What flu surge can teach us about next pandemic

Why in the News

Different parts of India have reported 2 to 10 times more influenza cases this year than last year. The official position is that the circulating strain has not changed, and public advisories ask people to remain vigilant without becoming alarmed. That instruction states no action a reader can take. The detection layer built after Covid-19 is working, and the layer that must convert a detection into a decision is not. A surge of this size is the period in which that gap can be closed, since a pandemic is the worst time to learn.

Pillars of outbreak management

1. Surveillance: The ability to detect an outbreak early and to initiate action on that detection. For influenza it also covers genomic surveillance to identify the strain or variant behind the rise, which is what allows its virulence and the population’s susceptibility to be gauged.
2. Prevention: Issuing advisories to high-risk individuals to avoid crowded places, promoting mask use, and vaccinating high-risk individuals and health workers.
3. Control: Ensuring that those already infected receive proper medical care.

What does the current surge actually show?

1. The size of the rise: Reported influenza cases across different parts of the country are 2 to 10 times last year’s level.
2. Hospital positivity has risen: Among patients admitted with severe acute respiratory infection (an acute respiratory illness severe enough to require hospitalisation), the positivity rate in selected hospitals was 16 per cent this year against 12 per cent last year.
3. An unchanged strain is not by itself the answer: A well-established virus does not warrant serious concern on virological grounds alone. The scale of transmission still decides how many avoidable deaths occur.

Why does surveillance not convert into action?

1. No alert threshold is defined: A rise in influenza positivity past a defined threshold should trigger an alert. No such thresholds exist.
2. The data is not public: There is no publicly available dashboard on which positivity trends can be seen, so no one outside the system can tell when a threshold would have been crossed.
3. Responsibility is split three ways: Laboratory surveillance sits with the Indian Council of Medical Research (ICMR), response coordination with the National Centre for Disease Control (NCDC), and implementation with State health systems.
4. No one holds authority to act on the signal: No integrated command structure exists with clear authority to coordinate and implement a response during a disease upsurge. This was the specific lesson Covid-19 offered and it was not learnt.

Where is the line between an appropriate response and one that causes panic?

1. The stated fear is panic: Governments hesitate to issue advisories on the ground that a public warning will itself cause alarm.
2. The line is genuinely thin: Governments across the world struggle to place it, and the WHO has itself been accused of overreacting.
3. The asymmetry decides it: Where the primary concern is to save lives, overreaction is the better error of the two.
4. The current position sits on the wrong side: The response is too cautious and too bureaucratic for the scale of the surge.
5. This is a professional capability, not a temperament: Situations of this kind require trained risk communication and named experts speaking, rather than a general advisory.

Why does influenza vaccine use stay low even among high-risk groups?

1. Poorly perceived threat: Influenza is treated as an ordinary seasonal illness, so the risk it carries for the elderly and the immunocompromised is discounted.
2. Non-affordability: The vaccine is largely an out-of-pocket purchase for those outside institutional programmes.
3. Doubtful effectiveness: Protection varies by season and by strain match, which weakens the case a physician can make for it.
4. The annual injection requirement: Immunity does not carry over, so the decision has to be taken and paid for again every year.

What should the response to this surge prioritise?

1. Preventing avoidable deaths: At the current scale the objective is not to stop transmission but to keep high-risk people out of severe illness.
2. A specific advisory rather than a general one: The advisory should tell high-risk people to avoid crowded places and to wear masks, in those terms.
3. Immunising high-risk groups during the surge: The case for routine immunisation is debatable and the case during a major seasonal surge is not. Skipping it leaves the system unpractised for the next pandemic.
4. Low antiviral use needs examination: Antiviral use stays low even in peak influenza season, which calls for a relook at the influenza management guidelines.
5. The private sector has to be inside the response: Private providers and professional bodies deliver most outpatient care and cannot be reached through public system instructions alone.

