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FUTURE PANDEMIC
PREPAREDNESS AND
EMERGENCY RESPONSE
A Framework for Action
Report of the Expert Group FUTURE PANDEMIC
PREPAREDNESS AND
EMERGENCY RESPONSE-
A FRAMEWORK FOR ACTION
REPORT OF THE EXPERT GROUP
AUGUST 2024
Disclaimer: This report represents the views of the Expert Group members. It does not constitute the official
views of NITI Aayog. NITI Aayog does not accept any legal liability for the accuracy or inferences drawn from
the material contained therein or for any consequences arising from the use of this material. Expert Group Members
1. Dr Renu Swarup, Former Secretary, Department of Biotechnology - Chairperson
2. Dr Soumya Swaminathan, Former Chief Scientist, WHO and Former DG, ICMR - Member
3. Dr Sujeet Singh, Former Director, NCDC - Member
4. Shri Rajib Kumar Sen, Senior Adviser (Health), NITI Aayog - Member-Secretary
Supported by: NITI Aayog, Health Division
1. Dr Sonali Rawal, Consultant Grade-II
2. Mr Varun Singh, Consultant Grade-II
3. Ms Neha Sharma, Young Professional Future Pandemic Preparedness and Emergency ResponseA Framework for Action= i
TABLE OF CONTENTS
List of Abbreviations1
Preface5
Executive Summary7
1Introduction 10
1.1Background10
1.2Setting up of the Expert Group12
2Methodology14
2.1Consultations14
2.2Research14
3Lessons from the Past -dealing with epidemics in the last two decades 15
4COVID-19 Learnings and Challenges18
5Future Pandemic Threats: Public Health Challenges and Preparedness 21
6Recommendations23
6.1Governance, Legislation, Finance and Management 27
6.1.1Governance 27
6.1.2Legislation 29
6.1.3Finance and Management31
6.2Data Management, Surveillance and Early Predictive Warning,
Forecasting and Modelling,
32
6.2.1Data Management (Generation/Sharing/Analysis) & Data
Communication
32
6.2.2Surveillance33
6.2.3Forecasting & Modelling38
6.3Research and Innovation, Manufacturing, Infrastructure,
Capacity building/Skilling
39
6.3.1Research & Innovation 39
6.3.2Regulatory Reforms47
6.3.3Capacity and competency building in Mission Mode47
6.3.4Resilient Supply Chains49
6.4Partnership: Community engagement including risk
communication, Private sector partnerships, and international
collaborations
50
6.4.1 Community involvement and Engagement with Private Sector 50
6.4.2Communication53
6.4.3Collaborations and Partnerships54 Future Pandemic Preparedness and Emergency ResponseA Framework for Action= ii
7Continuous Monitoring of progress to redefine priorities55
8Indicative timelines 58
Annexure - I59
Annexure - II61
Annexure - III66
Annexure - IV69 Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 1
LIST OF ABBREVIATIONS
ADMEAbsorption, Distribution, Metabolism, and Excretion
AMRAnti-Microbial Resistance
ARBAntibiotic Resistance Bacteria
AMTZAndhra Pradesh Med Tech Zone
BPPLBacterial Priority Pathogen List
BSLBiological Safety Level
cCAMP Centre for Cellular and Molecular Platforms
CBRNChemical, Biological, Radiological, and Nuclear
CCMBCentre For Cellular and Molecular Biology
CCHFCrimean–Congo Haemorrhagic Fever
CDCCentre for Disease Control
CDSCO Central Drugs Standard Control Organisation
CEPICoalition for Epidemic Preparedness Innovations
CLIAChemiluminescence Immunoassay
CoECentre of Excellence
COVID Coronavirus Disease
CSIRCouncil of Scientific and Industrial Research
CSOCivil Society Organization
DAHDDepartment of Animal Husbandry and Dairying
DBTDepartment of Biotechnology
DHRDepartment of Health Research
DNADeoxyribonucleic Acid
DoHFW Department of Health & Family Welfare
DoPDepartment of Pharmaceuticals
DRDODefence Research and Development Organisation
DSTDepartment of Science & Technology
EDAEpidemic Diseases Act
EISEpidemic Intelligence Service
EGsEmpowered Groups
EGoSEmpowered Group of Secretaries
ELISA Enzyme Linked Immunosorbent Assay
EOC-NET Emergency Operations Centre -Network
EVDEbola Virus Disease
FETPField Epidemiology Training Program
GISGeographic Information System
HCWHealthcare workers
IAPSM Indian Association of Preventive and Social Medicine
ICARIndian Council of Agricultural Research
ICMRIndian Council of Medical Research
IDSPIntegrated Disease Surveillance Programme Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 2
IECInformation Education Communication
IHRInternational Health Regulations
IHIPIntegrated Health Information Platform
INSACOG Indian SARS-COV-2 Genomic Consortium
IPIntellectual Property
IPDInpatient Department
IPPS International Pandemic Preparedness Secretariat
IPPRS
Independent Panel for Pandemic Preparedness and Response
Secretariat
JEEJoint External Evaluation
KFDKyasanur Forest Disease
MDRMulti Drug Resistant
MERS-CoV Middle East Respiratory Syndrome Coronavirus
MoHFW Ministry of Health and Family Welfare
mRNAmessenger Ribonucleic Acid
NADRES National Animal Disease Referral Expert System
NBRIC National Biomedical Resource Indigenization Consortium
NCDCNational Centre for Disease Control
NCENew Chemical Entity
NDCTNew Drugs and Clinical Trials
NDMANational Disaster Management Authority
NEG-VAC National Expert Group on Vaccine Administration for COVID-19
NGONon-Governmental Organization
NGSNext Generation Sequencing
NIBNational Institute of Biologicals
NIDMNational Institute of Disaster Management
NII National Institute of Immunology
NITI Aayog National Institution for Transforming India Aayog
NIVNational Institute of Virology
NIPER National Institute of Pharmaceutical Education and Research
NSCNational Security Council
NTAGI National Technical Advisory Group on Immunization
OHOne Health
OPD Outpatient Department
PHEPublic Health Emergency
PHEDM Public Health Emergency and Disaster Management
PHEIC Public Health Emergencies of International Concern
PHEMA Public Health Emergency Management Act Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 3
PHEOCs Public Health Emergency Operations Centres
PHFIPublic Health Foundation of India
PK-PD Pharmacokinetic-Pharmacodynamic
POCPoint-Of- Care
PPEPersonal Protective Equipment
PPERPandemic Preparedness and Emergency Response Framework
PRETPreparedness and Resilience for Emerging Threats
PSAPrincipal Scientific Adviser
RATRapid Antigen Test
RIARadioimmunoassay
RCCERisk Communication and Community Engagement
SARS-COV2 Severe Acute Respiratory Syndrome Corona Virus 2
SEARO South-East Asia Regional Office World Health Organization (WHO)
SECSubject Expert Committee
SOPStandard Operating Procedure
THSTI Translational Health Science and Technology Institute
UHPRUniversal Health & Preparedness Review
UNICEF United Nations International Children’s Emergency Fund
WHOWorld Health Organization
ZVDZika Virus Disease Future Pandemic Preparedness and Emergency ResponseA Framework for Action 4 Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 5
It is a matter of great honour for the Expert Group constituted by NITI Aayog on
Future Pandemic Preparedness to submit the Final Report entitled “Future Pandemic
Preparedness and Emergency Response —A Framework for Action”. The Expert Group
would like to compliment the NITI Aayog leadership, especially Dr Vinod Paul, Member
(Health), NITI Aayog, for the vision to set up the Expert Group. The TOR of the group was
to draw lessons and experiences, both national and global, on how COVID was managed
and visualise preparedness elements and future pathways for fighting any infectious
public health crisis. The Expert Group is pleased to propose recommendations based
on the learnings and challenges faced during COVID -19 and other public health crises.
Preparing the proposed framework for action for future pandemic preparedness and
emergency response involved several consultations with experts and stakeholders,
analysing the experience so far, examining national and global success stories and
identifying key gaps that need attention. The stakeholder meetings were crucial and
provided valuable insights for preparing the report. The consultations included experts
from multilateral organisations, academia, Indian industry, clinicians, epidemiologists,
researchers, policymakers etc.
The Government of India (GoI) proactively initiated a scientific preparedness plan for
future pandemic through the One Health (OH) approach. The Office of the Principal
Scientific Adviser (PSA) to the Government of India, along with thirteen other Ministries/
Departments, have conceptualised the One Health Mission to have a scientific strategy
to tackle future pandemics with a focus on surveillance, data management, research for
developing innovative countermeasures and partnerships for an effective response.
This Expert Group noted the OH Mission’s activities and integrated them into the core
recommendations of the report. The proposed recommendations complement the
initiatives of the OH Mission with a focus on proactive preparedness for pandemics,
epidemics and outbreaks, as well as developing a robust response strategy that focuses
on implementation, accountability and timely execution. Considering that the first
100 days of any public health emergency are critical, and an immediate response is
essential, the proposed framework provides a road map on how the country can deliver
the appropriate interventions in the first 100 days. From institutionalised governance
mechanisms to a separate legislation for Public Health Emergency Management, an
emergency pandemic preparedness and response fund, robust surveillance, forecasting
and modelling, and innovation research ecosystem, the key recommendations cover all
these aspects in detail.
PREFACE Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 6
Once again, the Expert Group would like to convey its special thanks to Dr Vinod Paul,
for putting the group together being with us throughout the discussions and providing
his valuable advice and guidance. The group also acknowledges the support from the
team at NITI Aayog, Health vertical and other stakeholders who have provided valuable
insights which have helped us put together a comprehensive plan of action. We hope
that the recommendations will be helpful to the government and that appropriate action
will be taken to implement them. We stand ready to assist in this endeavour.
The message is clear, we need to be ready for War when not at War Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 7
EXECUTIVE SUMMARY
The COVID-19 pandemic was the worst public health emergency witnessed, which
impacted humanity not just in a few nations or regions but across the world. Although
the health systems had experience dealing with infectious outbreaks and epidemics, we
did not have the processes and systems in place to deal with a public health emergency
at this scale. NITI Aayog constituted an Expert Group to prepare a Framework for Action
for Future Pandemic Preparedness and Emergency Response. The Terms of Reference
for the group were to examine how we managed COVID-19 at the national and global
levels, pick up the key learnings both from the success stories and challenges faced, and
assess the key gaps which need to be addressed to help us prepare and respond more
efficiently and effectively in any such future public health crisis.
The Expert Group did a detailed assessment and landscaping of what worked and what
did not in that crisis. Series of stakeholder consultations were held with National and
International experts, policy makers, researchers, clinicians, epidemiologists, funding
agencies, and international organisations - all those who played a key role in COVID
management.
Learning from the experience of COVID-19, the experts have realised that responding
in the first 100 days of an outbreak is crucial for effective management. It is critical to
be ready with strategies and countermeasures which can be made available within the
first 100 days. It is essential that the proposed framework provides recommendations
for a robust ecosystem so that when there is any outbreak from known or unknown
pathogens, India is ready to respond in 100 days. This report provides an action plan for
a 100-day response to any outbreak or pandemic. It outlines the detailed roadmap for
preparedness and an implementation phase, indicating the steps on how the outbreak
can be tracked, tested, treated and managed through a well-developed framework in a
100-day time frame. It suggests a structure that integrates and strengthens all existing
components and builds the required components to deliver the outputs that meet the
targets of a 100-day response mission.
The recommendations of the Pandemic Preparedness and Emergency Response
Framework (PPER) are in four pillars:
1. Governance, Legislation, Finance and Management
2. Data Management, Surveillance and Early Predictive Warning, Forecasting and
Modelling,
3. Research and Innovation, Manufacturing, Infrastructure, Capacity building/Skilling
4. Partnership, Community engagement including risk communication, Private sector
partnerships, and international collaborations
The actions proposed under each of these are detailed in this report. During report
preparation, an analysis was done on the challenges faced and the country’s response Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 8
while managing earlier epidemics. Over the years, there has been an effort to build
a robust ecosystem for managing the Epidemic/Pandemic public health challenge. A
strong foundation has been laid, from developing epidemiological surveillance to piloting
data input portals like the Integrated Health Information Platform (IHIP) and Integrated
Disease Surveillance Programme (IDSP) to strengthening research infrastructure and
capacity for innovative technology development. During COVID-19, there was an effort
to plug the gaps and build those components that supplemented the existing strengths.
A separate Public Health Emergency Management Act (PHEMA) is proposed to facilitate
the management of any public health crisis. The PHEMA can address various aspects
beyond epidemics, including non-communicable diseases, disasters, and bioterrorism,
and should be in place for a developed country. It will allow a holistic approach to
health management, covering prevention, control, and disaster response. The Act would
also provide for the creation of skilled public health cadres at national and state levels.
The effective management of COVID-19 was possible due to a robust governance system
through the Empowered Groups (EGs) with a whole-of-government approach. It is
proposed that an Empowered Group of Secretaries (EGoS) chaired by Cabinet Secretary
be established for Pandemic Preparedness and Emergency Response and a well-oiled
machinery is put into action which prepares and readies itself before any emergency.
A well-structured scorecard mechanism should regularly monitor the progress of key
targets. The priority targets would be the development of capacities for both human
resource and infrastructure, the development of innovative countermeasures, appropriate
high-risk financing for getting high returns, in terms of saving lives and minimising
economic loss, a well-developed robust, responsive regulatory framework, and a strong
surveillance network connecting epidemiological data with genomic, laboratory and
clinical data.
There is a need to connect the epidemiological surveillance data with the genomic
data and develop clinical correlations using hospital and lab data. A strong surveillance
network is proposed, which allows community and hospital data to flow seamlessly to a
unified data portal for data access and sharing across all relevant sectors. This will need
a well-articulated data sharing and communication policy and assigning authority to key
persons for decision-making.
Challenges faced during COVID-19 regarding an India-based forecasting and prediction
modelling system, therapeutic development and platform technologies for developing
prototype vaccine candidates need to be addressed through new missions and centres
which have been suggested in the report.
To take effective, timely action, a Pandemic Preparedness and Emergency Response
Fund needs to be established. During COVID, need-based finance packages were made
available for some of the emergency response activities like genomic surveillance, vaccine
and diagnostic development, research resources and shared infrastructure. However,
adequate finances are also required to be made available for pandemic preparation.
The research ecosystem needs strengthening. The special high-risk innovation research
fund announced by the Government as a special package —‘Mission COVID Suraksha’,
gave the country the capability to develop indigenous vaccines for the world’s most
extensive vaccination programme. The private sector could successfully develop a Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 9
portfolio of vaccines including the world’s first DNA vaccine, the first thermostable
mRNA vaccine, the first nasal vaccine and other vaccine candidates, using different
platform technologies. The high-risk fund also helped to scale up vaccine manufacturing
capacities. This experience highlights the need for continued support for developing
platform technologies and vaccine candidate libraries. A new Institute of Innovation for
new platform technologies and vaccine research, development and manufacture, and
Centres of Excellence (CoEs) for research on priority pathogens (including development
of countermeasures) should get special financial allocation to prepare for future threats
and be ready to deliver in 100 days of detection of a new pathogen.
Indian regulatory system needs special attention. There is a need for global harmonisation
of regulatory norms to allow acceptance of regulatory data across the world’s recognised
regulatory authorities and a common framework for innovative technologies and
accelerated response for emergency approval. The need for a clinical trial network for
global multi-locational trials has been suggested. This would facilitate speedy access to
globally developed countermeasures. The regulatory authority (CDSCO)needs special
powers through legislation and requires technical competence strengthening and
autonomy in functioning to meet these requirements.
Partnerships and coordination play a significant role in implementing an effective
response during an emergency, especially centres-state partnerships and community
engagement. Strengthening the existing system and developing a strong institutionalised
framework is needed.
The expert group in the report has provided a blueprint for the country to prepare for any
future public health emergency or pandemic and have a rapid response system. From
examining the lessons learned and challenges faced during the COVID-19 pandemic to
recommendations and a roadmap for governance and management of public health
emergencies in the future, this report is a starting point for the country’s pandemic
preparedness and prevention efforts. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 10
FUTURE PANDEMIC PREPAREDNESS
AND EMERGENCY RESPONSE-
A FRAMEWORK FOR ACTION
REPORT OF THE EXPERT GROUP
1. Introduction
1.1 Background
As India recovers from the COVID-19 pandemic, the worst human health crisis
humanity has witnessed, it is imperative that we draw lessons from the country’s
and the world’s experiences and accordingly visualise preparedness elements and
pathways for potential future pandemic(s).
The world was caught unaware when we were struck by the infectious virus SARs
CoV2. It took us a while to understand the impact this virus had on life, livelihood
and economic conditions, not just in the country but worldwide. We collectively
fought the SARS-CoV2 challenge using a strong public health surveillance network,
scientific knowledge and tools, and could successfully mitigate its impact. Worldwide,
there have been several science-based measures and countermeasures to tackle this
deadly virus. India, too, deployed epidemiologic, surveillance and genomic tools to
contain it. We produced diagnostics, medical technologies, vaccines and drugs to
treat the disease. India deployed a whole-of-government approach to managing the
pandemic. It encountered numerous challenges, which are learnings for the country
to better prepare for the future and have a Pandemic Preparedness and Emergency
Response framework in place which allows urgent action in any such conditions and
delivers impact in a 100-day mission mode time frame.
India deployed epidemiologic and genomic surveillance, IT-based data analytics, and
novel technology-based countermeasures and tools to contain the deadly virus. It
scaled up behavioural, clinical and therapeutic measures. Timely application of non-
pharmaceutical interventions helped firm up the manufacturing of PPEs and supply
chains to prevent infection and treat the disease. The country produced vaccines,
diagnostics and medical technologies to meet the demand. The nation ramped up
its entire machinery from R&D for new technology and product development to
manufacturing, implementation, and last mile delivery. India produced and licensed
seven vaccines at affordable cost and administered more than 2.2 billion doses of
Made in India vaccines, almost entirely through the public health system, with an
unprecedented speed.
The COVID-19 contagion is undoubtedly not the last pandemic. Given the
unpredictably changing planetary ecology, climate and human-animal-plant
dynamics, new large-scale infectious threats to human health are inevitable.
The WHO has warned the world that 75% of future public health threats are likely to be
zoonotic threats (which could be due to emerging, re-emerging and new pathogens). Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 11
Over the last two decades, seven Public Health Emergencies of International
Concern (PHEICs) have been declared by the World Health Organisation (WHO).
These include the H1N1 influenza (2009), Ebola Virus Disease (EVD) (2014-16, 2018-
2020), Zika Virus Disease (ZVD) (2016), Poliomyelitis (2014), COVID-19 (2020),
and Monkey Pox (2022). In addition, the world has tackled public health threats of
SARS, Avian influenza (bird flu), MERS-CoV, and Nipah virus outbreak which have
challenged health systems across countries. However, it is worth mentioning that
the COVID-19 pandemic was more complex in terms of high public health impact,
recurring waves and unpredictable course due to changing pathogenicity associated
with virus mutations and variants. This has highlighted the importance of a targeted
approach towards zoonotic and other potential pathogens that are likely to emerge
in the future. Such threats could be due to emerging and re-emerging pathogens,
or could also arise due to newly emerging pathogens from viruses which routinely
are infective for bats or other avian populations but may cross over to humans due
to frequent mutations directly or via vectors due to environmental or occupational
aspects of human animal interface. Considering the above aspects, the Government
of India is in the process of launching the One Health (OH) Mission, focusing on
multi-disciplinary human, animal and environmental sectors through an effective
integrated surveillance ecosystem, joint outbreak response system and targeted
research.
While the One Health (OH) approach is crucial for addressing many pandemic threats,
there are challenges from CBRN agents, threats from bioterrorism, the possibilities of
deliberate release of pathogens for malicious purposes and pandemic scenarios that
extend beyond its scope and require strategies which are beyond the OH approach
involving national security, international collaborations with inter-disciplinary
approach and high-tech systems. Further, factors like increased travel and trade
due to globalisation, effects of climate change on pathogens, and determinants of
pathogenicity among vulnerable groups, including emerging resistant pathogens
and social determinants of health, require a separate mechanism.
Globally, countries and multi-lateral organisations are working towards preparedness
to deal with novel pathogens and disease outbreaks. WHO has already identified
around 30 viral and bacterial families, which could have potential for epidemics or
pandemics and hence need to be targeted for future research, development of new
laboratory techniques for diagnosis, and countermeasures. The WHO has revised
the International Health Regulations (IHR) to reflect the post pandemic reality; Inter-
governmental negotiations on a Pandemic Accord were also conducted and a global
scientific framework for epidemic and pandemic research preparedness is being
developed. The recent 77
th
World Health Assembly also highlighted the need for a
collaborative surveillance framework and developing a roadmap for epidemiological
capacity building at all levels and aligning with regional and global initiatives.
Therefore, it is imperative that countries also take stock of their needs and prepare
a robust road map aligned with global instruments like Preparedness and Resilience
for Emerging Threats (PRET) and obligations under International Health Regulations
(IHR), which are legally binding on all WHO member countries for preparing and
responding to future pandemic threats to public health systems. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 12
1.2 Setting up of the Expert Group
In response to SARS-COV2, India made efforts to produce novel countermeasures
and strengthened its research and development framework. These included
mechanisms for funding of industry and researchers, establishment of shared
resources; policy and guidelines for sharing of data, samples, regulation; public-
private partnerships and global collaborations. India also invested in digital tools for
pandemic response and vaccination, which helped manage data of more than 1.4
billion population. Despite this, a huge number of lives were lost, and the economy
took a big hit. The country must learn from planning and implementing such a
multi-modal pandemic response. More importantly, it is paramount to envision an
approach on tackling a future challenge of this magnitude due to a new pathogen
with even greater efficacy and speed building upon the networks and frameworks
established during the Covid-19 pandemic.
Consequently, an Expert Group was set up to examine these issues in depth, consult
other experts (national/global), learn from the positive experiences and challenges,
and develop a detailed analysis of what worked and what did not. The report looks
at the lessons learnt from the country’s response and global experiences and offers
a clear strategy and road map on what our preparedness should be to handle any
such and even more dangerous public health crisis in future.
Terms of Reference of the Expert Group:
The Expert Group on India’s Future Pandemic Preparedness was set up with the following
Terms of Reference:
1. Study emerging information on pathogens with the potential to power large outbreaks
in the future and suggest mechanisms for focusing on surveillance taking ‘one earth one
world’ approach to ensure that we are prepared for diseases of potentially unknown
agents.
2. With a focus on the scientific and technological approaches, tools, products and systems
deployed in the COVID-19 pandemic response, prepare a synthesis report on the learnings
thereof and propose preparedness pathways for the country. In particular, undertake this
task with specific reference to pandemic epidemiology, forecasting, surveillance, testing
and containment, virus characterisation including genome sequencing, and diagnostics,
digital tools, therapeutics, medical technologies and vaccines.
3. Recommend specific action to be taken for strengthening and creating a robust
ecosystem for pandemic prediction and prevention, biomedical research, and new
innovative, affordable and accessible countermeasures.
a) Further, identify gaps that exist in infrastructure, human resources and systems in
this regard and recommend actions to be taken to build this at a world-class level
through Atma Nirbhar effort.
b) Suggest how to create systems that allow complete forward and backward linkages
to ensure no dependency on imported raw material; and recommend building
networks for clinical trials to take up disease-based vaccine and therapeutics
research ensuring compliance with global regulatory standards.
c) Recommend scale-up mechanisms to promote the capacities of our industry to
become manufacturing hubs to be able to meet the needs of the country and also
supply to the world. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 13
d) Suggest improvements to strengthen the framework for data and sample
sharing.
4. Provide guidance on meaningful national and international, including bilateral,
multilateral, and public-private partnerships.
The Composition of the Expert Group is as follows -
• Chairperson: Dr Renu Swarup, Former Secretary to Govt of India, Department of
Biotechnology
• Members:
»Dr Soumya Swaminathan, Former Chief Scientist WHO & Former DG ICMR
»Dr Sujeet Singh, Former Director NCDC
• Member Secretary: Sh. Rajib Kumar Sen, Senior Adviser Health, NITI Aayog
This report offers a blueprint for the country to prepare for any future public health
emergency or pandemic to have a rapid response system. From examining the
lessons learned and challenges faced from the country’s response and global
experience during the COVID-19 pandemic to recommendations and a roadmap for
governance and management of public health emergencies in the future, this report
is a starting point for the country’s pandemic preparedness efforts.
Target audience - This report is intended to inform policymakers, National and State
governments, partners and researchers, industry and academia working on health
system resilience and preparedness for public health emergencies. It may also be
helpful to the lay public.
Caveats (if any): The contents of this report are the views and recommendations
of the expert group. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 14
2. Methodology
2.1 Consultations
The Expert Group has consulted with national and international experts from public
health, clinical medicine, epidemiology, microbiology, industry and academia, and
senior government officials at the Centre and State level. These experts were at
the frontline of the COVID-19 response at the local, national and international levels
and played an important role in the policy, planning and implementation of the
COVID response. Expert views on the learnings and challenges of dealing with the
COVID-19 pandemic and recommendations for future preparedness were sought.
Fourteen consultations have been held with more than sixty experts.
An overview of the institutions, organizations and experts consulted are annexed at
Annexure III.
»Presentation to concerned Ministries/Departments
Following the consultations with experts, members of the expert group prepared
the critical recommendations for future preparedness. The recommendations
were discussed with Secretaries and senior officers of concerned ministries and
departments in a meeting held on 24 May 2024 at NITI Aayog; co-chaired by Member
(Health), NITI Aayog and the Principal Scientific Adviser to the Government of India.
The participants welcomed the comprehensive recommendations of the expert
group prepared through a thorough assessment of the current preparedness status
and lessons learnt from COVID-19. Recommendations for a separate legislation
managing public health emergencies, earmarking a separate Pandemic Preparedness
and Emergency Response fund, strengthening surveillance and data management,
and investing in research and development of countermeasures (diagnostics,
vaccines, therapeutics, protective equipment) were appreciated by the participants
as timely and actionable recommendations that would also serve to strengthen
current activities and facilitate improved implementation.
2.2 Research
Research complementing future pandemic priorities has also been undertaken by
the Expert Group. This includes research on the work being undertaken by global
health organisations, multi-lateral groups like the Independent Panel for Pandemic
Preparedness and Response Secretariat (IPPRS), the 100 days Mission, etc.
Published literature on the COVID-19 pandemic, evolving science about the SARS-
CoV2 pathogen, COVID-19 disease and its sequelae have also been considered
by the Expert Group in its deliberations. Details of key references are included at
Annexure IV. Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 15
3. Lesson from the Past -dealing with epidemics in the last two
decades
Between 2009- 2022, WHO has declared seven Public Health Emergency of
International Concern (PHEICs) —Influenza A in 2009, poliomyelitis in 2014, Ebola
West Africa in 2014, Zika in 2016, Ebola Democratic Republic of Congo 2018, COVID-19
in 2020 and Monkey-pox in 2022. Public Health Emergency of International Concern
(PHEIC), as per IHR, is “an extraordinary event which is determined as per IHR
decision instrument (1) to constitute a public health risk to other countries through
the international spread, and (2) to potentially require a coordinated international
response”. Further, during the last few years, many countries have witnessed the
occurrence of several infectious diseases, outbreaks/public health threats which
were potential pandemic threats both outside and inside the country, which resulted
in the loss of lives, property, and economic consequences.
Important events/outbreaks during last two decades (which caused pandemic
threat) are described below. These also have the potential to cause future pandemics;
hence, preparedness measures should also be developed to manage their outbreaks.
Event/Outbreak DescriptionLearnings
SARS in 2003 The first infectious disease in
this century, which started in two
provinces of China, spread to over
50 countries in a very short time
through international travel and
resulted in around 850 deaths
within a period of 3-4 months.
Highly infectious and contagious;
R
0
of around 8 spread primarily
through respiratory mode. A
multi-country high-level expert
group got exposed in a group
meeting in Hong Kong Hotel
(event) which caused multi-
country spread during air travel
and also after return. Countries
used ad hoc measures in absence
of any international provisions,
primarily on basis of past
experience.
• Need for International
legally binding rules/
regulations.
• Novel pathogens are
difficult to identify and
hence the primers and
probes for developing
diagnostic tests/facilities
take time and; thus,
detection of infection
among exposed persons
is a challenge during the
initial phase.
• Need for core capacities
for screening, sample
collection and quarantine
facilities at international
airports. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 16
Avian Flu (H5N1) Since 2005 onwards, repeated
outbreaks in birds (primarily
in poultry) have caused
significant harm to at-risk human
populations.
In 2024, H5N1 has been circulating
among cattle farms in the US, and
a few human cases have been
reported.
• An effective strategy of
surveillance of at-risk
populations and culling sick
birds was developed as a
coordinated surveillance
and response plan for both
human and animal sectors.
This helped the country
in effective containment
and prevented spillover
of infection among at
-populations from birds.
• A standing committee on
zoonosis was established
following avian influenza.
H1N1 pandemic
(pandemic
declared as
PHEIC))
Emerged in 2009 in Mexico, it
spread through respiratory routes
to over 74 countries, causing
about 491000 lab-confirmed
cases and 18449 deaths. This was
the first pandemic to be declared
as PHEIC in accordance with IHR
(2005).
• IHR (2005), a legally
binding regulation, was in
place.
• Countries were
developing core
capacities as per IHR
at points of entry and
inside the country for
surveillance and response.
• Countries adopted
public health measures
like screening at POEs,
early detection of
suspects, quarantine,
contact tracing of
suspect surveillance and
management of cases
in isolation in dedicated
wards.
• Public health measures
were helpful in mitigating
and delaying the entry of
infection.
• Need for coordinated
surveillance between
Points of entry and in-
country surveillance
system. Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 17
Ebola Outbreaks
(2014-2016)
(2018-2021)
Multiple Ebola outbreaks (around
7 since 1976) occurred in different
regions of Africa. The epidemics
in the west African countries were
significant from the perspective
of international spread in over 7
countries in Europe and the threat
of spread in other countries via
international travellers.
• Efforts to control these
outbreaks involved
screening, surveillance of
exposed, contact tracing,
data management,
laboratory testing,
and health education,
including use of PPEs.
• Public health efforts were
much more effective,
limiting entry into the
country.
MERS-CoV Outbreaks in the Middle Eastern
countries have been regularly
occurring since 2012 and are
potential threats from the
perspective of international
spread via travellers, for e.g. in
South Korea in 2015, leading to
186 cases and around 34 deaths.
• Zoonotic diseases,
particularly highly
infectious diseases that
spread via respiratory/
droplets route could be
challenging to prevent.
• Most of the threats
leading to pandemics
were due to novel viruses
of zoonotic origin,
possibly transmitted
through the human-
animal interface.
• Infectious diseases
having a respiratory
mode of transmission are
dangerous.
Zika Virus
disease
A disease transmitted via Aedes
mosquitos has already spread to
over 90 countries and has been
detected in over 12 states in the
country.
• ZVD- a disease with
over 80% asymptomatic
cases and mild clinical
symptoms with full
recovery cannot be
prevented using public
health measures directed
towards travellers.
• Effective vector
surveillance and control
is essential to prevent
entry and transmission
of vector-transmitted
diseases.
• Need for multi-sectoral
collaborative surveillance. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 18
4. COVID-19 Learnings and Challenges
The COVID-19 pandemic (2019-23) caused by the SARS-CoV-2 virus emerged
in late 2019 and quickly spread worldwide. The world was caught unaware and
although there were strategies for managing outbreaks and epidemics, developing
and deploying countermeasures for the different outbreaks, the magnitude of the
problem faced when the pandemic hit us was overwhelming and required urgent
coordinated action. It resulted in millions of deaths, widespread illness, and significant
economic and social disruptions. Efforts to control the spread of the virus included
cluster containment, disruption of social gatherings, lockdowns, travel restrictions,
mask mandates, and the development of vaccines and mass vaccination.
The country had a well-developed strategy-based response system for earlier
outbreaks, which effectively implemented and successfully managed the disease.
However, there were challenges faced and key gaps noted in the ecosystem which
need urgent attention for better management of any future public health crisis.
These lessons are important to plan a road map for future pandemics. Some of the
key issues are listed below -
4.1 Governance
i. The whole–of-government, whole-of-society approach, and inter-
departmental, inter-ministerial, and centre-state coordination worked well
during COVID -19.
ii. Role of Empowered Group Systems, National Task Forces – NTAGI & NEG-
VAC were critical for quick decision-making and interagency coordination
iii. Science-based evidence played a key role in informed decision-making.
This evolved with a scientific understanding of the pathogen and disease,
iv. The role and responsibility of each agency and organisation however,
required more clarity, and the mechanisms for close coordination of
agencies to work together were not in place.
v. Risk communication systems need to be established. What was missing
in COVID management was a well-developed communication mechanism
which allowed data to flow both ways.
vi. The need was also felt for a well-defined rapid response SOP/instruction
document and delegation of powers to empower key officials to act without
going through the multilayered hierarchal process. This was essential for
speedy time-bound action.
4.2 Legislation
i. The National Disaster Management Act (NDMA) was enforced – enabling
Centre and State government to respond quickly and implement public
health measures.
ii. However, a need is felt for a specific Public Health Act.
iii. Provisions of NDMA are not entirely suited for a public health emergency
and its public health and clinical management.
iv. The previous epidemic act has a limited scope and is not suited to the
modern approach for pandemic/epidemic management. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 19
4.3 Surveillance and Data management
i. The Disease agent was a novel virus of zoonotic origin. A One Health
Approach was needed to tackle this
ii. Data collection, management and analysis were the key issues.
