Editorial: India flounders as H1N1 spreads

 

2009 H1N1 photo - Photo Credit - C. S. Goldsmith and A. Balish, CDC
2009 H1N1. – Photo: C.S. Goldsmith and A. Balish, CDC

The influenza A(H1N1) virus continues to kill people in India, although its spread is not at a galloping pace. As on March 21, the number of people affected was over 32,200, and the death toll in excess of 1,900. The worst-affected States are Gujarat and Rajasthan. In Gujarat, the number of cases has crossed 6,300 and the death toll is 410. In Rajasthan, the cases number over 6,400 and the death toll is 400. The possibility of the actual numbers being much more than government data indicate cannot be ruled out. The influenza virus circulating in the country since last year has revealed how ill-prepared India is in managing and preventing the spread of an infectious disease that could cripple it. The Pune-based National Institute of Virology had sequenced the haemagglutinin (HA) protein. But it is not known if it has completed the sequencing of the whole genome of the circulating virus strain; it had not done so till the end of February 2015. The Ministry of Health and Family Welfare rubbished the results of a study published on March 12 in Cell Host & Microbe by a Massachusetts Institute of Technology team that claimed three mutations in the HA protein in the 2009 pandemic virus strain. The team found mutations in two samples deposited last year by India in a public database. While the government continues to vehemently deny new mutations in the circulating virus, it has thus far failed to support the claim convincingly.

A March 14, 2015 report in The Lancet makes it abundantly clear that India has not shared some critical information with the World Health Organization that would help determine if the circulating strains are the same as the two strains that have shown resistance to the anti-viral drug. “We have not yet received detailed information in regard to the characteristics of the circulating viruses [in India]”, Masato Tashiro, Director of the WHO Collaborating Centre for Reference and Research on Influenza, Tokyo, told the journal. The failure to share the full genome sequence data with the WHO reference laboratories and/or deposit them in public databases, severely hampers global efforts to study the evolution of the virus. India has no national influenza policy either, to vaccinate doctors and health-care workers who run the highest risk of contracting the infection; it only “recommends” vaccination of health-care workers. The time has come to take influenza more seriously, especially since H1N1 and H3N1 have become seasonal influenza. Though Indian drug companies are capable of manufacturing influenza vaccines to make the country self-reliant on this count, they have no real incentive to do so in advance in the absence of assured procurement by the government. With its arsenals ill-equipped to prevent the spread, India can only hope the summer heat would rein in the infection.

Published in The Hindu on March 25, 2015

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