Epidemic vs. Pandemic: Sufficient or not to address the challenges

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Abhavya Rabra
Author of this article is a Law Student, School of Law, Jagran Lakecity University, Bhopal

“Natural Forces within us are the true healers of disease.”

An epidemic disease is one which affects many persons at the same time, and spreads from person to person in a locality where the disease is not permanently prevalent. The World Health Organization (WHO) further specifies epidemic as occurring at the level of a region or community. The ‘–demic’ part of epidemic and pandemic comes from the Greek demos, which means people of a district. On the other hand pandemic as compared to an epidemic disease, a pandemic disease is an epidemic that has spread over a large area, that is, it is prevalent throughout an entire country, continent, or the whole world. In layman’s language epidemics is spreading of an infectious disease in a community whereas pandemic is worldwide spreading of disease.

India has witnessed many large outbreaks of emerging and re-emerging infectious diseases in the recent past as of now . The outbreak of a cholera epidemic due to the O139 strain in 1992, that of plague in Surat in 1994, the large-scale spread of Chikungunya and dengue fever, and that of avian influenza (H5N1) and pandemic H1N1 influenza were some which caused widespread havoc. As in any other country, diseases with the potential for international spread, such as Ebola virus disease and Zika virus, also pose threats to the public health.

Legal frameworks are important during emergency situations as they can delineate the scope of the government’s responses to public health emergencies and also, the duties and rights of citizens. In recent years, many states in India have invoked various provisions of the Epidemic Diseases Act of 1897 to force H1N1-affected persons to be segregated and get them treated at recognised hospitals and to set up isolation facilities for the public. It is important to evaluate the Epidemic Diseases Act of 1897 with its relevance in the current context and whether it has kept up with the recent global developments in disease surveillance, control and rights perspective.

Description of the Epidemic Diseases Act, 1897
The Epidemic Diseases Act was passe with the aim of better preventing the spread of “dangerous epidemic diseases”[1]. It evolved to tackle the epidemic of bubonic plague that broke out in the then Bombay state at the time. The Governor General of colonial India conferred special powers upon the local authorities to implement the measures necessary for the control of epidemics.

The Epidemic Diseases Act is one of the shortest Acts in India, comprising just four sections. The first section explains the title and the extent, while the second gives powers to the state and Central governments to take special measures and formulate regulations that are to be observed by the people to contain the spread of disease. The third section describes penalties for violating the regulations, in accordance with Section 188 of the Indian Penal Code. The fourth deals with legal protection to the implementing officers acting under the Act (5).

According to the provisions of Section 2 of the Act, which describes the powers of the government, “When the state government is satisfied that the state or any part thereof is visited by or threatened with an outbreak of any dangerous epidemic disease; and if it thinks that the ordinary provisions of the law are insufficient for the purpose, then the state may take, or require or empower any person to take some measures and by public notice prescribe such temporary regulations to be observed by the public. The state government may prescribe regulations for inspection of persons travelling by railway or otherwise, and the segregation, in hospital, temporary accommodation or otherwise, of persons suspected by the inspecting officer of being infected with any such disease.” (5: p 2). Section 2A empowers the Central government to inspect any ship leaving or arriving at any port and for detention thereof, or of any person intending to sail therein, or arriving thereby. Section 3 states, “Six months’ imprisonment or 1,000 rupees fine or both could be charged out to the person who disobeys this Act.”

The Act was executed vigorously to control the plague epidemic that broke out in the 1890s . The powers it conferred were invoked to search for suspected plague cases in homes and among passengers. There was forcible segregation of affected persons, disinfections, evacuation, and demolition of infected places. The assembly of crowds was prevented, public meetings and festivals were banned and pilgrimages suspended in order to avoid the consequences. Alleged humiliation of and violence against women gave rise to concerns among the citizens, and riots were reported in some areas. In many places, military powers were used to ensure the proper implementation of the preventive measures.