• There were several data portals for human disease – IDSP, IHIP (an
Integrated Health Information Portal) apart from State portals.
Additionally, multiple data sources like ICMR COVID-19 (https://cvstatus.
icmr.gov.in/) test data and data collected in segregated portals.
• The National Animal Disease Referral Expert System (NADRES) provides
monthly livestock disease forewarning at the district level which is
published in the form of a monthly bulletin to alert the animal husbandry
departments, both at the National and state levels, to take appropriate
control measures.
• Centre & State dashboards had collected data. However, it is imperative
to integrate this data for a proper analysis. Modelling, forecasting and
early warning based on our data was a missing gap. This requires not
just data flow from the networks but also human resource capacity to
analyse and develop predictive models.
• The challenge was to get a seamless flow of this data, data integration
for proper data analysis using epidemiological intelligence and access
to relevant stakeholders for different types of research, development
of countermeasures, and prediction models. A continuous, uniform,
interoperable data flow is essential from state to centre, from field sites,
connected with laboratory and clinical/hospital networks.
• Surveillance was a critical aspect of COVID management. While there was
a solid existing epidemiological surveillance through the IDSP network,
the gap was a well-integrated surveillance network for pandemics like
COVID-19. Hence, in April 2020, special efforts established a dedicated
Special Surveillance System (S-3), i.e., https://covid19.nhp.gov.in for
data capture from the district level on surveillance, logistics planning
including hot spot data on quarantine, and patient management. Digital
platforms – like Aarogya Setu mobile tracking Bluetooth-based app
for contact tracing & information dissemination - to lab and S3 system;
CoWIN platform – played a very important role in vaccination and
individual risk assessment.
iii. The INSACOG Network on Genomic Surveillance was helpful in identifying
new strains, but there was limited capacity across the country. This network
linking epidemiological and genomic surveillance should be strengthened
and connected with clinical surveillance and hospital networks.
iv. The INSACOG potential could not be optimally utilised as the linkages with
state laboratories of primary and secondary health care centres and the
private sector needed strengthening. For future pandemics, INSACOG can
function in a hub and spoke model with centre-state partnership and active
involvement of the private sector both for hospital network and genomic
surveillance. Mathematical modelling systems must be in place to connect
epidemiological, genomic surveillance and clinical data for early prediction
and warning. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 20
v. Wastewater analysis and serological surveillance also helped identify the
spread of viruses; this should be done regularly.
vi. Hence a unified, comprehensive National Data Portal that aggregates all
information about the virus and disease spread from various sources is
suggested to identify trends and quickly predict surges/next outbreaks,
including data from scientific research and predictive modelling.
4.4 Research and Development, translation and product development
i. Public and private collaborations were a strong factor for efficient pandemic
management. It has been well established that there is sufficient capacity
and competency in industries both in innovative research and manufacturing
and the pieces of the ecosystem have existed in the translational value chain.
The rapid tests and low-cost tests developed by ICMR, and other institutes
were required to be linked with relevant industries for bulk manufacturing.
However, there was a need for creating a structured mechanism linking
research bodies like ICMR and the private sector with appropriate industries
under the overall framework for pandemic management. A well-laid-out
validation network is essential for the development of diagnostic kits.
ii. Vaccine candidates were developed, and manufacturing capacities were
scaled up. This was possible due to the High-Risk Innovation Funding
Mission COVID Suraksha. India’s strength in diagnostics and vaccines needs
to be developed in a proper framework involving research, regulatory
bodies and industries. This could also serve as a valuable resource for the
entire Southeast Asia region.
iii. Animal challenge facilities, BSL3 network, validation labs, and bio repositories
were set up. The challenge was to have systems in place that allow access to
the shared infrastructure and access to biological and clinical material and
samples. We need the tools and instruments, including MoUs and Material
Transfer Agreements which provide necessary access.
iv. Start-ups played a significant role in the manufacturing of low-cost PPEs,
sanitisers and other protective gear like face masks. We, however, need
forward and backward linkages and uninterrupted supply chains to ensure
a large-scale cost-effective production.
4.5 Regulatory Reforms
i. Although we quickly developed a rapid response regulatory framework to
respond to our requirements for COVID-19, the regulatory system was not
geared up for accelerated emergency authorisation. The need for regulatory
process harmonisation and clear guidelines for new technology is of utmost
importance.
ii. The established guidelines and SOPs and the technical competence to
understand the complexities of new technologies need strengthening.
Since we did not have harmonized global regulatory guidelines, this delayed
the approval of products already approved by other recognized national
regulators.
iii. A well-established, globally accepted clinical trial site network was also
essential for trials of products developed by other global groups. Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 21
5. Future Pandemic threats: Public Health Challenges and
Preparedness
Evidence suggests that the risk of emerging infectious diseases due to known and
unknown pathogens, particularly of zoonotic (animal, avian and wildlife) origin,
has increased over time due to the intensification of international travel, trade and
livestock husbandry, as well as increasing human population density and changing
interactions between humans and wild animals. These drivers of disease emergence
are likely to continue and intensify, and additional drivers of ecological change and
disruption, such as climate change and global warming, are likely to further amplify
disease emergence risk.
The WHO has initiated a global process to update the list of priority pathogens—
agents that can cause outbreaks or pandemics—to guide global investment, research
and development (R&D), especially in vaccines, tests and treatments. The current
list includes COVID-19, Crimean-Congo haemorrhagic fever, Ebola virus disease and
Marburg virus disease, Lassa fever, Middle East Respiratory Syndrome (MERS) and
Severe Acute Respiratory Syndrome (SARS), Nipah and henipaviral diseases, Rift
Valley fever, Zika and Disease ‘X’. The 2024 Bacterial Priority Pathogen List (BPPL)
includes 15 families of antibiotic-resistant (ABR) pathogens grouped into critical,
high and medium categories of priority for R&D and public health measures. In
addition, 200+ scientists from 53 countries independently evaluated the evidence
related to 30 viral families to identify priority viral pathogens. Research on pathogens
and categorization as agents which can or which have the potential for casing
epidemics and pandemics is a dynamic process, coordinated by WHO. Periodically
WHO expert group updates the list of priority pathogens. The current (as of June
2024) list of priority pathogens is placed at Annexure II.
In the face of current and future pandemic threats, the importance of collaborative
surveillance cannot be overstated. The key challenges are timely detection of early
warning signs, the identification of emerging and new pathogens (which could
potentially lead to future pandemic threats), the assessment of the public health
impact and the implementation of multi-disciplinary surveillance to capture various
dimensions of a disease and its impact. It is imperative that collaborative surveillance
in community and health facilities is established for the regular assessment of the
impact of CBRN agents on transmission, morbidity, severity and mortality in the
community, thereby enabling proactive planning.
In addition, the following epidemiological aspects of infectious diseases/agents
may also pose specific challenge to public health strategies:
i. Diseases with large asymptomatic carriers contributing to transmission and
possible health impact, like spontaneous vaginal delivery in pregnant women,
may be associated with congenital microcephaly.
ii. Highly pathogenic agents causing high mortality and high rate of transmission
Ro > 5 or so
iii. Infectious diseases with Resistant pathogens (viruses, bacteria and fungi)
iv. Diseases with a reservoir in domestic animals (largely asymptomatic like CCHF),
birds, cattle, pigs, bats etc.
v. Diseases with unknown transmission routes (milk, food, touch, droplets, air etc.) Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 22
Strategy: Given future threats, the traditional public health surveillance strategy
should be aligned with new initiatives focused on:
i. Global Preparedness: Pandemics have the potential for cross-border spread and,
hence, country preparedness needs to align regional and global core capacities
for robust collaboration and communication to prevent or mitigate cross-border
spread.
ii. Cross-sectoral and cross-border collaboration: for enhancing coordination
between public health authorities, disaster management agencies, and other
relevant sectors to manage pandemic threats effectively.
iii. Risk assessment and community engagement: Strategy for assessment of
potential future risks, allowing possible misconceptions and rumours during
outbreaks and ensuring accurate information dissemination and community
cooperation.
iv. Resource Availability: Ensuring necessary funds and resources are available to
support pandemic response efforts.
v. One Health Approach: Developing the multi-hazard plan, strategy, SOPs, and
processes for implementation for coordinated surveillance and response to
zoonotic and other emerging infectious diseases.
These challenges highlight the need for proactive preparedness to strengthen public
health systems and response capabilities in the face of current and future potential
pandemic threats. Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 23
6. Recommendations
While over the years, we have had many outbreaks, and the country has built response
mechanisms both at the centre and state level, including community engagement,
the onset of COVID-19 was a situation which brought out the key challenges in
the system and highlighted the specific gaps which need to be addressed. Clearly,
we cannot wait for the next infectious pathogen to strike before we act. We need
a well-articulated action plan which gives us a clear road map on how we should
prepare in advance and keep our tools and capacity ready so that without wasting
any time, an emergency response which begins action on day zero and gives the
required results to have disease prevention, mitigation and control is in place within
100 days.
Accordingly, a Pandemic Preparedness and Emergency Response (PPER)
framework for action is proposed for consideration. The PPER aims to have a well-
developed framework in place that will make the system ready for any future public
health crisis and deliver a response in a 100-day time frame. The framework keeps
the preparedness in peacetime to respond to emergency war.
Based on our learnings from earlier epidemics and the key actions taken and strategy
followed to manage the COVID pandemic, it is evident that a special focus must be
placed on sustaining the efforts made and addressing the challenges faced with a
well thought-out action plan that can respond to a public health emergency in the
shortest period of time.
Post-COVID, there has been a proactive approach by the Government, and One
Health (OH) Mission has been launched, which focuses on Surveillance, Research,
Data management, Outbreak management and Pandemic preparedness.
The OH Mission focuses on:
i. Surveillance with emphasis on Priority pathogens, especially, viral families and
representative or prototype viruses within each family
ii. Bacterial threats in the context of Anti-Microbial Resistance (AMR)
iii. Data management and analysis
iv. Research and development covering medical countermeasures, including
diagnostics, drugs and vaccines
v. Building on lessons from the COVID.19 pandemic
In addition to the areas covered under OH Mission, some key actions are proposed
under PPER for consideration. The recommendations are under four pillars:
6.1 Governance, Legislation, Finance and Management
6.2 Data Management, Surveillance and Early Predictive Warning, Forecasting
and Modelling
6.3 Research and Innovation, Manufacture, Infrastructure, Capacity building
6.4 Risk Communication, Community engagement, Private sector partnerships,
and International collaborations Future Pandemic Preparedness and Emergency ResponseA Framework for Action 24
Key Recommendations
Creating a well-connected/integrated robust surveillance network linking epidemiological, genomic
and clinical data, including humans, animals and the environment.
Establishing a harmonized system for data collection, access, sharing, analysis, and a unified data
portal for infectious diseases
Building a strong modelling and forecasting network for early prediction of emerging threats
Creating a strong biosecurity network of BSL3 and BSL 4 facilities for characterization and
epidemiological study of all priority pathogens and known/ unknown pathogens
Surveillance, Data Management, Forecasting, Modelling,
Early Predictive Warning
Governance, Legislation, Finance and Managementv
Enacting a new Public Health Emergency Act
Creating an institutionalised empowered governance mechanism for Public Health Emergencies. An
Empowered Group of Secretaries on PPER chaired by the Cabinet Secretary
A Continuous Monitoring Group to be constituted co-chaired by the Secretary Health and Secretary DHR
A well-defined SOP manual for rapid response to be prepared
Setting up of a special Pandemic Preparedness and Emergency Response fund for all PPER activities
of surveillance, data management, forecasting and modeling, research, innovation and manufacture,
development of counter-measures, infrastructure and capacity building
Research & Innovation, Manufacture, Infrastructure,
Capacity Building
Focused research on priority pathogens to develop countermeasures
Development of countermeasures -diagnostics, drugs, vaccines
Allocating Pandemic Preparedness and Emergency Response fund for High-risk Research and
Innovation
Setting up an Institute of Innovation for New Platform technologies and vaccine research,
development and manufacture
Scaling manufacturing capacities and logistic supply chains for availability of counter measures
Creating strong forward and backward linkages with vertical integration to develop strong supply
chains, for countermeasures
Creating Centres of Excellence for Skilling Human Resources in identified gap areas
Risk Communication, Community Engagement, Private Sector
Partnerships and International Collaborations
Setting up of a specialised Risk communication unit with Pre approved SOPs and protocols for
release and dissemination of information on a regular basis to different stakeholders
Having pre-approved instrument, guidelines and agreements for Private sector participation in
surveillance, research, manufacture and disease management including testing, vaccination and
treatment
Community engagement SOPs to be developed for proper disease management Building strong
Partnership models at Centre, State, district and community level and collaboration with the
international organisations Future Pandemic Preparedness and Emergency ResponseA Framework for Action 25
Some key recommendations are listed below. Those areas/activities taken up under
the OH Mission can be further strengthened and integrated with the implementation
plan proposed under the PPER Framework.
6.1 Governance, Legislation, Finance and Management
i. Enacting a new Public Health Emergency Management Act (PHEMA)
ii. Creating an institutionalized empowered governance mechanism for Public
Health Emergencies - An Empowered Group of Secretaries on PPER chaired
by the Cabinet Secretary
iii. Constituting a Monitoring Group co-chaired by the Secretary Health and the
Secretary Dept. of Health Research (DHR)
iv. Preparing a detailed SOP (implementation manual) for rapid response to
biological threats
v. Setting up of a special Pandemic Preparedness and Emergency Response
fund for all PPER activities of surveillance, data management, forecasting
and modelling, research, innovation and manufacturing, development of
countermeasures, infrastructure and capacity building
6.2 Data Management, Surveillance and Early Predictive Warning,
Forecasting and Modelling,
i. Creating a well-connected/integrated robust surveillance network linking
epidemiological, genomic and clinical data, including humans, animals and
the environment.
ii. Establishing a harmonised system for data collection, access, sharing,
analysis, and a unified data portal for infectious diseases.
iii. Building a solid modelling and forecasting network for early prediction of
emerging threats.
iv. Creating a strong biosecurity network of BSL3 and BSL4 facilities for
characterisation and epidemiological study of priority and known/unknown
pathogens (in animals and humans).
6.3 Research and Innovation, Manufacturing, Infrastructure, Capacity
building/Skilling
i. Multi-disciplinary research on priority pathogens
ii. Development of countermeasures - diagnostics, therapeutics, vaccines,
protective equipment
The proposed PPER Framework encompasses the One Health Mission and its activities
of Surveillance, Research, Data Management and Infrastructure networks.
The PPER Framework proposes a road map and Action Plan for preparing for any
Public Health Emergency and delivering a well-articulated response in 100 Days.
The recommendations recognise existing frameworks, identify gaps that need to be
strengthened and suggest how this Action plan could be implemented. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 26
iii. PPER fund for High-risk Research and Innovation
iv. Setting up an Institute of Innovation for New Platform technologies and
vaccine research and development
v. Scaling manufacturing capacities and logistic supply chains for the
availability of countermeasures, and stockpile management.
vi. Creating strong forward and backward linkages with vertical integration to
develop resilient supply chains for countermeasures
vii. Creating Centers of Excellence for Skilling Human Resources in identified
gap areas.
6.4 Partnership: Community engagement including risk communication,
Private sector partnerships, and International collaborations
i. Setting up a specialised risk communication unit in MoHFW (NCDC) with
preapproved SOPs and protocols for dissemination of information regularly
to different stakeholders
ii. Having preapproved instruments, guidelines and agreements for Private
sector participation in surveillance, research, and manufacturing
iii. Community engagement SOPs are to be developed for clinical care,
including preventive measures, testing, vaccination, and treatment
iv. Building strong mechanisms for centre-state collaboration during
emergencies with well-defined responsibilities, accountability and reporting
structures Future Pandemic Preparedness and Emergency ResponseA Framework for Action 27
6.1 Governance, Legislation, Finance and Management
6.1.1 Governance
The unique aspect of managing the COVID pandemic was the empowering
governing mechanisms - the Empowered Groups constituted for COVID-19
pandemic management were crucial to facilitating a rapid response and urgent
action to address the unique challenges faced.
As a learning, it is therefore essential emphasise building systems that are active
not just in wartime but also in peacetime. What is needed is institutionalised
empowered systems like those built at COVID times to ensure effective
collaboration and operationalisation for preparing for pandemics and responding
on priority. It is proposed that a Standing Empowered Group of Secretaries
(EGoS) for Pandemic Preparedness and Emergency Response (PPER) should
be constituted and chaired by Cabinet Secretary and Co-Chaired by Member
Health NITI Aayog and PSA, with all concerned departments and agencies and
nodal officers from States/UTs represented at the level of Secretary as Members.
EGoS would monitor preparedness and give required directions and approvals
for the essential governance mechanisms, financial budgets and other approvals
necessary required with the approved governance framework for the OH Mission
and other pandemic-related activities.
For future preparedness, it is imperative to institutionalise the existing governance
structures and develop Standard Operating Procedure (SOP) for rapid response,
which is essential to act in different emergency situations. Therefore, operational
manuals/SOPs with local and global learnings for epidemic/pandemic times
must be prepared. The operative mechanism should be institutionalised, and
drills should be performed (like war-room operations of armed forces) as
a preparedness measure. It is proposed that the systems developed during
COVID-19 should be institutionalised for the whole of government approach to
facilitate rapid inter-government response.
The progress of the action plan needs to be continuously monitored through a
scorecard developed with defined targets and milestones. A PPER monitoring
working group chaired by Secy Health and Secy DHR will monitor the progress
on a continuous basis through the scorecard and report to the EGoS.
»A Standing Empowered Group of Secretaries (EGoS) for Pandemic Preparedness
and Emergency Response (PPER) should be constituted to prepare and monitor
preparedness during peace times - to guide on governance, finance, R&D,
surveillance, partnerships and collaborations, and other necessary functions
that can be ramped up for immediate response in a public health emergency
»EGoS to be chaired by Cabinet Secretary and Co-Chaired by Member, Health,
NITI Aayog, and PSA, with all concerned departments and agencies represented
at the level of Secretary as Members. This will connect with the approved
governance framework for the OH Mission and other pandemic related activities.
»EGoS to establish separate empowered working groups for each area in the
time of any emergency, like the Empowered Groups during COVID-19. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 28
Engagement with States: Centre-State Coordination
In India, health being a state subject there have been challenges in managing
outbreak-prone diseases, and we need special focus on inter-state and centre-
state collaboration particularly to strengthen some of the following areas:
i. Data flow on outbreak prone diseases for planning surveillance and response strategies.
ii. Coordination and data sharing amongst relevant nodal officers, since
infectious diseases and public health events are not limited within district/
state boundaries.
iii. Creation of sentinel sites in state hospitals and laboratories for surveillance
and sample collection for genome sequencing. Transportation of samples
to identified laboratories of the centre has been quite challenging during
pandemic times. This system needs better coordination.
iv. There were specific challenges related to supplies of Viral Transport Medium
(VTM), testing kits, PPEs, Vaccines and other logistics at the state level, it
is therefore essential that the EGoS-approved SoPs should give specific
instructions in this regard.
v. The availability of finances for emergency procurements, deploying HR
during surges, and involving private sector labs and hospitals at the state
level need special attention.
Accordingly, it is suggested that a seamless coordination between the State/UTs
and the centre is an essential pre- requisite for effective pandemic preparedness.
During COVID this coordination played a vital role in the mitigation of the impact
on morbidity and mortality. Hence, it is recommended that:
i. At the State/UT level, a senior officer should also be designated as the Nodal Officer
for coordinating all activities related to pandemic preparedness and response.
ii. Outbreak-prone diseases and diseases or events with potential for cross-
border spread/impact need to be coordinated by the designated nodal
officer and the central surveillance unit of NCDC.
iii. SSU and DSU need to ensure proper data uploading and real-time sharing with
CSU to detect, assess, and notify outbreaks or events of public health significance.
iv. Competency building training needs to be completed in a time-bound, manner.
v. All events declared as PHEIC or potential PHEIC need to be under MoHFW,
GOI and the nodal officer should be responsible for coordinating all the
activities related to pandemic preparedness in the respective State/UT.
vi. The nodal officers of five State/UTs should be ex-officio members of the EGoS
proposed to be set up under the Cabinet Secretariat on a rotation basis.
»Every State/UT to have a designated senior officer as a Nodal Officer
»Nodal officer to be responsible for: coordinating activities for pandemic
preparedness and response; proper dissemination of data/information as and
when required
»EGoS under Cabinet Secretariat to have Nodal Officers of a few States as
members Future Pandemic Preparedness and Emergency ResponseA Framework for Action 29
6.1.2 Legislation
A key factor to be considered is the need for a special Public Health Legislation.
At the Central level, two laws – the Epidemic Diseases Act (EDA) 1897 and the
National Disaster Management Act (NDMA) 2005, direct the legal framework on
PHEs. During COVID-19, the pandemic was managed under the National Disaster
Management Act 2005. While this provided the required powers for taking
necessary actions on priority, especially at the central and state levels, there are
key areas of medical health which need to be tackled with special powers and
provisions for which a special Medical Emergency or Public Health Emergency
Management Act (PHEMA) is essentially required.
The NDMA 2005 was enacted after the 2004 tsunami; it was not designed to cater
to health emergencies. It does not specifically define public health emergencies
or epidemics. It focuses on managing several types of disasters, including natural
disasters (such as earthquakes, floods, and cyclones) and man-made disasters
(such as industrial accidents, chemical spills, and nuclear incidents). It provides
a comprehensive framework for disaster preparedness, response, mitigation, and
recovery at the national, state, and district levels.
The Epidemic Diseases Act (EDA) 1897 authorises the Central and State
governments to take measures and prescribe regulations to be observed by the
citizens to contain the spread of a disease. The law outlines a set of rudimentary
elements, including travel restrictions, examination and quarantine of persons
suspected of being infected in hospitals or temporary accommodations, and
statutory health inspections of any ship or vessel leaving or arriving at any port
of call. However, over the years, no standard or model rules and regulations have
been prescribed as a corollary to the law nor has it been amended.
The EDA 1897 does not define “dangerous”, “infectious”, or “contagious
diseases”, or “epidemic”. It contains no provisions for the processes required
for dissemination of drugs/vaccines, and the quarantine measures and other
preventive steps that need to be taken. Further, the EDA 1897 only confers powers
and does not describe the government’s duties in preventing and controlling the
epidemic, nor does it explicitly state the rights of the citizens during the event of
a significant disease outbreak.
The International Health Regulations (IHR) require States to undertake measures
during a PHE including communication of public health information to the WHO
and the regulation of travellers and vessels at ports of entry into the country that
national authorities can best address. A PHE also requires interstate coordination
and the regulation of the movement of people and goods, as was evident during
the COVID-19 pandemic which necessitates central intervention. Further, effective
PHE response also requires capacity building at the state, district and local levels.
The absence of modern, overarching legislation specifically targeted at PHEs has
meant that capacity and expertise for PHE preparedness and response needed
to be faster to develop at all levels.
A Public Health Emergency Management Act can address various aspects beyond
epidemic, including non-communicable diseases, disasters, and bioterrorism. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 30
It allows for a holistic approach to health management, covering prevention,
control, and disaster response. The Act would also create public health cadres at
national and state levels.
This special provision act would empower public health agencies to take urgent
action. A first responding lead agency responsible for implementing this Act
should be identified. This allows for immediate rapid response by all health
agencies, organisations, and departments with no time lag. This also allows
building a workforce which is always trained and in peacetime has full preparedness
to be the first responder on war outbreak.
Globally, such Acts exist. Countries such as the United Kingdom, Canada, and the
United States of America (USA) have in place more comprehensive and updated
legislation to deal with public health emergencies. The Public Health Service Act
is a United States federal law that was enacted in 1944. This Act provided a
legislative basis for public health services in the United States. The Pandemic
and All-Hazards Preparedness Reauthorization Act of 2013 was enacted March
13, 2013, as a law by the 113th United States Congress. The Act amends the Public
Health Service Act to extend, fund, and improve several programs designed to
prepare the United States and health professionals in the event of a pandemic,
epidemic, or biological, chemical, radiological, or nuclear accident or attack. The
Act clarifies the authority of different US officials, makes it easier to reassign
personnel to respond to emergency situations temporarily, and alters the process
for testing and producing medical countermeasures. The Act is focused on
improving preparedness for any public health emergency.
The Public Health Service Act established the federal government’s quarantine
authority for the first time. It gave the United States Public Health Service
responsibility for preventing the introduction, transmission and spread of
communicable diseases from foreign countries into the United States. The
Declaration of Public Health Emergency Management Act (PHEMA) with special provisions at
the centre and state levels will facilitate priority action for-
»Building the required expertise for PHE preparedness and response at national,
state and local government levels
»Repositioning of personnel for special tasks
»Regulation of travellers and vessels at ports of entry into the country
»Interstate coordination and the regulation of the movement of people and goods
»Communication of public health information, dealing with infodemic
»Accelerated development and regulatory approval of diagnostics, therapeutics
and vaccines
»Special Procurement provisions for necessary goods and services for emergency
response
»Coordination with international organisations and countries for a PHEIC
»Carrying out the government’s duties in preventing and controlling the epidemic Future Pandemic Preparedness and Emergency ResponseA Framework for Action 31
Public Health Service Act granted the original authority for scientists and special
consultants to be appointed “without regard to the civil-service laws”, known as
a Title 42 appointment.
6.1.3 Finance and Management
During COVID management, special financial packages were made available on an
emergency basis for all activities, from surveillance to research, testing, tracking,
treatment, health infrastructure, vaccination, etc. For effective preparedness and
response to any future outbreak, epidemic, pandemic or public health crisis, it is
essential that a special Pandemic Preparedness and Emergency Response Fund
is established. This fund should be specially earmarked for all activities being
proposed under the PPER Framework. The aim of the fund would be to be fully
prepared in advance so that we are ready to deliver in any emergency in a 100
days time frame. This fund should be deployed as per the requirement assessed
and approved by EGoS. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 32
6.2 Data Management, Early Predictive Warning and
Surveillance, Forecasting and Modelling
6.2.1 (a) Data Management (Generation/Sharing/ Analysis)
The COVID-19 pandemic threw up particularly important aspects for predicting
disease trajectory in affected areas, epidemiological monitoring of morbidity and
mortality, countermeasure development, clinical management, treatment, and
effectiveness monitoring. Mutations leading to variants of concern associated
with unpredictable transmission rates and severity even in exposed/infected
persons required harmonised, interoperable data collection, seamless flow of
data across different systems and most importantly, data analysis, for proper
interpretation to facilitate speedy decision-making. Hence, it is important that all
data portals must be integrated.
»Build a single unified data platform and integrate all data portals for data sharing
along with an advanced system for data analysis. At present, data availability
and sharing pose a challenge, specifically the seamless sharing of raw data,
which affects the analysis of data and the drawing of meaningful inferences.
»Utilise IHIP and IDSP data to design the outbreak module in case of a future
outbreak and further strengthening of IHIP and IDSP system.
»Work on further development in data collection, with its optimal management,
and archiving, systems in place for training, capacity building, and integration
with modelling systems after due analysis.
Generation of data on clinical, genomic, serological surveys, and immunological
surveys will help build predictable modelling systems, which thereby will provide
a defined strategy for intermittent lockdown and restricting the spread in a
contained and controlled manner. This is possible if existing data systems are
integrated and a Unified Data Management System is maintained. This can
then be supported by the setting up of an Analytical Cell at the National level to
extract the data from different sources and further interpret it effectively as per
requirement. Surveillance data on environment, sewage, hospitals, and community
to be integrated into the system along with the genomic and serological data.
6.2.1 (b) Data Communication
Data Communication is a critical component and needs to be conveyed in a
timely and correct manner:
i. An empowered Data Analysis and Reporting Unit to be established at
NCDC, which is headed by a senior level technically competent person who is
empowered to allow access and sharing of data and is responsible for timely
Data communication to the right agencies including public communication
ii. A manual of pre-approved delegated powers to be available to allow such
data communication, sharing and access. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 33
6.2.2 Surveillance
The country already has a strong surveillance network from centre to state to
district level. This massive system exists in the remotest areas. All components
of this system should be strengthened and connected to work in a harmonised,
auto pilot mode that gets ignited as soon as the first warning sign is received.
This surveillance system needs connection and close coordination between the
centre, state, and district with laboratories, hospitals and points of entry (airports,
ports and international border) surveillance systems.
In unknown pathogen-driven disease epidemics and pandemics, the key aspect
to be considered is the need for a robust surveillance network.
»Strengthen and connect all components of the existing surveillance system to
work in a harmonised, autopilot mode that gets ignited as soon as the first
warning sign is received with precursor for regular testing of the system
»Building a strong surveillance system including both public and private sectors
with a One Health approach including biosecurity and focus on surveillance at
border, ports of entry.
»Developing strong community surveillance (trend-data time) system; especially
in susceptible areas/hot spots, so that an alert can be generated when something
goes wrong.
»Strengthen real-time surveillance to include the rate of rise and severity of a
disease to understand the severity of the pandemic on the ground, incorporating
the use of Artificial Intelligence and new tools and technologies.
»Strengthening the Genome sequencing Network at the country level to
monitor the genetic variations in the pathogen and study the linkages between
the genomic variants and epidemiological trends. INSACOG needs to be
strengthened.
»Reinforce Wildlife/Animal sector surveillance, as it has been a weak link in the
surveillance
»Setting up a Regional Surveillance Network and further connecting it with
Genomic surveillance, specially to monitor the trans-boundary movement of
pathogens
Epidemiological surveillance should have Genomic surveillance as an integral
component on one end and hospital surveillance data on the other end. Key
actions required are:
I. Emergency Operations Center – Network (EOC-NET)
During various outbreaks and pandemics, Public Health Emergency Operations
Centres (PHEOCs) have played a key role in monitoring the ground level situations,
providing them necessary feedback through a roster of experts and ensuring
regular quality data flow. Apart from the Ministry of Health, EOCs are functioning
under various ministries, including NDMA and SDMA, up to the district level.
However, there is need to ensure that EOCs and PHEOCs are established to
cover all districts of the country and integrate for maximizing the use and output
through mutual sharing and convergence. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 34
The Emergency Operations Centre-Network (EOC-NET) will be a specialized
network infrastructure designed to enhance communication and coordination
within various Emergency Operations Centres (EOC) working in isolation for
specific hazards. EOCs serve as central command and control facilities during
crises like natural disasters or pandemics. The EOC-NET plays a crucial role in
facilitating real-time information exchange, collaboration, and decision-making
among various emergency response agencies and stakeholders. It incorporates
advanced communication technologies, data sharing platforms, and secure
channels to ensure seamless information flow and coordination within the EOC.
The effectiveness of the EOC-NET is vital for prompt and efficient emergency
responses, enabling responders to share critical data, assess situations, and
deploy resources strategically. This integration of technology underscores a
commitment to improving overall preparedness and resilience in the face of
unexpected events.
II. Focused attention on Bats:
Most viral pathogens in humans have animal origins and arise through cross-
species transmission. Over the past 50 years, several viruses, including Ebola
virus, Marburg virus, Nipah virus, Hendra virus, severe acute respiratory syndrome
coronavirus (SARS-CoV), Middle East respiratory coronavirus (MERS-CoV)
and SARS-CoV-2, have been linked to various bat species. Despite decades of
research on bats and the pathogens they carry, the fields of bat virus ecology and
molecular biology are still nascent, with many questions largely unexplored, thus
hindering our ability to anticipate and prepare for the next viral outbreak. More
than 200 viruses have been associated with bats and almost all are RNA viruses;
probably owing to their remarkable ability to adapt to changing environmental
conditions through a higher genetic variability. In fact, RNA viruses have higher
mutation rates compared to DNA viruses as the viral RNA polymerases lack
proofreading activity.
The natural reservoirs for Marburgvirus and Ebolavirus are both fruit and
insectivorous bats. Recently, two new subtypes evolutionarily distinct from all
others – H17N10 and H18N11 – were detected in different fruit bat species in Central
and South America. Further, Influenza A virus is an uncommon promiscuous virus
with a wide host range including humans, pigs, and birds.
The first hantavirus isolated from bats was the Hantaan virus, the etiological agent
of haemorrhagic fever with renal syndrome. Successively, although hantaviruses
were identified in other bat species, to date, no bat-to-human transmission of
hantaviruses has been observed. This pathogen has been identified as having the
risk of spreading to humans and having pandemic potential.
Hence, focusing on One Health approach for bat-human interface is imperative.
III. Setting up a Regional Consortium for Molecular Surveillance
As the world witnessed the global impact of the COVID-19 pandemic and the critical
role of surveillance, it is important to consider some effective preventive measures
and prepare ourselves to counter emerging infections in future efficiently. The
neighbouring countries are the most vulnerable when a communicable disease Future Pandemic Preparedness and Emergency ResponseA Framework for Action 35
spreads. Scientific intervention is one of the valuable tools which can curb the
disease burden between adjacent countries. Therefore, a well-established regional
collaboration platform for molecular surveillance of emerging and re-emerging
diseases will be advantageous since India has a long border shared with many
of the neighbouring nations, which enhances the chance of spreading infectious
diseases across the border. This transboundary movement of pathogens includes
zoonotic pathogens, and a One Health approach and should be adopted. The
countries which could be included in this regional consortium are those which
have similar concerns and would require stringent monitoring of transboundary
movement of pathogens.
The INSACOG network for Genomic surveillance of SARS CoV-2 is well established
today across the country, across states and in different departments. The network
is linked to epidemiological surveillance and clinical or hospital networks. This
provides a distinctive advantage of strong surveillance and an early warning
of any clinically important pathogen. A virtual network can be established by
considering the scientific bodies of the participating countries as well as several
veterinary research organisations for continuous surveillance of infections and
screening of emerging novel mutations among circulating strains.
