India's bioterror plans will take some time to get off the ground

Published 31 December 2008

India is augmenting its preparations for bioterror attacks; experts complain that one of the major weaknesses in India’s ability to cope with a bioterror attack is the lack of interest, so far, of the private sector in being enlisted in the effort

The Mumbai attacks last month were a reminder, if one was needed, that India is facing a serious terrorism threat. LiveMint’s Seema Singh writes that even as India tries to prevent such terrorist attacks, security experts say that despite not facing a biological attack so far, the country must not ignore that threat. The National Disaster Management Authority (NDMA) has begun preparedness, but concedes more cooperation is needed from companies and communities.

India is not alone in worrying about a potential bioterror attack. Earlier in December, the US Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism released its World at Risk report, which predicts the world is likely to experience a biological or nuclear weapons attack in the next five years, and calls for decisive global action (see 23 November 2008 HS Daily Wire). NDMA had in July notified the biological disaster management guidelines, prepared under the chairmanship of Lt. Gen. (retd.) J. R. Bhardwaj, former director general of the Armed Forces Medical Services. “We are lucky that not a single incident has occurred in the continent because non-state actors haven’t tried the capabilities and they don’t have self-protection, but the day may not be far (of acquiring such capabilities),” says  Bhardwaj. The eight-member NDMA is chaired by Prime Minister Manmohan Singh.

NDMA has started the Integrated Disease Surveillance Program (IDSP), which is funded by the World Health Organization, and for which the National Institute of Communicable Diseases is the nodal agency. Modeled after a similar program run by the Centers for Disease Control and Prevention (CDC) in Atlanta, the IDSP has started taking shape, but will be a while before it reaches many of the 600 or so districts in India, says Bhardwaj.

To strengthen the existing eight battalions of the National Disaster Response Force, each consisting of 1,000, two more battalions have been sanctioned. Half of the existing force is specifically trained to deal with chemical, biological, radiological and nuclear (CBRN) threats. NDMA has also asked the state governments to get part of the state forces trained in such areas.

At the time of the SARS (severe acute respiratory syndrome) outbreak in 2002-3, India had one BioSafety Level-4 (BSL) lab, but now it has two. Since such situations require BSL-3 labs, which can work with indigenous or exotic agents-dozens of these are coming up in medical colleges and defense institutions, according to Bhardwaj. Singh writes that experts also say that funding has not been a constraint so far. The 11th Plan has allocated Rs10,000 crore for medical preparedness. A 10 percent of all development plans can also be utilized for disaster mitigation. What is a constraint, though, is a “lack of participation from the people and private sector”, claims Bhardwaj.

The structuring of medical care in India is such that more than 70 percent of it falls in the private sector, which is not “committed to community health services” but is confined to “care of individual patients”, says Lt. Gen. (retd.) D. Raghunath, principal executive of Sir Dorabji Tata Center for Tropical Diseases in Bangalore, and lead author of the NDMA guidelines. The private sector has to be more responsive to national needs and for which a complementary public health system needs  to  be put in place, notes  Raghunath. “Public health has been moribund for sometime and moving that is a challenge.”

Raghunath worries that if a patient turns up at a private hospital with fever and vesicles on his face, it is important that it is diagnosed properly to rule out small pox. “Will a private clinic come forward to report it?” he wonders. This is a challenge NDMA is battling with, even though most big private hospitals have shown interest and offered three days of free treatment in case of an outbreak. “But we need a legal instrument that would ensure they (private hospitals) must do it,” says Bhardwaj. He has written to the government to enact a law.

Private sector participation also falls short when it comes to detection readiness. “We have a tough time attracting the companies to manufacture the kits we develop,” says R. Vijayraghavan, director of the Defense Research and Development Establishment, in Gwalior. His lab, he claims, has “perfected the rapid detection” of CBRN and stocks 500-1,000 kits for emergencies but can produce more within 6-24 hours.

No measure is effective if people do not participate. “People should know if their neighbor’s pressure cooker is on all night, it is suspicious…he could be making anthrax spores,” says Bhardwaj. Hence, money has been allocated to bring civil defense into disaster management. NDMA is running a pilot program in Nagpur, which can become a model for the rest of the country. The Armed Forces have always prepared for biowarfare, but to galvanize government machinery and prepare civilians for bioterrorism is no mean task. “The delay happens, but we’ll do it; we’ve done it in the Army for 40 years,” says Bhardwaj.