In his novel The Plague, Albert Camus writes, “There have been as many plagues as wars in history; yet always plagues and wars take people equally by surprise.” In the face of yet another global public health crisis, let us hope that we are not taken by surprise like with the Covid-19 pandemic.
Monkeypox, which was subsequently rechristened as Mpox after the stigma that came to be associated with the disease in 2022, has reared its head again. On August 14, the World Health Organization declared that the increase in cases was a global emergency requiring urgent action.
There have been no reported cases in India yet and the government claims that the risk is low for a large scale outbreak – a suspected case is being investigated since September 8 and the patient has been isolated. But it is high time that lessons are learnt from the Covid-19 pandemic to be better prepared for what seems to be the next public health crisis the world faces.
First and foremost, there should be adequate training in evidence-based medicine for medical staff, including physicians and nurses, and robust systems should be put in place in preparation for a large-scale outbreak. All such trainings should be in consultation with public health experts and misinformation should be avoided.
During Covid-19, for instance, there were widespread claims that cow urine could cure the viral infection with some groups even holding “cow urine parties”. Resources should be invested towards ensuring effective and safe treatments that are equitably accessible to everyone in India. Such medical and clinical interventions must be scientifically robust, with transparent and accurate reporting of adverse effects, mortality and data.
Second, public health authorities, at the national and state levels, should play an active role in destigmatising the disease, which can otherwise become a barrier in access to care. Although Mpox disproportionately affects gay and bisexual men, there should be proper methods for prevention, testing, care and treatment before there is an outbreak.
The guidelines issued by the Ministry of Health and Family Welfare against Mpox in July 2022 have no mention of gay and bisexual men, gender diverse people or transgender persons and instead uses uses outdated terms like “MSM” – men who have sex with men. The risk of violence and potential criminalisation should be avoided at all costs. During the early days of the Covid-19 outbreak in India, polarising and hateful messages and news coverage falsely blamed a gathering of the Tablighi Jamaat in Delhi for exacerbating the situation.
Healthcare systems must be accessible but personal information should not be a grounds to discriminate against or persecute people on the basis of their gender identity or sexual orientations. Stigma not only has a serious, detrimental effect on healthcare outcomes, but also increases the risk of transmission.
Third, misinformation and pseudoscience on social media about communicable diseases needs to be effectively encountered. Uncertainty, instability and the lack of proper information can be a major detractor in a public health crisis. There is a need for urgent cooperation between the government, healthcare workers and civil society to counter misinformation and disinformation.
During the Covid-19 pandemic, India’s Department of Science and Technology funded a study to determine if chanting the Gayatri Mantra, a religious hymn, could help recover from the infection. The study was also registered with the Indian Council of Medical Research, India’s highest body to look into clinical trials. This money, allocated when patients were struggling to get oxygen, could have instead been used better to import oxygen or set up new plants even as people were dying of asphyxiation in hospitals and their homes. By any stretch of imagination, this cannot be a wise investment of resources and should be avoided.
Finally, care must be taken to ensure that social determinants of health are paid adequate attention to while crafting a response. It is now clear that healthcare outcomes are determined by more than access to medical care but also a variety of social factors such as class, caste, gender, income levels, nutrition and sexuality. These factors must be taken into account when drafting a response to a public health crisis not just at the national but also international level. A model for preparedness must be just and equitable, ensuring that the most vulnerable communities are paid attention to first.
The tale of health inequalities and public health crises is an old one that has befuddled ethicists, public health experts and governments. But there are lessons to be learnt from the mistakes made during the Covid-19 pandemic and the collapse of the public health systems.
The government must act now and ensure that it is adequately prepared not just medically but also socioeconomically. There is hope that surveillance systems for communicable diseases, vaccination programmes and adequate strengthening of healthcare infrastructures is done with the alacrity that it demands while an outbreak has not yet happened.
Rohin Bhatt is a lawyer and a bioethicist. His book Urban Elite v. Union of India will be released in October.