Biology of the disease progression and transmission in the neighbouring countries
is important to take proper decisions on the future preventive measures and
health policies. The participating countries’ population density, hygiene habits
and public health policies are unique in each case. Hence, addressing the burden
of viral diseases with respect to these unique characteristics would be beneficial.
Confirmed decisions can be taken about international travel between the
countries.
This joint scientific venture between the participating countries will enable
the viral genomes of patients to be analysed quickly with the application of
standardised guidelines. Such a regional consortium can prepare the countries
for future pandemics which could quickly adopt preventive measures.
IV. Setting up of the National Biosafety & Biosecurity Network:
The current COVID-19 pandemic crisis has highlighted the need to develop a
“National Biosecurity and Biosafety Network” across the country. There is a
need to have a better surveillance system with advanced diagnostic facilities and
customary network facilities to tackle pathogens affecting humans, livestock,
and animals, including marine life as well as plants, integrating several areas of
activities to address issues on Biosecurity and Biosafety. It is essential to integrate
animal and human pathogens as a ’One Health’ issue, rather than to treat them
as separate entities in the manner that has been adopted thus far in the country.
An integrated approach would be needed to strengthen the nation on the
biosecurity and biosafety front, and various aspects of research and development
need to be developed, such as a) pathogen identification b) clinical profiling
c) disease epidemiology d) platform technology for vaccine development
e) drug development f) treatment strategies and e) disease surveillance etc.
Currently, no one organisation, institute or network, puts in concerted efforts Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 36
on these focused areas to manage viruses. Therefore, it is very important
to establish a new generation network,“National Biosecurity and Biosafety
Network”, for preparedness to tackle the future epidemic/pandemic. The most
critical component of the National Biosecurity and Biosafety Network would be
surveillance of known pathogens/diseases outbreak forecasting, and discovery of
unknown emerging pathogens and development technologies for responding to
their threat. This would need to be a network across all concerned Ministries and
agencies – NCDC, DBT, ICMR, DRDO, ICAR, etc. Such a network has been proposed
as a part of the One Health Mission and should be operationalised on priority.
The National Biosafety Biosecurity Network would have state-of-the-art
laboratory facilities dedicated to defending the nation against biological threats.
This network would support preparedness, planning and response and should
have a network of laboratories which include biocontainment facilities (BSL-2, 3 &
4), biorepositories with research capacities for characterisation of the biological
agents, which include bacterial, fungal & viral culture; PCR & Genomic sequencing
and access to high throughput infrastructure which allows generation of high-
quality data to address the challenges and guide policy and decision making.
The proposed National Biosafety and Biosecurity Network should focus on the following:
i. A network of at least 2-3 strategically funded research laboratories which have
the capacities and capabilities to prepare the country for future pandemics
would include
• A network of biosafety containment facilities BSL-2, BSL-3 & BSL-4
• Well-characterised biorepositories for viral and bacterial pathogens such
repositories should have well-characterised reference cultures for panel
threat pathogens and through a network of surveillance laboratories, they
should build the stock and maintain the pathogens which are likely to be
a threat hazardous. This would be for humans, animals and plants.
ii. Expansion and strengthening of BSL 4 facilities in the country, which are a
mandatory requirement for handling risk group 4 organisms. These facilities
should be well prepared and maintain viral strains of all major diseases which
have already caused epidemics/pandemics or are likely to be a cause of such
future crises.
iii. A network of BSL-3 facilities, that can handle pathogen and strains that can
be quickly used as reference sample. Mobile diagnostic laboratories (with
high containment) should be established under the BSL2/3 laboratories for
deployment in the event of an epidemic.
iv. Genome sequencing centres which are linked to these repositories
continuously access different viral strains which have been collected or
identified through surveillance studies and generate genomic sequences
from them. This is important to help us to initiate our research quickly with
speed without wasting any time as and when any epidemic situation arises.
v. Centres of Excellence in the country that continuously train human resource
on the latest technologies related to viral research.
vi. The network of research laboratories nationwide of the best scientific groups
across different agencies to be brought together and supported for research
on infectious and zoonotic diseases. Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 37
vii. At least 2 to 3 Centres of Excellence should be established, which would
study not just epidemiology but also related aspects regarding transmissions,
genetic structure, etc., and would play a significant role in the diagnostic
testing and disease management.
viii. Strengthening Centres of Diagnostic Development which can create platform
technologies that would help quickly develop new diagnostics in response
to any major disease outbreak. While such an immediate response was seen
in the case of COVID-19, but for other zoonotic diseases, the country is still
dependent on imported kits and reagents. An emergency vaccine bank
should be established for agents which are exotic to the country (stockpiling).
These vaccine banks can source its vaccines either from within or outside
the country. A network of diagnostic test labs to be continuously monitored
with trained human resources and infrastructure for conducting tests with
the ability to scale up when the need arises. The large network of laboratories
across agencies which have been brought together as validation and testing
centres for COVID 19 need be strengthened.
ix. The key to the success of the proposed National Network would be to hire
personnel with very high levels of training and competence and to offer
an ecosystem conducive to undertaking globally competitive research and
development activities. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 38
6.2.3. Forecasting & Modelling
Modelling during pandemics is helpful in the assessment of the course of the
epidemic/pandemic and the trajectory of cases, morbidity and mortality. These
are crucial for public health agencies in ensuring future preparedness regarding
provision of PPEs, quarantine and isolation beds, human resource, etc for making
policy decisions and implementing policy. However, for development of predictive
models, the relevant institutes depend on reliable multi-source data along with
epidemiological determinants like incubation period, reproductive number R
0
(the average number of secondary infections caused by an infected individual in
a fully susceptible population) and Rt (the current transmission dynamics during
an outbreak), secondary attack rate etc. for short-term forecasting on likelihood
of different trajectories in different areas and populations in the immediate future.
A key challenge during COVID was the lack of a strong Indian forecasting and
modelling network, availability of reliable data on cases, testing, demographics
and inconsistent reporting. Further, amid ever-evolving uncertainty faced during
the pandemic. The models should also account for uncertainties in transmission
rates, incubation periods, and other factors particularly with variants that have
different public health impacts.
It is proposed to build a strong scientific framework for Epidemiology Forecasting
and Modelling to develop prediction models based on reliable Indian data at par
with global standards. This will also allow the creation of mathematical models
for predicting transmission dynamics of infectious diseases and monitoring the
effectiveness of countermeasures, including vaccination, in different scenarios
driven by variants.
It is recommended to create a Network of Centres for mathematical modelling,
with a partnership between academicians, the private sector, the public sector,
hospitals, etc. We need to build capacities and have trained human resources
with different skill sets.
Developing an Early Warning and Predictive Modelling for epidemic and pandemic trend
»Build a strong Epidemiology Forecasting and Modelling Network of Centres of
Excellence to develop prediction models based on Indian epidemiological data
and make these models at par with global standards
»The use of AI and other emerging technologies would be critical for such
modelling efforts
»The data from surveillance systems - community, laboratory, clinical, hospital,
genomic, sewage etc. is a critical source for such modelling efforts
»DST may launch this Epidemiological Forecasting and Modelling Network in a
mission mode for early prediction.
»The ICMR National Institute for Research in Digital Health and Data Science can
be a nodal institute; however, the network should involve competent groups in
IITs, research institutes both public and private, supported financially by DST,
O/o PSA, Dept. of Education and philanthropic and private funds.
»Create Centres of Mathematical Modelling to build capacities in new technologies
and Human Resource Future Pandemic Preparedness and Emergency ResponseA Framework for Action 39
6.3 Research and Innovation, Manufacturing, Infrastructure,
Capacity building/Skilling
6.3.1 Research & Innovation
Infectious, emerging and re-emerging zoonotic epidemics are a significant threat
to public health. Coronaviruses are a group of related viruses that are mainly
considered to cause diseases in mammals, birds and humans. During the last
two decades, it has spilt over three times by zoonotic pathways with genetic
modification and emerged as Severe Acute Respiratory Syndrome Coronavirus 1
(SARS-CoV-1), Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). SARS-CoV-2
is highly pathogenic, and human-to-human spread makes it more virulent.
COVID demonstrates that research and innovation have played a leading role
in our fight against the pandemic. Our risk-taking ability allowed new platform
technologies for vaccines and a range of diagnostics to be developed indigenously.
High-risk funding through Mission COVID Suraksha gave us the desired results
and was critical in building the levels of research competence in both the public
and private sectors. It is imperative that this is promoted, and a strong Research
and Innovation ecosystem is built.
The robust ecosystem that existed before COVID for research and innovation,
especially in the healthcare sector, was a strong foundation on which the COVID
countermeasure development activities were scaled. From basic research
capacities to shared infrastructure for translational research, all these were critical
value chain components for affordable product development. During COVID, the
scientists successfully developed several new platform technologies and a strong
portfolio of candidate vaccines - mRNA, DNA, Nasal vaccine etc.
A need-based strengthening of the ecosystem was done. However, there were
challenges faced, and there is a need to plug the gaps. The key challenge was
the need for established protocols and SoPs for sharing biological and clinical
samples and the need for more centres for characterization of viruses. When the
Chinese and US research groups released the first gene sequence of the Virus,
they started immediate action for developing the countermeasures. Candidate
vaccine libraries were quickly worked upon, and the development of vaccines
on different platform technologies was pushed on an accelerated scale. Access
to the characterised virus strain and assay panels allowed quick development of
diagnostics which were needed essentially in large numbers to track the disease.
While the country had the competencies to take up these tasks, time was lost in
building the processes for them. The first characterised virus strain was available
only with NIV, ICMR in April, and that was made available to Bharat Biotech, who
then developed Covaxin in partnership with ICMR.
The Empowered Group for Emergency Management Chaired by Dr Vinod Paul,
Member NITI Aayog, issued guidelines for sharing of biological and clinical data,
and also sample sharing and managing of biorepositories for access to these
clinical samples. Subsequently, the notified biorepositories played an important
role in making available the assays required for developing diagnostic kits. Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 40
The other key challenge in developing diagnostic kits was the dependency on
imported reagents and enzymes. Mechanisms such as the DBT-led NBRIC and
the cCAMP and AMTZ centres brought together different industries and startups,
who provided the required reagents, enzymes, etc. This enabled a speedy
indigenous manufacture of large quantities of diagnostic kits.
These capacities, tools, and instruments to enable priority action should now
implemented so that during any emergency, action begins on day one. It
is, therefore, essential to establish mechanisms for supporting research &
development of innovative countermeasures on a continuous basis. Some specific
actions are
i. There is an urgent need to allocate the High-Risk Innovation Research and
Development Fund from the special fund for pandemic preparedness and
emergency response for:
• supporting Research & Development for diagnostics, therapeutics and
vaccines,
• capacity building both Human Resources and Infrastructure
• cutting-edge technology development
ii. Fund to be earmarked and positioned with Department of Expenditure; to
be released to concerned Ministries/Departments on the recommendation
of EGoS
iii. Financial support for basic, applied and translational research across the
value chain for continuous development of:
• new prototype vaccine candidates and vaccine libraries for the priority
pathogens
• platform technologies
• New drug molecules for priority infectious diseases and antibiotics for
tackling the issue of AMR
• New highly specific and sensitive diagnostics for each identified pathogen
iv. Supporting and encouraging the industry and startup ecosystem to be part
of this high-risk innovation research
v. Set up a Network of Centres of Excellence (CoE) for research on priority
pathogens. Research efforts to focus on priority pathogens in the priority list
released by WHO.
vi. New emerging pathogens identified through One Health, national surveillance
or recombinant research efforts to be studied, characterized and maintained
in designated repositories
vii. Develop diagnostics, therapeutics and vaccines for an identified prototype
pathogen from the priority pathogen family
viii. Centres that have access to Bio Safety Level (BSL) 3, BSL 4 laboratories and
biorepositories to be part of the National Biosecurity Network
ix. ICMR, DBT, CSIR, NCDC to be part of the CoEs Future Pandemic Preparedness and Emergency ResponseA Framework for Action 41
»Establish a special High-Risk Innovation Research and Development Fund for
Pandemic preparedness and Emergency response
»Establish a Vaccine Science & Development Institute
»Launch National Mission on Therapeutics and novel drug development
»Development of novel diagnostics (such as molecular diagnostics)
»Development of vaccines, antimicrobials, and monoclonal antibodies in a PPP mode
»Set up a Network of Centres of Excellence (CoE) for research on priority
pathogens
Development of Countermeasures
Diagnostics
When COVID struck the world, the first challenge was the development of testing
capacity. Testing was important for tracking the disease and finding treatment
solutions. A large number of sensitive and specific diagnostic kits were needed.
There were urgent demands on the few global manufacturers who had developed
the diagnostics with high specificity and sensitivity. There was massive pressure on
supply chains because of increasing global demands. Countries were accelerating
their indigenous development. In India, there exists a strong medical diagnostics
start-up ecosystem and industry. These were given the responsibility, along with a
number of academic laboratories, to develop indigenous diagnostic kits.
The work started in a mission mode; however, faced huge challenges. While kits were
developed indigenously, India was entirely dependent on the import of reagents
and enzymes. The other challenge was the validation of new diagnostics, for which
notified validation centres were required. It was also essential that the necessary
assay panels were made available, which required the availability of clinical samples,
access to virus culture and biorepositories were needed. These challenges were
overcome, and within three months, India built the required competencies and
started manufacturing kits in the desired numbers.
It is now recommended that this ecosystem should be further strengthened.
The focus should be on the development of novel diagnostics (such as molecular
diagnostics) for the identification of emerging infections from new pathogens.
»Case study – Disease “X “outbreak – Diagnostic kit Development, validation and
Access for Distribution in Market.
In the event of a Disease outbreak, the immediate development and deployment of
a diagnostic kit for public diagnosis and subsequent treatment is crucial to prevent
the rapid spread of the disease. This process involves three major activities as follows:
a) Diagnostic Kit development: Value chain of Raw materials
Diagnostic kits come in two types: Immuno Diagnostic tests and Clinical
Chemistry & Molecular Biology tests. Immuno Diagnostic tests (Platforms:
Lateral Flow Assay (LFA) kits, Enzyme-linked Immunosorbent Assay (ELISA),
Chemiluminescence Immunoassay (CLIA), Radioimmunoassay (RIA)) and
Clinical Chemistry & Molecular tests (Technologies: Biochemistry/Clinical
Chemistry, Microbiology, Serology tests, Polymerase Chain Reaction (PCR)). Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 42
Most raw materials for these tests, such as Chemicals, Reagents, Enzymes,
Primers, Probes etc. are locally available. Specialised items like nanoparticles,
radioisotopes, antigens, antibodies etc. might be needed., supply chains for
these should be built.
Timeline: Common raw materials have a lead time of 1-2 weeks (Local availability).
Specialised materials that are imported take 1-2 months to deliver. Therefore,
all dependency on imported material should be removed, and indigenous
manufacture and supply chains developed.
b) Testing & Validation: Laboratory infrastructure for testing and reference
samples.
The final stage of diagnostic kit development is testing, which includes internal
and external validation.
i. Internal Validation: Reference samples or controls can be sourced from
authorized bodies (e.g., AIIMS, NIV, ICMR Centres) for internal performance
evaluation (Specificity and Sensitivity).
ii. External Validation: Kit are sent to accredited labs (e.g., ICMR, CDSCO, NIB,
NIV) for validation. These labs test the kits using available reference samples
and provide results to the manufacturer.
iii. Regulatory Approval: The above results are submitted to CDSCO to obtain a
license for manufacturing and sale.
Timeline: The testing, validation, and regulatory licensing process takes more
than 2- 3 months. It is crucial that we build a robust system for validation and have
approved protocols and processes in place to ensure the accuracy and reliability
of the diagnostic kits. In emergencies, CDSCO may audit the manufacturing
facility and expedite licensing based on test reports on conditional basis, with
full performance reports to be submitted once the outbreak is under control.
c) Distribution/ Deployment in the market: Access, Distribution, Logistics.
The next step for the licensed kit is distribution to testing centres and healthcare
outlets (e.g., pharmacies etc.). Key logistics considerations include:
i. Quantity and Type: Based on the outbreak’s nature (endemic, pandemic,
epidemic), scale, and location.
ii. Central Warehouses: These Facilities have temperature control and use
inventory management systems to track stock levels, expiration dates, and
distribution, reducing logistics time.
iii. Transportation: Plan for transporting kits from central storage to local
distribution points, ensuring temperature control with systems like cold
storage if necessary.
iv. Distribution Strategy: Kits are distributed based on outbreak severity and
population density in coordination with local health departments.
Timeline: This varies depending on the outbreak location and the source of
kit manufacturing or central warehouses. The plan of action and SOPs for this
should be in place and notified.
An immediate Mission is to be started for developing the kits for the identified
priority pathogens. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 43
Drugs and Therapeutics
A focused National Mission on Therapeutics and novel drug development should
be launched. The Council of Scientific and Industrial Research (CSIR) could lead
with the National Institute of Pharmaceutical Education and Research (NIPER) and
other laboratories in PPP model with Industry.
During COVID, the country faced a situation where, while several therapies
and drugs were available for treatment, the required drugs were not available
as repurposed, or new drug development for specific disease targets is still in a
nascent stage. Over the years, while capacities have been built for infrastructure,
international partnerships etc., what needs to be added is a coordinated effort to
take initial discovery research leads/hits to product development through the value
chain right up to manufacture and licensure/market authorisation involving various
stakeholders. This effort can now be given the required momentum by bringing
together the public and private sectors, researchers, manufacturers etc. to meet a
targeted goal of developing drugs for priority pathogens A Mission on Therapeutics
for priority pathogens needs to be launched urgently.
Drug discovery efforts can be undertaken against viruses of pandemic potential
for which two key major approaches can be deployed for the identifying of direct
antiviral drugs in the event of a pandemic: 1) Repurposing of approved drugs
and 2) Identification of novel compounds. Each approach has its advantages and
disadvantages. Whichever approach one chooses, compounds must be characterized
and taken up to Phase 1 clinical trials to establish the safety of compounds. This way,
compounds are primed and ready for a Phase 2 study should the need arise. In the
event of a pandemic, a limited Phase 2 in patients should be planned and discussed
with the Regulator to establish the efficacious dose range and safety considerations.
1) Repurposing of approved drugs (Figure 1): Over 19,000 FDA-approved drugs
have a full clinical package and dosing information. If repurposed for a different
indication, this group of compounds does not have to go through Phase 1 studies
unless the doses predicted for human use fall outside the approved range.
The approved drug library should be purchased and screened against a panel of
viruses in whole-cell screening assays. Criteria for hit selection should be defined.
Such compounds should be evaluated for pharmacokinetics by the oral and
intravenous route in the efficacy species and then tested in vivo in the appropriate
model. The ED50 should be determined, as well as a PK-PD correlation. If PK data
are available for a higher species, allometric scaling should be utilised to determine
the therapeutic dose in humans. No further toxicity testing would be needed if this
falls within the approved dose range. If the dose is predicted to be higher than the
approved dose range, the regulator may require Tox studies in rodent and non-
rodent species, as well as a Phase 1 study. A discussion with the regulator would be
needed at this stage to decide on the clinical development and regulatory strategy.
2) Identification of novel compounds (Figure 2): There are two options. The first
would be to screen a library of compounds for activity against a panel of viruses. Such
compounds should be evaluated for in vitro ADME, followed by pharmacokinetic
studies. Compounds with PK profiles suitable for oral dosing should be tested for
toxicity in the in vivo models and in rodent and non-rodent species for toxicity, Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 44
following all requirements for NCE development as per NDCT 2019 rules. Studies
should be undertaken to understand the mechanism of action.
The second approach would be to conduct an in-silico screen against specific
viral targets, such as RNA polymerase, helicase, etc., selecting compounds that
show affinity for essential viral proteins for more than one class of viruses. Such
compounds should be tested for antiviral activity and target-specific activity.
Medicinal chemistry and structure guided/AI guided drug design should be used to
optimize the compounds. As with the other approaches, pharmacokinetic profiles,
efficacy in vivo and toxicity studies should be undertaken for the best compounds.
Toxicity studies should be undertaken as per NDCT 2019 rules.
For this, capacities need to be built for the following:
• Antibody Library: Develop and maintain a naïve human antibody library that can
be quickly screened to produce antiviral antibodies.
Figure 1: Repurposing of approved drugs
Antiviral Activity
IC
50
< 1 u MYes
Dose Selection
Cytotoxicity
Compounds ready for Phase 2
FDA Approved Drugs
Selectivity>10No
ED50 determination
Pharmacokinetics
Efficacy
Toxicity (only if needed)
• Library of Compounds: Maintain a library of antiviral and antimicrobial compounds
that can be rapidly screened against new pathogens.
• Animal Models and Simulations: Develop and validate animal models and
computer simulations for testing drug efficacy and safety.
• Robust AI-based Platforms: Develop in silico methods to quickly predict the
protein structure that could be used to design drug molecules and vaccine
candidates. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 45
Figure 2: Identification of novel compounds
In silicoDocking
Target based Activity
Cytotoxicity
Pharmacokinetics
Efficacy
Toxicity
(Rodent & Non-Rodent)
Phase 1 candidate
Antiviral Activity
Med Chem and
SGDD/Al
Med Chem
Mechanism of
action
Antiviral Activity
1C
50
<10uM
1C
50
<10uM
1C
50
<10uM
Selectivity> 10
PK suitable for i.v./oral administration
10X safety window
Compound Library Screening
A PPP model involving public and private organisations would be important.
Companies with experience in antivirals/drug discovery should be involved.
Manufacturers of drugs that are being repurposed should be encouraged to
participate. Where Intellectual Property (IP) may not allow compounds to be
repurposed, discussions with manufacturers should be initiated early.
Vaccines
During COVID, one of our major success stories was the development of a portfolio
of vaccines on different platform technologies. India built partnerships with the
private sector, provided necessary shared infrastructure for discovery, research
and candidate development, immunoassay labs were set up which were of global
standards and recognised as a part of the CEPI global network for vaccine trials.
Animal challenge facilities, clinical trial network were the other key components
which facilitated the development and manufacture of the world’s first DNA Vaccine,
mRNA vaccine, nasal vaccine, and others on different platforms.
This was possible because of the high-risk innovation funding made available and
creation of an ecosystem for vaccine development, validation and manufacture.
Using these facilities and competencies to establish platform technologies (e.g.,
mRNA, viral vectors, protein expression systems) that can be quickly adapted to
new pathogens is important.
Establish an Innovation and Vaccine Science & Development Institute:
• Conduct active research on vaccine development, including basic and
translational research and development of innovative technology platforms, Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 46
candidate vaccine libraries
• To set up the institute with the lead by DBT and collaborative partnership with
other Institutes of ICMR, DST, CSIR, etc. Existing institutes such as THSTI, NII
and others like NIV, CCMB, etc, and facilities created during Covid such as
immunoassay labs, animal facilities, clinical trial network sites, etc., can be part
of the network
• The One Health Mission/Centre approach to be adopted for operational
management and governance with the involvement and participation of all
concerned Agencies/Ministries
• Support public-private partnerships and involve all stakeholders, including Start-
ups
• Focus on both Human and Animal Health for research and manufacture of
prototype vaccines, new platforms and candidate vaccines
• Include scientific ways for new adjuvant development and all integral components
for scale up and manufacture of vaccines
Biological threats may encompass outbreaks of infectious diseases, pandemics,
accidental release of pathogens from the laboratory and also deliberate release
pathogens to create public health threats.
India is a signatory to the Biological Weapon Convention. As per the Ministry of
External Affairs Gazette notification dated 18th June 2016 under section 26 of the
Weapons of Mass Destruction and their Delivery System (Prohibition of Unlawful
Activities) Act 2005 (21 of 2005), appointment of Advisory Committees has been
notified. The advisory committee on biological weapons and related items is being
chaired by the Department of Biotechnology.
In India, The Weapons of Mass Destruction and their Delivery Systems (Prohibition
of Unlawful Activities) Act, 2005 prohibits unlawful activities, concerning weapons
of mass destruction and their delivery systems and for matters connected therewith
or incidental thereto. As per the provisions of the Act- “No person shall unlawfully
manufacture, acquire, possess, develop or transport a biological or chemical weapon
or their means of delivery”.
There is a need to strengthen the preparedness aspects for dealing with biological
disasters and unforeseen events in view of biowarfares. The Biological Weapons
are not necessarily the new and emerging pathogens. As per WHO, Biological
agents like anthrax, botulinum toxin, and plague can pose a difficult public health
challenge, causing large numbers of deaths in a short amount of time. Biological
agents capable of secondary transmission can lead to epidemics.
It is proposed that the following may also be considered for Pandemic Preparedness
and Emergency Response:
• To support research, development, and innovation in sensor-based detections of
biowarfare agents, including toxins
• R & D support for development of newer decontamination strategies and PPEs
• Development of Prophylaxis: R & D support to develop newer vaccine platforms
• Development of therapeutics: R & D support to develop broad-based antibiotics.
Development of antivirals, particularly for diseases like smallpox. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 47
• Some toxins are classified as potential biowarfare- R&D support to develop
anti-toxin drugs
6.3.2 Regulatory Reforms
Regulation plays a vital role in developing new innovative products and making
them available and accessible to the public, not only in the country but across
borders. During COVID, a rapid response regulatory framework was developed,
which facilitated the approval and authorisation of a number of products –
vaccines and diagnostics, which were crucial for the COVID management strategy.
There were challenges faced in getting accelerated approvals and in the global
harmonisation of regulatory protocols. Accessibility of innovative products could
have been speeded up if we had a well-developed clinical trial network accepted
by international regulatory authorities. Acceptance of regulatory data across
National regulatory authorities also needed to be included.
»A well-harmonised regulatory system to be developed with other globally
recognised regulators for mutual acceptance of regulatory data
»Accelerated approval pathways and protocols to be prepared and pre-approved
»Subject Expert Committees (SECs) should be strengthened with technical
competence in different fields with a training program for experts
»A strong Clinical Trial network and adaptive Clinical Trial methodology should
be developed to expedite the development of drugs/devices/diagnostics. Also,
the Licensing of Products/Technologies process should be simplified/expedited.
»Inclusion/recognition of a few well-equipped district hospitals and the AIIMSs
and INIs in the Clinical Trail Network.
»The existing Central Drugs Standard Control Organisation (CDSCO) to be made
an Independent Regulatory Authority, with the Chief Regulator technically
proficient and having special powers of making Rapid Regulatory Approvals.
The Chief regulator is to be directly reporting to the Minister of Health and in
the rank of Secretary to the Govt of India
It is therefore essential that to prepare for future pandemics and respond urgently
to emergencies there are major initiatives which need to be taken:
i. A robust Clinical Trial system for conducting systematic clinical trials, with the
inclusion/recognition of a few well-equipped district hospitals, in addition to
the AIIMSs and INIs should be developed. A good example is the participation
of District Hospitals in the Plasma trial for COVID.
ii. Ear-marked clinical trial teams, with the required expertise to carry out robust
clinical trials from appropriate organizations (such as the ICMR Clinical Trial
Unit and AIIMS System) need to be identified for launching necessary trials
on short notice. Further, this should not be mixed with regulatory trials.
6.3.3 Capacity and competency building in Mission Mode
Presently, there is a need for competent human resources in IDSP units, RRTs,
One Health surveillance and response, an all-hazard approach in CBRN, IHR, Future Pandemic Preparedness and Emergency ResponseA Framework for Action 48
and laboratory techniques and IT infrastructure like PHEOCs to carry out
epidemiological analytics at various levels. There is also need for:
i. Capacity building of scientific professionals and bringing in international
experts for collaboration in research areas.
ii. Establishing infrastructure and techniques for high-quality Next Generation
Sequencing (NGS)
iii. Harnessing new-age technologies such as AI and GIS (Geographic Information
System)
iv. Competencies to handle all biological threat agents and putting in place a
bio-security network proposed through the National Security Council (NSC)
connecting all BSL3 and BSL4.
Proposed mechanism:
i. Assessment of training needs regarding competencies of various HR involved
in pandemic preparedness.
ii. Documenting the number of HR people to be trained and the available
training courses for building competencies.
iii. Identify gaps and areas for strengthening.
iv. Develop a roadmap for ensuring appropriate training of relevant HR from
district to apex level in mission mode during the next 1 to 2 years.
v. Collaborate with private public health institutes, international bodies, and
other partner agencies that have the required competent technical and
financial resources to partner with NCDC in specific areas.
vi. MoHFW & NCDC may prepare a roadmap for specific nation-wide programs to
be taken up in mission mode for technical competencies like IDSP surveillance
and response, IHIP data portal, epidemiological intelligence, and one health
approach for multi-disciplinary data analytics.
Challenges:
»Surveillance capacities for data capture and analytics at all levels (740 districts
and 35 states/UTs) and provision of surge capacity.
»Community, laboratory and health facilities including tertiary hospitals
»Public and Private sector
»Trainings for Rapid response teams: Field Epidemiology Training Program (FETP),
Epidemic Intelligence Service (EIS), Sector connect, Public Health Emergency
and Disaster Management (PHEDM)
»Advanced competencies: data analytics using AI, Laboratory capacities (NGS)
and data integration (One Health)
»Public health response support for CBRN
»Mission mode: Development of a roadmap Involving all government, international
and partner NGOs (which are currently providing support) for ensuring country-
wide training in a maximum of one year.
»Identification of core mentors from NCDC, ICMR, NIDM, WHO, CDC and other
NGOs etc. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 49
6.3.4 Resilient Supply Chains
Developing capacities for indigenous manufacturing of consumables/equipment
such as swabs, masks, PPEs, sanitisers, oxygen cylinders, ventilators, etc, by
identification and attaining self-sufficiency of critical components (such as zeolite
for oxygen concentrators) is especially important for the pandemic-scenarios
when international supply chains are constrained. Further, ensuring access to
essential supplies such as filter adjuvants, and mapping the supply of critical
items to have an uninterrupted strong supply chain and be resilient for future
pandemic should be ensured.
»Institutionalisation of supply chain systems: Proper forward and backward
linkages to be established for ensuring robust supply chains of all essential
components and ingredients for development of countermeasures.
»Develop capacities for indigenous manufacturing of consumables/equipment
such as swabs, masks, PPEs, sanitisers, oxygen cylinders, ventilators, etc., for
new pathogens
»Develop capacities for components for indigenous development and manufacture
of diagnostics and vaccines –such as reagents, adjuvants, VVMs, etc.
It is important to have parallel systems in place for meeting supply-
chain constraints, such as an alternative source of oxygen supply
through the steel industry, during the COVID-19 Pandemic.
The requirements of different pandemics may be different. Each case scenario
must be kept in mind while planning the supply chain. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 50
6.4 Partnership: Community engagement including risk
communication, Private sector partnerships and
international collaborations
6.4.1 Community involvement and Engagement with Private Sector
Risk assessment and community engagement are the pre-requisite for effective
planning of surveillance and control strategies during outbreaks, emergencies
and pandemics. WHO also underlines the importance of Swift Assessment
(within 24-72 hours) of a public health event or outbreak report as an essential
element for an early response and containment. However, rapid assessment
needs to be followed with a Comprehensive Assessment to enhance in-depth
understanding of the situation, risk characterisation and plan subsequent
interventions for affected and at-risk community. During COVID-19 pandemic,
it has been well appreciated that community involvement plays a key role in
public health measures like surveillance and response for effective mitigation
and for non-pharmaceutical measures like the creation of containment zones
and lockdown for preventing the spread of infection in new areas. Further, as the
pandemic progressed, the need for home quarantine, home isolation and timely
referral gradually scaled up community involvement with the whole of society
approach. Thus, it is crucial to engage with communities transparently with
current/available scientific knowledge and evidence to empower communities for
public health efforts during pandemics. During the early phase of pandemic, the
non-scientific information/rumours on virus contamination of articles, survival of
the virus on various surfaces and possibilities of routes of transmission required
active community involvement to spread awareness about scientific facts,
government strategies and knowledge about measures for disinfection, effective
personal protective gears and treatment therapies to alley panic and build public
confidence in government efforts.
The Ministry of Health proactively established a control room first at NCDC,
followed by control rooms in the Ministry of Health and health departments
in States for providing updated information on disease agents, spread and
available protective measures. As the pandemic spread to newer areas at an
alarming pace, measures like closure of schools, cinemas, social gatherings
were aggressively applied to reduce transmission through person-to-person
contact. The widespread use of non-scientific measures created fear psychology,
disrupting social and workplace fabrics.
However, there is a need for the establishment of defined structures for community
involvement, SOPs and specific competency-based HR for Risk Communication
and Community Engagement (RCCE) and actively engaging with communities
for timely management of infodemic and rumours. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 51
»Develop strategies and guidelines for working with communities especially at
the local level for managing PHEs especially for:
• implement public health and social measures for disease prevention,
• restricting movement of people and goods,
• information dissemination, managing infodemics, etc.
