The H1N1 influenza, commonly known as swine flu, has claimed over 700 lives in India this season. Hospitals have also reported a shortage of flu vaccines and drugs. Randeep Guleria, head of the department of pulmonary medicine and sleep disorders at the All India Institute of Medical Sciences (Delhi), speaks to Manavi Kapur about the measures that can be taken to control this outbreak
Is India equipped to handle this outbreak of H1N1 influenza? Is the disease currently out of control in the country?
It isn't that we're not equipped, but we can always be better equipped. Most importantly, "swine flu" is a misnomer-- it has nothing to do with pigs. The disease is a pandemic influenza caused by the H1N1 virus. It is also not a novel disease but took a milder form in the last two to three years, and hence, it seems as though it is a disease that has made a comeback with vengeance. The fact is that we will keep having these outbreaks. The answer lies in being better prepared.
India needs to equip itself with an outbreak management system. It lacks a protocol plan where medical services and facilities can be upgraded on a need basis. For example, the number of beds, staff and testing facilities should be reviewed based on the current situation and should allow for quick upscaling.
Why has there been a sudden increase in the number of cases this year?
With such a spike in numbers, there was an initial fear that the virus might have mutated. But data collected and analysed by the National Institute of Virology in Pune and National Centre for Disease Control (NCDC) in New Delhi shows that there is no such mutation. The increase in the number of patients who have tested positive for H1N1 is perhaps because of a severe winter season. But the disease has spread in pockets, probably in areas with poor or low infection control mechanisms. One index case in an area has spread to a large number of people. The reason for the increase in the number of fatalities is because of a delay in treatment. In most cases the patients have waited too long to get treated.
What is causing the drug shortage for treating H1N1?
Influenza drugs came to the Indian market in 2009-10. But the influenza season has been significantly milder in the last two to three years, which made the demand lower. Manufacturers scaled down the production since these drugs have a limited shelf life. But they have been asked to restart production and the government has also intervened by making production of such drugs mandatory. We have been told that the immediate shortage will be fully met within the next couple of days.
There exists a flu vaccine shortage, especially since these vaccines are imported. This too is a simple demand and supply issue that should soon be resolved. What we need to remember about vaccines is that not everyone needs them. Many of us may have even had the H1N1 influenza this season, which our immune system tackled in a few days. The vaccines are meant for people whose immune systems are compromised due to existing illnesses.
The diagnostic tests for H1N1 have been offered at various prices by different laboratories. How can this be regulated?
This is an area where policymakers need to step in. The government offers a few free testing centres, but these are not fully equipped to handle large crowds. For this, government medical colleges should also be enabled to offer updated tests, especially in smaller cities. Several novel tests at private laboratories are sometimes offered at a 30 to 40 per cent margin. This needs to be addressed with a proper balancing of the costs involved along with a sustainable profit margin. Private players need to be kept interested because the government mechanism can only handle so much. For example, NCDC gets over 400 samples a day to study and the process takes time. This causes a delay in understanding the disease.
What measures can the government take to be better equipped?
We need a protocol for outbreak management. These outbreaks have been occurring with a greater frequency in the last 10 years, with diseases like SARS, Ebola and bird flu. Our reaction has been largely knee-jerk in such situations. We need to think of long-term solutions, just as we do for disaster management. In fact, this might even cost the government less money than the present knee-jerk reactions. Public awareness and education must become the focus so that panic is contained.
