Countries in South Asia including India are “vulnerable” to infectious ailments like Ebola and Zika, says a new analysis. The preparedness levels of these countries to protect public health isn’t enough either, it says.

An uneven health system capacity and inadequate surveillance could speed up the spread of such diseases in regions that are already rife with diseases as HIV, tuberculosis and Malaria. The analysis, that was part of twelve analyses on health in S.Asia was published in the British Medical Journal(BMJ).

Regular epidemics on the rise

The analysis says how even though sporadic cases of dengue were found in many S.Asian nations during the 1960s, regular epidemics only started in the early 1990s in S.Lanka and India.

“In India and Sri Lanka, by around 40 years of age 90-95 per cent of adults have been infected with the dengue virus, while 41 per cent have been infected with chikungunya,” it said.

Anthrax is endemic in many parts of S.Asia. As per the analysis, in the border regions of Bangladesh, India and Myanmar, poor vaccination and surveillance have been accompanied by rising anthrax cases- something that made Bangladesh announce a red alert in 2010.

Rabies also remains endemic in eight South east Asian countries, notes the analysis. This puts 1.4 billion people at risk. Around 45 percent of global rabies deaths happen in the region.

“Brucellosis, bovine tuberculosis, and a range of food- borne diseases contribute to the morbidity and mortality attributable to zoonotic infections but are struggling to gain the attention of policymakers in the subcontinent, despite it resulting in 150 million illnesses, 175,000 deaths, and 12 million disability-adjusted life years,” the analysis said.

As per the analysis, the HPAI virus A/H5N1 that got introduced into the subcontinent in 2005 through wild birds has since become endemic in regions across northeast India and Bangladesh.

“South Asia stands vulnerable to emerging infectious diseases. Examining the vulnerability to emerging and growing infectious disease threats and the capacity to respond to outbreaks, the analysis finds the level of preparedness is inadequate to protect public health,” it said.

Significant risk for a region already burdened with diseases

The World Bank defines South Asia as Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka.

“Emerging and growing infectious diseases, like Zika, Ebola, MERS-CoV, and avian influenza, are adding to the already significant burden of disease, and their spread may accelerate in the face of factors such as inadequate surveillance and uneven health system capacity.

“The current state of affairs appears to result from a severe policy neglect, including a general lack of commitment to the ‘One Health’ approach in policy discourse, which would consider the interrelation of animal health, human health, and the environment,” the authors noted.

The analysis also mentions the Nipah virus that emerged in Malaysia in the late 1990s. It was initially misdiagnosed as Japanese encephalitis. Since then, there has been frequent outbreaks in Bangladesh. To a lesser degree, outbreaks happened in India too.

“With rapid shifts in urbanization and increasing population, South Asia has the opportunity and obligation to implement meaningful policy changes to prepare against emerging infectious diseases.

“Millions of lives are at stake and betting against the spread of emerging infectious diseases would be irresponsible,” said Laxminarayan, Director, Centre for Disease Dynamics, Economics and Policy(CDDEP).

The analysis also noted as a “landmark” achievement the elimination of polio from many nations in the region- the most recent being in India.

“At the global scale, South Asia must become more engaged in the health security agenda. The government of India is a founder contributor to the Coalition for Epidemic Preparedness Innovation (CEPI), an initiative that aims to accelerate the development of new vaccines for high threat pathogens.

“This leadership is commendable, but such research and development pipelines need to be linked to strengthened surveillance, response, and research platforms within South Asia to ensure that it can be evaluated and implemented locally. Finally, global science communities can help enhance regional conversation to encourage local collaboration,” the analysis says.

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