»Linkage with health NGOs and CSOs for last-mile connectivity
»Models for engaging with the private health sector for disease management
and especially for ensuring surge capacities in the Indian context should be
developed. For example, learnings from States: Maharashtra- engaged the
private sector to ensure the availability of hospital beds for COVID-19 patients
Private sector involvement:
In India, the private sector caters to nearly 60% of the population, and primarily
provides clinical management and laboratory services. The IDSP data on IHIP, which
is mainly from the public sector needs to be complemented with private sector data
from laboratories and hospitals particularly on epidemic-prone diseases, to assist in
monitoring the outbreak trends and distribution. Further, the private sector also plays
a crucial role in providing early warning signals for outbreaks and distribution (time,
place, person) of increased transmission. Clinicians and labs in private sector often
provide initial signals even in unusual diseases like H3N2, Nipah virus, Zika, Kyasanur
Forest Disease (KFD) etc. The different phases of COVID-19 pandemic involving
the private sector complemented government efforts, particularly the surge in the
need for testing of samples from suspects, quarantine & isolation beds in hospitals
and supporting genome sequencing. Hence, it is important to develop a dynamic
repository of labs and health facilities at all levels (district, state and centre) with
details of testing competencies and beds with available human resources in health
facilities are maintained. Additionally, the SOPs/MoUs needed along with clarity on
supplies and costing for tests and relevant authorities can also fine-tune health care.
The role of private sector and NGOs can be broadly grouped into 3 phases:
1. Pre-pandemic or inter-pandemic phase:
a) Surveillance: Providing data on outbreak-prone diseases and other events
of public health significance related to IHIP.
b) Firming up institutional arrangements for involving testing laboratories,
hospitals and doctors for clinical care (quarantine, isolation and intensive
care services) during pandemic times.
2. Pandemic phase:
a) During pandemic surges/waves, private sector labs and hospitals should
be involved. When the system is overburdened, labs are needed for timely
testing and sequencing. The community should be supported in tests for
confirmation and tracking of infection, severity markers, antibody estimation,
and advanced tests like genome sequencing.
b) Providing Hospital data on Outpatient Department (OPD) and Inpatient
Department (IPD) cases, morbidity, severity and mortality data. Data on
clinical therapies, drug efficacy and side effects. Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 52
c) Private sector research centres can coordinate with public sector laboratories
of DBT, ICMR, and CSIR for the development of primers, probes, and low-
cost tests (like Rapid Antigen Test (RAT), Point- of-Care (POC) tests
etc.) including advanced procedures like vaccine development, sewage
sequencing.
d) Private sector laboratories’ involvement in modelling and developing
predictive indicators, epidemiological surveillance, genome sequencing,
and sewage surveillance is also important.
e) Private sector plays a very important role in community awareness and IEC.
f) Partnership between the public and private sector is a critical factor for the
development of drugs and therapeutics, vaccine candidates and platform
technologies and to support the development of appropriate PPEs and
other protective equipment.
3. Post Pandemic phase:
a) Monitoring mutations, variants and hospital data (like re-infection by variants
and cases among vaccinated persons).
b) Providing information on unusual presentations (loss of smell or taste,
symptoms of gastric upset, long-term impact (long covid, side-effects of
steroids etc.) Future Pandemic Preparedness and Emergency ResponseA Framework for Action 53
6.4.2 Communication
Regular clear communication of policies, plans, and implementation strategies from
government authorities to HCW at all levels (national, state and district) and to the
community is essential for building trust among people and implementing mitigation
and management strategies. Effective communication to HCWs (those engaged in
surveillance, sample collection and providing clinical care) is also required to focus
on the importance of several types of data (epidemiological, laboratory and hospital)
and ensure regular data uploading for enabling data analytics. Such a communication
plan is central to pandemic preparedness. Also, capacities have to be developed in
the scientific community for communicating clearly and succinctly with the media
and general public. Further, communication must be in both directions - grass-root
to top level and vice versa.
»A special Risk Communication Unit to be established at NCDC, Ministry of
Health, with a Senior officer as the Head who has the responsibility of releasing
communication updates for all sections of organisations, including communities
and public
»Strategic Communication Plan for building trust among people and implementing
mitigation and management strategies essential for managing a PHE
»Build capacities in the scientific community for communicating clearly and
succinctly with the media and public
»Develop strategies and capacities for infodemic management (behavioural
science expertise within NCDC, health ministry)
»Partnering with UNICEF and other social science institutes on developing a
robust communication framework for pandemic threats
Communication requires specific competencies and coordination between
technical experts (public health, microbiologists, and clinicians), IT, social media,
and communication for development of appropriate data formats, Information
Education Communication (IEC) material, and monitoring tools. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 54
6.4.3 Collaborations and Partnerships
Partnership and collaboration were the key to scientific success. Collaborations
were seen between different agencies such as:
i. Academia and Industry
ii. Centre and state
iii. Central Departments and Ministries
iv. National and International research institutes, organisations and agencies
However, it was noted that it was the existing partnerships which worked well and
were taken forward. New partnerships took a long time to fructify. It is therefore
imperative to put in place pre-agreed protocols and MoUs for data, knowledge
sharing, technology transfer and licensing, intellectual property right management
etc. which will be important during any public health emergency.
»Put in place Pre-agreed MoUs, protocols, agreements and other instruments for
data, sample, knowledge sharing and collaborative funding
»Institutionalize collaborative learning during peacetime while preparing for the
future
»Establish collaborations between institutes such as the ICMR and NCDC to bring
efficiencies for reducing delays and costs for testing novel pathogens.
»International partnerships and networks to be aggressively developed for
information sharing and technology transfer; cultivate South-South co-operative
partnerships while focusing on self-sufficiency.
»Collaborate with WHO (WR, India and SEARO) CDC (CDC, India and US – CDC)
and partner agencies.
India has been globally recognised for its strength in biotechnology and biomedical
research, and there are important bilateral, multilateral, and agency-specific
collaborations which can be strengthened to develop robust systems for pandemic
preparedness and response. Partnerships and continuous dialogue with WHO and
other globally recognised national regulators are important to be prepared for
global regulatory approvals of countermeasures developed. Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 55
7. Continuous Monitoring of progress to assess action taken
To ensure that the Action Plan is being implemented as per the targets that are laid
out in the framework, it is essential to have a proper system to monitor the progress
of each step during the preparedness to be able to deliver in any emergency. It is
therefore essential to:
i. Establish a continuous monitoring mechanism. For this, the EGoS for Pandemic
Preparedness and Emergency Response to set up a Working Group for
Monitoring Progress regularly, preferably quarterly
ii. Develop a Scorecard system with well-defined priority targets; the data should
be collected and fed into an online portal
iii. Regularly track defined parameters, including the research pipeline, human
resource and funding systems
iv. Surveillance systems to be activated for any ongoing disease outbreaks in pilot/
sentinel sites
v. Participate in WHO peer review Joint External Evaluation (JEE)/ Universal Health
& Preparedness Review (UHPR) system to check capacities and competencies
A well-developed scorecard is needed for continuous monitoring. The scorecard
should have a very elaborate set of parameters that can be regularly assessed. An
indicative list can be -
i. R&D ecosystem readiness
ii. Funding for diagnostics, therapeutics and vaccines
iii. Research on the WHO List of priority pathogens
iv. Capacities for surveillance, forecasting and modelling, AI and new technologies,
clinical trials
v. Unified Data portal and data-analysis unit
vi. Forecasting and modelling simulation exercises
vii. Rapid response SOPs for data and sample sharing, data communication,
accelerated regulatory approvals
viii. Pre-agreed MoUs for international cooperation and partnership, including
technology transfer and licensing.
We do not need to wait for an outbreak to test this framework. The system can be
tested on three or four priority pathogens already a threat in our country -Nipah,
Zika, Monkey pox, H5N1 to begin with. Cultures of these pathogens have been
isolated and are deposited at the ICMR -NIV; this could be a starting point. The
preparatory phase should take 3-6 months, and then the entire system should be
set in motion. Each step should be monitored to ensure that the system is ready to
deliver in 100 days. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 56
PREPAREDNESSACTION
OUTCOME
/IMPACT
PATHOGEN
IDENTIFICATION
FORECASTING AND
MODELLING
SURVEILLANCE,
DATA MANAGEMENT
SURVEILLANCE,
DATA MANAGEMENT
DEVELOPMENT OF
COUNTERMEASURES
MANUFACTURE MARKET
AUTHORISATION,
DEPLOYMENT
A 100 Days Mission Future Pandemic Preparedness and Emergency ResponseA Framework for Action 57
Preparedness
Public Health Emergency Management Act
EGoS on Pandemic Preparedness and Emergency Response
A high- risk innovation and research fund for pandemic preparedness and response
A robust surveillance system with a well connected genomic, epidemiological, clinical and hospital
network
Unified Data management system
Forecasting and Modelling
Study and research on Priority Pathogens
Well characterised and sequenced strains maintained in a network of repositories
Development of prototype candidates for diagnostics and vaccines for each priority pathogen
Pre Approved SoPs for Accelerated Regulatory Approval, Data communication, International Agreements
100days Response
Tracking the infection and pathogen identification
Development of sensitive diagnostics and manufacture at scale
Vaccine development for specific pathogen and manufacture
Therapeutics /drugs developed
Forecasting and modelling exercise to give early prediction to put in management protocols in identified
hot spots
Rapid response teams to be positioned on day one
Data analysis to be on a continuous basis and feed into research groups ,state health and clinical
systems
Characterised and sequenced strains, biological and clinical samples and validation assays to be shared
across organisations
Harmonized regulatory systems and accelerated regulatory approval SOPs to facilitate new
countermeasures EUA
Output and Impact
Countermeasures to be available at scale for mass deployment for public health
Continuous epidemiological ,clinical and genomic surveillance data for disease management in hot spots
Rapid response teams on ground to take urgent action as per SoPs
Regular risk communication
Continuous community engagement
Efficient Prevention ,treatment and management of disease with minimal infection levels
Preparing for Future Pandemic -
A 100 Days Mission Framework Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 58
8. Indicative Timelines
To mount a considered response to a public health emergency in the first 100 days,
the proposed systems and processes detailed in this report should function well
before any emergency. An indicative time frame for action on the recommendations
of this report is given below, which outlines which actions should commence in the
immediate short term (3 to 6 months), in the medium term (6 to 12 months) and
which may require a longer time frame (18 to 24 months).
i. Indicative time frame for key steps (1): 3 to 6 months
• Setting up an EGoS for Pandemic Preparedness
• Approval for a Special Pandemic Preparedness and Emergency Response
Fund
• Preparing a framework for monitoring of identified targets as per scorecard
• Operationalisation of One Health Institute: for coordinated collaborative
surveillance & research
• Institutionalisation of the Epidemiological and INSACOG framework and SOP
for regional expansion
• Develop the SOP Document for Data sharing and Risk communication
• Nation-wide capacity building roadmap for surveillance and response
ii. Indicative time frame for key steps (2): 6 to 12 months
• Engaging with states and other ministries.
• Develop a framework for collaboration and partnership with TORs with pre-
agreed MoUs, protocols, agreements and other instruments for data, samples,
knowledge sharing and collaborative funding
• Integration of all data portals, including ICMR and NCDC data, on a single
platform and coordination, SOPs developed with Scientific research bodies
and relevant ministries.
• Approval for a High-Risk Innovation Research Fund
• Establishing a Vaccine Science & Development Institute
• Initiating Priority Pathogen research through the Centre of Excellence
Network
• Launching a Regional Consortium for Surveillance with neighbouring
countries
iii. Indicative time frame for key steps (3): 12 to 24 months
• Approval of a New Public Health Emergency Management Act
• Setting up an Epidemiological Forecasting and Modelling Network
• Launching a Mission on Therapeutics and Drug Development
• Setting up a National Biosecurity Biorepository Network
• Giving Autonomy to the Regulatory body with well-developed approved SOPs
for Accelerated Emergency Use Authorisation for innovative technologies
and innovative products and provision for fast-tracking during pandemics
• Having a well-established capacity-building training programme at all level Future Pandemic Preparedness and Emergency ResponseA Framework for Action 59
ANNEXURE - I Future Pandemic Preparedness and Emergency ResponseA Framework for Action 60 Future Pandemic Preparedness and Emergency ResponseA Framework for Action 61
ANNEXURE - II
WHO List of Priority Pathogens and diseases
A. Virus:
Around 200+ scientists from 53 countries are independently evaluating the evidence
related to 30 viral families. The number of pathogens that could trigger the next
pandemic has grown to more than 30, and now includes influenza A virus, dengue
virus and monkeypox virus, according to a recent updated list published by the
World Health Organization (WHO). Families and pathogens that were prioritized in
2024 as compared to 2017 and 2018 prioritization process.
2017 2018 2024
Family
Priority
Pathogens
Priority
Pathogens
PHEIC
risk
Priority
Pathogens
Prototype
Pathogens
Adenoviridae
Low-
Medium
Recombinant
Mastadenovirus
AdenoviridaeLow
Low-Medium
Arenaviral
hemorrhagic
fevers including
Lassa Fever
Lassa Fever
virus
High
Mammarenavirus
lassaense
Mammarenavirus
lassaense
AnelloviridaeHigh
Mammarenavirus
juninense
ArenaviridaeHigh
Mammarenavirus
lujoense
ArenaviridaeLow
Mamastrovirus
virginiaense
BacteriaHigh
Vibrio cholerae
serogroup
0139
BacteriaHigh Yersinia Pestis
BacteriaHigh
Shigella
dysenteriae
serotype 1
BacteriaHigh
Salmonella
enterica non
typhoidal
serovars
BacteriaHigh
Klebsiella
pneumoniae
BornaviridaeLow
Orthobornavirus
bornaense
Coronaviridae
Middle East
Respiratory
Syndrome
Coronavirus
Middle East
Respiratory
Syndrome
Coronavirus
High
Subgenus
Merbecovirus
Subgenus
Merbecovirus
Coronaviridae
Other highly
pathogenic
coronaviral
diseases such
as Severe Acute
Respiratory
Syndrome
Severe Acute
Respiratory
Syndrome
High
Subgenus
Sarbecovirus
Subgenus
Sarbecovirus Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 62
2017 2018 2024
Family
Priority
Pathogens
Priority
Pathogens
PHEIC
risk
Priority
Pathogens
Prototype
Pathogens
Filoviridae
Filoviral
diseases Ebola
Ebola virus
disease
High
Orthoebolavirus
zairense Orthoebolavirus
zairense
Filoviridae
Filoviral
diseases
Marburg
Marburg virus
disease
High
Orthomarburgvirus
marburgense
FiloviridaeHigh
Orthoebolavirus
sudanense
Flaviviridae Zika virus Zika virus High
Orthoflavivirus
zikaense
Orthoflavivirus
zikaense
FlaviviridaeHigh
Orthoflavivirus
denguei
Orthoflavivirus
denguei
FlaviviridaeHigh
Orthoflavivirus
flavi
FlaviviridaeHigh
Orthoflavivirus
encephalitidis
FlaviviridaeHigh
Orthoflavivirus
nilense
HantaviridaeHigh
Orthohantavirus
sinnombreense
Orthohantavirus
sinnombreense
HantaviridaeHigh
Orthohantavirus
hantanense
HepadnaviridaeLow
Orthohepadnavirus
hominoidei
genotype C
HepeviridaeLow
Paslahepevirus
balayani
genotype 3
HerpesviridaeLow
Nairoviridae
Crimean Congo
Haemorrhagic
Fever
Crimean
Congo
Haemorrhagic
Fever
High
Orthonairovirus
haemorrhagiae
Orthonairovirus
haemorrhagiae
Orthomyxoviridae
High
Alphainfluenzavirus
Influenzae H1
Alphainfluenzavirus
Influenzae H1
OrthomyxoviridaeHigh
Alphainfluenzavirus
Influenzae H2
OrthomyxoviridaeHigh
Alphainfluenzavirus
Influenzae H3
OrthomyxoviridaeHigh
Alphainfluenzavirus
Influenzae H5
Alphainfluenzavirus
Influenzae H5
OrthomyxoviridaeHigh
Alphainfluenzavirus
Influenzae H6
OrthomyxoviridaeHigh
Alphainfluenzavirus
Influenzae H7
OrthomyxoviridaeHigh
Alphainfluenzavirus
Influenzae H10
PapillomaviridaeLow
Paramyxoviridae
Nipah and
related
henipaviral
diseases
Nipah and
henipaviral
diseases
High
Henipavirus
nipahense
Henipavirus
nipahense
ParvoviridaeLow
Protoparvovirus
carnivoran Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 63
2017 2018 2024
Family
Priority
Pathogens
Priority
Pathogens
PHEIC
risk
Priority
Pathogens
Prototype
Pathogens
PeribunyaviridaeLow
Orthobunyavirus
oropoucheense
Phenuiviridae
Severe
Fever with
Thrombocy-
topenia
Syndrome
High
Bandavirus
dabieense
Bandavirus
dabieense
Phenuiviridae
Rift Valley
Fever
Rift Valley
Fever
High
Phlebovirus
riftense
PicobirnaviridaeLow
Orthopicobirnavirus
hominis
PicornaviridaeMedium
Enterovirus
coxsackiepol
PicornaviridaeMedium
Enterovirus
alphacoxsackie
71
PicornaviridaeMedium
Enterovirus
deconjucti 68
Pneumoviridae
Low-
Medium
Metapneumovirus
hominis
PolyomaviridaeLow
PoxviridaeHigh
Orthopoxvirus
variola
PoxviridaeHigh
Orthopoxvirus
vaccinia
PoxviridaeHigh
Orthopoxvirus
monkeypox
Orthopoxvirus
monkeypox
RetroviridaeMedium
Lentivirus
humimdef1
Lentivirus
humimdef1
RhabdoviridaeLow
Genus
Vesiculovirus
SedoreoviridaeLow
Genus
Rotavirus
SpinareoviridaeLow
Orthoreovirus
mammalis
TogaviridaeHigh
Alphavirus
chikungunya
Alphavirus
chikungunya
TogaviridaeHigh
Alphavirus
venezuelan
Alphavirus
venezuelan
Pathogen X Pathogen X Pathogen XPathogen X
Note: Prioritization of pathogens by WHO is a dynamic process and it is pertinent to refer
to the latest updated list for the purpose of pandemic preparedness planning process. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 64
B. Bacteria:
• The 2024 BPPL includes 15 families of antibiotic-resistant (ABR) pathogens,
grouped into critical, high, and medium priority categories for R&D and public
health measures.
• Critical priority gram-negative bacteria that are resistant to last-resort
antibiotics, such as Acinetobacter baumannii and various pathogens in the
Entero bacterales order, as well as rifampicin-resistant (RR) Mycobacterium
tuberculosis, because of their ability to transfer resistance genes, the severity
of the infections and disease they cause and their significant global burden,
particularly in LMIC.
• High-priority bacteria: Salmonella and Shigella due to their increasing
resistance to existing treatments and the high burden of infection associated
with these pathogens, particularly in LMIC.
• Other high-priority pathogens are antibiotic-resistant Pseudomonas
aeruginosa and Staphylococcus aureus due to their global threat, especially in
healthcare settings. Also included are Neisseria gonorrhoeae, which present
distinct public health challenges due to the emergence of multidrug-resistant
(MDR) strains, limiting treatment options.
• The medium-priority category includes Group A and B Streptococci,
Streptococcus pneumoniae, and Haemophilus influenzae, particularly in
vulnerable populations in resource-limited settings.
Diseases:
The WHO priority diseases are:
• COVID-19
• Crimean-Congo haemorrhagic fever
• Ebola virus disease and Marburg virus disease
• Lassa fever Future Pandemic Preparedness and Emergency ResponseA Framework for Action 65
• Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute
Respiratory Syndrome (SARS)
• Nipah and henipaviral diseases
• Rift Valley fever
• Zika
• “Disease X” *
Ref:
1. Pathogens prioritization: A scientific and Research framework for epidemic and
pandemic research preparedness. WHO – R&D Blue print Powering research to
prevent Epidemics; Health Emergencies, June 2024.
2. WHO Bacterial Priority Pathogens List, 2024 Bacterial pathogens of public health
importance to guide research, development and strategies to prevent and control
and antimicrobial resistance.
3. Emerging viral diseases from a vaccinology perspective: preparing for the next
pandemic - nature immunology December 14, 2017: Barney S Graham and Nancy
J Sullivan Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 66
ANNEXURE - III
Future Pandemic Preparedness and Emergency Response –
Experts Consulted
Fourteen separate consultations have been held with more than sixty experts.
The detail of the individuals and the institutions consulted is below:
I. Government Representatives
1. Prof. Ajay Kumar Sood, Principal Scientific Advisor to the Govt of India
2. Dr Rajiv Bahl, Secretary Department of Health Research and Director General
ICMR
3. Sh. Arunish Chawla, Secretary Department of Pharmaceuticals
4. Dr Atul Goel, Director General Health Services
5. Dr Rajeev Singh Raghuvanshi, Drugs Controller General of India (DCGI), CDSCO
6. Sh. Krishna S. Vatsa, Member NDMA
7. Vaidya Rajesh Kotecha, Secretary, Department of AYUSH
8. Dr Sanjeev Khosla, Director, CSIR IMTECH
9. Prof. K Vijayaraghavan, Former Principal Scientific Advisor to the Govt of India
10. Mrs Preeti Sudan Former Secretary, Ministry of Health & Family Welfare
11. Prof. Ashutosh Sharma, Former Secretary, Department of Science & Technology
12. Dr Ram A Vishwakarma, Director, CSIR-IIM, Jammu
13. Prof. Balram Bhargava, Former DG, ICMR
14. Dr G Satheesh Reddy, Scientific Advisor to Minister of Defence, GoI
15. Mr Safi Ahsan Rizvi, Advisor (Mitigation), NDMA
16. Dr Ashok Kumar, ADG (Animal Health), Indian Council of Agricultural Research
(ICAR)
17. Dr Parvinder Maini, Scientific Secretary, Office of PSA
18. Dr Nitin Kumar Jain, Scientist G, DBT
19. Dr Anita Aggarwal, Head (SEED)
20. Dr Abhijit Mitra, Animal Husbandry Commissioner, Department of Animal
Husbandry and Dairying (DAHD)
21. Dr Aruna Sharma, Deputy Commissioner, DAHD
22. Sh. Saikat Sarkar, Adviser (Trade), Department of Agriculture, Cooperation &
Farmers Welfare
23. Dr A. Raghu, Dy. DGHS, Ministry of AYUSH
24. Dr Himanshu Chauhan, Joint Director National Centre for Disease Control
(NCDC)
II. Government Leadership
1. Shri Rajesh Bhushan, Former Secretary, Ministry of Health & Family Welfare
Govt. of India
2. Shri Amit Mohan Prasad, Additional Chief Secretary, Government of Uttar
Pradesh
3. Mohd. Suleman, Principal Secretary, Government of Madhya Pradesh
4. Dr J Radhakrishnan, Commissioner, Govt. of Tamil Nadu Tamil Nadu
5. Shri JV Prasad Rao, Former Secretary, Ministry of Health & Family Welfare Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 67
III. Industry
1. Dr Kiran Mazumdar Shaw, Executive Chair, Biocon
2. Dr Vijay Chandru, Co-founder and Chair, Strand Life sciences
3. Shri Pankaj Patel, Chairman, Cadila Healthcare
4. Dr Sanjay Singh, CEO, Gennova Biopharmaceuticals Ltd.
5. Dr Prasad Kulkarni (Executive Director), Serum Institute of India
6. Hasmukh Rawal (Managing Director)/ Mylab Discovery Solutions
7. Dr Jitendra Sharma, Managing Director & CEO, AMTZ
8. Dr Satish Reddy, (Chairman), Dr Reddy’s Laboratories
9. Dr Heulwen Philpot, Head of Secretariat, International Pandemic Preparedness
Secretariat (IPPS) and team
IV. Technical Institutions
International Institutions
1. Dr Ana Maria Henao-Restrepo, Co-Lead R&D Blueprint for Epidemics, WHO
Health Emergencies programme
2. Dr Jeremy Farrar, Chief Scientist WHO
3. Dr Richard Hatchett, CEO, Coalition for Epidemic Preparedness Innovations
(CEPI)
4. Dr Mariangela Simao, Director ITPS Brazil
5. Mr Bill Rodriguez, CEO, FIND
6. Mr Seth Berkley, Former CEO, GAVI
7. Dr Rick Bright, Former Sr. Vice President, Rockefeller Foundation
8. Dr Meghna Desai, Country Director, Centers for Disease Control and Prevention
(CDC), India
9. Dr Heulwen Philpot, Head of Secretariat , International Pandemic Preparedness
Secretariat (IPPS) and team
National Institutions
1. Dr Pavana Murthy, NPO Surveillance and Response, WHO India
2. Prof. Saumitra Das, Dept. of Microbiology and Cell Biology, Indian Institute of
Science (IISc)
3. Prof Sudhanshu Vrati, Executive Director, Regional Centre for Biotechnology
(RCB)
4. Retd. General Dr Madhuri Kanitkar, Vice-Chancellor, Maharashtra University of
Health Sciences (MUHS)
5. Prof. Manindra Agrawal, Dept. of Computer Science & Engineering, IIT-Kanpur
6. Dr Sanket V Kulkarni, Joint Director, NCDC
7. Dr Saurabh Goel, Joint Director, NCDC
8. Dr Pramod Kumar Garg, Executive Director THSTI
9. Dr Heulwen Philpot, Head of Secretariat, International Pandemic Preparedness
Secretariat (IPPS) and team
V. Clinicians, Microbiologists, Virologists and Epidemiologists
1. Dr NK Arora, NEG-VAC (National Expert Group on Vaccines)
2. Dr Gagandeep Kang, Director BMGF (former head THSTI)
3. Dr K. Srinath Reddy, President PHFI
4. Dr Shiv Kumar Sarin, Institute of Liver and Biliary Science (ILBS), Delhi Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 68
5. Dr Sanjay Pujari, Director Institute of Infectious Diseases, Pune
6. Dr Lalit Dar, Professor, Dept. of Microbiology, AIIMS New Delhi
7. Dr Aakash Shrivastava, Additional Director, NCDC
8. Dr Randeep Guleria, former Director AIIMS
9. Dr Naveet Wig, Professor, Dept of Medicine, AIIMS New Delhi
10. Dr Raman R Gangakhedkar, Former Head - Division of Epidemiology,
Communicable Diseases, ICMR
11. Dr Nivedita Gupta, Scientist F, ICMR New Delhi
12. Dr Tarun Bhatnagar, Scientist, ICMR – National Institute of Epidemiology,
Chenna
13. Dr Priya Abraham, Former Director, National Institute of Virology Pune
14. Dr Manoj Murhekar, Director ICMR – National Institute of Epidemiology, Chennai
15. Dr Subhash Salunke, Senior Adviser, Public Health Foundation of India (PHFI),
Delhi
16. Dr Giridhar R. Babu, Professor, Public Health Foundation of India (PHFI), Delhi
17. Dr J.M Deshpande, Former director, Enterovirus Research Centre Mumbai
18. Dr Sanghamitra Ghosh, President, Indian Public Health Association (IPHA)
19. Dr A. M. Kadri, President, Indian Association of Preventive and Social Medicine Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 69
ANNEXURE - IV
Key References
i. From Emergency Response To Long-Term Covid-19 Disease Management:
Sustaining Gains Made During The Covid-19 Pandemic Report by WHO (May
2023); https://www.who.int/publications/i/item/WHO-WHE-SPP-2023.1
The Report talks about the Global Strategic Preparedness, Readiness and Response
Plan (SPRP) for the period 2023-2025. In 2023, WHO updated the global strategy
to reflect the evolving situation and outline a strategy for the next two years (April
2023-April 2025) to support countries in transitioning, when and as appropriate,
towards integrating the COVID-19 pandemic response into broader infectious disease
prevention and control programmes. The updated 2023-2025 COVID-19 strategy
outlines practical, high-level actions that need to be sustained as response activities
are adjusted to address the drivers of SARS-CoV-2 transmission and prioritizes
activities that will continue to lessen the impact of the COVID-19 disease. Activities
outlined are organized to reflect management and integration of COVID-19 activities
along the five core components of WHO’s proposed global health architecture for
health emergency preparedness, response and resilience. The components are
emergency coordination, collaborative surveillance
, community protection, safe
and scalable care, and access to countermeasures.
ii. A WORLD AT RISK - Annual report on global preparedness for health emergencies
by Global Preparedness Monitoring Board (September 2019); https://www.gpmb.
org/docs/librariesprovider17/default-document-library/annual-reports/gpmb-2019-
annualreport-en.pdf?sfvrsn=bd1b8933_36
The Report highlights the need for determined political leadership to prepare for
health threats at national and global levels and outlines seven urgent actions to prepare
the world for health emergencies; i. Commitment and Investment from Government
Heads: Heads of government in every country must commit to preparedness by
implementing their binding obligations under the International Health Regulations
(IHR (2005); ii. Countries and regional organizations must lead by example: G7,
G20 and G77 Member States, and regional intergovernmental organizations must
follow through on their political and funding commitments for preparedness and
agree to routinely monitor progress during their annual meetings; iii. All countries
must build strong systems: Heads of government must appoint a national high-
level coordinator with authority and political accountability to lead whole-of-
government and whole-of-society approaches, and routinely conduct multisectoral
simulation exercises to establish and maintain effective preparedness; iv. Countries,
donors and multilateral institutions must be prepared for the worst: Donors and
multilateral institutions must ensure adequate investment in developing innovative
vaccines and therapeutics, surge manufacturing capacity, broad-spectrum antivirals
and appropriate non-pharmaceutical interventions; v. Financing institutions must
link preparedness with financial risk planning: Funding replenishments of the IDA,
Global Fund to Fight AIDS, TB and Malaria (Global Fund), and GAVI should include
explicit commitments regarding preparedness; vi. Development assistance funders
must create incentives and increase funding for preparedness; Donors, international Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 70
financing institutions, global funds and philanthropies must increase funding for the
poorest and most vulnerable countries through development assistance for health
and greater/earlier access to the United Nations Central Emergency Response Fund
to close financing gaps for their national actions plans for health security as a joint
responsibility and a global public good; vii. The United Nations must strengthen
coordination mechanisms: The Secretary General of the United Nations, with WHO
and United Nations Office for the Coordination of Humanitarian Affairs (OCHA), must
strengthen coordination in different country, health and humanitarian emergency
contexts, by ensuring clear United Nations systemwide roles and responsibilities;
rapidly resetting preparedness and response strategies during health emergencies;
and, enhancing United Nations system leadership for preparedness, including
through routine simulation exercises.
iii. A Fragile State of Preparedness 2023 Report On The State Of The World’s
Preparedness; https: // www. gpmb. org / reports / m / item / a- fragile- state - of-
preparedness-2023-report-on-the-state-of-the-worlds-preparedness
The GPMB Monitoring Framework for Preparedness, 2023, provides a robust,
evidence-based methodology to assess global preparedness. It has been applied for
the first time in this Report, reporting on 30 of its full 90 indicators most pertinent
to equity, leadership and accountability, and coherence. Across the indicators
reviewed, the assessment shows that capacities are inadequate. There are particular
weaknesses in global R&D coordination, addressing the impact of misinformation,
providing financing and including all actors in governance. Some improvements
following COVID-19 have been seen in relation to global information platforms,
community engagement, independent monitoring and regional laboratory capacity.
Weaknesses in the global financing system for Pandemic Prevention, Preparedness
and Response (PPPR) and the failure of international commitment to strengthening
independent monitoring will weaken future prospects for effective PPPR.
iv. COVID-19: Make it the Last Pandemic by The Independent Panel for Pandemic
Preparedness & Response; https://theindependentpanel.org/wp-content/
uploads/2021/05/COVID-19-Make-it-the-Last-Pandemic_final.pdf
The Panel has examined the state of pandemic preparedness prior to COVID-19, the
circumstances of the identification of severe acute respiratory syndrome coronavirus
2 (SARS-CoV-2) and the disease it causes, coronavirus disease (COVID-19), and
responses globally, regionally and nationally, particularly in the pandemic’s early
months. It has also analysed the wide-ranging impact of the pandemic and the
ongoing social and economic crisis that it has precipitated. This report presents the
Panel’s findings on what happened, the lessons to be learned from that, and our
recommendations for strategic action now to end this pandemic and to ensure that
any future infectious disease outbreak does not become a catastrophic pandemic.
Complementing this report, the Panel presents a companion report describing
thirteen defining moments which have been pivotal in shaping the course of
the pandemic. In addition, the Panel is publishing a series of background papers
representing in-depth research including a chronology of the early response. Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 71
v. 100 Days Mission Implementation Report by International Pandemic
Preparedness Secretariat (IPPS); https://d7npznmd5zvwd.cloudfront.net/prod/
uploads/2023/01/100-Days-Mission-2nd-Implementation-Report-1.pdf
The 100DM offers a framework for implementers at all levels to take forward and
apply, whether at the global, regional or national level. The essence of the 100DM is
to significantly reduce the time to develop diagnostics, therapeutics, and vaccines
(DTVs), maximising the health impact and saving lives.
This year’s report maintains a rigorous focus on the overarching end goals of the
100DM which gives a more quantifiable sense of our state of readiness. Within
each section, overarching goals, critical bottlenecks to achieving these goals
and the proposed inputs needed in 2024 to maintain satisfactory progress have
been reiterated. The chapters provide high-level analysis, and a summary of 2024
milestones those already planned by implementation partners, and more aspirational
goals set by the IPPS.
For this year, while significant progress has been made, analysis from implementation
partner feedback and the 100DM scorecard data highlights key areas needing urgent
attention in 2024: 1. Therapeutics Pipeline Enhancement; 2. Diagnostics Framework
Funding, 3. Regulatory Alignment And Preparatory Regulatory Approaches; 4.
