Dr Suneela Garg, Dr Ishwar Gilada, Dr Sagar Galwankar, Shobha Shukla, Bobby Ramakant
When health emergencies occur it is the doctors and other healthcare providers who are on the frontlines in responding to the humanitarian and public health crises. These frontline responders often know best what the problem is and what effective and pragmatic solutions could help improve responses. Are these healthcare providers engaged to play a key role in shaping effective solutions that work in local contexts? Are different medical specialities who have a crucial role during emergencies and humanitarian crises, coordinating amongst themselves and with government and other agencies who are decision makers for the response?
Undoubtedly, along with most affected people, it is the frontline healthcare providers and other responders who should be shaping responses to the pandemics and health emergencies. Failure to do this will exacerbate the crisis by sub-optimal responses.
Organized Medicine in India
Recognizing the dire need for associations of different medical specialities to join forces and give input to the government to help improve responses to health emergencies, the Organized Medicine Academic Guild (OMAG) of India1 came into being. OMAG is the academic guild of professional medical organizations in India, founded at the Annual Conference of Indian Academy of Paediatrics (PEDICON), on 7 January 2018 at Nagpur, India. OMAG is constituted by the leading professional medical organizations and mandated to support the Sustainability Health Agenda of the Government of India. Currently OMAG is a network of over 15 professional medical associations in the country including Association of Surgeons of India, AIDS Society of India, Indian Academy of Paediatricians, Indian Association of Preventive and Social Medicine, Emergency Medicine, Indian Associations of Opthalmologists, Orthopaedicians, Anaesthesiologists, INDUSEM, National Centres for Disease control, among others.
It is the collective vision that will help accelerate progress towards achieving health of our societies. Global health security is one of the biggest challenges for a highly diverse and populous nation like India.
Even in so-called ‘normal’ or non-pandemic times, there are health challenges that warrant multisectoral response and collaboration between different medical specialities and other associations and networks. For example, antimicrobial resistance, or trauma.
That is why OMAG is already unifying different medical experts’ associations to improve responses to antimicrobial resistance, TB, trauma, noncommunicable diseases (NCDs), infectious diseases, health emergencies and pandemics. These health emergencies and pandemics need clinical and public health solutions.
The commitment for global health security2 was also reiterated six years ago (2016) when Indian Prime Minister and then USA President had jointly endorsed the global health security agenda. Need of the hour is to bring people’s health centre-stage with measurable impacts at national level.
One world one health
Ensuring quality healthcare services for everyone worldwide is so vital. The commitment for expanding the universal healthcare coverage to one billion, protecting another one billion people from health emergencies, and ensuring one billion are enjoying better health and wellbeing worldwide are key cog-in-the-wheel for global health security. These are also interim goals towards health for all worldwide. One World One health agenda must be the unifying force. These ‘Triple Billion’ goals are also enshrined in the Global Programme of the World Health Organization (WHO)3.
That is why OMAG dedicatedly is trying to advance collective progress on antimicrobial resistance and multidrug resistant organisms4. Lack of public health convergence in terms of education, research and care is a challenge. Deeply entrenched disparities and inequalities are another major challenge when it comes to ensuring health for all. Emergency medicine, family medicine, infectious diseases, toxicology, or other such disciplines are in infancy currently. If we do not develop them quickly enough then it will severely limit our response.
Coordinated response is key. Connecting care, competencies and culture is a challenge.
OMAG and COVID-19 response in India
OMAG had also responded during COVID5 and continues to do so for ensuring the response to the pandemic is backed by science and evidence, and takes into account important recommendations emerging from OMAG member associations of different medical specialities6.
The Government of India's NTAGI (National Technical Advisory Group on Immunization) had accepted several of the science-backed and evidence-based suggestions made by OMAG, and the Ministry of Health and Family Welfare is implementing them7. Reducing gap between first and second primary doses of Covishield, addressing supply chain issues, vaccine hesitancy, sciencebacked rollout of more vaccines such as ZyCov-D, SMS-V campaign, are some of the suggestions that were put forth by OMAG to the authorities.
SMSV (Social distancing, Masks, Sanitization, and Vaccination) approach8
SMSV (Social distancing, Masks, Sanitization, and Vaccination) approach is a central cog in the wheel as we open up social mixing and economic activities and relax COVID-19 protocols. OMAG leaders had suggested SMS campaign (and then revised it to SMSV when vaccines became available for public rollout) to authorities since the beginning of the pandemic. Public education campaigns also using social media in local vernacular languages like Marathi was used9.
