COVER STORY/PANDEMIC
It made people aware of the need for clean air and ventilation and even changed architecture (large windows and balconies),” says Pai. Since malnutrition was linked to TB, efforts were made to improve nutrition, he adds.
Substantial advances have been made in digital health, remote service provision, ultra-portable digital X-ray systems with artificial-intelligence-based reading software, use of digital technologies for promoting medication adherence, and use of e-pharmacies. These can be used to build back better health systems. “Technologies such as telemedicine catapulted to the forefront during the pandemic, accelerating a trend that was already occurring. It is also the case the home diagnostic technologies now have momentum and will hopefully expand to other diseases such as influenza and respiratory syncytial virus,” says Adalja. Respiratory syncytial virus or RSV is a common respiratory virus that causes mild, cold-like symptoms.
One of the most notable advancements brought about by COVID-19 is the use of mRNAbased vaccines. “Both mRNA and adenoviruses platforms were so successful in developing vaccines in record time, they will change the way emerging infectious disease outbreaks are responded to in the future. Their success will also galvanise the use of these technologies for other medical applications,” says Adalja. “The unforeseen efficacy of vaccines based on this novel technological platform has spurred a remarkable amount of interest for developing novel vaccines for diseases such as HIV, Epstein-Barr virus and even specific types of cancer,” adds Ramamurthy.
But there is no room for complacency in this fight against microbes—contagions are hard to control even when treatment and vaccines are available. Cholera is one classic case of how a pathogen persists in the environment and emerges to cause intermittent outbreaks or even pandemics irrespective of availability of treatment or vaccines. Cholera is a water-borne acute diarrhoeal disease caused by bacteria,
The first known pandemic of cholera originated along the banks of the Ganga
There is no room for complacency in this fight against microbes— diseases such as cholera and measles are hard to control even when treatment and vaccines are available
some 200 years ago (around 1817) and has caused not one but seven pandemics—the current pandemic started in South Asia in 1961, according to WHO, and is still ongoing. “During each pandemic, the bacteria emerged from the Gangetic region where the disease is endemic,” says Ramamurthy. Though cholera has become endemic in many countries, it causes 1.3-4 million infections and 21,000-143,000 deaths worldwide a year.
Uninterrupted monitoring and persistent prevention and treatment measures are the key to ensure that the pathogens do not spread. “The recent [2011] epidemic of cholera in Haiti was caused due to the disease being imported most likely by UN peacekeepers tasked with assisting the nation,” says Ramamurthy. “It would be wise to be aware of the risks of introducing the disease or virulent variants of COVID-19, from an endemic region to a region that might have brought the disease under control,” he adds.
India already has a vaccine against cholera licensed since 2009 named Shanchol by Shantha Biotechnics, now an associate of multinational vaccine manufacturers Sanofi and Pasteur. However, despite being prequalified by WHO and stock-piled by the Gavi Vaccine Alliance, a global health initiative aimed to increase access to vaccines, Shanchol is not a part of India’s cholera control program. The low number of deaths and alleged under-reporting have meant that immunisation has not been made a priority, notes a paper published in
in May 2016 by researchers from Translational Health Science & Technology Institute, Haryana and Union Ministry of Health & Family Welfare.
Unfortunately, reduction of funds available to fight infectious disease is a chronic problem. For example, there is a need to upgrade the century-old Bacille CalmetteGuérin vaccine for tuberculosis (TB), but investments in new vaccines is barely US $0.1 billion per year. Overall research and development investments reached only $0.9 billion in 2020, as compared with an
Note: #Earliest known records, in 2020; ^lesbian, gay, bisexual, transgender community, +as on February 22, 2022 Source: World Health Organization, Joint United Nations Programme on HIV and AIDS, US Center for Disease Control