Sustain And Strengthen Regional And Global Clinical Trial Infrastructure. Designed by: Future Pandemic Preparedness and Emergency ResponseA Framework for Action 74
Printed by:
Communication cell, NITI Aayog
www.niti.gov.in
FUTURE PANDEMIC
PREPAREDNESS AND
EMERGENCY RESPONSE
A Framework for Action
Report of the Expert Group
Communication cell, NITI Aayog
www.niti.gov.in
FUTURE PANDEMIC
PREPAREDNESS AND
EMERGENCY RESPONSE
A Framework for Action
Report of the Expert Group FUTURE PANDEMIC
PREPAREDNESS AND
EMERGENCY RESPONSE-
A FRAMEWORK FOR ACTION
REPORT OF THE EXPERT GROUP
AUGUST 2024
Disclaimer: This report represents the views of the Expert Group members. It does not constitute the official
views of NITI Aayog. NITI Aayog does not accept any legal liability for the accuracy or inferences drawn from
the material contained therein or for any consequences arising from the use of this material. Expert Group Members
1. Dr Renu Swarup, Former Secretary, Department of Biotechnology - Chairperson
2. Dr Soumya Swaminathan, Former Chief Scientist, WHO and Former DG, ICMR - Member
3. Dr Sujeet Singh, Former Director, NCDC - Member
4. Shri Rajib Kumar Sen, Senior Adviser (Health), NITI Aayog - Member-Secretary
Supported by: NITI Aayog, Health Division
1. Dr Sonali Rawal, Consultant Grade-II
2. Mr Varun Singh, Consultant Grade-II
3. Ms Neha Sharma, Young Professional Future Pandemic Preparedness and Emergency ResponseA Framework for Action= i
TABLE OF CONTENTS
List of Abbreviations1
Preface5
Executive Summary7
1Introduction 10
1.1Background10
1.2Setting up of the Expert Group12
2Methodology14
2.1Consultations14
2.2Research14
3Lessons from the Past -dealing with epidemics in the last two decades 15
4COVID-19 Learnings and Challenges18
5Future Pandemic Threats: Public Health Challenges and Preparedness 21
6Recommendations23
6.1Governance, Legislation, Finance and Management 27
6.1.1Governance 27
6.1.2Legislation 29
6.1.3Finance and Management31
6.2Data Management, Surveillance and Early Predictive Warning,
Forecasting and Modelling,
32
6.2.1Data Management (Generation/Sharing/Analysis) & Data
Communication
32
6.2.2Surveillance33
6.2.3Forecasting & Modelling38
6.3Research and Innovation, Manufacturing, Infrastructure,
Capacity building/Skilling
39
6.3.1Research & Innovation 39
6.3.2Regulatory Reforms47
6.3.3Capacity and competency building in Mission Mode47
6.3.4Resilient Supply Chains49
6.4Partnership: Community engagement including risk
communication, Private sector partnerships, and international
collaborations
50
6.4.1 Community involvement and Engagement with Private Sector 50
6.4.2Communication53
6.4.3Collaborations and Partnerships54 Future Pandemic Preparedness and Emergency ResponseA Framework for Action= ii
7Continuous Monitoring of progress to redefine priorities55
8Indicative timelines 58
Annexure - I59
Annexure - II61
Annexure - III66
Annexure - IV69 Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 1
LIST OF ABBREVIATIONS
ADMEAbsorption, Distribution, Metabolism, and Excretion
AMRAnti-Microbial Resistance
ARBAntibiotic Resistance Bacteria
AMTZAndhra Pradesh Med Tech Zone
BPPLBacterial Priority Pathogen List
BSLBiological Safety Level
cCAMP Centre for Cellular and Molecular Platforms
CBRNChemical, Biological, Radiological, and Nuclear
CCMBCentre For Cellular and Molecular Biology
CCHFCrimean–Congo Haemorrhagic Fever
CDCCentre for Disease Control
CDSCO Central Drugs Standard Control Organisation
CEPICoalition for Epidemic Preparedness Innovations
CLIAChemiluminescence Immunoassay
CoECentre of Excellence
COVID Coronavirus Disease
CSIRCouncil of Scientific and Industrial Research
CSOCivil Society Organization
DAHDDepartment of Animal Husbandry and Dairying
DBTDepartment of Biotechnology
DHRDepartment of Health Research
DNADeoxyribonucleic Acid
DoHFW Department of Health & Family Welfare
DoPDepartment of Pharmaceuticals
DRDODefence Research and Development Organisation
DSTDepartment of Science & Technology
EDAEpidemic Diseases Act
EISEpidemic Intelligence Service
EGsEmpowered Groups
EGoSEmpowered Group of Secretaries
ELISA Enzyme Linked Immunosorbent Assay
EOC-NET Emergency Operations Centre -Network
EVDEbola Virus Disease
FETPField Epidemiology Training Program
GISGeographic Information System
HCWHealthcare workers
IAPSM Indian Association of Preventive and Social Medicine
ICARIndian Council of Agricultural Research
ICMRIndian Council of Medical Research
IDSPIntegrated Disease Surveillance Programme Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 2
IECInformation Education Communication
IHRInternational Health Regulations
IHIPIntegrated Health Information Platform
INSACOG Indian SARS-COV-2 Genomic Consortium
IPIntellectual Property
IPDInpatient Department
IPPS International Pandemic Preparedness Secretariat
IPPRS
Independent Panel for Pandemic Preparedness and Response
Secretariat
JEEJoint External Evaluation
KFDKyasanur Forest Disease
MDRMulti Drug Resistant
MERS-CoV Middle East Respiratory Syndrome Coronavirus
MoHFW Ministry of Health and Family Welfare
mRNAmessenger Ribonucleic Acid
NADRES National Animal Disease Referral Expert System
NBRIC National Biomedical Resource Indigenization Consortium
NCDCNational Centre for Disease Control
NCENew Chemical Entity
NDCTNew Drugs and Clinical Trials
NDMANational Disaster Management Authority
NEG-VAC National Expert Group on Vaccine Administration for COVID-19
NGONon-Governmental Organization
NGSNext Generation Sequencing
NIBNational Institute of Biologicals
NIDMNational Institute of Disaster Management
NII National Institute of Immunology
NITI Aayog National Institution for Transforming India Aayog
NIVNational Institute of Virology
NIPER National Institute of Pharmaceutical Education and Research
NSCNational Security Council
NTAGI National Technical Advisory Group on Immunization
OHOne Health
OPD Outpatient Department
PHEPublic Health Emergency
PHEDM Public Health Emergency and Disaster Management
PHEIC Public Health Emergencies of International Concern
PHEMA Public Health Emergency Management Act Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 3
PHEOCs Public Health Emergency Operations Centres
PHFIPublic Health Foundation of India
PK-PD Pharmacokinetic-Pharmacodynamic
POCPoint-Of- Care
PPEPersonal Protective Equipment
PPERPandemic Preparedness and Emergency Response Framework
PRETPreparedness and Resilience for Emerging Threats
PSAPrincipal Scientific Adviser
RATRapid Antigen Test
RIARadioimmunoassay
RCCERisk Communication and Community Engagement
SARS-COV2 Severe Acute Respiratory Syndrome Corona Virus 2
SEARO South-East Asia Regional Office World Health Organization (WHO)
SECSubject Expert Committee
SOPStandard Operating Procedure
THSTI Translational Health Science and Technology Institute
UHPRUniversal Health & Preparedness Review
UNICEF United Nations International Children’s Emergency Fund
WHOWorld Health Organization
ZVDZika Virus Disease Future Pandemic Preparedness and Emergency ResponseA Framework for Action 4 Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 5
It is a matter of great honour for the Expert Group constituted by NITI Aayog on
Future Pandemic Preparedness to submit the Final Report entitled “Future Pandemic
Preparedness and Emergency Response —A Framework for Action”. The Expert Group
would like to compliment the NITI Aayog leadership, especially Dr Vinod Paul, Member
(Health), NITI Aayog, for the vision to set up the Expert Group. The TOR of the group was
to draw lessons and experiences, both national and global, on how COVID was managed
and visualise preparedness elements and future pathways for fighting any infectious
public health crisis. The Expert Group is pleased to propose recommendations based
on the learnings and challenges faced during COVID -19 and other public health crises.
Preparing the proposed framework for action for future pandemic preparedness and
emergency response involved several consultations with experts and stakeholders,
analysing the experience so far, examining national and global success stories and
identifying key gaps that need attention. The stakeholder meetings were crucial and
provided valuable insights for preparing the report. The consultations included experts
from multilateral organisations, academia, Indian industry, clinicians, epidemiologists,
researchers, policymakers etc.
The Government of India (GoI) proactively initiated a scientific preparedness plan for
future pandemic through the One Health (OH) approach. The Office of the Principal
Scientific Adviser (PSA) to the Government of India, along with thirteen other Ministries/
Departments, have conceptualised the One Health Mission to have a scientific strategy
to tackle future pandemics with a focus on surveillance, data management, research for
developing innovative countermeasures and partnerships for an effective response.
This Expert Group noted the OH Mission’s activities and integrated them into the core
recommendations of the report. The proposed recommendations complement the
initiatives of the OH Mission with a focus on proactive preparedness for pandemics,
epidemics and outbreaks, as well as developing a robust response strategy that focuses
on implementation, accountability and timely execution. Considering that the first
100 days of any public health emergency are critical, and an immediate response is
essential, the proposed framework provides a road map on how the country can deliver
the appropriate interventions in the first 100 days. From institutionalised governance
mechanisms to a separate legislation for Public Health Emergency Management, an
emergency pandemic preparedness and response fund, robust surveillance, forecasting
and modelling, and innovation research ecosystem, the key recommendations cover all
these aspects in detail.
PREFACE Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 6
Once again, the Expert Group would like to convey its special thanks to Dr Vinod Paul,
for putting the group together being with us throughout the discussions and providing
his valuable advice and guidance. The group also acknowledges the support from the
team at NITI Aayog, Health vertical and other stakeholders who have provided valuable
insights which have helped us put together a comprehensive plan of action. We hope
that the recommendations will be helpful to the government and that appropriate action
will be taken to implement them. We stand ready to assist in this endeavour.
The message is clear, we need to be ready for War when not at War Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 7
EXECUTIVE SUMMARY
The COVID-19 pandemic was the worst public health emergency witnessed, which
impacted humanity not just in a few nations or regions but across the world. Although
the health systems had experience dealing with infectious outbreaks and epidemics, we
did not have the processes and systems in place to deal with a public health emergency
at this scale. NITI Aayog constituted an Expert Group to prepare a Framework for Action
for Future Pandemic Preparedness and Emergency Response. The Terms of Reference
for the group were to examine how we managed COVID-19 at the national and global
levels, pick up the key learnings both from the success stories and challenges faced, and
assess the key gaps which need to be addressed to help us prepare and respond more
efficiently and effectively in any such future public health crisis.
The Expert Group did a detailed assessment and landscaping of what worked and what
did not in that crisis. Series of stakeholder consultations were held with National and
International experts, policy makers, researchers, clinicians, epidemiologists, funding
agencies, and international organisations - all those who played a key role in COVID
management.
Learning from the experience of COVID-19, the experts have realised that responding
in the first 100 days of an outbreak is crucial for effective management. It is critical to
be ready with strategies and countermeasures which can be made available within the
first 100 days. It is essential that the proposed framework provides recommendations
for a robust ecosystem so that when there is any outbreak from known or unknown
pathogens, India is ready to respond in 100 days. This report provides an action plan for
a 100-day response to any outbreak or pandemic. It outlines the detailed roadmap for
preparedness and an implementation phase, indicating the steps on how the outbreak
can be tracked, tested, treated and managed through a well-developed framework in a
100-day time frame. It suggests a structure that integrates and strengthens all existing
components and builds the required components to deliver the outputs that meet the
targets of a 100-day response mission.
The recommendations of the Pandemic Preparedness and Emergency Response
Framework (PPER) are in four pillars:
1. Governance, Legislation, Finance and Management
2. Data Management, Surveillance and Early Predictive Warning, Forecasting and
Modelling,
3. Research and Innovation, Manufacturing, Infrastructure, Capacity building/Skilling
4. Partnership, Community engagement including risk communication, Private sector
partnerships, and international collaborations
The actions proposed under each of these are detailed in this report. During report
preparation, an analysis was done on the challenges faced and the country’s response Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 8
while managing earlier epidemics. Over the years, there has been an effort to build
a robust ecosystem for managing the Epidemic/Pandemic public health challenge. A
strong foundation has been laid, from developing epidemiological surveillance to piloting
data input portals like the Integrated Health Information Platform (IHIP) and Integrated
Disease Surveillance Programme (IDSP) to strengthening research infrastructure and
capacity for innovative technology development. During COVID-19, there was an effort
to plug the gaps and build those components that supplemented the existing strengths.
A separate Public Health Emergency Management Act (PHEMA) is proposed to facilitate
the management of any public health crisis. The PHEMA can address various aspects
beyond epidemics, including non-communicable diseases, disasters, and bioterrorism,
and should be in place for a developed country. It will allow a holistic approach to
health management, covering prevention, control, and disaster response. The Act would
also provide for the creation of skilled public health cadres at national and state levels.
The effective management of COVID-19 was possible due to a robust governance system
through the Empowered Groups (EGs) with a whole-of-government approach. It is
proposed that an Empowered Group of Secretaries (EGoS) chaired by Cabinet Secretary
be established for Pandemic Preparedness and Emergency Response and a well-oiled
machinery is put into action which prepares and readies itself before any emergency.
A well-structured scorecard mechanism should regularly monitor the progress of key
targets. The priority targets would be the development of capacities for both human
resource and infrastructure, the development of innovative countermeasures, appropriate
high-risk financing for getting high returns, in terms of saving lives and minimising
economic loss, a well-developed robust, responsive regulatory framework, and a strong
surveillance network connecting epidemiological data with genomic, laboratory and
clinical data.
There is a need to connect the epidemiological surveillance data with the genomic
data and develop clinical correlations using hospital and lab data. A strong surveillance
network is proposed, which allows community and hospital data to flow seamlessly to a
unified data portal for data access and sharing across all relevant sectors. This will need
a well-articulated data sharing and communication policy and assigning authority to key
persons for decision-making.
Challenges faced during COVID-19 regarding an India-based forecasting and prediction
modelling system, therapeutic development and platform technologies for developing
prototype vaccine candidates need to be addressed through new missions and centres
which have been suggested in the report.
To take effective, timely action, a Pandemic Preparedness and Emergency Response
Fund needs to be established. During COVID, need-based finance packages were made
available for some of the emergency response activities like genomic surveillance, vaccine
and diagnostic development, research resources and shared infrastructure. However,
adequate finances are also required to be made available for pandemic preparation.
The research ecosystem needs strengthening. The special high-risk innovation research
fund announced by the Government as a special package —‘Mission COVID Suraksha’,
gave the country the capability to develop indigenous vaccines for the world’s most
extensive vaccination programme. The private sector could successfully develop a Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 9
portfolio of vaccines including the world’s first DNA vaccine, the first thermostable
mRNA vaccine, the first nasal vaccine and other vaccine candidates, using different
platform technologies. The high-risk fund also helped to scale up vaccine manufacturing
capacities. This experience highlights the need for continued support for developing
platform technologies and vaccine candidate libraries. A new Institute of Innovation for
new platform technologies and vaccine research, development and manufacture, and
Centres of Excellence (CoEs) for research on priority pathogens (including development
of countermeasures) should get special financial allocation to prepare for future threats
and be ready to deliver in 100 days of detection of a new pathogen.
Indian regulatory system needs special attention. There is a need for global harmonisation
of regulatory norms to allow acceptance of regulatory data across the world’s recognised
regulatory authorities and a common framework for innovative technologies and
accelerated response for emergency approval. The need for a clinical trial network for
global multi-locational trials has been suggested. This would facilitate speedy access to
globally developed countermeasures. The regulatory authority (CDSCO)needs special
powers through legislation and requires technical competence strengthening and
autonomy in functioning to meet these requirements.
Partnerships and coordination play a significant role in implementing an effective
response during an emergency, especially centres-state partnerships and community
engagement. Strengthening the existing system and developing a strong institutionalised
framework is needed.
The expert group in the report has provided a blueprint for the country to prepare for any
future public health emergency or pandemic and have a rapid response system. From
examining the lessons learned and challenges faced during the COVID-19 pandemic to
recommendations and a roadmap for governance and management of public health
emergencies in the future, this report is a starting point for the country’s pandemic
preparedness and prevention efforts. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 10
FUTURE PANDEMIC PREPAREDNESS
AND EMERGENCY RESPONSE-
A FRAMEWORK FOR ACTION
REPORT OF THE EXPERT GROUP
1. Introduction
1.1 Background
As India recovers from the COVID-19 pandemic, the worst human health crisis
humanity has witnessed, it is imperative that we draw lessons from the country’s
and the world’s experiences and accordingly visualise preparedness elements and
pathways for potential future pandemic(s).
The world was caught unaware when we were struck by the infectious virus SARs
CoV2. It took us a while to understand the impact this virus had on life, livelihood
and economic conditions, not just in the country but worldwide. We collectively
fought the SARS-CoV2 challenge using a strong public health surveillance network,
scientific knowledge and tools, and could successfully mitigate its impact. Worldwide,
there have been several science-based measures and countermeasures to tackle this
deadly virus. India, too, deployed epidemiologic, surveillance and genomic tools to
contain it. We produced diagnostics, medical technologies, vaccines and drugs to
treat the disease. India deployed a whole-of-government approach to managing the
pandemic. It encountered numerous challenges, which are learnings for the country
to better prepare for the future and have a Pandemic Preparedness and Emergency
Response framework in place which allows urgent action in any such conditions and
delivers impact in a 100-day mission mode time frame.
India deployed epidemiologic and genomic surveillance, IT-based data analytics, and
novel technology-based countermeasures and tools to contain the deadly virus. It
scaled up behavioural, clinical and therapeutic measures. Timely application of non-
pharmaceutical interventions helped firm up the manufacturing of PPEs and supply
chains to prevent infection and treat the disease. The country produced vaccines,
diagnostics and medical technologies to meet the demand. The nation ramped up
its entire machinery from R&D for new technology and product development to
manufacturing, implementation, and last mile delivery. India produced and licensed
seven vaccines at affordable cost and administered more than 2.2 billion doses of
Made in India vaccines, almost entirely through the public health system, with an
unprecedented speed.
The COVID-19 contagion is undoubtedly not the last pandemic. Given the
unpredictably changing planetary ecology, climate and human-animal-plant
dynamics, new large-scale infectious threats to human health are inevitable.
The WHO has warned the world that 75% of future public health threats are likely to be
zoonotic threats (which could be due to emerging, re-emerging and new pathogens). Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 11
Over the last two decades, seven Public Health Emergencies of International
Concern (PHEICs) have been declared by the World Health Organisation (WHO).
These include the H1N1 influenza (2009), Ebola Virus Disease (EVD) (2014-16, 2018-
2020), Zika Virus Disease (ZVD) (2016), Poliomyelitis (2014), COVID-19 (2020),
and Monkey Pox (2022). In addition, the world has tackled public health threats of
SARS, Avian influenza (bird flu), MERS-CoV, and Nipah virus outbreak which have
challenged health systems across countries. However, it is worth mentioning that
the COVID-19 pandemic was more complex in terms of high public health impact,
recurring waves and unpredictable course due to changing pathogenicity associated
with virus mutations and variants. This has highlighted the importance of a targeted
approach towards zoonotic and other potential pathogens that are likely to emerge
in the future. Such threats could be due to emerging and re-emerging pathogens,
or could also arise due to newly emerging pathogens from viruses which routinely
are infective for bats or other avian populations but may cross over to humans due
to frequent mutations directly or via vectors due to environmental or occupational
aspects of human animal interface. Considering the above aspects, the Government
of India is in the process of launching the One Health (OH) Mission, focusing on
multi-disciplinary human, animal and environmental sectors through an effective
integrated surveillance ecosystem, joint outbreak response system and targeted
research.
While the One Health (OH) approach is crucial for addressing many pandemic threats,
there are challenges from CBRN agents, threats from bioterrorism, the possibilities of
deliberate release of pathogens for malicious purposes and pandemic scenarios that
extend beyond its scope and require strategies which are beyond the OH approach
involving national security, international collaborations with inter-disciplinary
approach and high-tech systems. Further, factors like increased travel and trade
due to globalisation, effects of climate change on pathogens, and determinants of
pathogenicity among vulnerable groups, including emerging resistant pathogens
and social determinants of health, require a separate mechanism.
Globally, countries and multi-lateral organisations are working towards preparedness
to deal with novel pathogens and disease outbreaks. WHO has already identified
around 30 viral and bacterial families, which could have potential for epidemics or
pandemics and hence need to be targeted for future research, development of new
laboratory techniques for diagnosis, and countermeasures. The WHO has revised
the International Health Regulations (IHR) to reflect the post pandemic reality; Inter-
governmental negotiations on a Pandemic Accord were also conducted and a global
scientific framework for epidemic and pandemic research preparedness is being
developed. The recent 77
th
World Health Assembly also highlighted the need for a
collaborative surveillance framework and developing a roadmap for epidemiological
capacity building at all levels and aligning with regional and global initiatives.
Therefore, it is imperative that countries also take stock of their needs and prepare
a robust road map aligned with global instruments like Preparedness and Resilience
for Emerging Threats (PRET) and obligations under International Health Regulations
(IHR), which are legally binding on all WHO member countries for preparing and
responding to future pandemic threats to public health systems. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 12
1.2 Setting up of the Expert Group
In response to SARS-COV2, India made efforts to produce novel countermeasures
and strengthened its research and development framework. These included
mechanisms for funding of industry and researchers, establishment of shared
resources; policy and guidelines for sharing of data, samples, regulation; public-
private partnerships and global collaborations. India also invested in digital tools for
pandemic response and vaccination, which helped manage data of more than 1.4
billion population. Despite this, a huge number of lives were lost, and the economy
took a big hit. The country must learn from planning and implementing such a
multi-modal pandemic response. More importantly, it is paramount to envision an
approach on tackling a future challenge of this magnitude due to a new pathogen
with even greater efficacy and speed building upon the networks and frameworks
established during the Covid-19 pandemic.
Consequently, an Expert Group was set up to examine these issues in depth, consult
other experts (national/global), learn from the positive experiences and challenges,
and develop a detailed analysis of what worked and what did not. The report looks
at the lessons learnt from the country’s response and global experiences and offers
a clear strategy and road map on what our preparedness should be to handle any
such and even more dangerous public health crisis in future.
Terms of Reference of the Expert Group:
The Expert Group on India’s Future Pandemic Preparedness was set up with the following
Terms of Reference:
1. Study emerging information on pathogens with the potential to power large outbreaks
in the future and suggest mechanisms for focusing on surveillance taking ‘one earth one
world’ approach to ensure that we are prepared for diseases of potentially unknown
agents.
2. With a focus on the scientific and technological approaches, tools, products and systems
deployed in the COVID-19 pandemic response, prepare a synthesis report on the learnings
thereof and propose preparedness pathways for the country. In particular, undertake this
task with specific reference to pandemic epidemiology, forecasting, surveillance, testing
and containment, virus characterisation including genome sequencing, and diagnostics,
digital tools, therapeutics, medical technologies and vaccines.
3. Recommend specific action to be taken for strengthening and creating a robust
ecosystem for pandemic prediction and prevention, biomedical research, and new
innovative, affordable and accessible countermeasures.
a) Further, identify gaps that exist in infrastructure, human resources and systems in
this regard and recommend actions to be taken to build this at a world-class level
through Atma Nirbhar effort.
b) Suggest how to create systems that allow complete forward and backward linkages
to ensure no dependency on imported raw material; and recommend building
networks for clinical trials to take up disease-based vaccine and therapeutics
research ensuring compliance with global regulatory standards.
c) Recommend scale-up mechanisms to promote the capacities of our industry to
become manufacturing hubs to be able to meet the needs of the country and also
supply to the world. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 13
d) Suggest improvements to strengthen the framework for data and sample
sharing.
4. Provide guidance on meaningful national and international, including bilateral,
multilateral, and public-private partnerships.
The Composition of the Expert Group is as follows -
• Chairperson: Dr Renu Swarup, Former Secretary to Govt of India, Department of
Biotechnology
• Members:
»Dr Soumya Swaminathan, Former Chief Scientist WHO & Former DG ICMR
»Dr Sujeet Singh, Former Director NCDC
• Member Secretary: Sh. Rajib Kumar Sen, Senior Adviser Health, NITI Aayog
This report offers a blueprint for the country to prepare for any future public health
emergency or pandemic to have a rapid response system. From examining the
lessons learned and challenges faced from the country’s response and global
experience during the COVID-19 pandemic to recommendations and a roadmap for
governance and management of public health emergencies in the future, this report
is a starting point for the country’s pandemic preparedness efforts.
Target audience - This report is intended to inform policymakers, National and State
governments, partners and researchers, industry and academia working on health
system resilience and preparedness for public health emergencies. It may also be
helpful to the lay public.
Caveats (if any): The contents of this report are the views and recommendations
of the expert group. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 14
2. Methodology
2.1 Consultations
The Expert Group has consulted with national and international experts from public
health, clinical medicine, epidemiology, microbiology, industry and academia, and
senior government officials at the Centre and State level. These experts were at
the frontline of the COVID-19 response at the local, national and international levels
and played an important role in the policy, planning and implementation of the
COVID response. Expert views on the learnings and challenges of dealing with the
COVID-19 pandemic and recommendations for future preparedness were sought.
Fourteen consultations have been held with more than sixty experts.
An overview of the institutions, organizations and experts consulted are annexed at
Annexure III.
»Presentation to concerned Ministries/Departments
Following the consultations with experts, members of the expert group prepared
the critical recommendations for future preparedness. The recommendations
were discussed with Secretaries and senior officers of concerned ministries and
departments in a meeting held on 24 May 2024 at NITI Aayog; co-chaired by Member
(Health), NITI Aayog and the Principal Scientific Adviser to the Government of India.
The participants welcomed the comprehensive recommendations of the expert
group prepared through a thorough assessment of the current preparedness status
and lessons learnt from COVID-19. Recommendations for a separate legislation
managing public health emergencies, earmarking a separate Pandemic Preparedness
and Emergency Response fund, strengthening surveillance and data management,
and investing in research and development of countermeasures (diagnostics,
vaccines, therapeutics, protective equipment) were appreciated by the participants
as timely and actionable recommendations that would also serve to strengthen
current activities and facilitate improved implementation.
2.2 Research
Research complementing future pandemic priorities has also been undertaken by
the Expert Group. This includes research on the work being undertaken by global
health organisations, multi-lateral groups like the Independent Panel for Pandemic
Preparedness and Response Secretariat (IPPRS), the 100 days Mission, etc.
Published literature on the COVID-19 pandemic, evolving science about the SARS-
CoV2 pathogen, COVID-19 disease and its sequelae have also been considered
by the Expert Group in its deliberations. Details of key references are included at
Annexure IV. Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 15
3. Lesson from the Past -dealing with epidemics in the last two
decades
Between 2009- 2022, WHO has declared seven Public Health Emergency of
International Concern (PHEICs) —Influenza A in 2009, poliomyelitis in 2014, Ebola
West Africa in 2014, Zika in 2016, Ebola Democratic Republic of Congo 2018, COVID-19
in 2020 and Monkey-pox in 2022. Public Health Emergency of International Concern
(PHEIC), as per IHR, is “an extraordinary event which is determined as per IHR
decision instrument (1) to constitute a public health risk to other countries through
the international spread, and (2) to potentially require a coordinated international
response”. Further, during the last few years, many countries have witnessed the
occurrence of several infectious diseases, outbreaks/public health threats which
were potential pandemic threats both outside and inside the country, which resulted
in the loss of lives, property, and economic consequences.
Important events/outbreaks during last two decades (which caused pandemic
threat) are described below. These also have the potential to cause future pandemics;
hence, preparedness measures should also be developed to manage their outbreaks.
Event/Outbreak DescriptionLearnings
SARS in 2003 The first infectious disease in
this century, which started in two
provinces of China, spread to over
50 countries in a very short time
through international travel and
resulted in around 850 deaths
within a period of 3-4 months.
Highly infectious and contagious;
R
0
of around 8 spread primarily
through respiratory mode. A
multi-country high-level expert
group got exposed in a group
meeting in Hong Kong Hotel
(event) which caused multi-
country spread during air travel
and also after return. Countries
used ad hoc measures in absence
of any international provisions,
primarily on basis of past
experience.
• Need for International
legally binding rules/
regulations.
• Novel pathogens are
difficult to identify and
hence the primers and
probes for developing
diagnostic tests/facilities
take time and; thus,
detection of infection
among exposed persons
is a challenge during the
initial phase.
• Need for core capacities
for screening, sample
collection and quarantine
facilities at international
airports. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 16
Avian Flu (H5N1) Since 2005 onwards, repeated
outbreaks in birds (primarily
in poultry) have caused
significant harm to at-risk human
populations.
In 2024, H5N1 has been circulating
among cattle farms in the US, and
a few human cases have been
reported.
• An effective strategy of
surveillance of at-risk
populations and culling sick
birds was developed as a
coordinated surveillance
and response plan for both
human and animal sectors.
This helped the country
in effective containment
and prevented spillover
of infection among at
-populations from birds.
• A standing committee on
zoonosis was established
following avian influenza.
H1N1 pandemic
(pandemic
declared as
PHEIC))
Emerged in 2009 in Mexico, it
spread through respiratory routes
to over 74 countries, causing
about 491000 lab-confirmed
cases and 18449 deaths. This was
the first pandemic to be declared
as PHEIC in accordance with IHR
(2005).
• IHR (2005), a legally
binding regulation, was in
place.
• Countries were
developing core
capacities as per IHR
at points of entry and
inside the country for
surveillance and response.
• Countries adopted
public health measures
like screening at POEs,
early detection of
suspects, quarantine,
contact tracing of
suspect surveillance and
management of cases
in isolation in dedicated
wards.
• Public health measures
were helpful in mitigating
and delaying the entry of
infection.
• Need for coordinated
surveillance between
Points of entry and in-
country surveillance
system. Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 17
Ebola Outbreaks
(2014-2016)
(2018-2021)
Multiple Ebola outbreaks (around
7 since 1976) occurred in different
regions of Africa. The epidemics
in the west African countries were
significant from the perspective
of international spread in over 7
countries in Europe and the threat
of spread in other countries via
international travellers.
• Efforts to control these
outbreaks involved
screening, surveillance of
exposed, contact tracing,
data management,
laboratory testing,
and health education,
including use of PPEs.
• Public health efforts were
much more effective,
limiting entry into the
country.
MERS-CoV Outbreaks in the Middle Eastern
countries have been regularly
occurring since 2012 and are
potential threats from the
perspective of international
spread via travellers, for e.g. in
South Korea in 2015, leading to
186 cases and around 34 deaths.
• Zoonotic diseases,
particularly highly
infectious diseases that
spread via respiratory/
droplets route could be
challenging to prevent.
• Most of the threats
leading to pandemics
were due to novel viruses
of zoonotic origin,
possibly transmitted
through the human-
animal interface.
• Infectious diseases
having a respiratory
mode of transmission are
dangerous.
Zika Virus
disease
A disease transmitted via Aedes
mosquitos has already spread to
over 90 countries and has been
detected in over 12 states in the
country.
• ZVD- a disease with
over 80% asymptomatic
cases and mild clinical
symptoms with full
recovery cannot be
prevented using public
health measures directed
towards travellers.
• Effective vector
surveillance and control
is essential to prevent
entry and transmission
of vector-transmitted
diseases.
• Need for multi-sectoral
collaborative surveillance. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 18
4. COVID-19 Learnings and Challenges
The COVID-19 pandemic (2019-23) caused by the SARS-CoV-2 virus emerged
in late 2019 and quickly spread worldwide. The world was caught unaware and
although there were strategies for managing outbreaks and epidemics, developing
and deploying countermeasures for the different outbreaks, the magnitude of the
problem faced when the pandemic hit us was overwhelming and required urgent
coordinated action. It resulted in millions of deaths, widespread illness, and significant
economic and social disruptions. Efforts to control the spread of the virus included
cluster containment, disruption of social gatherings, lockdowns, travel restrictions,
mask mandates, and the development of vaccines and mass vaccination.
The country had a well-developed strategy-based response system for earlier
outbreaks, which effectively implemented and successfully managed the disease.
However, there were challenges faced and key gaps noted in the ecosystem which
need urgent attention for better management of any future public health crisis.
These lessons are important to plan a road map for future pandemics. Some of the
key issues are listed below -
4.1 Governance
i. The whole–of-government, whole-of-society approach, and inter-
departmental, inter-ministerial, and centre-state coordination worked well
during COVID -19.
ii. Role of Empowered Group Systems, National Task Forces – NTAGI & NEG-
VAC were critical for quick decision-making and interagency coordination
iii. Science-based evidence played a key role in informed decision-making.
This evolved with a scientific understanding of the pathogen and disease,
iv. The role and responsibility of each agency and organisation however,
required more clarity, and the mechanisms for close coordination of
agencies to work together were not in place.
v. Risk communication systems need to be established. What was missing
in COVID management was a well-developed communication mechanism
which allowed data to flow both ways.
vi. The need was also felt for a well-defined rapid response SOP/instruction
document and delegation of powers to empower key officials to act without
going through the multilayered hierarchal process. This was essential for
speedy time-bound action.
4.2 Legislation
i. The National Disaster Management Act (NDMA) was enforced – enabling
Centre and State government to respond quickly and implement public
health measures.
ii. However, a need is felt for a specific Public Health Act.
iii. Provisions of NDMA are not entirely suited for a public health emergency
and its public health and clinical management.
iv. The previous epidemic act has a limited scope and is not suited to the
modern approach for pandemic/epidemic management. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 19
4.3 Surveillance and Data management
i. The Disease agent was a novel virus of zoonotic origin. A One Health
Approach was needed to tackle this
ii. Data collection, management and analysis were the key issues.