Less the virus circulates in human population, less is the chance of new variants. Breaking the chain of infection transmission remains centre-stage as pandemic response. SMSV is more important than ever before as we open up social mixing and economic activities, say experts.
Keeping science centre-stage
OMAG experts have been playing a key role in helping keep the response grounded in science and evidence. There is no doubt that even in times of crisis, we need to stick to reason, science and evidence. For instance, instead of comparing number of cases or deaths in a country, we should stick to number of cases or deaths per million population for comparative analysis and emerging disease trends. India stands at 2nd position worldwide in number of cases, or no.3 in total COVID-19 deaths globally. But if we look at number of cases per million, then India stands at 149th position worldwide and number 135th position if we look at deaths per million population.
During the recent and ongoing wave of COVID-19, nine out of every ten people who were hospitalised due to the corona virus, were unvaccinated. It is clear that vaccinations against COVID-19 helps reduce the risk of being hospitalised or dying if one gets infected with corona virus. With 97% of eligible population having received the first dose of COVID19 vaccine and 85% of these fully vaccinated, and almost similar part of the population having been exposed to the virus, immunity against COVID-19 is reasonably high in India, thereby risk of another catastrophic wave is perhaps minimal – though we need to be vigilant against emerging variants.
We should expect infectious disease like COVID-19 to be with us for few years, but hopefully as an endemic and we better learn to live with it. Disaster management and preparedness plans and those addressing global health security must also include organised medicine.
OMAG calls on all countries to remain vigilant, continue to vaccinate, test, sequence, provide early care for patients, and apply common-sense public health measures to protect health workers and the public.
The government must optimally and fully engage professional medical associations like OMAG and OMAG partners and members, nursing homes and clinics and other healthcare facilities which can play a catalytic role in accelerating vaccination programmes, especially for children and population sub-groups who are at higher risk of COVID-19, such as those living with HIV.
While India is rolling out the booster dose (precaution dose) and primary doses to those who are not fully vaccinated, it is prudent to invest in bridge studies to have more evidence of public health impact of further booster doses, or the need to lower dose of vaccine or combining different vaccine doses.
References
Dr Suneela Garg, Dr Ishwar Gilada, Dr Sagar Galwankar, Shobha Shukla, Bobby Ramakant
Ensuring quality healthcare services for everyone worldwide is so vital. The commitment for expanding the universal healthcare coverage to one billion, protecting another one billion people from health emergencies, and ensuring one billion are enjoying better health and wellbeing worldwide are key cog-in-the-wheel for global health security. These are also interim goals towards health for all worldwide. One World One health agenda must be the unifying force. These ‘Triple Billion’ goals are also enshrined in the Global Programme of the World Health Organization (WHO)3.
That is why OMAG dedicatedly is trying to advance collective progress on antimicrobial resistance and multidrug resistant organisms4. Lack of public health convergence in terms of education, research and care is a challenge. Deeply entrenched disparities and inequalities are another major challenge when it comes to ensuring health for all. Emergency medicine, family medicine, infectious diseases, toxicology, or other such disciplines are in infancy currently. If we do not develop them quickly enough then it will severely limit our response.
Coordinated response is key. Connecting care, competencies and culture is a challenge.
OMAG and COVID-19 response in India
OMAG had also responded during COVID5 and continues to do so for ensuring the response to the pandemic is backed by science and evidence, and takes into account important recommendations emerging from OMAG member associations of different medical specialities6.
The Government of India's NTAGI (National Technical Advisory Group on Immunization) had accepted several of the science-backed and evidence-based suggestions made by OMAG, and the Ministry of Health and Family Welfare is implementing them7. Reducing gap between first and second primary doses of Covishield, addressing supply chain issues, vaccine hesitancy, sciencebacked rollout of more vaccines such as ZyCov-D, SMS-V campaign, are some of the suggestions that were put forth by OMAG to the authorities.
SMSV (Social distancing, Masks, Sanitization, and Vaccination) approach8
SMSV (Social distancing, Masks, Sanitization, and Vaccination) approach is a central cog in the wheel as we open up social mixing and economic activities and relax COVID-19 protocols. OMAG leaders had suggested SMS campaign (and then revised it to SMSV when vaccines became available for public rollout) to authorities since the beginning of the pandemic. Public education campaigns also using social media in local vernacular languages like Marathi was used9.
