With about 70 deaths and 4,000 cases of hospitalization due to leptospirosis, dengue, typhoid, hepatitis and gastro-enteritis, the post-flood Mumbai City is the best example of what follows a natural disaster in India. Epidemics of various proportions are always a certainty in the aftermath of any natural disaster in the country. The failure of the government system to tackle the situation effectively is a regular feature associated with such disasters. In Mumbai floods also, reports suggest laxity on the part of central and state authorities to check the outbreak of diseases in the city. The problem becomes more serious as the Indian sub-continent, by virtue of its unique geographical configuration and associated climatic diversities, is most vulnerable to natural disasters like earthquakes, landslides, cyclone, floods, droughts and Tsunamis etc. Each disaster means more epidemics, more deaths and more hospitalizations. Seen in this context, the central government's plans for setting up permanent mechanisms for disease surveillance assumes significance. The Union Ministry of Home Affairs, the nodal agency for disaster management, has planned a "National Disaster Response Force" for training and equipping specialist response teams in "medical first responses". The other major initiative is from the Union Health Ministry that announced plans for a "National Authority for Disease Surveillance (NADS)". While the Response Force is meant to handle the crisis arising out of major disaster situations, the NADS would be the backbone of all efforts meant to check the outbreak of any epidemic in the post-disaster days. While the Response Force will be a reserve team, NADS is to be a full-fledged agency on the lines of Centres for Disease Control and Prevention (CDC), USA, with a bigger mandate to predict and check the outbreak of all communicable diseases in the country.
The Centre's plans for NADS are timely considering the fact that even without natural disasters, the country is prone to major epidemics like brain fever due to Japanese Encephalitis. Disease surveillance has also become important in the wake of newer infections such as SARS, Avian influenza and the increasing trend of drug resistant infections and non-communicable diseases. As per the current plan, the National Institute of Communicable Diseases (NICD), New Delhi, is to be upgraded to house NADS.
NADS will have linkages with field offices spread over 500 districts of the country. The network of surveillance machinery would help NADS pick early warning signals and take appropriate preventive and control measures. The Integrated Disease Surveillance Project launched by the Prime Minister few months ago would help NADS build linkages. Even while appreciating all these efforts, one has to be cautious against NADS turning into a purely "central" initiative. The government should take care to assert NADS's linkages with various state health mechanisms. There should be advisory teams consisting of medical experts both at the apex level as well as the regional levels. It should be realized that for the success of efforts of such magnitude, a proper, democratically functioning, mechanism is a pre-requisite.