Context: India is witnessing a significant rise in influenza cases, with different regions reporting 2–10 times more cases than the previous year. The surge provides an opportunity to test and strengthen India’s preparedness before the next major pandemic.
Three Pillars of Outbreak Management
- Surveillance: Detect outbreaks early, monitor disease trends and initiate timely action. For influenza, this must include genomic surveillance to identify circulating strains/variants and assess their virulence and population susceptibility.
- Prevention: Reduce transmission through timely public advisories, masks and avoidance of crowded places, particularly for high-risk groups; vaccination of vulnerable groups and healthcare workers can also be considered.
- Control: Ensure infected individuals receive timely and appropriate medical care to prevent complications and deaths.
What Does the Current Influenza Surge Indicate?
- India has developed a relatively strong viral disease surveillance system after COVID-19, but the link between surveillance and timely action remains weak.
- A study across selected hospitals found that influenza positivity among patients admitted with severe acute respiratory infection (SARI) increased from 12% last year to 16% this year.
- Despite established surveillance mechanisms, India reportedly lacks clearly defined and publicly available alert thresholds that would automatically trigger a stronger response.
- A publicly accessible influenza surveillance dashboard could improve transparency, risk assessment and timely decision-making.
Weak Surveillance-to-Action Link
- Influenza surveillance involves multiple institutions, creating possible gaps in coordination:
- ICMR: Conducts laboratory-based disease surveillance.
- National Centre for Disease Control (NCDC): Coordinates the public-health response.
- State health systems: Implement measures on the ground.
- The absence of a sufficiently integrated command mechanism can delay the conversion of early warning into coordinated action.
- An integrated command structure with clearly defined authority and responsibilities is therefore needed for disease surges as well as future pandemics.
Communication: Avoiding Both Panic and Complacency
- Government communication currently appears cautious, asking people to remain vigilant without creating alarm.
- However, vague reassurance that the influenza strain has not changed may create uncertainty about the actual level of risk.
- Risk communication should clearly explain what is known, what is uncertain and what preventive actions people should take.
- Advisories for high-risk groups to avoid crowded places and use masks can prevent avoidable infections and deaths.
- Governments often fear that stronger warnings may cause panic, but in a public-health emergency, proportionate overreaction may be preferable to delayed action when the objective is preventing deaths.
- Professional communication strategies involving public-health experts and risk-communication specialists are essential.
Low Influenza Vaccination Coverage
- Influenza vaccination remains low even among high-risk groups because of low perceived threat, affordability concerns, doubts about effectiveness and the need for annual vaccination.
- While universal influenza vaccination can be debated during normal periods, a significant seasonal surge provides an opportunity to consider targeted immunisation of high-risk groups.
- Failing to vaccinate vulnerable groups during major surges may leave India less prepared for future outbreaks and pandemics.
Need to Review Influenza Treatment
- The relatively low use of antiviral medicines, even during peak influenza seasons, requires examination.
- India should reconsider whether existing influenza management guidelines adequately address current epidemiological conditions.
- The private healthcare sector and professional medical bodies need to be integrated into outbreak preparedness and response.
Influenza Surges as “Mini-Pandemic” Preparedness Exercises
- Outbreaks, epidemics and pandemics lie on a continuum and require responses calibrated to their scale and severity.
- Seasonal influenza surges can function as real-world stress tests for surveillance, communication, vaccination and healthcare-response systems.
- The inter-pandemic period should therefore be used to identify institutional weaknesses and strengthen preparedness rather than waiting for another pandemic.
- Lessons from COVID-19 should be institutionalised, particularly by improving the surveillance-to-action mechanism and inter-agency coordination.
Way Forward
- Establish clear, publicly available epidemiological alert thresholds for influenza and other priority diseases.
- Create an integrated command mechanism linking ICMR surveillance, NCDC coordination and state-level implementation.
- Strengthen genomic surveillance to detect significant changes in circulating pathogens early.
- Adopt transparent, expert-led risk communication that avoids both complacency and unnecessary panic.
- Improve access to vaccination and antivirals for high-risk groups and periodically update treatment guidelines.
- Use seasonal disease surges as opportunities to test and refine India’s pandemic preparedness before the next major health emergency