Limitations of the Epidemic Diseases Act in the changed context
The factors leading to the emergence and spread of communicable diseases have also changed and thus hold major limitations in this era of changing priorities in public health emergency management. Some factors that need to be addressed, now are the increasing rates of international travel, more extensive use of air travel compared to sea travel, greater migration within states for the sake of earning a livelihood, increased urbanization, grossly increased density of populations in certain areas, increasing intensity of contact, man-made ecological changes, changing climatic conditions, technologies of mass food production, breakdown of public measures and bio-safety lapses. The Epidemic Diseases Act needs modifications in the changing scenario. As it mainly oriented towards travel by ship and silent on air travel, which was uncommon at that time. The epidemiological concepts used in relation to the prevention and control of epidemic diseases have also changed over time. This Act is not in line with the contemporary scientific understanding of outbreak prevention and response, but only reflects the scientific and legal standards that prevailed at the time when it was framed. The Act places too much emphasis on isolation or quarantine measures, but is silent on the other scientific methods of outbreak prevention and control, such as vaccination, surveillance and organised public health response. This Act as such, is not sufficient to deal with the prevention and control of communicable disease in the current situation. Therefore this Act of 1897 is quite quandary in nature.
 Dangerous epidemic disease as the definition of it is nowhere provided in the Act. There is no clear definition of whether an epidemic is dangerous on the basis of the magnitude of the problem, the severity of the problem, the age of the population affected or it’s potential to spread internationally. It is very essential to know what a “dangerously epidemic disease” is and what criteria the meaning is based on, if one prevents misuse of the Act and also for transparency.

In the case of Devarshi Pragneshbhai Patel v State of Gujarat[2],the respondent authorities are, by way of preventive measures, providing the vaccine for swine flu free of cost to the intended beneficiaries as per the guidelines issued by the Ministry of Health and Family Welfare. More than 2000 health care workers and doctors, involved in treatment of such patients are vaccinated with Influenza A H1N1 vaccines free of cost and not at the subsidized rate and for curing this kind of complications, one has to go for curative measures like Early Diagnoses and Prompt Treatment (EDPT) by taking medicine which is dispensed as capsule Oseltamivir, which holds potent anti-virus properties and if taken within 48 hours of manifestation of symptoms of A H1N1, it works as magic bullet and more than 90% of the viral load of the patients gets decreased in just 3-4 doses and will get cured within five days. The medicines are provided free of cost by the State Government. The court stated that the State Government has taken very effective methods and they may continue with the same and the manner in which the State Government has taken steps to prevent and control swine flu shows that it is interested in the welfare of the people of Gujarat. In the case of Justice Brigad vs Union of India and Ors[3] the Union Cabinet Secretary has directed all the States and Union Territories to invoke Section 2 of the Epidemic Diseases Act, 1897. Submissions made that when the Essential Commodities such as masks, sanitizers etc, are sold by the medical shops, at exorbitant rates, taking advantage of the prevailing situation, in the State of Kerala, Government of Kerala should be directed to respond forthwith and take adequate measures for control of the price of such essential commodities, and to ensure that the same is easily available to the public. The Collector, administered the respondents to take measures to control the price rise of the essential commodities and ensure adequate supply of the said commodities in the State of Kerala. 
 
Addressing Challenges
When an influenza pandemic emerges, all countries worldwide will inevitably have it’s affect. However, the impact may vary both between and within countries which leads to several factors including lack of access to adequate medical care, weak public health infrastructures, social factors such as housing conditions and population density, and host factors such as nutritional status and co-existing medical conditions and several possible interventions can be implemented to control or mitigate the effects of an influenza pandemic, which include pharmaceutical interventions such as vaccines, and non-pharmaceutical interventions such as quarantine, isolation, social distancing, and personal hygiene.

Pharmaceutical interventions are needed for mitigating the impact of an influenza pandemic. During an influenza pandemic, essential medical supplies such as gloves, masks, syringes, antipyretics, and antimicrobial agents will also be required in order to ensure safety. These supplies are though insufficient in healthcare facilities in developing countries, even in non-emergency situations as lack of these supplies may hamper provision of adequate medical care for patients with pandemic influenza. Basic protective equipment such as disposable gloves and surgical masks are needed for protecting healthcare workers. In countries with limited healthcare resources, providing routine medical care for other conditions may become difficult during a pandemic. As the health consequences of a pandemic, including deaths, can substantially be  reduced by providing better medical care.

Individuals can also take preventive measures of their own, including regularly washing their hands, covering their sneezes, and wiping down surfaces. As current scenario, of COVID-19 intersects with the underlying inequality crisis that was already fragmenting our societies and creating an age of anger. Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. Most people throughout the world infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment.  Older people and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness.

Conclusion
There is a need to strengthen legal frameworks to prevent and control the entry, spread and existence of communicable diseases in India. The Epidemic Diseases Act 1897, which is more than a century old, has major limitations when it comes to tackling the emergence and re-emergence of communicable diseases in the country, especially in the changing public health context. There is a need for an integrated, comprehensive, actionable and relevant legal provision for the control of outbreaks in India that should be articulated in a rights-based, people-focused and public health-oriented manner.



[2] 26 February, 2015
[3] WP(C).No.8260 OF 2020(S)

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