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Urgency for next pandemic? But Mr Health Secretary, you're barking up wrong tree

By Dr Amitav Banerjee, MD* 

The Union Health Secretary, Mr Rajesh Bhushan addressing the Health Working Group of G20 India, at Hyderabad on 05 June 2023, cautioned that the next pandemic would not wait for us to make global treaties and called on countries to work together.
He upped the alarm level, saying that billions of lives and livelihoods will be at stake; hence we must act with a sense of urgency. Seconding him, Michael Ryan, the WHO spokesperson, said that it is time countries came together to ensure that drugs, vaccines, and diagnostics reached those who needed them the most.
Which drugs? Which vaccines? Which diagnostics? Which disease? Neither he nor our honourable health secretary specified. Without naming any specific disease which can have pandemic potential, Mr Ryan continued to elaborate on India’s pharmaceuticals manufacturing base and innovations in digital technology. Meanwhile our health secretary seems eager to promote the “Pandemic Treaty” which has provision for control of misinformation and censorship. To fight against unknown “deadlier pandemics.”
Drugs, vaccines, diagnostics, pharma industry and digital technology. This is the strategy of the pandemic generals on a war footing! Like military generals demanding for modernization of the armed forces for imminent war by stressing on ammunition, guns, artillery, battle tanks, arms industry and radar systems. And of course rumour control and censorship – military matters are top secret. To fight future wars against as yet unknown enemy. This combative philosophy led to a burgeoning arms race. A similar combative philosophy against “deadlier yet unknown pandemics” can lead us into a never-ending and costly pharma race.
The common citizen is dazed into compliance by such sabre-rattling be it against “deadlier pandemics” or “deadlier wars.” And the price of war whether against a mortal enemy or against pandemics are paid by humans by way of collateral harm. The recent pandemic response by way of harsh lockdowns caused much collateral harm with no benefit to the poor citizen. 
A commentary in The Lancet states that Draconian war like measures imperils the life of the poor to save the rich. Lockdowns pushed people to extreme poverty and misery. Child malnutrition and child deaths are predicted to rise exponentially without any fancy models from overrated foreign universities.
No Mr Bhushan, we should not take such war-like measures against an unknown pandemic. The WHO seems to have forgotten that the “H” in its name stands for “Health” which is “...complete, physical, mental and social wellbeing and not merely absence of disease of infirmity,” defined by this very organization! An unknown disease is only one dimension of health. If the physical, mental and social dimensions are addressed future pandemics will have little impact on populations. This is not speculation but borne out by hard data from the recent pandemic.
Throughout the Covid-19 pandemic, the Western countries continued to have 5-10 times higher mortality compared to the Asian and African countries. Most importantly, obesity was the highest driver of mortality, far more than the population level vaccination cover. The obesity rates of the West are almost three times higher than the African and Asian countries. 
Asian and more particularly the African countries in spite of the least vaccination coverage had the least mortality. This observation also finds support from a study across 68 countries and 2947 American counties which failed to find any relationship with population level vaccination and incidence of Covid-19.
Japan has the one of the most aged population in the world, yet it had just about 1/10th of Covid-19 deaths compared to Western countries. The obesity levels of the Western countries are almost 2 to 3 times higher than the Japanese.
Any new infection if it strikes an obese population will have higher impact. Vaccines and diagnostics won't save us
Brazil also drives home the hazards of obesity. In spite of having a younger population, its obesity prevalence is on par with the developed countries. And its mortality rates from the pandemic were also similar to the West. India like Brazil is a fast growing economy. While its obesity has yet to catch up with the West, the middle class Indian is well on its way to obesity and may soon reach there.
Well Mr Bhushan, the silent pandemic of obesity is ready to strike us soon, particularly among our Westernized middle class aided by market forces. While overall we have a leaner population because of large pool of poor people, there is a tendency for the recently affluent to adopt sedentary lifestyles, fast food, alcohol and smoking. Moreover due to genetic handicap Indians are more prone to diabetes and diseases of coronary heart diseases a decade or two earlier than their Caucasian counterpart. Therefore our obesity criteria have to be more stringent.
To avert the pandemic of obesity crossing into our borders from the West we do not have to check passengers at airports but to educate our people about the hazards of sedentary lifestyles and fast foods and create an enabling environment for cyclists and pedestrians rather than introducing more vehicles on crowded and ill maintained Indian roads. We have the highest road traffic accidents in the world with over 400 mostly young people dying daily on Indian roads. Would you not call it a pandemic?
More than 5000 children die in India every day due to preventable causes against a background of one of the highest rates of child malnutrition in the world. Daily, over 1300 die from tuberculosis in India. Would you not call these pandemics?
We have other unidentified “pandemics” in our own country such as dengue, typhoid, Japanese Encephalitis, and so on which we cannot quantify as data keeping of these “mundane” diseases have no glamour and therefore not carried out with the same gusto as any “new and deadlier pandemic” imported from abroad.
We have our plates full, Mr Bhushan. Any new infection if it strikes an obese population will have higher impact. Vaccines and diagnostics will not save us. We have a window of opportunity to prevent obesity taking roots in our country like it has in the West. If we have to check entry into our borders it should not be by way of restricting people but by way of restricting fast food chains.
Why prepare for an unknown deadlier pandemic when there are so many far more deadlier diseases in our own country.
You are barking up the wrong, rather, non-existent tree!
*Post doctoral in epidemiology who was a field epidemiologist for over two decades in the Indian Armed Forces. He was awarded for his work on Tribal Malaria and Viral Hepatitis E. He is currently Professor at DY Patil Medical College. Pune



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