Combating emerging infectious diseases in India: Orchestrating a symphony

J. Biosci. 33(4), November 2008 When in 1967, US Surgeon General William Stewart made a statement that “...the time has come to close the book on infectious diseases”, little did he realize that in the next 30 years or so more than 30 organisms would be newly discovered (Fauci 2001). Some of them like HIV/AIDS have given more pain and misery than the pandemic of Spanish fl u in fi rst quarter of 20th century. With the emergence of new infections and re-emergence of known diseases, the books on infectious diseases might never be closed. Emerging disease is a term used to include diseases of infectious origin, new or whose incidence in humans has increased within the recent past or threatens to increase in the near future or those which are re-emerging after a period of quiescence. These new organism emerge from the dynamic interaction between the classical epidemiological triad of agent, host, and the environment. A large number of factors are thought to be playing a role in this, with varying degrees of contribution in emergence of each infection. Examples of some of selected factors are microbial adaptation and change, human susceptibility to infection, climate and weather, changing ecosystems, human demographics and behaviour, economic development and land use, international travel and commerce, technology and industry, breakdown of public health measures, poverty and social inequality, war, and famine and intent to harm (Committee on Emerging Microbial Threats to Health in 21st Century 2003). In an analysis of emerging infectious diseases between 1940 and 2004, it has been observed that a majority (about 60%) are caused by zoonotic pathogens and vector borne diseases are responsible for 23% of them. The predicted emerging disease hotspots due to zoonotic diseases and vector borne pathogens are more concentrated in lower latitude developing countries (Jones et al 2008). It is also feared that in all probabilities the next fl u pandemic too would raise its head from Asia. Multiple factors mentioned above are perhaps present and interacting with one another at the same time and at the same place. Main factors believed to drive the increased incidence, geographic range or both of emerging and re-emerging pathogens have been identifi ed by conducting a systematic review of emerging diseases literature. Changes in land use or agricultural practices and changes in human demographics and society are the most common drivers. Followed by poor population health (e.g. HIV, malnutrition); hospital and medical procedures; pathogen evolution (e.g. antimicrobial drug resistance, increased virulence); contaminating food sources or water supplies; international travel; failure of public health system; international trade and climate change (Woolhouse and Gowtage-Sequeria Sonya 2005). A fi ve pronged strategy has been suggested for countries of the South East Asia region i.e. epidemic preparedness and rapid response; vibrant public health infrastructure; effective risk communication; appropriate research and its utilization; and passionate advocacy for political commitment and partnership building (WHO South-East Asia Regional Offi ce 2005). Amongst the South East Asian countries, India is the big brother. It should be able to provide leadership in the region and assist other countries in their fi ght against the emerging infections. I would focus on the health research component of the strategy. In India, the research domains in emerging infectious diseases are in various stages of development i.e. basic and fundamental, applied and strategic, translational and operational. Some of our infrastructural facilities are comparable to the best in the world. We also have a large pool of talented scientists. But we have not always clicked as an orchestra to produce symphonies. India has had its share of emerging infections (Vibrio cholerae 0139, plague, Gp–B rota virus, HIV/AIDS, Nipah virus, chikungunya fever, Chandipura encephalitis, H5N1 infl uenza, etc.) laced with successes and controversies. The Indian Council of Medical Research (ICMR) is the apex organization for health research within the country, and it has played a very signifi cant role in research on these organisms.