• There were several data portals for human disease – IDSP, IHIP (an
Integrated Health Information Portal) apart from State portals.
Additionally, multiple data sources like ICMR COVID-19 (https://cvstatus.
icmr.gov.in/) test data and data collected in segregated portals.
• The National Animal Disease Referral Expert System (NADRES) provides
monthly livestock disease forewarning at the district level which is
published in the form of a monthly bulletin to alert the animal husbandry
departments, both at the National and state levels, to take appropriate
control measures.
• Centre & State dashboards had collected data. However, it is imperative
to integrate this data for a proper analysis. Modelling, forecasting and
early warning based on our data was a missing gap. This requires not
just data flow from the networks but also human resource capacity to
analyse and develop predictive models.
• The challenge was to get a seamless flow of this data, data integration
for proper data analysis using epidemiological intelligence and access
to relevant stakeholders for different types of research, development
of countermeasures, and prediction models. A continuous, uniform,
interoperable data flow is essential from state to centre, from field sites,
connected with laboratory and clinical/hospital networks.
• Surveillance was a critical aspect of COVID management. While there was
a solid existing epidemiological surveillance through the IDSP network,
the gap was a well-integrated surveillance network for pandemics like
COVID-19. Hence, in April 2020, special efforts established a dedicated
Special Surveillance System (S-3), i.e., https://covid19.nhp.gov.in for
data capture from the district level on surveillance, logistics planning
including hot spot data on quarantine, and patient management. Digital
platforms – like Aarogya Setu mobile tracking Bluetooth-based app
for contact tracing & information dissemination - to lab and S3 system;
CoWIN platform – played a very important role in vaccination and
individual risk assessment.
iii. The INSACOG Network on Genomic Surveillance was helpful in identifying
new strains, but there was limited capacity across the country. This network
linking epidemiological and genomic surveillance should be strengthened
and connected with clinical surveillance and hospital networks.
iv. The INSACOG potential could not be optimally utilised as the linkages with
state laboratories of primary and secondary health care centres and the
private sector needed strengthening. For future pandemics, INSACOG can
function in a hub and spoke model with centre-state partnership and active
involvement of the private sector both for hospital network and genomic
surveillance. Mathematical modelling systems must be in place to connect
epidemiological, genomic surveillance and clinical data for early prediction
and warning. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 20
v. Wastewater analysis and serological surveillance also helped identify the
spread of viruses; this should be done regularly.
vi. Hence a unified, comprehensive National Data Portal that aggregates all
information about the virus and disease spread from various sources is
suggested to identify trends and quickly predict surges/next outbreaks,
including data from scientific research and predictive modelling.
4.4 Research and Development, translation and product development
i. Public and private collaborations were a strong factor for efficient pandemic
management. It has been well established that there is sufficient capacity
and competency in industries both in innovative research and manufacturing
and the pieces of the ecosystem have existed in the translational value chain.
The rapid tests and low-cost tests developed by ICMR, and other institutes
were required to be linked with relevant industries for bulk manufacturing.
However, there was a need for creating a structured mechanism linking
research bodies like ICMR and the private sector with appropriate industries
under the overall framework for pandemic management. A well-laid-out
validation network is essential for the development of diagnostic kits.
ii. Vaccine candidates were developed, and manufacturing capacities were
scaled up. This was possible due to the High-Risk Innovation Funding
Mission COVID Suraksha. India’s strength in diagnostics and vaccines needs
to be developed in a proper framework involving research, regulatory
bodies and industries. This could also serve as a valuable resource for the
entire Southeast Asia region.
iii. Animal challenge facilities, BSL3 network, validation labs, and bio repositories
were set up. The challenge was to have systems in place that allow access to
the shared infrastructure and access to biological and clinical material and
samples. We need the tools and instruments, including MoUs and Material
Transfer Agreements which provide necessary access.
iv. Start-ups played a significant role in the manufacturing of low-cost PPEs,
sanitisers and other protective gear like face masks. We, however, need
forward and backward linkages and uninterrupted supply chains to ensure
a large-scale cost-effective production.
4.5 Regulatory Reforms
i. Although we quickly developed a rapid response regulatory framework to
respond to our requirements for COVID-19, the regulatory system was not
geared up for accelerated emergency authorisation. The need for regulatory
process harmonisation and clear guidelines for new technology is of utmost
importance.
ii. The established guidelines and SOPs and the technical competence to
understand the complexities of new technologies need strengthening.
Since we did not have harmonized global regulatory guidelines, this delayed
the approval of products already approved by other recognized national
regulators.
iii. A well-established, globally accepted clinical trial site network was also
essential for trials of products developed by other global groups. Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 21
5. Future Pandemic threats: Public Health Challenges and
Preparedness
Evidence suggests that the risk of emerging infectious diseases due to known and
unknown pathogens, particularly of zoonotic (animal, avian and wildlife) origin,
has increased over time due to the intensification of international travel, trade and
livestock husbandry, as well as increasing human population density and changing
interactions between humans and wild animals. These drivers of disease emergence
are likely to continue and intensify, and additional drivers of ecological change and
disruption, such as climate change and global warming, are likely to further amplify
disease emergence risk.
The WHO has initiated a global process to update the list of priority pathogens—
agents that can cause outbreaks or pandemics—to guide global investment, research
and development (R&D), especially in vaccines, tests and treatments. The current
list includes COVID-19, Crimean-Congo haemorrhagic fever, Ebola virus disease and
Marburg virus disease, Lassa fever, Middle East Respiratory Syndrome (MERS) and
Severe Acute Respiratory Syndrome (SARS), Nipah and henipaviral diseases, Rift
Valley fever, Zika and Disease ‘X’. The 2024 Bacterial Priority Pathogen List (BPPL)
includes 15 families of antibiotic-resistant (ABR) pathogens grouped into critical,
high and medium categories of priority for R&D and public health measures. In
addition, 200+ scientists from 53 countries independently evaluated the evidence
related to 30 viral families to identify priority viral pathogens. Research on pathogens
and categorization as agents which can or which have the potential for casing
epidemics and pandemics is a dynamic process, coordinated by WHO. Periodically
WHO expert group updates the list of priority pathogens. The current (as of June
2024) list of priority pathogens is placed at Annexure II.
In the face of current and future pandemic threats, the importance of collaborative
surveillance cannot be overstated. The key challenges are timely detection of early
warning signs, the identification of emerging and new pathogens (which could
potentially lead to future pandemic threats), the assessment of the public health
impact and the implementation of multi-disciplinary surveillance to capture various
dimensions of a disease and its impact. It is imperative that collaborative surveillance
in community and health facilities is established for the regular assessment of the
impact of CBRN agents on transmission, morbidity, severity and mortality in the
community, thereby enabling proactive planning.
In addition, the following epidemiological aspects of infectious diseases/agents
may also pose specific challenge to public health strategies:
i. Diseases with large asymptomatic carriers contributing to transmission and
possible health impact, like spontaneous vaginal delivery in pregnant women,
may be associated with congenital microcephaly.
ii. Highly pathogenic agents causing high mortality and high rate of transmission
Ro > 5 or so
iii. Infectious diseases with Resistant pathogens (viruses, bacteria and fungi)
iv. Diseases with a reservoir in domestic animals (largely asymptomatic like CCHF),
birds, cattle, pigs, bats etc.
v. Diseases with unknown transmission routes (milk, food, touch, droplets, air etc.) Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 22
Strategy: Given future threats, the traditional public health surveillance strategy
should be aligned with new initiatives focused on:
i. Global Preparedness: Pandemics have the potential for cross-border spread and,
hence, country preparedness needs to align regional and global core capacities
for robust collaboration and communication to prevent or mitigate cross-border
spread.
ii. Cross-sectoral and cross-border collaboration: for enhancing coordination
between public health authorities, disaster management agencies, and other
relevant sectors to manage pandemic threats effectively.
iii. Risk assessment and community engagement: Strategy for assessment of
potential future risks, allowing possible misconceptions and rumours during
outbreaks and ensuring accurate information dissemination and community
cooperation.
iv. Resource Availability: Ensuring necessary funds and resources are available to
support pandemic response efforts.
v. One Health Approach: Developing the multi-hazard plan, strategy, SOPs, and
processes for implementation for coordinated surveillance and response to
zoonotic and other emerging infectious diseases.
These challenges highlight the need for proactive preparedness to strengthen public
health systems and response capabilities in the face of current and future potential
pandemic threats. Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 23
6. Recommendations
While over the years, we have had many outbreaks, and the country has built response
mechanisms both at the centre and state level, including community engagement,
the onset of COVID-19 was a situation which brought out the key challenges in
the system and highlighted the specific gaps which need to be addressed. Clearly,
we cannot wait for the next infectious pathogen to strike before we act. We need
a well-articulated action plan which gives us a clear road map on how we should
prepare in advance and keep our tools and capacity ready so that without wasting
any time, an emergency response which begins action on day zero and gives the
required results to have disease prevention, mitigation and control is in place within
100 days.
Accordingly, a Pandemic Preparedness and Emergency Response (PPER)
framework for action is proposed for consideration. The PPER aims to have a well-
developed framework in place that will make the system ready for any future public
health crisis and deliver a response in a 100-day time frame. The framework keeps
the preparedness in peacetime to respond to emergency war.
Based on our learnings from earlier epidemics and the key actions taken and strategy
followed to manage the COVID pandemic, it is evident that a special focus must be
placed on sustaining the efforts made and addressing the challenges faced with a
well thought-out action plan that can respond to a public health emergency in the
shortest period of time.
Post-COVID, there has been a proactive approach by the Government, and One
Health (OH) Mission has been launched, which focuses on Surveillance, Research,
Data management, Outbreak management and Pandemic preparedness.
The OH Mission focuses on:
i. Surveillance with emphasis on Priority pathogens, especially, viral families and
representative or prototype viruses within each family
ii. Bacterial threats in the context of Anti-Microbial Resistance (AMR)
iii. Data management and analysis
iv. Research and development covering medical countermeasures, including
diagnostics, drugs and vaccines
v. Building on lessons from the COVID.19 pandemic
In addition to the areas covered under OH Mission, some key actions are proposed
under PPER for consideration. The recommendations are under four pillars:
6.1 Governance, Legislation, Finance and Management
6.2 Data Management, Surveillance and Early Predictive Warning, Forecasting
and Modelling
6.3 Research and Innovation, Manufacture, Infrastructure, Capacity building
6.4 Risk Communication, Community engagement, Private sector partnerships,
and International collaborations Future Pandemic Preparedness and Emergency ResponseA Framework for Action 24
Key Recommendations
Creating a well-connected/integrated robust surveillance network linking epidemiological, genomic
and clinical data, including humans, animals and the environment.
Establishing a harmonized system for data collection, access, sharing, analysis, and a unified data
portal for infectious diseases
Building a strong modelling and forecasting network for early prediction of emerging threats
Creating a strong biosecurity network of BSL3 and BSL 4 facilities for characterization and
epidemiological study of all priority pathogens and known/ unknown pathogens
Surveillance, Data Management, Forecasting, Modelling,
Early Predictive Warning
Governance, Legislation, Finance and Managementv
Enacting a new Public Health Emergency Act
Creating an institutionalised empowered governance mechanism for Public Health Emergencies. An
Empowered Group of Secretaries on PPER chaired by the Cabinet Secretary
A Continuous Monitoring Group to be constituted co-chaired by the Secretary Health and Secretary DHR
A well-defined SOP manual for rapid response to be prepared
Setting up of a special Pandemic Preparedness and Emergency Response fund for all PPER activities
of surveillance, data management, forecasting and modeling, research, innovation and manufacture,
development of counter-measures, infrastructure and capacity building
Research & Innovation, Manufacture, Infrastructure,
Capacity Building
Focused research on priority pathogens to develop countermeasures
Development of countermeasures -diagnostics, drugs, vaccines
Allocating Pandemic Preparedness and Emergency Response fund for High-risk Research and
Innovation
Setting up an Institute of Innovation for New Platform technologies and vaccine research,
development and manufacture
Scaling manufacturing capacities and logistic supply chains for availability of counter measures
Creating strong forward and backward linkages with vertical integration to develop strong supply
chains, for countermeasures
Creating Centres of Excellence for Skilling Human Resources in identified gap areas
Risk Communication, Community Engagement, Private Sector
Partnerships and International Collaborations
Setting up of a specialised Risk communication unit with Pre approved SOPs and protocols for
release and dissemination of information on a regular basis to different stakeholders
Having pre-approved instrument, guidelines and agreements for Private sector participation in
surveillance, research, manufacture and disease management including testing, vaccination and
treatment
Community engagement SOPs to be developed for proper disease management Building strong
Partnership models at Centre, State, district and community level and collaboration with the
international organisations Future Pandemic Preparedness and Emergency ResponseA Framework for Action 25
Some key recommendations are listed below. Those areas/activities taken up under
the OH Mission can be further strengthened and integrated with the implementation
plan proposed under the PPER Framework.
6.1 Governance, Legislation, Finance and Management
i. Enacting a new Public Health Emergency Management Act (PHEMA)
ii. Creating an institutionalized empowered governance mechanism for Public
Health Emergencies - An Empowered Group of Secretaries on PPER chaired
by the Cabinet Secretary
iii. Constituting a Monitoring Group co-chaired by the Secretary Health and the
Secretary Dept. of Health Research (DHR)
iv. Preparing a detailed SOP (implementation manual) for rapid response to
biological threats
v. Setting up of a special Pandemic Preparedness and Emergency Response
fund for all PPER activities of surveillance, data management, forecasting
and modelling, research, innovation and manufacturing, development of
countermeasures, infrastructure and capacity building
6.2 Data Management, Surveillance and Early Predictive Warning,
Forecasting and Modelling,
i. Creating a well-connected/integrated robust surveillance network linking
epidemiological, genomic and clinical data, including humans, animals and
the environment.
ii. Establishing a harmonised system for data collection, access, sharing,
analysis, and a unified data portal for infectious diseases.
iii. Building a solid modelling and forecasting network for early prediction of
emerging threats.
iv. Creating a strong biosecurity network of BSL3 and BSL4 facilities for
characterisation and epidemiological study of priority and known/unknown
pathogens (in animals and humans).
6.3 Research and Innovation, Manufacturing, Infrastructure, Capacity
building/Skilling
i. Multi-disciplinary research on priority pathogens
ii. Development of countermeasures - diagnostics, therapeutics, vaccines,
protective equipment
The proposed PPER Framework encompasses the One Health Mission and its activities
of Surveillance, Research, Data Management and Infrastructure networks.
The PPER Framework proposes a road map and Action Plan for preparing for any
Public Health Emergency and delivering a well-articulated response in 100 Days.
The recommendations recognise existing frameworks, identify gaps that need to be
strengthened and suggest how this Action plan could be implemented. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 26
iii. PPER fund for High-risk Research and Innovation
iv. Setting up an Institute of Innovation for New Platform technologies and
vaccine research and development
v. Scaling manufacturing capacities and logistic supply chains for the
availability of countermeasures, and stockpile management.
vi. Creating strong forward and backward linkages with vertical integration to
develop resilient supply chains for countermeasures
vii. Creating Centers of Excellence for Skilling Human Resources in identified
gap areas.
6.4 Partnership: Community engagement including risk communication,
Private sector partnerships, and International collaborations
i. Setting up a specialised risk communication unit in MoHFW (NCDC) with
preapproved SOPs and protocols for dissemination of information regularly
to different stakeholders
ii. Having preapproved instruments, guidelines and agreements for Private
sector participation in surveillance, research, and manufacturing
iii. Community engagement SOPs are to be developed for clinical care,
including preventive measures, testing, vaccination, and treatment
iv. Building strong mechanisms for centre-state collaboration during
emergencies with well-defined responsibilities, accountability and reporting
structures Future Pandemic Preparedness and Emergency ResponseA Framework for Action 27
6.1 Governance, Legislation, Finance and Management
6.1.1 Governance
The unique aspect of managing the COVID pandemic was the empowering
governing mechanisms - the Empowered Groups constituted for COVID-19
pandemic management were crucial to facilitating a rapid response and urgent
action to address the unique challenges faced.
As a learning, it is therefore essential emphasise building systems that are active
not just in wartime but also in peacetime. What is needed is institutionalised
empowered systems like those built at COVID times to ensure effective
collaboration and operationalisation for preparing for pandemics and responding
on priority. It is proposed that a Standing Empowered Group of Secretaries
(EGoS) for Pandemic Preparedness and Emergency Response (PPER) should
be constituted and chaired by Cabinet Secretary and Co-Chaired by Member
Health NITI Aayog and PSA, with all concerned departments and agencies and
nodal officers from States/UTs represented at the level of Secretary as Members.
EGoS would monitor preparedness and give required directions and approvals
for the essential governance mechanisms, financial budgets and other approvals
necessary required with the approved governance framework for the OH Mission
and other pandemic-related activities.
For future preparedness, it is imperative to institutionalise the existing governance
structures and develop Standard Operating Procedure (SOP) for rapid response,
which is essential to act in different emergency situations. Therefore, operational
manuals/SOPs with local and global learnings for epidemic/pandemic times
must be prepared. The operative mechanism should be institutionalised, and
drills should be performed (like war-room operations of armed forces) as
a preparedness measure. It is proposed that the systems developed during
COVID-19 should be institutionalised for the whole of government approach to
facilitate rapid inter-government response.
The progress of the action plan needs to be continuously monitored through a
scorecard developed with defined targets and milestones. A PPER monitoring
working group chaired by Secy Health and Secy DHR will monitor the progress
on a continuous basis through the scorecard and report to the EGoS.
»A Standing Empowered Group of Secretaries (EGoS) for Pandemic Preparedness
and Emergency Response (PPER) should be constituted to prepare and monitor
preparedness during peace times - to guide on governance, finance, R&D,
surveillance, partnerships and collaborations, and other necessary functions
that can be ramped up for immediate response in a public health emergency
»EGoS to be chaired by Cabinet Secretary and Co-Chaired by Member, Health,
NITI Aayog, and PSA, with all concerned departments and agencies represented
at the level of Secretary as Members. This will connect with the approved
governance framework for the OH Mission and other pandemic related activities.
»EGoS to establish separate empowered working groups for each area in the
time of any emergency, like the Empowered Groups during COVID-19. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 28
Engagement with States: Centre-State Coordination
In India, health being a state subject there have been challenges in managing
outbreak-prone diseases, and we need special focus on inter-state and centre-
state collaboration particularly to strengthen some of the following areas:
i. Data flow on outbreak prone diseases for planning surveillance and response strategies.
ii. Coordination and data sharing amongst relevant nodal officers, since
infectious diseases and public health events are not limited within district/
state boundaries.
iii. Creation of sentinel sites in state hospitals and laboratories for surveillance
and sample collection for genome sequencing. Transportation of samples
to identified laboratories of the centre has been quite challenging during
pandemic times. This system needs better coordination.
iv. There were specific challenges related to supplies of Viral Transport Medium
(VTM), testing kits, PPEs, Vaccines and other logistics at the state level, it
is therefore essential that the EGoS-approved SoPs should give specific
instructions in this regard.
v. The availability of finances for emergency procurements, deploying HR
during surges, and involving private sector labs and hospitals at the state
level need special attention.
Accordingly, it is suggested that a seamless coordination between the State/UTs
and the centre is an essential pre- requisite for effective pandemic preparedness.
During COVID this coordination played a vital role in the mitigation of the impact
on morbidity and mortality. Hence, it is recommended that:
i. At the State/UT level, a senior officer should also be designated as the Nodal Officer
for coordinating all activities related to pandemic preparedness and response.
ii. Outbreak-prone diseases and diseases or events with potential for cross-
border spread/impact need to be coordinated by the designated nodal
officer and the central surveillance unit of NCDC.
iii. SSU and DSU need to ensure proper data uploading and real-time sharing with
CSU to detect, assess, and notify outbreaks or events of public health significance.
iv. Competency building training needs to be completed in a time-bound, manner.
v. All events declared as PHEIC or potential PHEIC need to be under MoHFW,
GOI and the nodal officer should be responsible for coordinating all the
activities related to pandemic preparedness in the respective State/UT.
vi. The nodal officers of five State/UTs should be ex-officio members of the EGoS
proposed to be set up under the Cabinet Secretariat on a rotation basis.
»Every State/UT to have a designated senior officer as a Nodal Officer
»Nodal officer to be responsible for: coordinating activities for pandemic
preparedness and response; proper dissemination of data/information as and
when required
»EGoS under Cabinet Secretariat to have Nodal Officers of a few States as
members Future Pandemic Preparedness and Emergency ResponseA Framework for Action 29
6.1.2 Legislation
A key factor to be considered is the need for a special Public Health Legislation.
At the Central level, two laws – the Epidemic Diseases Act (EDA) 1897 and the
National Disaster Management Act (NDMA) 2005, direct the legal framework on
PHEs. During COVID-19, the pandemic was managed under the National Disaster
Management Act 2005. While this provided the required powers for taking
necessary actions on priority, especially at the central and state levels, there are
key areas of medical health which need to be tackled with special powers and
provisions for which a special Medical Emergency or Public Health Emergency
Management Act (PHEMA) is essentially required.
The NDMA 2005 was enacted after the 2004 tsunami; it was not designed to cater
to health emergencies. It does not specifically define public health emergencies
or epidemics. It focuses on managing several types of disasters, including natural
disasters (such as earthquakes, floods, and cyclones) and man-made disasters
(such as industrial accidents, chemical spills, and nuclear incidents). It provides
a comprehensive framework for disaster preparedness, response, mitigation, and
recovery at the national, state, and district levels.
The Epidemic Diseases Act (EDA) 1897 authorises the Central and State
governments to take measures and prescribe regulations to be observed by the
citizens to contain the spread of a disease. The law outlines a set of rudimentary
elements, including travel restrictions, examination and quarantine of persons
suspected of being infected in hospitals or temporary accommodations, and
statutory health inspections of any ship or vessel leaving or arriving at any port
of call. However, over the years, no standard or model rules and regulations have
been prescribed as a corollary to the law nor has it been amended.
The EDA 1897 does not define “dangerous”, “infectious”, or “contagious
diseases”, or “epidemic”. It contains no provisions for the processes required
for dissemination of drugs/vaccines, and the quarantine measures and other
preventive steps that need to be taken. Further, the EDA 1897 only confers powers
and does not describe the government’s duties in preventing and controlling the
epidemic, nor does it explicitly state the rights of the citizens during the event of
a significant disease outbreak.
The International Health Regulations (IHR) require States to undertake measures
during a PHE including communication of public health information to the WHO
and the regulation of travellers and vessels at ports of entry into the country that
national authorities can best address. A PHE also requires interstate coordination
and the regulation of the movement of people and goods, as was evident during
the COVID-19 pandemic which necessitates central intervention. Further, effective
PHE response also requires capacity building at the state, district and local levels.
The absence of modern, overarching legislation specifically targeted at PHEs has
meant that capacity and expertise for PHE preparedness and response needed
to be faster to develop at all levels.
A Public Health Emergency Management Act can address various aspects beyond
epidemic, including non-communicable diseases, disasters, and bioterrorism. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 30
It allows for a holistic approach to health management, covering prevention,
control, and disaster response. The Act would also create public health cadres at
national and state levels.
This special provision act would empower public health agencies to take urgent
action. A first responding lead agency responsible for implementing this Act
should be identified. This allows for immediate rapid response by all health
agencies, organisations, and departments with no time lag. This also allows
building a workforce which is always trained and in peacetime has full preparedness
to be the first responder on war outbreak.
Globally, such Acts exist. Countries such as the United Kingdom, Canada, and the
United States of America (USA) have in place more comprehensive and updated
legislation to deal with public health emergencies. The Public Health Service Act
is a United States federal law that was enacted in 1944. This Act provided a
legislative basis for public health services in the United States. The Pandemic
and All-Hazards Preparedness Reauthorization Act of 2013 was enacted March
13, 2013, as a law by the 113th United States Congress. The Act amends the Public
Health Service Act to extend, fund, and improve several programs designed to
prepare the United States and health professionals in the event of a pandemic,
epidemic, or biological, chemical, radiological, or nuclear accident or attack. The
Act clarifies the authority of different US officials, makes it easier to reassign
personnel to respond to emergency situations temporarily, and alters the process
for testing and producing medical countermeasures. The Act is focused on
improving preparedness for any public health emergency.
The Public Health Service Act established the federal government’s quarantine
authority for the first time. It gave the United States Public Health Service
responsibility for preventing the introduction, transmission and spread of
communicable diseases from foreign countries into the United States. The
Declaration of Public Health Emergency Management Act (PHEMA) with special provisions at
the centre and state levels will facilitate priority action for-
»Building the required expertise for PHE preparedness and response at national,
state and local government levels
»Repositioning of personnel for special tasks
»Regulation of travellers and vessels at ports of entry into the country
»Interstate coordination and the regulation of the movement of people and goods
»Communication of public health information, dealing with infodemic
»Accelerated development and regulatory approval of diagnostics, therapeutics
and vaccines
»Special Procurement provisions for necessary goods and services for emergency
response
»Coordination with international organisations and countries for a PHEIC
»Carrying out the government’s duties in preventing and controlling the epidemic Future Pandemic Preparedness and Emergency ResponseA Framework for Action 31
Public Health Service Act granted the original authority for scientists and special
consultants to be appointed “without regard to the civil-service laws”, known as
a Title 42 appointment.
6.1.3 Finance and Management
During COVID management, special financial packages were made available on an
emergency basis for all activities, from surveillance to research, testing, tracking,
treatment, health infrastructure, vaccination, etc. For effective preparedness and
response to any future outbreak, epidemic, pandemic or public health crisis, it is
essential that a special Pandemic Preparedness and Emergency Response Fund
is established. This fund should be specially earmarked for all activities being
proposed under the PPER Framework. The aim of the fund would be to be fully
prepared in advance so that we are ready to deliver in any emergency in a 100
days time frame. This fund should be deployed as per the requirement assessed
and approved by EGoS. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 32
6.2 Data Management, Early Predictive Warning and
Surveillance, Forecasting and Modelling
6.2.1 (a) Data Management (Generation/Sharing/ Analysis)
The COVID-19 pandemic threw up particularly important aspects for predicting
disease trajectory in affected areas, epidemiological monitoring of morbidity and
mortality, countermeasure development, clinical management, treatment, and
effectiveness monitoring. Mutations leading to variants of concern associated
with unpredictable transmission rates and severity even in exposed/infected
persons required harmonised, interoperable data collection, seamless flow of
data across different systems and most importantly, data analysis, for proper
interpretation to facilitate speedy decision-making. Hence, it is important that all
data portals must be integrated.
»Build a single unified data platform and integrate all data portals for data sharing
along with an advanced system for data analysis. At present, data availability
and sharing pose a challenge, specifically the seamless sharing of raw data,
which affects the analysis of data and the drawing of meaningful inferences.
»Utilise IHIP and IDSP data to design the outbreak module in case of a future
outbreak and further strengthening of IHIP and IDSP system.
»Work on further development in data collection, with its optimal management,
and archiving, systems in place for training, capacity building, and integration
with modelling systems after due analysis.
Generation of data on clinical, genomic, serological surveys, and immunological
surveys will help build predictable modelling systems, which thereby will provide
a defined strategy for intermittent lockdown and restricting the spread in a
contained and controlled manner. This is possible if existing data systems are
integrated and a Unified Data Management System is maintained. This can
then be supported by the setting up of an Analytical Cell at the National level to
extract the data from different sources and further interpret it effectively as per
requirement. Surveillance data on environment, sewage, hospitals, and community
to be integrated into the system along with the genomic and serological data.
6.2.1 (b) Data Communication
Data Communication is a critical component and needs to be conveyed in a
timely and correct manner:
i. An empowered Data Analysis and Reporting Unit to be established at
NCDC, which is headed by a senior level technically competent person who is
empowered to allow access and sharing of data and is responsible for timely
Data communication to the right agencies including public communication
ii. A manual of pre-approved delegated powers to be available to allow such
data communication, sharing and access. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 33
6.2.2 Surveillance
The country already has a strong surveillance network from centre to state to
district level. This massive system exists in the remotest areas. All components
of this system should be strengthened and connected to work in a harmonised,
auto pilot mode that gets ignited as soon as the first warning sign is received.
This surveillance system needs connection and close coordination between the
centre, state, and district with laboratories, hospitals and points of entry (airports,
ports and international border) surveillance systems.
In unknown pathogen-driven disease epidemics and pandemics, the key aspect
to be considered is the need for a robust surveillance network.
»Strengthen and connect all components of the existing surveillance system to
work in a harmonised, autopilot mode that gets ignited as soon as the first
warning sign is received with precursor for regular testing of the system
»Building a strong surveillance system including both public and private sectors
with a One Health approach including biosecurity and focus on surveillance at
border, ports of entry.
»Developing strong community surveillance (trend-data time) system; especially
in susceptible areas/hot spots, so that an alert can be generated when something
goes wrong.
»Strengthen real-time surveillance to include the rate of rise and severity of a
disease to understand the severity of the pandemic on the ground, incorporating
the use of Artificial Intelligence and new tools and technologies.
»Strengthening the Genome sequencing Network at the country level to
monitor the genetic variations in the pathogen and study the linkages between
the genomic variants and epidemiological trends. INSACOG needs to be
strengthened.
»Reinforce Wildlife/Animal sector surveillance, as it has been a weak link in the
surveillance
»Setting up a Regional Surveillance Network and further connecting it with
Genomic surveillance, specially to monitor the trans-boundary movement of
pathogens
Epidemiological surveillance should have Genomic surveillance as an integral
component on one end and hospital surveillance data on the other end. Key
actions required are:
I. Emergency Operations Center – Network (EOC-NET)
During various outbreaks and pandemics, Public Health Emergency Operations
Centres (PHEOCs) have played a key role in monitoring the ground level situations,
providing them necessary feedback through a roster of experts and ensuring
regular quality data flow. Apart from the Ministry of Health, EOCs are functioning
under various ministries, including NDMA and SDMA, up to the district level.
However, there is need to ensure that EOCs and PHEOCs are established to
cover all districts of the country and integrate for maximizing the use and output
through mutual sharing and convergence. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 34
The Emergency Operations Centre-Network (EOC-NET) will be a specialized
network infrastructure designed to enhance communication and coordination
within various Emergency Operations Centres (EOC) working in isolation for
specific hazards. EOCs serve as central command and control facilities during
crises like natural disasters or pandemics. The EOC-NET plays a crucial role in
facilitating real-time information exchange, collaboration, and decision-making
among various emergency response agencies and stakeholders. It incorporates
advanced communication technologies, data sharing platforms, and secure
channels to ensure seamless information flow and coordination within the EOC.
The effectiveness of the EOC-NET is vital for prompt and efficient emergency
responses, enabling responders to share critical data, assess situations, and
deploy resources strategically. This integration of technology underscores a
commitment to improving overall preparedness and resilience in the face of
unexpected events.
II. Focused attention on Bats:
Most viral pathogens in humans have animal origins and arise through cross-
species transmission. Over the past 50 years, several viruses, including Ebola
virus, Marburg virus, Nipah virus, Hendra virus, severe acute respiratory syndrome
coronavirus (SARS-CoV), Middle East respiratory coronavirus (MERS-CoV)
and SARS-CoV-2, have been linked to various bat species. Despite decades of
research on bats and the pathogens they carry, the fields of bat virus ecology and
molecular biology are still nascent, with many questions largely unexplored, thus
hindering our ability to anticipate and prepare for the next viral outbreak. More
than 200 viruses have been associated with bats and almost all are RNA viruses;
probably owing to their remarkable ability to adapt to changing environmental
conditions through a higher genetic variability. In fact, RNA viruses have higher
mutation rates compared to DNA viruses as the viral RNA polymerases lack
proofreading activity.
The natural reservoirs for Marburgvirus and Ebolavirus are both fruit and
insectivorous bats. Recently, two new subtypes evolutionarily distinct from all
others – H17N10 and H18N11 – were detected in different fruit bat species in Central
and South America. Further, Influenza A virus is an uncommon promiscuous virus
with a wide host range including humans, pigs, and birds.
The first hantavirus isolated from bats was the Hantaan virus, the etiological agent
of haemorrhagic fever with renal syndrome. Successively, although hantaviruses
were identified in other bat species, to date, no bat-to-human transmission of
hantaviruses has been observed. This pathogen has been identified as having the
risk of spreading to humans and having pandemic potential.
Hence, focusing on One Health approach for bat-human interface is imperative.
III. Setting up a Regional Consortium for Molecular Surveillance
As the world witnessed the global impact of the COVID-19 pandemic and the critical
role of surveillance, it is important to consider some effective preventive measures
and prepare ourselves to counter emerging infections in future efficiently. The
neighbouring countries are the most vulnerable when a communicable disease Future Pandemic Preparedness and Emergency ResponseA Framework for Action 35
spreads. Scientific intervention is one of the valuable tools which can curb the
disease burden between adjacent countries. Therefore, a well-established regional
collaboration platform for molecular surveillance of emerging and re-emerging
diseases will be advantageous since India has a long border shared with many
of the neighbouring nations, which enhances the chance of spreading infectious
diseases across the border. This transboundary movement of pathogens includes
zoonotic pathogens, and a One Health approach and should be adopted. The
countries which could be included in this regional consortium are those which
have similar concerns and would require stringent monitoring of transboundary
movement of pathogens.
The INSACOG network for Genomic surveillance of SARS CoV-2 is well established
today across the country, across states and in different departments. The network
is linked to epidemiological surveillance and clinical or hospital networks. This
provides a distinctive advantage of strong surveillance and an early warning
of any clinically important pathogen. A virtual network can be established by
considering the scientific bodies of the participating countries as well as several
veterinary research organisations for continuous surveillance of infections and
screening of emerging novel mutations among circulating strains.
