipped modern society. Nothing but a blatant and systematic abdication of social responsibility by the Governments can be held responsible for these deaths.

Now that Rhoru has evoked grim memories and exposed once again the vulnerability of the Indian healthcare system, it is important that a comprehensive approach is adopted to correct the failings. The most crucial lesson from the plague deaths — the gruesome interplay between ecology, epidemics and human health — cannot be ignored. To begin with, high priority must be given to restoring the time-tested surveillance mechanism that has been in place. Paucity of funds, a reason that is increasingly gaining ground for several state failures, cannot be made an excuse. For instance, all that was required to prevent the Rhoru epidemic was routine monitoring of rodent-infested forests and basic administrative measures. Moreover, lack of resources is only a part of the issue. Caring for public health involves institutions that spread across a wide social and political spectrum. Broadly put, the Central and State Ministries and their several departments, city and local Governments, ground-level health and sanitation officials constitute important links in the maintenance of basic services. Preventing epidemics requires all these actors to pull together in the same direction. If national efforts saw success in eliminating some communicable diseases, it was a result of coordinated efforts. The victory against small pox, a major killer in pre-Independence India, is a case in point.

To successfully prevent the relapse of epidemics that take a heavy emotional and economic toll of the country, it is imperative that the public health policy is recast along pro-active lines. The shrinkage of services by local bodies, especially in areas such as sanitation, does not come as a good augury. The Ninth Five Year Plan's warning that with the existing conditions of poor environmental sanitation and weaknesses, the public health system may not be able to prevent outbreaks of diseases cannot be ignored. Now that efforts are on to make sectoral resource allocations, it is important that the unfinished task is completed. In addition, the Approach Paper to the Tenth Plan has emphasised the need to integrate all services relating to disease control programmes. The task of re-organising and restructuring the existing healthcare infrastructure should assume greater importance in the years ahead. The need is more so with the gradual redefinition of the economic role of the state. Making available better facilities at the local level, greater accountability and, above all, a perpetual sense of alertness on the part of public health authorities are crucial factors to check any recurrence of preventable epidemics.

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