Challenges to India’s outbreak surveillance and response system

1. Influenza carries no statutory duty to notify: Reporting rests on administrative instruction rather than legal obligation, so private-sector cases stay outside the national count. Eg. Most States have no public health Act listing notifiable conditions, and the Kerala Public Health Act, 2023 is among the few that do.
   The Fix: Enact a public health law fixing the list of notifiable conditions and placing the reporting duty on private providers as well as public ones.
2. Vaccine composition is set for the wrong season: Supply follows the Northern Hemisphere formulation while influenza in much of India peaks with the monsoon. Eg. The WHO issues separate Northern and Southern Hemisphere composition recommendations each year.
   The Fix: Procure the Southern Hemisphere formulation for monsoon-peak States and fix the public procurement calendar to that cycle.
3. Surveillance is an additional charge, not a post: District surveillance duties are given to serving clinical or programme officers on top of their own work, so analysis is done last. Eg. Rural Community Health Centres run at about an 80 per cent shortfall of specialists, which is the pool such officers are drawn from.
   The Fix: Create a separate public health cadre with dedicated district epidemiologist posts filled on their own recruitment line.
4. Antiviral supply is not pre-positioned: Oseltamivir was moved from Schedule X to Schedule H1 in 2017, and the prescription-record duty that follows keeps retail stocking low outside declared alerts. Eg. Shortages appear at the retail counter in the same weeks that hospital positivity rises.
   The Fix: Stock antivirals at district hospitals ahead of the seasonal peak rather than relying on retail availability during the surge.
5. Sequencing capacity is concentrated in a few laboratories: Sequencing volumes are set by laboratory capacity rather than by case load, so variant detection lags the epidemic curve. Eg. Sequencing effort fell sharply between Covid-19 waves and had to be rebuilt each time activity rose.
   The Fix: Fix a minimum sequencing share of positive samples per State per week as a standing requirement rather than an outbreak-time instruction.

Conclusion

An outbreak response is judged by the interval between a signal and a decision. India has built the layer that produces the signal and has not built the layer that must act on it, which is a governance problem rather than a scientific one. The next seasonal peak will test the same gap. The markers to watch before it arrives are whether a numeric alert threshold has been fixed and whether positivity data is published where the public can see it.

Outbreak Surveillance and Pandemic Preparedness in India

1. About: Disease surveillance is the continuous collection and analysis of health data to detect unusual disease activity early enough to act on it. Preparedness is the standing capacity to respond once that detection is made.
2. The zoonotic load: Over 60 per cent of emerging infectious diseases in India are zoonotic, so animal and human surveillance cannot be run separately. Eg. Nipah virus, avian influenza, rabies and brucellosis.
3. The triple burden: India faces infectious disease, rising non-communicable disease and emerging zoonotic threats at the same time.
4. The standing weakness: Surveillance remains event-based rather than predictive, with communicable disease, non-communicable disease and animal health data held in separate vertical silos.

Government Initiatives for Outbreak Surveillance and Pandemic Preparedness

1. Integrated Disease Surveillance Programme: Collects district-level disease data and has been upgraded to carry animal health indicators for integrated surveillance.
2. National One Health Mission: A cross-ministerial effort involving 13 departments to coordinate pandemic preparedness across human, animal and environmental health.
3. National Institute for One Health, Nagpur: The anchor institution for research, training and policy integration on zoonotic disease.
4. National Joint Outbreak Response Team: A multi-disciplinary team of human, animal and wildlife experts constituted for rapid outbreak investigation.
5. BSL-3 and BSL-4 laboratory network: A national grid of high-security biosafety laboratories, with a new BSL-4 facility in Gujarat foundation-laid in January 2026.
6. One Health Governance Framework: Released in December 2025 as a roadmap for States and Union Territories to set up State One Health Cells.

Matching Previous Year Question

“[2024, GS2, 15 marks] In a crucial domain like the public healthcare system, the Indian State should play a vital role to contain the adverse impact of marketisation of the system. Suggest some measures through which the State can enhance the reach of public healthcare at the grassroots level.”