The Indian Express | 2 months ago | 23-03-2023 | 01:45 pm
The recent rise in Covid-19 cases reminds us that the pandemic is not yet over. It has added some more concern to the ongoing influenza outbreaks. On the global stage, countries and a range of institutions are negotiating the “pandemic treaty” — a global accord on pandemic prevention, preparedness and response.As is reasonably well known now, the Covid XBB 1.16 variant seems to be fuelling the surge, nearly a three-fold rise in cases over the last fortnight. So far, it has not caused any mortality in India. With more than 6,000 currently active cases, 76 samples of XBB 1.16 have tested positive from eight states, the most so far from Karnataka and Maharashtra. XBB.1.5 has been reported from 38 countries and declared a variant of interest (VOI) by the WHO. It is expected to emerge as a dominant strain in the UK and Europe and is rapidly spreading in the US as well. Even individuals who had received three or four doses of an mRNA vaccine (such as Moderna or Pfizer), plus suffered a BA.5 infection, were not immune to this variant. There is no evidence of any potential change in severity though. The growth advantage of XBB 1.16 is nearly one-and-a-half times of XBB.1.5, making it a rather aggressive variant, and with immune escape properties too.Another potential worry from Israel is the identification of a combination of the BA.1 (Omicron) and infectious BA.2 variants. The virus was detected in the parents of an infant boy, in whom two viruses linked up and exchanged genetic materials. The current test positivity rate is 10 per cent, a worrying metric by all accounts.This current landscape of Covid-19 is layered with a huge surge of H3N2 Influenza A cases, with at least nine reported deaths. Influenza B has also been identified. Both these are seasonal influenzas, driving up the hospital — including intensive care — admissions. Much like Covid-19, the high-risk groups are pregnant women, the elderly and those with chronic medical conditions and immunosuppressive conditions. Healthcare workers are at particularly high risk of getting affected and in turn spread to vulnerable persons.The limitations of the International Health Regulations (IHR) 2005 were exposed during the Covid-19 pandemic — both in countries not reporting in time and the international agencies not responding adequately. Local, national and global governance is increasingly being recognised as an important determinant of the emergence and re-emergence of diseases of animal origin. To re-emphasise, both Covid-19 and the influenza viruses have animal origins — “spill over” in technical jargon — when a virus is able to overcome several barriers to “jump” and become feasible in another species.It is in this context that the World Health Assembly set off a global process in December 2021, at its second-ever special session, to draft and negotiate a convention agreement to strengthen pandemic prevention, preparedness and response. An intergovernmental negotiating body (INB) that includes WHO’s 194 countries is steering this process. At the same time, more than 300 amendments to the IHR are also being discussed. The World Health Assembly in 2024 is expected to ratify these, ushering in a “comprehensive, complementary and synergistic set of global health agreements”. The WHO Director-General referred to this initiative as a once-in-a-generation opportunity to strengthen the global health architecture to protect and promote the well-being of all people.The G20 group of countries, with the Indian presidency, has a significant role to play. This is particularly so in light of the One Health Mission that India is working on and is expected to be rolled out in the near future. The G20 is already engaged with One Health (OH) issues and pandemic preparedness is one of the current focus areas.India, representing the Global South, is expected to play a role in integrating equity considerations in the ongoing negotiations. Scholars have enunciated three key equity considerations. First, the appropriate use, recognition, and protection of indigenous knowledge, which has traditionally recognised the interconnectedness of human, non-human and ecosystem health. Second, the substantive and equitable inclusion of women and minority groups, including racial, ethnic and sexual minorities – traditionally under-represented groups in treaty design and implementation. Third, the use of health equity impact and gender-based analysis to identify and develop mitigation plans for the potentially inequitable impact of epidemics.On the domestic front, the tasks include promoting the establishment of OH infrastructure. This will need an integrated OH surveillance system, building and nurturing partnerships to connect and share data on infectious pathogens in wildlife, companion animals, livestock, humans, the environment, and related risk factors. India will also need to build OH capacity and pandemic preparedness monitoring and assessment into the state and district governance architecture that will draw upon an inter-/ transdisciplinary OH evaluation framework and methodology, including metrics for measuring success.The writer is chairperson, Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi and co-investigator at the UKRI-GCRF One Health Poultry Hub
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