Why is NCDC not in the centre of managing the Covid-19 crisis?

'We have the technical expertise, and international collaborations. We also have robust real-time data. We are a university of pandemic management. If the ministry neglects the role of NCDC, it is the loss of the country.'

Nivedita Mookerji and Ruchika Chitravanshi report.

For nearly one-and-a-half years now, the Union health ministry at Nirman Bhawan has been the war room for all Covid-related matters. Along with top bureaucrats in the health ministry such as Rajesh Bhushan and Lav Agarwal, Niti Aayog member V K Paul and Indian Council of Medical Research Director-General Balram Bhar¬gava have become the face of Covid management through their regular briefings. All India Institute of Medical Sciences Director Randeep Guleria, too, has added heft to these interactions at times.

The National Centre for Disease Control, which comes under the health ministry’s Directorate General of Health Services, has, however, been largely missing from these engagements, raising questions as to why an institute meant to control communicable diseases and conduct epidemiology research is not at the centre managing the Covid-19 crisis.

Spread over 15 acres at the Sham Nath Marg in Delhi’s Civil Lines -- a historic landmark less than 15 km from Nirman Bhawan, the hub of Covid policy-making -- NCDC’s role during the pandemic has often been compared with the Atlanta-based Centers for Disease Control and Prevention. The Rochelle P Walensky-led CDC is the national public health agency of the United States under the department of health and human services.

NCDC Director Sujeet K Singh said, “We took note of it (Covid-19) first when Wuhan got the initial cases. That was towards the end of 2019.’’ After a few days of monitoring, NCDC notified DGHS about Covid, along with the need for cautionary steps including sanitation and stopping of international flights, especially from China, according to an official in the know.

It was weeks later, on February 4, 2020, that the government banned all India-bound airlines from boarding any passenger from China on e-visa; by then Covid had claimed 400 lives in China. More than a month later, on March 23, 2020, India suspended all scheduled international flights.

When asked why NCDC was not in the limelight when the country was facing such a huge crisis, Singh said, “We are in the thick of things. It’s a long pandemic and roles could change.’’ According to Singh, NCDC is the real war room during the pandemic. “The (health) ministry is not a technical body and relies on NCDC’s feedback…. NCDC is a public health organisation focusing on disease control. ICMR is a research organisation,’’ he said.

Anand Krishnan, professor of community medicine at AIIMS, added, “By giving a key role to ICMR during Covid-19, perhaps the focus shifted from public health. ICMR is not a public health organisation though it has presence in many states.’’

While in its current form, NCDC may not have been able to lead during a pandemic of this proportion, the government should have seen this as an opportunity to strengthen the centre’s capacity, said Krishnan who’s worked closely with several NCDC projects. “The system is more important than any individual. We have not invested in this system,’’ he added.

Health ministry and ICMR officials did not respond to questions on the role of NCDC during the Covid-19 pandemic.

Although there are shortcomings and challenges, NCDC is not completely removed from the global healthcare system. Its India Epidemic Intelligence Service programme in collaboration with America’s CDC is an example of global engagement. It’s about hands-on training in epidemiologic service for public health professionals with the focus on outbreak investigation, designing and analysing epidemiological studies and evaluation of surveillance data. But there’s been no collaboration with CDC on the subject of Covid-19.

A former government official familiar with the organisation said that NCDC should have been a strong pillar for disaster management during the current pandemic, adding that upgradation of skill, infrastructure and leadership should be a must. He pointed out that the government has given significant support to NCDC but it has fallen short as an inspiring organisation.

Another reason is the short stint that most director generals have at the DGHS, the nodal health ministry organisation to which NCDC reports, the official said, adding, “It’s important to define the roles clearly so that there’s no confusion when the country faces an emergency like this. Systemic issues must be addressed.’’

A state-level branch official of NCDC in Varanasi captured the fuzziness around the roles and functions. Early 2020, NCDC officials had to knock on the doors of the district magistrate late at night to inform him of the warnings being issued about the coronavirus. The urgency of the matter was because Varanasi had an international airport and protocols had to be put in place immediately for passengers arriving from foreign countries.

“International passengers have their own rights. Preparations had to start from before, almost like a wedding,’’ the NCDC official said. Since Varanasi airport does not have an airport health organisation, the task fell on NCDC. As the cases rose, so did the workload of NCDC in screening and isolating passengers.

The same was true in some other branches, including NCDC Patna, which had to be vigilant because of the porous Nepal border. In both cities, NCDC officials had to set protocols at the airports for screening of passengers, though it is not their core function.

State officials at NCDC feel they have been underutilised in this pandemic. “We have the technical expertise, and international collaborations. We also have robust real-time data. We are a university of pandemic management. If the ministry neglects the role of NCDC, it is the loss of the country,” an official said.

Nutan Mundeja, director general health services in Delhi, said NCDC was an important agency in surveillance as well as in containment, testing and genome sequencing. “We look up to them for technical support,’’ she said.

As one of the state officials explained, the primary job of NCDC is prediction of the epidemic curve. Based on the data on disease burden and fatalities, the beginning and end can be mapped. “However, no one knows the big picture. We have the ability, but the resources are less utilised.”

Against a robust nationwide network in an organisation like CDC in the US, NCDC has only eight state branches with plans to go all-India.

According to Rajesh Kumar, former head of the department of community medicine and school of public health at PGIMER, Chandigarh, NCDC is an organisation with high esteem and good capacity for surveillance and disease prevention. “It’s constantly in touch with CDC and the World Health Organisation.’’