[Commentary] In the post-COVID world, health security must be a matter of national security

The Chinese New Year is a time to visit families and ancestral lands. It began with the Little Year (January 17 to 24), followed by the main Spring Festival (January 25 to February 4), and ended with the Lantern Festival (February 5 to 8).

As people were getting ready to travel in December 2019, pneumonia cases started showing up in hospitals across the Hubei Province of central China, especially in Wuhan, China’s ninth most populous city with about 11 million people – about the size of Bengaluru. Both Bengaluru and Wuhan are also denoted as “Beta” level cities by the Globalization and World Research Cities Network (GaWC), a think tank that charts the relationships of world cities to globalization. Both are cities that link moderate economic regions to the world economy.

But let us go back in time to when people were possibly making their New Year travel bookings, a new virus was jumping from bats into humans – either directly or through an intermediate animal host. Its spread in the human population timed perfectly with the New Year travel season, which spread it, first in China and then elsewhere.

Going back further to March 2019, researchers in Wuhan and Beijing, who were studying viruses in bats wrote almost prophetically in the journal Viruses: “it is highly likely that future SARS- or MERS-like coronavirus outbreaks will originate from bats, and there is an increased probability that this will occur in China.”

And even before that in 2018, researchers had discovered two novel coronaviruses from bats in eastern China that looked very similar to the Severe Acute Respiratory Syndrome (SARS) coronavirus that emerged in China in December 2002 and then disappeared by mid-2003, leaving about 8000 people infected and 774 dead.

Coronaviruses belong to a family of viruses that infect animals and humans, are distinguished by their crown-like (corona) appearance under a microscope, and cause a flu-like disease. Besides SARS-CoV, the family included the Middle East Respiratory Syndrome (MERS) virus and at least four other viruses endemic in the human population.

The 2019 novel coronavirus (2019-nCoV), later renamed SARS coronavirus 2 (SARS-CoV-2) due to its genetic similarity with the SARS virus, was established as the cause of a new disease called coronavirus infectious disease 2019, or COVID-19.

The World Health Organization (WHO) has declared COVID-19 to be a pandemic. As of April 7 2020, there are over 1.4 million confirmed cases and 80,000 deaths attributed to it in 184 countries. The pandemic is still growing in USA, Europe and other parts of the world, leaving the global economy, markets and supply chains in disarray.

The year 2020 is the Chinese Year of the Rat. It will be long remembered as the Year of the Bat.

As of April 8, 2020, India is early on the COVID-19 curve with about 4643 confirmed cases and 149 deaths; a 21-day nationwide lockdown is in place till April 14. There are no clear estimates on the scale of the impending outbreak, but all models point to tens of lakhs to crores of infections in India. Simulations on lockdown suggest repeats at national, state and regional levels. These would have to balance public health needs against the economic and humanitarian crisis, which has left so many without food, shelter and security.

A KPMG India report – Potential Impact of COVID-19 on the Indian Economy, says – “COVID-19 is unique in that it is a supply, demand and market shock.” It further adds that the “outbreak has disrupted manufacturing supply chains and sharply curtailed energy and commodity demand”. China is India’s second-largest trading partner, with total trade pegged at $92.68 Bn, which includes $74.72 Bn in imports and $17.95 Bn in exports. This amounts to 13.7% of India’s total imports and 5.1% of its exports.

Also read: It is not COVID-19 alone, but also the environment and the economy

Health security is national security

Though COVID-19 is a significant challenge, it also presents an opportunity. How must India prepare itself for the post-COVID world? My central argument is that India must start addressing health security as a matter of national security. It must build local capacity to reduce its dependence on imports and supply chains. It must also invest in public health preparedness and health research.

With the disruption in China, the most vulnerable sectors for India are electronics and pharmaceuticals, both of which impact our critical healthcare sector. India imported over 70% of its bulk drugs and their active pharmaceutical ingredients (APIs), amounting to $2.4 Bn, from China in 2018-19. Though this problem was highlighted by the National Security Advisor in November 2014, the continued dependence on China is worrisome, especially with a looming health crisis. In February this year, the government put together a list of 38 drug raw materials that it wants locally produced, including fermentation process-based ingredients for antibiotics, vitamins and hormone drugs. It would also be important to address bottlenecks such as environmental clearances and tax concessions for the local industry.

There is a need to increase the health budget allocation

India must also increase its allocation to healthcare and focus on public health. The FY 20-21 budget allocation for health is Rs. 69,000 crores, a public spending of 1.6% of GDP, even after the National Health Policy 2017 called for an increase to 2.5% of GDP. According to WHO, India ranks 184 out of 191 countries on its public spending on healthcare as a percent of GDP. Contrast this to India’s military spending pegged at Rs. 471,378 crores, almost seven times its health budget.

The Ayushman Bharat–PM Jan Arogya Yojana (AB-PMJAY) scheme to provide free healthcare to 10 crores families (50 crore people) is a promising addition, but disappointments include drastic cuts to the health insurance scheme (Rashtriya Swasthya Bima Yojana) and no increase for communicable diseases. The National Rural Health Mission (NRHM), which includes many health schemes, also received marginally less than last year.

India is projected to be a hotspot for zoonotic, vector-borne and drug-resistant infections. With over 1.3 Bn people, 536 Mn livestock and 851 Mn poultry, it has the world’s highest density of each, and is thus a ripe ecosystem for pathogen exchange. There are 117 species of bats in India, but what viral secrets they hold remain unknown. A recent study by the National Centre for Biological Sciences, Bengaluru to start addressing this remains mired in controversy.

One health and interdisciplinary approach needed

Our lessons from COVID-19 should be to strengthen the public health infrastructure, invest in ‘One Health’ science to understand the animal-human disease interface and modernize our approach to R&D. An independent National Centre for Pathogen Research, with a broad mandate for inter-disciplinary work – from pathogen discovery to characterization and product development – is needed for India. This may work in close partnership with organizations such as the Indian Council of Medical Research (ICMR) and the National Centre for Disease Control (NCDC), which have developed core expertise in outbreak investigation and diagnostics.

The 2002 SARS outbreak is estimated to have caused global economic losses of $40 Bn. For COVID-19, the UN’s trade and development agency UNCTAD puts notional losses at $1 Trillion. There are an estimated 631,000 to 827,000 yet-to-be-discovered viruses in animal reservoirs with zoonotic potential. The Global Virome Project aims to expand virus discovery to reduce their future impact on human populations, but their biggest challenge is the cost estimated to be $1.2 Bn.

Would this not be a sensible investment to make in the post-COVID world?

[Shahid Jameel, Ph.D., was Head, Virology Group at the International Centre for Genetic Engineering and Biotechnology, New Delhi. He is now CEO of the DBT/Wellcome Trust India Alliance].

Related: [Interview] Taking One Health approach to tackle zoonoses crucial for India

Banner image: A typically crowded marketplace in India before the COVID-19 pandemic struck. Photo from Unsplash.