Less the virus circulates in human population, less is the chance of new variants. Breaking the chain of infection transmission remains centre-stage as pandemic response. SMSV is more important than ever before as we open up social mixing and economic activities, say experts.
Keeping science centre-stage
OMAG experts have been playing a key role in helping keep the response grounded in science and evidence. There is no doubt that even in times of crisis, we need to stick to reason, science and evidence. For instance, instead of comparing number of cases or deaths in a country, we should stick to number of cases or deaths per million population for comparative analysis and emerging disease trends. India stands at 2nd position worldwide in number of cases, or no.3 in total COVID-19 deaths globally. But if we look at number of cases per million, then India stands at 149th position worldwide and number 135th position if we look at deaths per million population.
During the recent and ongoing wave of COVID-19, nine out of every ten people who were hospitalised due to the corona virus, were unvaccinated. It is clear that vaccinations against COVID-19 helps reduce the risk of being hospitalised or dying if one gets infected with corona virus. With 97% of eligible population having received the first dose of COVID19 vaccine and 85% of these fully vaccinated, and almost similar part of the population having been exposed to the virus, immunity against COVID-19 is reasonably high in India, thereby risk of another catastrophic wave is perhaps minimal – though we need to be vigilant against emerging variants.
We should expect infectious disease like COVID-19 to be with us for few years, but hopefully as an endemic and we better learn to live with it. Disaster management and preparedness plans and those addressing global health security must also include organised medicine.
OMAG calls on all countries to remain vigilant, continue to vaccinate, test, sequence, provide early care for patients, and apply common-sense public health measures to protect health workers and the public.
The government must optimally and fully engage professional medical associations like OMAG and OMAG partners and members, nursing homes and clinics and other healthcare facilities which can play a catalytic role in accelerating vaccination programmes, especially for children and population sub-groups who are at higher risk of COVID-19, such as those living with HIV.
While India is rolling out the booster dose (precaution dose) and primary doses to those who are not fully vaccinated, it is prudent to invest in bridge studies to have more evidence of public health impact of further booster doses, or the need to lower dose of vaccine or combining different vaccine doses.
References
- Organized Medicine Academic Guild (OMAG) of India: http://organizedmedicine.in
- Joint Statement: The United States and India: Enduring Global Partners in the 21st Century https://obamawhitehouse.archives.gov/the-pressoffice/2016/06/07/joint-statement-united-statesand-india-enduring-global-partners-21st
- Triple Billion dashboard of World Health Organization (WHO) https://www.who.int/data/triple-billion-dashboard
- Fighting Anti-microbial Resistance (AMR): Status Paper with Action Points by Organized Medicine Academic Guild https://www.researchgate.net/publication/333404928_Fighting_Antimicrobial_Resistance_AMR_Status_Paper_with_Actio n_Points_by_Organized_Medicine_Academic_Guild
- India's need for long-term solutions to COVID-19-like pandemics: a policy paper by organized medicine academic guild https://pesquisa.bvsalud.org/globalliterature-on-novel-coronavirus-2019ncov/resource/pt/covidwho-1235586
- OMAG calls for optimal engagement of medical experts in response to Covid-19 pandemic www.pharmabiz.com/NewsDetails.aspx?aid=147620&sid=1
- Doctors' body OMAG wants ban on international flights in wake of OMICRON variant https://www.deccanherald.com/national/west/doc tors-body-omag-wants-ban-on-international-flightsin-wake-of-omicron-variant-1055455.html
- SMS campaign and OMAG https://mumbaimirror.indiatimes.com/opinion/col umnists/by-invitation/india-is-in-for-a-verydifficult-period-ahead/articleshow/77340882.cms
- Dr Ishwar Gilada in Marathi on Lockdown versus SMS-Sanitizer,Mask,Social Distance to contain COVID19 https://www.youtube.com/watch?v=3FO7Kb7B3X8
- Dr Suneela Garg is the President, Organized Medicine Academic Guild (OMAG) Professor of Excellence (Community Medicine), and Ex-Sub-Dean of Maulana Azad Medical College (MAMC)
- Dr Ishwar Gilada is the Secretary General, Organized Medicine Academic Guild (OMAG) and President, AIDS Society of India (ASI) and Governing Council member of International AIDS Society (IAS)
- Dr Sagar Galwankar is the Director for Research and Development, Florida State University, USA; Scientific Chair of OMAG; and former Director of American College of Academic International Medicine
- Shobha Shukla is the founding Executive Director and Managing Editor of CNS and Bobby Ramakant is part of CNS team
