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India handles a 21st century pandemic with a 19th century legislation

Photo: Byju’s

The Indian Government invoked the Epidemic Diseases Act, 1897 in view of the growing coronavirus pandemic in the country. The only Act which deals with epidemics in India right now was passed on 4 February, 1897 by the British Government, at a time when Bombay was hit by the Bubonic Plague.

By Ayesha Fatima

It was the year of 1896. Bombay witnessed a thriving global trade which attracted laborers from other cities to migrate there. The month of August arrived, bringing with it a new disease into the city, later to be identified as the Bubonic Plague. With the first case being reported in September, the disease soon escalated to an epidemic. By the end of the year, there were 2,544 reported cases with 1,936 deaths. Laborers started fleeing the city in fear, unknowingly becoming the vectors themselves, spreading the disease to other parts of the country. When the otherwise unresponsive British government saw the situation getting worse, it hurriedly drafted the Epidemic Disease Bill which became the Epidemic Diseases Act on 4 February, 1897.

With the coronavirus pandemic growing in India, the Central government directed the states to invoke Section 2 of the Act on 11 March, 2020. The two-page Act has the provision to empower any person the state government would think fit to contain the threat or outbreak of an epidemic in the state or a part thereof. Since then the experts have criticized the Act for being too outdated and regulatory in nature.

“The main purpose of the Act was to regulate Indians,” says Kiran Kumbhar, a researcher of history of medicines in modern India at Harvard University. This was kind of deliberately done according to the logic of the colonial government, he further adds. Anant Bhan, a bioethics and global health researcher says, “The act is too small and a bit draconian in nature.”

Two centuries old

The advent of globalization in the late twentieth century accelerated the flow of goods, information and also of people from one country to another. Gradually, airways became a more convenient mode of transportation internationally than waterways. Sea voyages have become a primitive mode of transport for today’s generation. But the nineteenth century Act, applied today, talks about inspection and detention of any ship or vessel leaving or arriving at any port of the country, during a breakout or threat of breakout.

Since one can fly round the globe within twenty-four hours, the susceptibility of human beings to any disease has increased manifold. Bhan says that in terms of population, the nature of the Act should be inward looking. “But keeping in mind the susceptibility of infection through air travel, we need to cooperate with countries to work collectively,” he adds.

Vague terminologies

“An act to provide for the better prevention of the spread of dangerous epidemic disease,” reads the introduction of the Act. It lacks specific definition as to which disease will be a ‘dangerous’ epidemic. Adjectives like these can have social implications which may lead to stigmatization in the society. Bhan says that while it’s important to understand the risk attached to any disease, at the same time it should not lead to a person or a group of persons being targeted. “It’s important to be careful in terminology and have a scientific approach,” he adds.

The seriousness of a disease could be explained through certain parameters and then the usage of the Act can be decided upon. Vishal Bhambri who is at the frontline right now, treating Covid-19 patients, suggests this. Bhambri, senior consultant of Internal Medicine at Fortis Hospital, Chandigarh, recommends two parameters to decide the seriousness of a disease: mortality rate and infectiousness of the ailment. A certain number of cases could be fixed in both the combination to decide whether to apply the Act or not. “If a disease is less infectious and highly fatal like Ebola, the Act could be invoked in the hotspots only. But if the disease is highly infectious and less fatal like the coronavirus, then the Act can be applied to a larger area,” he says.

Privacy issues

Whenever a communicable disease hits an area, the hospital has to notify the authorities about the same. The notification calls for sharing of patient’s details. Since privacy wasn’t a fundamental right in the colonial era, the Act is silent about patient’s privacy rights.

Authorities in India have been putting up home quarantine notices on the houses where one or more members have come in contact with a corona positive patient or are symptomatic. While this is done to make other people in the locality aware to be extra cautious, this has led to stigmatization. Even after the quarantine period gets over and test results come out negative, people are avoiding interacting with them fearing infection.

Bhambri is of the view that, while privacy is important in normal times, the present situation requires right to health of the larger section of people to take precedence over an individual’s privacy rights. “It’s important that stigmatization doesn’t take place but measures like house notices are also important,” says Bhambri, who himself is undergoing a quarantine and has the notice applied at his home by the local administration. Bhambri informed that he was told by the authorities to remove the notice himself once the quarantine period gets over. He says that while ideally the authorities should remove the notice, one can do it on their own. The stigmatization can only be overcome through right information in the society.

Under normal circumstances experts fully back this right, but in a crisis situation like now, they say some rights may have to be reduced. Since notification is important, right to privacy has to be one of them. Bhan says that these aren’t normal times, so some rights have to be lowered. Although he further adds that there need to be some balance to ensure the individual’s interest. “Individuals within public health administration have to be accountable so that the information is decisively used for public health response,” he says.

Passing the pending Public Health Bill: The way forward

The Union Ministry of Health and Family Welfare had drafted the Public Health (Prevention, Control and Management of Epidemics, Bio-terrorism and Disasters) Bill, 2017, which was to replace the Epidemic Diseases Act. The Bill was uploaded online seeking comments from experts. Notifying a list of thirty-three diseases like dengue, chikungunya and Ebola, the Bill laid down executionary powers granted to the State and local authorities. Moreover, it has mentioned different modes of transportation like airplanes and ship. The Bill hasn’t got tabled in the Parliament yet.

After the situation returns to normal, the State should prioritize health and get the Bill passed, says Bhambri. The country has been witnessing acute shortage of Personal Protective Equipments (PPEs) like gloves, masks, hazmat suites for the medical professionals. But neither the current Act nor the proposed Bill has any provision for the same. As a consequence, doctors like Bhambri have to undergo quarantine. “Quarantine of doctors is tragic. You are taking out a very important element out from the system,” says Bhambri.

Kumbhar also backs Bhambri’s concern and says that any comprehensive legislation on public health action surely needs to take into account such things and clearly outline which agencies will be responsible for this. He points to a larger problem with public health action and response in India. “As long as corruption, nepotism, unlimited ministerial power, lack of transparency continues in broader socio-political milieu, we will have to contend with insufficient public health responses,” he says.

The Bubonic Plague was a chapter from the nineteenth century India. After the incident, history took its own course and reached where we are today. On its way, India attained its independence, the two world wars were fought, economic reforms were unleashed, Internet and social media have become new modes of communication. With each event, every aspect of our society has transformed in fundamental ways. The coronavirus pandemic is also one such event which will heavily influence every aspect of the society. Yet, the legislation to combat a pandemic has remained the same.

Finally, on 22 April, 2020, the union cabinet had promulgated an ordinance to amend the Act. It received President’s assent. The amendment included punishments for those who indulge in violence against the health workers or medical professionals.

Bio:
Ayesha Fatima is a student of Convergent Journalism at AJK Mass Communication Research Center, Jamia Millia Islamia, New Delhi.

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Read the latest issue of Cafe Dissensus Magazine, “Poetics and politics of the ‘everyday’: Engaging with India’s northeast”, edited by Bhumika R, IIT Jammu and Suranjana Choudhury, NEHU, India.

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