Biology of the disease progression and transmission in the neighbouring countries
is important to take proper decisions on the future preventive measures and
health policies. The participating countries’ population density, hygiene habits
and public health policies are unique in each case. Hence, addressing the burden
of viral diseases with respect to these unique characteristics would be beneficial.
Confirmed decisions can be taken about international travel between the
countries.
This joint scientific venture between the participating countries will enable
the viral genomes of patients to be analysed quickly with the application of
standardised guidelines. Such a regional consortium can prepare the countries
for future pandemics which could quickly adopt preventive measures.
IV. Setting up of the National Biosafety & Biosecurity Network:
The current COVID-19 pandemic crisis has highlighted the need to develop a
“National Biosecurity and Biosafety Network” across the country. There is a
need to have a better surveillance system with advanced diagnostic facilities and
customary network facilities to tackle pathogens affecting humans, livestock,
and animals, including marine life as well as plants, integrating several areas of
activities to address issues on Biosecurity and Biosafety. It is essential to integrate
animal and human pathogens as a ’One Health’ issue, rather than to treat them
as separate entities in the manner that has been adopted thus far in the country.
An integrated approach would be needed to strengthen the nation on the
biosecurity and biosafety front, and various aspects of research and development
need to be developed, such as a) pathogen identification b) clinical profiling
c) disease epidemiology d) platform technology for vaccine development
e) drug development f) treatment strategies and e) disease surveillance etc.
Currently, no one organisation, institute or network, puts in concerted efforts Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 36
on these focused areas to manage viruses. Therefore, it is very important
to establish a new generation network,“National Biosecurity and Biosafety
Network”, for preparedness to tackle the future epidemic/pandemic. The most
critical component of the National Biosecurity and Biosafety Network would be
surveillance of known pathogens/diseases outbreak forecasting, and discovery of
unknown emerging pathogens and development technologies for responding to
their threat. This would need to be a network across all concerned Ministries and
agencies – NCDC, DBT, ICMR, DRDO, ICAR, etc. Such a network has been proposed
as a part of the One Health Mission and should be operationalised on priority.
The National Biosafety Biosecurity Network would have state-of-the-art
laboratory facilities dedicated to defending the nation against biological threats.
This network would support preparedness, planning and response and should
have a network of laboratories which include biocontainment facilities (BSL-2, 3 &
4), biorepositories with research capacities for characterisation of the biological
agents, which include bacterial, fungal & viral culture; PCR & Genomic sequencing
and access to high throughput infrastructure which allows generation of high-
quality data to address the challenges and guide policy and decision making.
The proposed National Biosafety and Biosecurity Network should focus on the following:
i. A network of at least 2-3 strategically funded research laboratories which have
the capacities and capabilities to prepare the country for future pandemics
would include
• A network of biosafety containment facilities BSL-2, BSL-3 & BSL-4
• Well-characterised biorepositories for viral and bacterial pathogens such
repositories should have well-characterised reference cultures for panel
threat pathogens and through a network of surveillance laboratories, they
should build the stock and maintain the pathogens which are likely to be
a threat hazardous. This would be for humans, animals and plants.
ii. Expansion and strengthening of BSL 4 facilities in the country, which are a
mandatory requirement for handling risk group 4 organisms. These facilities
should be well prepared and maintain viral strains of all major diseases which
have already caused epidemics/pandemics or are likely to be a cause of such
future crises.
iii. A network of BSL-3 facilities, that can handle pathogen and strains that can
be quickly used as reference sample. Mobile diagnostic laboratories (with
high containment) should be established under the BSL2/3 laboratories for
deployment in the event of an epidemic.
iv. Genome sequencing centres which are linked to these repositories
continuously access different viral strains which have been collected or
identified through surveillance studies and generate genomic sequences
from them. This is important to help us to initiate our research quickly with
speed without wasting any time as and when any epidemic situation arises.
v. Centres of Excellence in the country that continuously train human resource
on the latest technologies related to viral research.
vi. The network of research laboratories nationwide of the best scientific groups
across different agencies to be brought together and supported for research
on infectious and zoonotic diseases. Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 37
vii. At least 2 to 3 Centres of Excellence should be established, which would
study not just epidemiology but also related aspects regarding transmissions,
genetic structure, etc., and would play a significant role in the diagnostic
testing and disease management.
viii. Strengthening Centres of Diagnostic Development which can create platform
technologies that would help quickly develop new diagnostics in response
to any major disease outbreak. While such an immediate response was seen
in the case of COVID-19, but for other zoonotic diseases, the country is still
dependent on imported kits and reagents. An emergency vaccine bank
should be established for agents which are exotic to the country (stockpiling).
These vaccine banks can source its vaccines either from within or outside
the country. A network of diagnostic test labs to be continuously monitored
with trained human resources and infrastructure for conducting tests with
the ability to scale up when the need arises. The large network of laboratories
across agencies which have been brought together as validation and testing
centres for COVID 19 need be strengthened.
ix. The key to the success of the proposed National Network would be to hire
personnel with very high levels of training and competence and to offer
an ecosystem conducive to undertaking globally competitive research and
development activities. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 38
6.2.3. Forecasting & Modelling
Modelling during pandemics is helpful in the assessment of the course of the
epidemic/pandemic and the trajectory of cases, morbidity and mortality. These
are crucial for public health agencies in ensuring future preparedness regarding
provision of PPEs, quarantine and isolation beds, human resource, etc for making
policy decisions and implementing policy. However, for development of predictive
models, the relevant institutes depend on reliable multi-source data along with
epidemiological determinants like incubation period, reproductive number R
0
(the average number of secondary infections caused by an infected individual in
a fully susceptible population) and Rt (the current transmission dynamics during
an outbreak), secondary attack rate etc. for short-term forecasting on likelihood
of different trajectories in different areas and populations in the immediate future.
A key challenge during COVID was the lack of a strong Indian forecasting and
modelling network, availability of reliable data on cases, testing, demographics
and inconsistent reporting. Further, amid ever-evolving uncertainty faced during
the pandemic. The models should also account for uncertainties in transmission
rates, incubation periods, and other factors particularly with variants that have
different public health impacts.
It is proposed to build a strong scientific framework for Epidemiology Forecasting
and Modelling to develop prediction models based on reliable Indian data at par
with global standards. This will also allow the creation of mathematical models
for predicting transmission dynamics of infectious diseases and monitoring the
effectiveness of countermeasures, including vaccination, in different scenarios
driven by variants.
It is recommended to create a Network of Centres for mathematical modelling,
with a partnership between academicians, the private sector, the public sector,
hospitals, etc. We need to build capacities and have trained human resources
with different skill sets.
Developing an Early Warning and Predictive Modelling for epidemic and pandemic trend
»Build a strong Epidemiology Forecasting and Modelling Network of Centres of
Excellence to develop prediction models based on Indian epidemiological data
and make these models at par with global standards
»The use of AI and other emerging technologies would be critical for such
modelling efforts
»The data from surveillance systems - community, laboratory, clinical, hospital,
genomic, sewage etc. is a critical source for such modelling efforts
»DST may launch this Epidemiological Forecasting and Modelling Network in a
mission mode for early prediction.
»The ICMR National Institute for Research in Digital Health and Data Science can
be a nodal institute; however, the network should involve competent groups in
IITs, research institutes both public and private, supported financially by DST,
O/o PSA, Dept. of Education and philanthropic and private funds.
»Create Centres of Mathematical Modelling to build capacities in new technologies
and Human Resource Future Pandemic Preparedness and Emergency ResponseA Framework for Action 39
6.3 Research and Innovation, Manufacturing, Infrastructure,
Capacity building/Skilling
6.3.1 Research & Innovation
Infectious, emerging and re-emerging zoonotic epidemics are a significant threat
to public health. Coronaviruses are a group of related viruses that are mainly
considered to cause diseases in mammals, birds and humans. During the last
two decades, it has spilt over three times by zoonotic pathways with genetic
modification and emerged as Severe Acute Respiratory Syndrome Coronavirus 1
(SARS-CoV-1), Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). SARS-CoV-2
is highly pathogenic, and human-to-human spread makes it more virulent.
COVID demonstrates that research and innovation have played a leading role
in our fight against the pandemic. Our risk-taking ability allowed new platform
technologies for vaccines and a range of diagnostics to be developed indigenously.
High-risk funding through Mission COVID Suraksha gave us the desired results
and was critical in building the levels of research competence in both the public
and private sectors. It is imperative that this is promoted, and a strong Research
and Innovation ecosystem is built.
The robust ecosystem that existed before COVID for research and innovation,
especially in the healthcare sector, was a strong foundation on which the COVID
countermeasure development activities were scaled. From basic research
capacities to shared infrastructure for translational research, all these were critical
value chain components for affordable product development. During COVID, the
scientists successfully developed several new platform technologies and a strong
portfolio of candidate vaccines - mRNA, DNA, Nasal vaccine etc.
A need-based strengthening of the ecosystem was done. However, there were
challenges faced, and there is a need to plug the gaps. The key challenge was
the need for established protocols and SoPs for sharing biological and clinical
samples and the need for more centres for characterization of viruses. When the
Chinese and US research groups released the first gene sequence of the Virus,
they started immediate action for developing the countermeasures. Candidate
vaccine libraries were quickly worked upon, and the development of vaccines
on different platform technologies was pushed on an accelerated scale. Access
to the characterised virus strain and assay panels allowed quick development of
diagnostics which were needed essentially in large numbers to track the disease.
While the country had the competencies to take up these tasks, time was lost in
building the processes for them. The first characterised virus strain was available
only with NIV, ICMR in April, and that was made available to Bharat Biotech, who
then developed Covaxin in partnership with ICMR.
The Empowered Group for Emergency Management Chaired by Dr Vinod Paul,
Member NITI Aayog, issued guidelines for sharing of biological and clinical data,
and also sample sharing and managing of biorepositories for access to these
clinical samples. Subsequently, the notified biorepositories played an important
role in making available the assays required for developing diagnostic kits. Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 40
The other key challenge in developing diagnostic kits was the dependency on
imported reagents and enzymes. Mechanisms such as the DBT-led NBRIC and
the cCAMP and AMTZ centres brought together different industries and startups,
who provided the required reagents, enzymes, etc. This enabled a speedy
indigenous manufacture of large quantities of diagnostic kits.
These capacities, tools, and instruments to enable priority action should now
implemented so that during any emergency, action begins on day one. It
is, therefore, essential to establish mechanisms for supporting research &
development of innovative countermeasures on a continuous basis. Some specific
actions are
i. There is an urgent need to allocate the High-Risk Innovation Research and
Development Fund from the special fund for pandemic preparedness and
emergency response for:
• supporting Research & Development for diagnostics, therapeutics and
vaccines,
• capacity building both Human Resources and Infrastructure
• cutting-edge technology development
ii. Fund to be earmarked and positioned with Department of Expenditure; to
be released to concerned Ministries/Departments on the recommendation
of EGoS
iii. Financial support for basic, applied and translational research across the
value chain for continuous development of:
• new prototype vaccine candidates and vaccine libraries for the priority
pathogens
• platform technologies
• New drug molecules for priority infectious diseases and antibiotics for
tackling the issue of AMR
• New highly specific and sensitive diagnostics for each identified pathogen
iv. Supporting and encouraging the industry and startup ecosystem to be part
of this high-risk innovation research
v. Set up a Network of Centres of Excellence (CoE) for research on priority
pathogens. Research efforts to focus on priority pathogens in the priority list
released by WHO.
vi. New emerging pathogens identified through One Health, national surveillance
or recombinant research efforts to be studied, characterized and maintained
in designated repositories
vii. Develop diagnostics, therapeutics and vaccines for an identified prototype
pathogen from the priority pathogen family
viii. Centres that have access to Bio Safety Level (BSL) 3, BSL 4 laboratories and
biorepositories to be part of the National Biosecurity Network
ix. ICMR, DBT, CSIR, NCDC to be part of the CoEs Future Pandemic Preparedness and Emergency ResponseA Framework for Action 41
»Establish a special High-Risk Innovation Research and Development Fund for
Pandemic preparedness and Emergency response
»Establish a Vaccine Science & Development Institute
»Launch National Mission on Therapeutics and novel drug development
»Development of novel diagnostics (such as molecular diagnostics)
»Development of vaccines, antimicrobials, and monoclonal antibodies in a PPP mode
»Set up a Network of Centres of Excellence (CoE) for research on priority
pathogens
Development of Countermeasures
Diagnostics
When COVID struck the world, the first challenge was the development of testing
capacity. Testing was important for tracking the disease and finding treatment
solutions. A large number of sensitive and specific diagnostic kits were needed.
There were urgent demands on the few global manufacturers who had developed
the diagnostics with high specificity and sensitivity. There was massive pressure on
supply chains because of increasing global demands. Countries were accelerating
their indigenous development. In India, there exists a strong medical diagnostics
start-up ecosystem and industry. These were given the responsibility, along with a
number of academic laboratories, to develop indigenous diagnostic kits.
The work started in a mission mode; however, faced huge challenges. While kits were
developed indigenously, India was entirely dependent on the import of reagents
and enzymes. The other challenge was the validation of new diagnostics, for which
notified validation centres were required. It was also essential that the necessary
assay panels were made available, which required the availability of clinical samples,
access to virus culture and biorepositories were needed. These challenges were
overcome, and within three months, India built the required competencies and
started manufacturing kits in the desired numbers.
It is now recommended that this ecosystem should be further strengthened.
The focus should be on the development of novel diagnostics (such as molecular
diagnostics) for the identification of emerging infections from new pathogens.
»Case study – Disease “X “outbreak – Diagnostic kit Development, validation and
Access for Distribution in Market.
In the event of a Disease outbreak, the immediate development and deployment of
a diagnostic kit for public diagnosis and subsequent treatment is crucial to prevent
the rapid spread of the disease. This process involves three major activities as follows:
a) Diagnostic Kit development: Value chain of Raw materials
Diagnostic kits come in two types: Immuno Diagnostic tests and Clinical
Chemistry & Molecular Biology tests. Immuno Diagnostic tests (Platforms:
Lateral Flow Assay (LFA) kits, Enzyme-linked Immunosorbent Assay (ELISA),
Chemiluminescence Immunoassay (CLIA), Radioimmunoassay (RIA)) and
Clinical Chemistry & Molecular tests (Technologies: Biochemistry/Clinical
Chemistry, Microbiology, Serology tests, Polymerase Chain Reaction (PCR)). Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 42
Most raw materials for these tests, such as Chemicals, Reagents, Enzymes,
Primers, Probes etc. are locally available. Specialised items like nanoparticles,
radioisotopes, antigens, antibodies etc. might be needed., supply chains for
these should be built.
Timeline: Common raw materials have a lead time of 1-2 weeks (Local availability).
Specialised materials that are imported take 1-2 months to deliver. Therefore,
all dependency on imported material should be removed, and indigenous
manufacture and supply chains developed.
b) Testing & Validation: Laboratory infrastructure for testing and reference
samples.
The final stage of diagnostic kit development is testing, which includes internal
and external validation.
i. Internal Validation: Reference samples or controls can be sourced from
authorized bodies (e.g., AIIMS, NIV, ICMR Centres) for internal performance
evaluation (Specificity and Sensitivity).
ii. External Validation: Kit are sent to accredited labs (e.g., ICMR, CDSCO, NIB,
NIV) for validation. These labs test the kits using available reference samples
and provide results to the manufacturer.
iii. Regulatory Approval: The above results are submitted to CDSCO to obtain a
license for manufacturing and sale.
Timeline: The testing, validation, and regulatory licensing process takes more
than 2- 3 months. It is crucial that we build a robust system for validation and have
approved protocols and processes in place to ensure the accuracy and reliability
of the diagnostic kits. In emergencies, CDSCO may audit the manufacturing
facility and expedite licensing based on test reports on conditional basis, with
full performance reports to be submitted once the outbreak is under control.
c) Distribution/ Deployment in the market: Access, Distribution, Logistics.
The next step for the licensed kit is distribution to testing centres and healthcare
outlets (e.g., pharmacies etc.). Key logistics considerations include:
i. Quantity and Type: Based on the outbreak’s nature (endemic, pandemic,
epidemic), scale, and location.
ii. Central Warehouses: These Facilities have temperature control and use
inventory management systems to track stock levels, expiration dates, and
distribution, reducing logistics time.
iii. Transportation: Plan for transporting kits from central storage to local
distribution points, ensuring temperature control with systems like cold
storage if necessary.
iv. Distribution Strategy: Kits are distributed based on outbreak severity and
population density in coordination with local health departments.
Timeline: This varies depending on the outbreak location and the source of
kit manufacturing or central warehouses. The plan of action and SOPs for this
should be in place and notified.
An immediate Mission is to be started for developing the kits for the identified
priority pathogens. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 43
Drugs and Therapeutics
A focused National Mission on Therapeutics and novel drug development should
be launched. The Council of Scientific and Industrial Research (CSIR) could lead
with the National Institute of Pharmaceutical Education and Research (NIPER) and
other laboratories in PPP model with Industry.
During COVID, the country faced a situation where, while several therapies
and drugs were available for treatment, the required drugs were not available
as repurposed, or new drug development for specific disease targets is still in a
nascent stage. Over the years, while capacities have been built for infrastructure,
international partnerships etc., what needs to be added is a coordinated effort to
take initial discovery research leads/hits to product development through the value
chain right up to manufacture and licensure/market authorisation involving various
stakeholders. This effort can now be given the required momentum by bringing
together the public and private sectors, researchers, manufacturers etc. to meet a
targeted goal of developing drugs for priority pathogens A Mission on Therapeutics
for priority pathogens needs to be launched urgently.
Drug discovery efforts can be undertaken against viruses of pandemic potential
for which two key major approaches can be deployed for the identifying of direct
antiviral drugs in the event of a pandemic: 1) Repurposing of approved drugs
and 2) Identification of novel compounds. Each approach has its advantages and
disadvantages. Whichever approach one chooses, compounds must be characterized
and taken up to Phase 1 clinical trials to establish the safety of compounds. This way,
compounds are primed and ready for a Phase 2 study should the need arise. In the
event of a pandemic, a limited Phase 2 in patients should be planned and discussed
with the Regulator to establish the efficacious dose range and safety considerations.
1) Repurposing of approved drugs (Figure 1): Over 19,000 FDA-approved drugs
have a full clinical package and dosing information. If repurposed for a different
indication, this group of compounds does not have to go through Phase 1 studies
unless the doses predicted for human use fall outside the approved range.
The approved drug library should be purchased and screened against a panel of
viruses in whole-cell screening assays. Criteria for hit selection should be defined.
Such compounds should be evaluated for pharmacokinetics by the oral and
intravenous route in the efficacy species and then tested in vivo in the appropriate
model. The ED50 should be determined, as well as a PK-PD correlation. If PK data
are available for a higher species, allometric scaling should be utilised to determine
the therapeutic dose in humans. No further toxicity testing would be needed if this
falls within the approved dose range. If the dose is predicted to be higher than the
approved dose range, the regulator may require Tox studies in rodent and non-
rodent species, as well as a Phase 1 study. A discussion with the regulator would be
needed at this stage to decide on the clinical development and regulatory strategy.
2) Identification of novel compounds (Figure 2): There are two options. The first
would be to screen a library of compounds for activity against a panel of viruses. Such
compounds should be evaluated for in vitro ADME, followed by pharmacokinetic
studies. Compounds with PK profiles suitable for oral dosing should be tested for
toxicity in the in vivo models and in rodent and non-rodent species for toxicity, Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 44
following all requirements for NCE development as per NDCT 2019 rules. Studies
should be undertaken to understand the mechanism of action.
The second approach would be to conduct an in-silico screen against specific
viral targets, such as RNA polymerase, helicase, etc., selecting compounds that
show affinity for essential viral proteins for more than one class of viruses. Such
compounds should be tested for antiviral activity and target-specific activity.
Medicinal chemistry and structure guided/AI guided drug design should be used to
optimize the compounds. As with the other approaches, pharmacokinetic profiles,
efficacy in vivo and toxicity studies should be undertaken for the best compounds.
Toxicity studies should be undertaken as per NDCT 2019 rules.
For this, capacities need to be built for the following:
• Antibody Library: Develop and maintain a naïve human antibody library that can
be quickly screened to produce antiviral antibodies.
Figure 1: Repurposing of approved drugs
Antiviral Activity
IC
50
< 1 u MYes
Dose Selection
Cytotoxicity
Compounds ready for Phase 2
FDA Approved Drugs
Selectivity>10No
ED50 determination
Pharmacokinetics
Efficacy
Toxicity (only if needed)
• Library of Compounds: Maintain a library of antiviral and antimicrobial compounds
that can be rapidly screened against new pathogens.
• Animal Models and Simulations: Develop and validate animal models and
computer simulations for testing drug efficacy and safety.
• Robust AI-based Platforms: Develop in silico methods to quickly predict the
protein structure that could be used to design drug molecules and vaccine
candidates. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 45
Figure 2: Identification of novel compounds
In silicoDocking
Target based Activity
Cytotoxicity
Pharmacokinetics
Efficacy
Toxicity
(Rodent & Non-Rodent)
Phase 1 candidate
Antiviral Activity
Med Chem and
SGDD/Al
Med Chem
Mechanism of
action
Antiviral Activity
1C
50
<10uM
1C
50
<10uM
1C
50
<10uM
Selectivity> 10
PK suitable for i.v./oral administration
10X safety window
Compound Library Screening
A PPP model involving public and private organisations would be important.
Companies with experience in antivirals/drug discovery should be involved.
Manufacturers of drugs that are being repurposed should be encouraged to
participate. Where Intellectual Property (IP) may not allow compounds to be
repurposed, discussions with manufacturers should be initiated early.
Vaccines
During COVID, one of our major success stories was the development of a portfolio
of vaccines on different platform technologies. India built partnerships with the
private sector, provided necessary shared infrastructure for discovery, research
and candidate development, immunoassay labs were set up which were of global
standards and recognised as a part of the CEPI global network for vaccine trials.
Animal challenge facilities, clinical trial network were the other key components
which facilitated the development and manufacture of the world’s first DNA Vaccine,
mRNA vaccine, nasal vaccine, and others on different platforms.
This was possible because of the high-risk innovation funding made available and
creation of an ecosystem for vaccine development, validation and manufacture.
Using these facilities and competencies to establish platform technologies (e.g.,
mRNA, viral vectors, protein expression systems) that can be quickly adapted to
new pathogens is important.
Establish an Innovation and Vaccine Science & Development Institute:
• Conduct active research on vaccine development, including basic and
translational research and development of innovative technology platforms, Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 46
candidate vaccine libraries
• To set up the institute with the lead by DBT and collaborative partnership with
other Institutes of ICMR, DST, CSIR, etc. Existing institutes such as THSTI, NII
and others like NIV, CCMB, etc, and facilities created during Covid such as
immunoassay labs, animal facilities, clinical trial network sites, etc., can be part
of the network
• The One Health Mission/Centre approach to be adopted for operational
management and governance with the involvement and participation of all
concerned Agencies/Ministries
• Support public-private partnerships and involve all stakeholders, including Start-
ups
• Focus on both Human and Animal Health for research and manufacture of
prototype vaccines, new platforms and candidate vaccines
• Include scientific ways for new adjuvant development and all integral components
for scale up and manufacture of vaccines
Biological threats may encompass outbreaks of infectious diseases, pandemics,
accidental release of pathogens from the laboratory and also deliberate release
pathogens to create public health threats.
India is a signatory to the Biological Weapon Convention. As per the Ministry of
External Affairs Gazette notification dated 18th June 2016 under section 26 of the
Weapons of Mass Destruction and their Delivery System (Prohibition of Unlawful
Activities) Act 2005 (21 of 2005), appointment of Advisory Committees has been
notified. The advisory committee on biological weapons and related items is being
chaired by the Department of Biotechnology.
In India, The Weapons of Mass Destruction and their Delivery Systems (Prohibition
of Unlawful Activities) Act, 2005 prohibits unlawful activities, concerning weapons
of mass destruction and their delivery systems and for matters connected therewith
or incidental thereto. As per the provisions of the Act- “No person shall unlawfully
manufacture, acquire, possess, develop or transport a biological or chemical weapon
or their means of delivery”.
There is a need to strengthen the preparedness aspects for dealing with biological
disasters and unforeseen events in view of biowarfares. The Biological Weapons
are not necessarily the new and emerging pathogens. As per WHO, Biological
agents like anthrax, botulinum toxin, and plague can pose a difficult public health
challenge, causing large numbers of deaths in a short amount of time. Biological
agents capable of secondary transmission can lead to epidemics.
It is proposed that the following may also be considered for Pandemic Preparedness
and Emergency Response:
• To support research, development, and innovation in sensor-based detections of
biowarfare agents, including toxins
• R & D support for development of newer decontamination strategies and PPEs
• Development of Prophylaxis: R & D support to develop newer vaccine platforms
• Development of therapeutics: R & D support to develop broad-based antibiotics.
Development of antivirals, particularly for diseases like smallpox. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 47
• Some toxins are classified as potential biowarfare- R&D support to develop
anti-toxin drugs
6.3.2 Regulatory Reforms
Regulation plays a vital role in developing new innovative products and making
them available and accessible to the public, not only in the country but across
borders. During COVID, a rapid response regulatory framework was developed,
which facilitated the approval and authorisation of a number of products –
vaccines and diagnostics, which were crucial for the COVID management strategy.
There were challenges faced in getting accelerated approvals and in the global
harmonisation of regulatory protocols. Accessibility of innovative products could
have been speeded up if we had a well-developed clinical trial network accepted
by international regulatory authorities. Acceptance of regulatory data across
National regulatory authorities also needed to be included.
»A well-harmonised regulatory system to be developed with other globally
recognised regulators for mutual acceptance of regulatory data
»Accelerated approval pathways and protocols to be prepared and pre-approved
»Subject Expert Committees (SECs) should be strengthened with technical
competence in different fields with a training program for experts
»A strong Clinical Trial network and adaptive Clinical Trial methodology should
be developed to expedite the development of drugs/devices/diagnostics. Also,
the Licensing of Products/Technologies process should be simplified/expedited.
»Inclusion/recognition of a few well-equipped district hospitals and the AIIMSs
and INIs in the Clinical Trail Network.
»The existing Central Drugs Standard Control Organisation (CDSCO) to be made
an Independent Regulatory Authority, with the Chief Regulator technically
proficient and having special powers of making Rapid Regulatory Approvals.
The Chief regulator is to be directly reporting to the Minister of Health and in
the rank of Secretary to the Govt of India
It is therefore essential that to prepare for future pandemics and respond urgently
to emergencies there are major initiatives which need to be taken:
i. A robust Clinical Trial system for conducting systematic clinical trials, with the
inclusion/recognition of a few well-equipped district hospitals, in addition to
the AIIMSs and INIs should be developed. A good example is the participation
of District Hospitals in the Plasma trial for COVID.
ii. Ear-marked clinical trial teams, with the required expertise to carry out robust
clinical trials from appropriate organizations (such as the ICMR Clinical Trial
Unit and AIIMS System) need to be identified for launching necessary trials
on short notice. Further, this should not be mixed with regulatory trials.
6.3.3 Capacity and competency building in Mission Mode
Presently, there is a need for competent human resources in IDSP units, RRTs,
One Health surveillance and response, an all-hazard approach in CBRN, IHR, Future Pandemic Preparedness and Emergency ResponseA Framework for Action 48
and laboratory techniques and IT infrastructure like PHEOCs to carry out
epidemiological analytics at various levels. There is also need for:
i. Capacity building of scientific professionals and bringing in international
experts for collaboration in research areas.
ii. Establishing infrastructure and techniques for high-quality Next Generation
Sequencing (NGS)
iii. Harnessing new-age technologies such as AI and GIS (Geographic Information
System)
iv. Competencies to handle all biological threat agents and putting in place a
bio-security network proposed through the National Security Council (NSC)
connecting all BSL3 and BSL4.
Proposed mechanism:
i. Assessment of training needs regarding competencies of various HR involved
in pandemic preparedness.
ii. Documenting the number of HR people to be trained and the available
training courses for building competencies.
iii. Identify gaps and areas for strengthening.
iv. Develop a roadmap for ensuring appropriate training of relevant HR from
district to apex level in mission mode during the next 1 to 2 years.
v. Collaborate with private public health institutes, international bodies, and
other partner agencies that have the required competent technical and
financial resources to partner with NCDC in specific areas.
vi. MoHFW & NCDC may prepare a roadmap for specific nation-wide programs to
be taken up in mission mode for technical competencies like IDSP surveillance
and response, IHIP data portal, epidemiological intelligence, and one health
approach for multi-disciplinary data analytics.
Challenges:
»Surveillance capacities for data capture and analytics at all levels (740 districts
and 35 states/UTs) and provision of surge capacity.
»Community, laboratory and health facilities including tertiary hospitals
»Public and Private sector
»Trainings for Rapid response teams: Field Epidemiology Training Program (FETP),
Epidemic Intelligence Service (EIS), Sector connect, Public Health Emergency
and Disaster Management (PHEDM)
»Advanced competencies: data analytics using AI, Laboratory capacities (NGS)
and data integration (One Health)
»Public health response support for CBRN
»Mission mode: Development of a roadmap Involving all government, international
and partner NGOs (which are currently providing support) for ensuring country-
wide training in a maximum of one year.
»Identification of core mentors from NCDC, ICMR, NIDM, WHO, CDC and other
NGOs etc. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 49
6.3.4 Resilient Supply Chains
Developing capacities for indigenous manufacturing of consumables/equipment
such as swabs, masks, PPEs, sanitisers, oxygen cylinders, ventilators, etc, by
identification and attaining self-sufficiency of critical components (such as zeolite
for oxygen concentrators) is especially important for the pandemic-scenarios
when international supply chains are constrained. Further, ensuring access to
essential supplies such as filter adjuvants, and mapping the supply of critical
items to have an uninterrupted strong supply chain and be resilient for future
pandemic should be ensured.
»Institutionalisation of supply chain systems: Proper forward and backward
linkages to be established for ensuring robust supply chains of all essential
components and ingredients for development of countermeasures.
»Develop capacities for indigenous manufacturing of consumables/equipment
such as swabs, masks, PPEs, sanitisers, oxygen cylinders, ventilators, etc., for
new pathogens
»Develop capacities for components for indigenous development and manufacture
of diagnostics and vaccines –such as reagents, adjuvants, VVMs, etc.
It is important to have parallel systems in place for meeting supply-
chain constraints, such as an alternative source of oxygen supply
through the steel industry, during the COVID-19 Pandemic.
The requirements of different pandemics may be different. Each case scenario
must be kept in mind while planning the supply chain. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 50
6.4 Partnership: Community engagement including risk
communication, Private sector partnerships and
international collaborations
6.4.1 Community involvement and Engagement with Private Sector
Risk assessment and community engagement are the pre-requisite for effective
planning of surveillance and control strategies during outbreaks, emergencies
and pandemics. WHO also underlines the importance of Swift Assessment
(within 24-72 hours) of a public health event or outbreak report as an essential
element for an early response and containment. However, rapid assessment
needs to be followed with a Comprehensive Assessment to enhance in-depth
understanding of the situation, risk characterisation and plan subsequent
interventions for affected and at-risk community. During COVID-19 pandemic,
it has been well appreciated that community involvement plays a key role in
public health measures like surveillance and response for effective mitigation
and for non-pharmaceutical measures like the creation of containment zones
and lockdown for preventing the spread of infection in new areas. Further, as the
pandemic progressed, the need for home quarantine, home isolation and timely
referral gradually scaled up community involvement with the whole of society
approach. Thus, it is crucial to engage with communities transparently with
current/available scientific knowledge and evidence to empower communities for
public health efforts during pandemics. During the early phase of pandemic, the
non-scientific information/rumours on virus contamination of articles, survival of
the virus on various surfaces and possibilities of routes of transmission required
active community involvement to spread awareness about scientific facts,
government strategies and knowledge about measures for disinfection, effective
personal protective gears and treatment therapies to alley panic and build public
confidence in government efforts.
The Ministry of Health proactively established a control room first at NCDC,
followed by control rooms in the Ministry of Health and health departments
in States for providing updated information on disease agents, spread and
available protective measures. As the pandemic spread to newer areas at an
alarming pace, measures like closure of schools, cinemas, social gatherings
were aggressively applied to reduce transmission through person-to-person
contact. The widespread use of non-scientific measures created fear psychology,
disrupting social and workplace fabrics.
However, there is a need for the establishment of defined structures for community
involvement, SOPs and specific competency-based HR for Risk Communication
and Community Engagement (RCCE) and actively engaging with communities
for timely management of infodemic and rumours. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 51
»Develop strategies and guidelines for working with communities especially at
the local level for managing PHEs especially for:
• implement public health and social measures for disease prevention,
• restricting movement of people and goods,
• information dissemination, managing infodemics, etc.
»Linkage with health NGOs and CSOs for last-mile connectivity
»Models for engaging with the private health sector for disease management
and especially for ensuring surge capacities in the Indian context should be
developed. For example, learnings from States: Maharashtra- engaged the
private sector to ensure the availability of hospital beds for COVID-19 patients
Private sector involvement:
In India, the private sector caters to nearly 60% of the population, and primarily
provides clinical management and laboratory services. The IDSP data on IHIP, which
is mainly from the public sector needs to be complemented with private sector data
from laboratories and hospitals particularly on epidemic-prone diseases, to assist in
monitoring the outbreak trends and distribution. Further, the private sector also plays
a crucial role in providing early warning signals for outbreaks and distribution (time,
place, person) of increased transmission. Clinicians and labs in private sector often
provide initial signals even in unusual diseases like H3N2, Nipah virus, Zika, Kyasanur
Forest Disease (KFD) etc. The different phases of COVID-19 pandemic involving
the private sector complemented government efforts, particularly the surge in the
need for testing of samples from suspects, quarantine & isolation beds in hospitals
and supporting genome sequencing. Hence, it is important to develop a dynamic
repository of labs and health facilities at all levels (district, state and centre) with
details of testing competencies and beds with available human resources in health
facilities are maintained. Additionally, the SOPs/MoUs needed along with clarity on
supplies and costing for tests and relevant authorities can also fine-tune health care.
The role of private sector and NGOs can be broadly grouped into 3 phases:
1. Pre-pandemic or inter-pandemic phase:
a) Surveillance: Providing data on outbreak-prone diseases and other events
of public health significance related to IHIP.
b) Firming up institutional arrangements for involving testing laboratories,
hospitals and doctors for clinical care (quarantine, isolation and intensive
care services) during pandemic times.
2. Pandemic phase:
a) During pandemic surges/waves, private sector labs and hospitals should
be involved. When the system is overburdened, labs are needed for timely
testing and sequencing. The community should be supported in tests for
confirmation and tracking of infection, severity markers, antibody estimation,
and advanced tests like genome sequencing.
b) Providing Hospital data on Outpatient Department (OPD) and Inpatient
Department (IPD) cases, morbidity, severity and mortality data. Data on
clinical therapies, drug efficacy and side effects. Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 52
c) Private sector research centres can coordinate with public sector laboratories
of DBT, ICMR, and CSIR for the development of primers, probes, and low-
cost tests (like Rapid Antigen Test (RAT), Point- of-Care (POC) tests
etc.) including advanced procedures like vaccine development, sewage
sequencing.
d) Private sector laboratories’ involvement in modelling and developing
predictive indicators, epidemiological surveillance, genome sequencing,
and sewage surveillance is also important.
e) Private sector plays a very important role in community awareness and IEC.
f) Partnership between the public and private sector is a critical factor for the
development of drugs and therapeutics, vaccine candidates and platform
technologies and to support the development of appropriate PPEs and
other protective equipment.
3. Post Pandemic phase:
a) Monitoring mutations, variants and hospital data (like re-infection by variants
and cases among vaccinated persons).
b) Providing information on unusual presentations (loss of smell or taste,
symptoms of gastric upset, long-term impact (long covid, side-effects of
steroids etc.) Future Pandemic Preparedness and Emergency ResponseA Framework for Action 53
6.4.2 Communication
Regular clear communication of policies, plans, and implementation strategies from
government authorities to HCW at all levels (national, state and district) and to the
community is essential for building trust among people and implementing mitigation
and management strategies. Effective communication to HCWs (those engaged in
surveillance, sample collection and providing clinical care) is also required to focus
on the importance of several types of data (epidemiological, laboratory and hospital)
and ensure regular data uploading for enabling data analytics. Such a communication
plan is central to pandemic preparedness. Also, capacities have to be developed in
the scientific community for communicating clearly and succinctly with the media
and general public. Further, communication must be in both directions - grass-root
to top level and vice versa.
»A special Risk Communication Unit to be established at NCDC, Ministry of
Health, with a Senior officer as the Head who has the responsibility of releasing
communication updates for all sections of organisations, including communities
and public
»Strategic Communication Plan for building trust among people and implementing
mitigation and management strategies essential for managing a PHE
»Build capacities in the scientific community for communicating clearly and
succinctly with the media and public
»Develop strategies and capacities for infodemic management (behavioural
science expertise within NCDC, health ministry)
»Partnering with UNICEF and other social science institutes on developing a
robust communication framework for pandemic threats
Communication requires specific competencies and coordination between
technical experts (public health, microbiologists, and clinicians), IT, social media,
and communication for development of appropriate data formats, Information
Education Communication (IEC) material, and monitoring tools. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 54
6.4.3 Collaborations and Partnerships
Partnership and collaboration were the key to scientific success. Collaborations
were seen between different agencies such as:
i. Academia and Industry
ii. Centre and state
iii. Central Departments and Ministries
iv. National and International research institutes, organisations and agencies
However, it was noted that it was the existing partnerships which worked well and
were taken forward. New partnerships took a long time to fructify. It is therefore
imperative to put in place pre-agreed protocols and MoUs for data, knowledge
sharing, technology transfer and licensing, intellectual property right management
etc. which will be important during any public health emergency.
»Put in place Pre-agreed MoUs, protocols, agreements and other instruments for
data, sample, knowledge sharing and collaborative funding
»Institutionalize collaborative learning during peacetime while preparing for the
future
»Establish collaborations between institutes such as the ICMR and NCDC to bring
efficiencies for reducing delays and costs for testing novel pathogens.
»International partnerships and networks to be aggressively developed for
information sharing and technology transfer; cultivate South-South co-operative
partnerships while focusing on self-sufficiency.
»Collaborate with WHO (WR, India and SEARO) CDC (CDC, India and US – CDC)
and partner agencies.
India has been globally recognised for its strength in biotechnology and biomedical
research, and there are important bilateral, multilateral, and agency-specific
collaborations which can be strengthened to develop robust systems for pandemic
preparedness and response. Partnerships and continuous dialogue with WHO and
other globally recognised national regulators are important to be prepared for
global regulatory approvals of countermeasures developed. Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 55
7. Continuous Monitoring of progress to assess action taken
To ensure that the Action Plan is being implemented as per the targets that are laid
out in the framework, it is essential to have a proper system to monitor the progress
of each step during the preparedness to be able to deliver in any emergency. It is
therefore essential to:
i. Establish a continuous monitoring mechanism. For this, the EGoS for Pandemic
Preparedness and Emergency Response to set up a Working Group for
Monitoring Progress regularly, preferably quarterly
ii. Develop a Scorecard system with well-defined priority targets; the data should
be collected and fed into an online portal
iii. Regularly track defined parameters, including the research pipeline, human
resource and funding systems
iv. Surveillance systems to be activated for any ongoing disease outbreaks in pilot/
sentinel sites
v. Participate in WHO peer review Joint External Evaluation (JEE)/ Universal Health
& Preparedness Review (UHPR) system to check capacities and competencies
A well-developed scorecard is needed for continuous monitoring. The scorecard
should have a very elaborate set of parameters that can be regularly assessed. An
indicative list can be -
i. R&D ecosystem readiness
ii. Funding for diagnostics, therapeutics and vaccines
iii. Research on the WHO List of priority pathogens
iv. Capacities for surveillance, forecasting and modelling, AI and new technologies,
clinical trials
v. Unified Data portal and data-analysis unit
vi. Forecasting and modelling simulation exercises
vii. Rapid response SOPs for data and sample sharing, data communication,
accelerated regulatory approvals
viii. Pre-agreed MoUs for international cooperation and partnership, including
technology transfer and licensing.
We do not need to wait for an outbreak to test this framework. The system can be
tested on three or four priority pathogens already a threat in our country -Nipah,
Zika, Monkey pox, H5N1 to begin with. Cultures of these pathogens have been
isolated and are deposited at the ICMR -NIV; this could be a starting point. The
preparatory phase should take 3-6 months, and then the entire system should be
set in motion. Each step should be monitored to ensure that the system is ready to
deliver in 100 days. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 56
PREPAREDNESSACTION
OUTCOME
/IMPACT
PATHOGEN
IDENTIFICATION
FORECASTING AND
MODELLING
SURVEILLANCE,
DATA MANAGEMENT
SURVEILLANCE,
DATA MANAGEMENT
DEVELOPMENT OF
COUNTERMEASURES
MANUFACTURE MARKET
AUTHORISATION,
DEPLOYMENT
A 100 Days Mission Future Pandemic Preparedness and Emergency ResponseA Framework for Action 57
Preparedness
Public Health Emergency Management Act
EGoS on Pandemic Preparedness and Emergency Response
A high- risk innovation and research fund for pandemic preparedness and response
A robust surveillance system with a well connected genomic, epidemiological, clinical and hospital
network
Unified Data management system
Forecasting and Modelling
Study and research on Priority Pathogens
Well characterised and sequenced strains maintained in a network of repositories
Development of prototype candidates for diagnostics and vaccines for each priority pathogen
Pre Approved SoPs for Accelerated Regulatory Approval, Data communication, International Agreements
100days Response
Tracking the infection and pathogen identification
Development of sensitive diagnostics and manufacture at scale
Vaccine development for specific pathogen and manufacture
Therapeutics /drugs developed
Forecasting and modelling exercise to give early prediction to put in management protocols in identified
hot spots
Rapid response teams to be positioned on day one
Data analysis to be on a continuous basis and feed into research groups ,state health and clinical
systems
Characterised and sequenced strains, biological and clinical samples and validation assays to be shared
across organisations
Harmonized regulatory systems and accelerated regulatory approval SOPs to facilitate new
countermeasures EUA
Output and Impact
Countermeasures to be available at scale for mass deployment for public health
Continuous epidemiological ,clinical and genomic surveillance data for disease management in hot spots
Rapid response teams on ground to take urgent action as per SoPs
Regular risk communication
Continuous community engagement
Efficient Prevention ,treatment and management of disease with minimal infection levels
Preparing for Future Pandemic -
A 100 Days Mission Framework Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 58
8. Indicative Timelines
To mount a considered response to a public health emergency in the first 100 days,
the proposed systems and processes detailed in this report should function well
before any emergency. An indicative time frame for action on the recommendations
of this report is given below, which outlines which actions should commence in the
immediate short term (3 to 6 months), in the medium term (6 to 12 months) and
which may require a longer time frame (18 to 24 months).
i. Indicative time frame for key steps (1): 3 to 6 months
• Setting up an EGoS for Pandemic Preparedness
• Approval for a Special Pandemic Preparedness and Emergency Response
Fund
• Preparing a framework for monitoring of identified targets as per scorecard
• Operationalisation of One Health Institute: for coordinated collaborative
surveillance & research
• Institutionalisation of the Epidemiological and INSACOG framework and SOP
for regional expansion
• Develop the SOP Document for Data sharing and Risk communication
• Nation-wide capacity building roadmap for surveillance and response
ii. Indicative time frame for key steps (2): 6 to 12 months
• Engaging with states and other ministries.
• Develop a framework for collaboration and partnership with TORs with pre-
agreed MoUs, protocols, agreements and other instruments for data, samples,
knowledge sharing and collaborative funding
• Integration of all data portals, including ICMR and NCDC data, on a single
platform and coordination, SOPs developed with Scientific research bodies
and relevant ministries.
• Approval for a High-Risk Innovation Research Fund
• Establishing a Vaccine Science & Development Institute
• Initiating Priority Pathogen research through the Centre of Excellence
Network
• Launching a Regional Consortium for Surveillance with neighbouring
countries
iii. Indicative time frame for key steps (3): 12 to 24 months
• Approval of a New Public Health Emergency Management Act
• Setting up an Epidemiological Forecasting and Modelling Network
• Launching a Mission on Therapeutics and Drug Development
• Setting up a National Biosecurity Biorepository Network
• Giving Autonomy to the Regulatory body with well-developed approved SOPs
for Accelerated Emergency Use Authorisation for innovative technologies
and innovative products and provision for fast-tracking during pandemics
• Having a well-established capacity-building training programme at all level Future Pandemic Preparedness and Emergency ResponseA Framework for Action 59
ANNEXURE - I Future Pandemic Preparedness and Emergency ResponseA Framework for Action 60 Future Pandemic Preparedness and Emergency ResponseA Framework for Action 61
ANNEXURE - II
WHO List of Priority Pathogens and diseases
A. Virus:
Around 200+ scientists from 53 countries are independently evaluating the evidence
related to 30 viral families. The number of pathogens that could trigger the next
pandemic has grown to more than 30, and now includes influenza A virus, dengue
virus and monkeypox virus, according to a recent updated list published by the
World Health Organization (WHO). Families and pathogens that were prioritized in
2024 as compared to 2017 and 2018 prioritization process.
2017 2018 2024
Family
Priority
Pathogens
Priority
Pathogens
PHEIC
risk
Priority
Pathogens
Prototype
Pathogens
Adenoviridae
Low-
Medium
Recombinant
Mastadenovirus
AdenoviridaeLow
Low-Medium
Arenaviral
hemorrhagic
fevers including
Lassa Fever
Lassa Fever
virus
High
Mammarenavirus
lassaense
Mammarenavirus
lassaense
AnelloviridaeHigh
Mammarenavirus
juninense
ArenaviridaeHigh
Mammarenavirus
lujoense
ArenaviridaeLow
Mamastrovirus
virginiaense
BacteriaHigh
Vibrio cholerae
serogroup
0139
BacteriaHigh Yersinia Pestis
BacteriaHigh
Shigella
dysenteriae
serotype 1
BacteriaHigh
Salmonella
enterica non
typhoidal
serovars
BacteriaHigh
Klebsiella
pneumoniae
BornaviridaeLow
Orthobornavirus
bornaense
Coronaviridae
Middle East
Respiratory
Syndrome
Coronavirus
Middle East
Respiratory
Syndrome
Coronavirus
High
Subgenus
Merbecovirus
Subgenus
Merbecovirus
Coronaviridae
Other highly
pathogenic
coronaviral
diseases such
as Severe Acute
Respiratory
Syndrome
Severe Acute
Respiratory
Syndrome
High
Subgenus
Sarbecovirus
Subgenus
Sarbecovirus Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 62
2017 2018 2024
Family
Priority
Pathogens
Priority
Pathogens
PHEIC
risk
Priority
Pathogens
Prototype
Pathogens
Filoviridae
Filoviral
diseases Ebola
Ebola virus
disease
High
Orthoebolavirus
zairense Orthoebolavirus
zairense
Filoviridae
Filoviral
diseases
Marburg
Marburg virus
disease
High
Orthomarburgvirus
marburgense
FiloviridaeHigh
Orthoebolavirus
sudanense
Flaviviridae Zika virus Zika virus High
Orthoflavivirus
zikaense
Orthoflavivirus
zikaense
FlaviviridaeHigh
Orthoflavivirus
denguei
Orthoflavivirus
denguei
FlaviviridaeHigh
Orthoflavivirus
flavi
FlaviviridaeHigh
Orthoflavivirus
encephalitidis
FlaviviridaeHigh
Orthoflavivirus
nilense
HantaviridaeHigh
Orthohantavirus
sinnombreense
Orthohantavirus
sinnombreense
HantaviridaeHigh
Orthohantavirus
hantanense
HepadnaviridaeLow
Orthohepadnavirus
hominoidei
genotype C
HepeviridaeLow
Paslahepevirus
balayani
genotype 3
HerpesviridaeLow
Nairoviridae
Crimean Congo
Haemorrhagic
Fever
Crimean
Congo
Haemorrhagic
Fever
High
Orthonairovirus
haemorrhagiae
Orthonairovirus
haemorrhagiae
Orthomyxoviridae
High
Alphainfluenzavirus
Influenzae H1
Alphainfluenzavirus
Influenzae H1
OrthomyxoviridaeHigh
Alphainfluenzavirus
Influenzae H2
OrthomyxoviridaeHigh
Alphainfluenzavirus
Influenzae H3
OrthomyxoviridaeHigh
Alphainfluenzavirus
Influenzae H5
Alphainfluenzavirus
Influenzae H5
OrthomyxoviridaeHigh
Alphainfluenzavirus
Influenzae H6
OrthomyxoviridaeHigh
Alphainfluenzavirus
Influenzae H7
OrthomyxoviridaeHigh
Alphainfluenzavirus
Influenzae H10
PapillomaviridaeLow
Paramyxoviridae
Nipah and
related
henipaviral
diseases
Nipah and
henipaviral
diseases
High
Henipavirus
nipahense
Henipavirus
nipahense
ParvoviridaeLow
Protoparvovirus
carnivoran Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 63
2017 2018 2024
Family
Priority
Pathogens
Priority
Pathogens
PHEIC
risk
Priority
Pathogens
Prototype
Pathogens
PeribunyaviridaeLow
Orthobunyavirus
oropoucheense
Phenuiviridae
Severe
Fever with
Thrombocy-
topenia
Syndrome
High
Bandavirus
dabieense
Bandavirus
dabieense
Phenuiviridae
Rift Valley
Fever
Rift Valley
Fever
High
Phlebovirus
riftense
PicobirnaviridaeLow
Orthopicobirnavirus
hominis
PicornaviridaeMedium
Enterovirus
coxsackiepol
PicornaviridaeMedium
Enterovirus
alphacoxsackie
71
PicornaviridaeMedium
Enterovirus
deconjucti 68
Pneumoviridae
Low-
Medium
Metapneumovirus
hominis
PolyomaviridaeLow
PoxviridaeHigh
Orthopoxvirus
variola
PoxviridaeHigh
Orthopoxvirus
vaccinia
PoxviridaeHigh
Orthopoxvirus
monkeypox
Orthopoxvirus
monkeypox
RetroviridaeMedium
Lentivirus
humimdef1
Lentivirus
humimdef1
RhabdoviridaeLow
Genus
Vesiculovirus
SedoreoviridaeLow
Genus
Rotavirus
SpinareoviridaeLow
Orthoreovirus
mammalis
TogaviridaeHigh
Alphavirus
chikungunya
Alphavirus
chikungunya
TogaviridaeHigh
Alphavirus
venezuelan
Alphavirus
venezuelan
Pathogen X Pathogen X Pathogen XPathogen X
Note: Prioritization of pathogens by WHO is a dynamic process and it is pertinent to refer
to the latest updated list for the purpose of pandemic preparedness planning process. Future Pandemic Preparedness and Emergency ResponseA Framework for Action 64
B. Bacteria:
• The 2024 BPPL includes 15 families of antibiotic-resistant (ABR) pathogens,
grouped into critical, high, and medium priority categories for R&D and public
health measures.
• Critical priority gram-negative bacteria that are resistant to last-resort
antibiotics, such as Acinetobacter baumannii and various pathogens in the
Entero bacterales order, as well as rifampicin-resistant (RR) Mycobacterium
tuberculosis, because of their ability to transfer resistance genes, the severity
of the infections and disease they cause and their significant global burden,
particularly in LMIC.
• High-priority bacteria: Salmonella and Shigella due to their increasing
resistance to existing treatments and the high burden of infection associated
with these pathogens, particularly in LMIC.
• Other high-priority pathogens are antibiotic-resistant Pseudomonas
aeruginosa and Staphylococcus aureus due to their global threat, especially in
healthcare settings. Also included are Neisseria gonorrhoeae, which present
distinct public health challenges due to the emergence of multidrug-resistant
(MDR) strains, limiting treatment options.
• The medium-priority category includes Group A and B Streptococci,
Streptococcus pneumoniae, and Haemophilus influenzae, particularly in
vulnerable populations in resource-limited settings.
Diseases:
The WHO priority diseases are:
• COVID-19
• Crimean-Congo haemorrhagic fever
• Ebola virus disease and Marburg virus disease
• Lassa fever Future Pandemic Preparedness and Emergency ResponseA Framework for Action 65
• Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute
Respiratory Syndrome (SARS)
• Nipah and henipaviral diseases
• Rift Valley fever
• Zika
• “Disease X” *
Ref:
1. Pathogens prioritization: A scientific and Research framework for epidemic and
pandemic research preparedness. WHO – R&D Blue print Powering research to
prevent Epidemics; Health Emergencies, June 2024.
2. WHO Bacterial Priority Pathogens List, 2024 Bacterial pathogens of public health
importance to guide research, development and strategies to prevent and control
and antimicrobial resistance.
3. Emerging viral diseases from a vaccinology perspective: preparing for the next
pandemic - nature immunology December 14, 2017: Barney S Graham and Nancy
J Sullivan Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 66
ANNEXURE - III
Future Pandemic Preparedness and Emergency Response –
Experts Consulted
Fourteen separate consultations have been held with more than sixty experts.
The detail of the individuals and the institutions consulted is below:
I. Government Representatives
1. Prof. Ajay Kumar Sood, Principal Scientific Advisor to the Govt of India
2. Dr Rajiv Bahl, Secretary Department of Health Research and Director General
ICMR
3. Sh. Arunish Chawla, Secretary Department of Pharmaceuticals
4. Dr Atul Goel, Director General Health Services
5. Dr Rajeev Singh Raghuvanshi, Drugs Controller General of India (DCGI), CDSCO
6. Sh. Krishna S. Vatsa, Member NDMA
7. Vaidya Rajesh Kotecha, Secretary, Department of AYUSH
8. Dr Sanjeev Khosla, Director, CSIR IMTECH
9. Prof. K Vijayaraghavan, Former Principal Scientific Advisor to the Govt of India
10. Mrs Preeti Sudan Former Secretary, Ministry of Health & Family Welfare
11. Prof. Ashutosh Sharma, Former Secretary, Department of Science & Technology
12. Dr Ram A Vishwakarma, Director, CSIR-IIM, Jammu
13. Prof. Balram Bhargava, Former DG, ICMR
14. Dr G Satheesh Reddy, Scientific Advisor to Minister of Defence, GoI
15. Mr Safi Ahsan Rizvi, Advisor (Mitigation), NDMA
16. Dr Ashok Kumar, ADG (Animal Health), Indian Council of Agricultural Research
(ICAR)
17. Dr Parvinder Maini, Scientific Secretary, Office of PSA
18. Dr Nitin Kumar Jain, Scientist G, DBT
19. Dr Anita Aggarwal, Head (SEED)
20. Dr Abhijit Mitra, Animal Husbandry Commissioner, Department of Animal
Husbandry and Dairying (DAHD)
21. Dr Aruna Sharma, Deputy Commissioner, DAHD
22. Sh. Saikat Sarkar, Adviser (Trade), Department of Agriculture, Cooperation &
Farmers Welfare
23. Dr A. Raghu, Dy. DGHS, Ministry of AYUSH
24. Dr Himanshu Chauhan, Joint Director National Centre for Disease Control
(NCDC)
II. Government Leadership
1. Shri Rajesh Bhushan, Former Secretary, Ministry of Health & Family Welfare
Govt. of India
2. Shri Amit Mohan Prasad, Additional Chief Secretary, Government of Uttar
Pradesh
3. Mohd. Suleman, Principal Secretary, Government of Madhya Pradesh
4. Dr J Radhakrishnan, Commissioner, Govt. of Tamil Nadu Tamil Nadu
5. Shri JV Prasad Rao, Former Secretary, Ministry of Health & Family Welfare Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 67
III. Industry
1. Dr Kiran Mazumdar Shaw, Executive Chair, Biocon
2. Dr Vijay Chandru, Co-founder and Chair, Strand Life sciences
3. Shri Pankaj Patel, Chairman, Cadila Healthcare
4. Dr Sanjay Singh, CEO, Gennova Biopharmaceuticals Ltd.
5. Dr Prasad Kulkarni (Executive Director), Serum Institute of India
6. Hasmukh Rawal (Managing Director)/ Mylab Discovery Solutions
7. Dr Jitendra Sharma, Managing Director & CEO, AMTZ
8. Dr Satish Reddy, (Chairman), Dr Reddy’s Laboratories
9. Dr Heulwen Philpot, Head of Secretariat, International Pandemic Preparedness
Secretariat (IPPS) and team
IV. Technical Institutions
International Institutions
1. Dr Ana Maria Henao-Restrepo, Co-Lead R&D Blueprint for Epidemics, WHO
Health Emergencies programme
2. Dr Jeremy Farrar, Chief Scientist WHO
3. Dr Richard Hatchett, CEO, Coalition for Epidemic Preparedness Innovations
(CEPI)
4. Dr Mariangela Simao, Director ITPS Brazil
5. Mr Bill Rodriguez, CEO, FIND
6. Mr Seth Berkley, Former CEO, GAVI
7. Dr Rick Bright, Former Sr. Vice President, Rockefeller Foundation
8. Dr Meghna Desai, Country Director, Centers for Disease Control and Prevention
(CDC), India
9. Dr Heulwen Philpot, Head of Secretariat , International Pandemic Preparedness
Secretariat (IPPS) and team
National Institutions
1. Dr Pavana Murthy, NPO Surveillance and Response, WHO India
2. Prof. Saumitra Das, Dept. of Microbiology and Cell Biology, Indian Institute of
Science (IISc)
3. Prof Sudhanshu Vrati, Executive Director, Regional Centre for Biotechnology
(RCB)
4. Retd. General Dr Madhuri Kanitkar, Vice-Chancellor, Maharashtra University of
Health Sciences (MUHS)
5. Prof. Manindra Agrawal, Dept. of Computer Science & Engineering, IIT-Kanpur
6. Dr Sanket V Kulkarni, Joint Director, NCDC
7. Dr Saurabh Goel, Joint Director, NCDC
8. Dr Pramod Kumar Garg, Executive Director THSTI
9. Dr Heulwen Philpot, Head of Secretariat, International Pandemic Preparedness
Secretariat (IPPS) and team
V. Clinicians, Microbiologists, Virologists and Epidemiologists
1. Dr NK Arora, NEG-VAC (National Expert Group on Vaccines)
2. Dr Gagandeep Kang, Director BMGF (former head THSTI)
3. Dr K. Srinath Reddy, President PHFI
4. Dr Shiv Kumar Sarin, Institute of Liver and Biliary Science (ILBS), Delhi Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 68
5. Dr Sanjay Pujari, Director Institute of Infectious Diseases, Pune
6. Dr Lalit Dar, Professor, Dept. of Microbiology, AIIMS New Delhi
7. Dr Aakash Shrivastava, Additional Director, NCDC
8. Dr Randeep Guleria, former Director AIIMS
9. Dr Naveet Wig, Professor, Dept of Medicine, AIIMS New Delhi
10. Dr Raman R Gangakhedkar, Former Head - Division of Epidemiology,
Communicable Diseases, ICMR
11. Dr Nivedita Gupta, Scientist F, ICMR New Delhi
12. Dr Tarun Bhatnagar, Scientist, ICMR – National Institute of Epidemiology,
Chenna
13. Dr Priya Abraham, Former Director, National Institute of Virology Pune
14. Dr Manoj Murhekar, Director ICMR – National Institute of Epidemiology, Chennai
15. Dr Subhash Salunke, Senior Adviser, Public Health Foundation of India (PHFI),
Delhi
16. Dr Giridhar R. Babu, Professor, Public Health Foundation of India (PHFI), Delhi
17. Dr J.M Deshpande, Former director, Enterovirus Research Centre Mumbai
18. Dr Sanghamitra Ghosh, President, Indian Public Health Association (IPHA)
19. Dr A. M. Kadri, President, Indian Association of Preventive and Social Medicine Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 69
ANNEXURE - IV
Key References
i. From Emergency Response To Long-Term Covid-19 Disease Management:
Sustaining Gains Made During The Covid-19 Pandemic Report by WHO (May
2023); https://www.who.int/publications/i/item/WHO-WHE-SPP-2023.1
The Report talks about the Global Strategic Preparedness, Readiness and Response
Plan (SPRP) for the period 2023-2025. In 2023, WHO updated the global strategy
to reflect the evolving situation and outline a strategy for the next two years (April
2023-April 2025) to support countries in transitioning, when and as appropriate,
towards integrating the COVID-19 pandemic response into broader infectious disease
prevention and control programmes. The updated 2023-2025 COVID-19 strategy
outlines practical, high-level actions that need to be sustained as response activities
are adjusted to address the drivers of SARS-CoV-2 transmission and prioritizes
activities that will continue to lessen the impact of the COVID-19 disease. Activities
outlined are organized to reflect management and integration of COVID-19 activities
along the five core components of WHO’s proposed global health architecture for
health emergency preparedness, response and resilience. The components are
emergency coordination, collaborative surveillance
, community protection, safe
and scalable care, and access to countermeasures.
ii. A WORLD AT RISK - Annual report on global preparedness for health emergencies
by Global Preparedness Monitoring Board (September 2019); https://www.gpmb.
org/docs/librariesprovider17/default-document-library/annual-reports/gpmb-2019-
annualreport-en.pdf?sfvrsn=bd1b8933_36
The Report highlights the need for determined political leadership to prepare for
health threats at national and global levels and outlines seven urgent actions to prepare
the world for health emergencies; i. Commitment and Investment from Government
Heads: Heads of government in every country must commit to preparedness by
implementing their binding obligations under the International Health Regulations
(IHR (2005); ii. Countries and regional organizations must lead by example: G7,
G20 and G77 Member States, and regional intergovernmental organizations must
follow through on their political and funding commitments for preparedness and
agree to routinely monitor progress during their annual meetings; iii. All countries
must build strong systems: Heads of government must appoint a national high-
level coordinator with authority and political accountability to lead whole-of-
government and whole-of-society approaches, and routinely conduct multisectoral
simulation exercises to establish and maintain effective preparedness; iv. Countries,
donors and multilateral institutions must be prepared for the worst: Donors and
multilateral institutions must ensure adequate investment in developing innovative
vaccines and therapeutics, surge manufacturing capacity, broad-spectrum antivirals
and appropriate non-pharmaceutical interventions; v. Financing institutions must
link preparedness with financial risk planning: Funding replenishments of the IDA,
Global Fund to Fight AIDS, TB and Malaria (Global Fund), and GAVI should include
explicit commitments regarding preparedness; vi. Development assistance funders
must create incentives and increase funding for preparedness; Donors, international Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 70
financing institutions, global funds and philanthropies must increase funding for the
poorest and most vulnerable countries through development assistance for health
and greater/earlier access to the United Nations Central Emergency Response Fund
to close financing gaps for their national actions plans for health security as a joint
responsibility and a global public good; vii. The United Nations must strengthen
coordination mechanisms: The Secretary General of the United Nations, with WHO
and United Nations Office for the Coordination of Humanitarian Affairs (OCHA), must
strengthen coordination in different country, health and humanitarian emergency
contexts, by ensuring clear United Nations systemwide roles and responsibilities;
rapidly resetting preparedness and response strategies during health emergencies;
and, enhancing United Nations system leadership for preparedness, including
through routine simulation exercises.
iii. A Fragile State of Preparedness 2023 Report On The State Of The World’s
Preparedness; https: // www. gpmb. org / reports / m / item / a- fragile- state - of-
preparedness-2023-report-on-the-state-of-the-worlds-preparedness
The GPMB Monitoring Framework for Preparedness, 2023, provides a robust,
evidence-based methodology to assess global preparedness. It has been applied for
the first time in this Report, reporting on 30 of its full 90 indicators most pertinent
to equity, leadership and accountability, and coherence. Across the indicators
reviewed, the assessment shows that capacities are inadequate. There are particular
weaknesses in global R&D coordination, addressing the impact of misinformation,
providing financing and including all actors in governance. Some improvements
following COVID-19 have been seen in relation to global information platforms,
community engagement, independent monitoring and regional laboratory capacity.
Weaknesses in the global financing system for Pandemic Prevention, Preparedness
and Response (PPPR) and the failure of international commitment to strengthening
independent monitoring will weaken future prospects for effective PPPR.
iv. COVID-19: Make it the Last Pandemic by The Independent Panel for Pandemic
Preparedness & Response; https://theindependentpanel.org/wp-content/
uploads/2021/05/COVID-19-Make-it-the-Last-Pandemic_final.pdf
The Panel has examined the state of pandemic preparedness prior to COVID-19, the
circumstances of the identification of severe acute respiratory syndrome coronavirus
2 (SARS-CoV-2) and the disease it causes, coronavirus disease (COVID-19), and
responses globally, regionally and nationally, particularly in the pandemic’s early
months. It has also analysed the wide-ranging impact of the pandemic and the
ongoing social and economic crisis that it has precipitated. This report presents the
Panel’s findings on what happened, the lessons to be learned from that, and our
recommendations for strategic action now to end this pandemic and to ensure that
any future infectious disease outbreak does not become a catastrophic pandemic.
Complementing this report, the Panel presents a companion report describing
thirteen defining moments which have been pivotal in shaping the course of
the pandemic. In addition, the Panel is publishing a series of background papers
representing in-depth research including a chronology of the early response. Future Pandemic Preparedness and Emergency ResponseA Framework for Action= 71
v. 100 Days Mission Implementation Report by International Pandemic
Preparedness Secretariat (IPPS); https://d7npznmd5zvwd.cloudfront.net/prod/
uploads/2023/01/100-Days-Mission-2nd-Implementation-Report-1.pdf
The 100DM offers a framework for implementers at all levels to take forward and
apply, whether at the global, regional or national level. The essence of the 100DM is
to significantly reduce the time to develop diagnostics, therapeutics, and vaccines
(DTVs), maximising the health impact and saving lives.
This year’s report maintains a rigorous focus on the overarching end goals of the
100DM which gives a more quantifiable sense of our state of readiness. Within
each section, overarching goals, critical bottlenecks to achieving these goals
and the proposed inputs needed in 2024 to maintain satisfactory progress have
been reiterated. The chapters provide high-level analysis, and a summary of 2024
milestones those already planned by implementation partners, and more aspirational
goals set by the IPPS.
For this year, while significant progress has been made, analysis from implementation
partner feedback and the 100DM scorecard data highlights key areas needing urgent
attention in 2024: 1. Therapeutics Pipeline Enhancement; 2. Diagnostics Framework
Funding, 3. Regulatory Alignment And Preparatory Regulatory Approaches; 4.
Sustain And Strengthen Regional And Global Clinical Trial Infrastructure. Designed by: Future Pandemic Preparedness and Emergency ResponseA Framework for Action 74
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FUTURE PANDEMIC
PREPAREDNESS AND
EMERGENCY RESPONSE
A Framework for Action
Report of the Expert Group