J Krishnamurti, a renowned philosopher, describes fear as the transition from the convictions of the Known to the flux of the Unknown¹. The weakening of the interspecies transmission barrier between the animal and human interface has strengthened this fear. Consequently, our impulsive selves have taken precedence over our reflective voices.

Some numbers from 2019 should put things in perspective: The National Centre for Disease Control reports 28,798 seasonal influenza (H1N1) cases in our country with 1218 deaths (1), The National Vector Borne Disease Control Programme reports 1,36,422 cases of dengue with 132 deaths, 3,34,693 cases of malaria and 1,55,809 p falciparum cases with 50 deaths, 3128 cases of kala-azar, 14,464 acute encephalitis cases with 732 deaths, 2294 cases of Japanese encephalitis with 231 deaths, and 9477 chikungunya cases (1, 2). To top the burden, there is community acquired pneumonia, typhoid, UTIs, sepsis, whose national data is not available. Most of these numbers should be staggering enough to ring alarm bells; yet, there has been no panic. Diarrhoea is the third most common cause of death in under-five children, responsible for 13% deaths in this age-group, killing an estimated 300,000 children in India each year (3). There has not been a shortage of masks; sanitisers have not flown off the shelves and nothing remotely approaching a lockdown has occurred. Lack of safe drinking water has never been seen an emergency. All of these non-Covid-19 burdens seem to have lost their relevance now. Hospitals are restructuring themselves solely as Covid-19 “warzones”.

It may be salutary to recall the herculean efforts that India has put in to eradicate a communicable disease ─ tuberculosis. TB is a far more deadly disease than Covid-19 and has a wider range of transmissibility (4). RNTCP reports India had 2150,000 notified TB cases in 2018 (5). Till this day, active TB does not have a serological rapid card detection test with high sensitivity and specificity for diagnosis. BCG has proven efficacy only in severe forms of TB in childhood and new cases of pulmonary TB continue to occur despite the high coverage of BCG. Since TB is just a disease of historical interest in more affluent countries with low burden, not many trials are underway in search of a better vaccine. The estimated cost of developing a safe and effective TB vaccine is reported to be around over 1.25 billion dollars (6), unaffordable for countries bearing the TB burden. Further complicating matters, is the bunch of vector-borne diseases (malaria, dengue, chikungunya, etc), which every year debilitate thousands of people in the country, waiting in line for candidate vaccines from over 50 years (7). While there is no silver lining in sight for these diseases, Covid-19 seems to have jumped the queue with billion dollar funding for the fastest ever development of vaccine in history.

A century ago, the global North was also fighting against polio, diphtheria and pertussis. The vaccines were introduced to the world then, shipped to the South after decades, and immunisation programmes began. Anti-tubercular therapy (including the latest Bedaquiline for MDR-TB) was developed for affluent societies, so was anti-retro viral treatment for HIV/AIDS- both of which arrived much later in the South. The drug development pipeline indicates that of the 1,393 total new drugs approved between 1975 and 1999, only 1 % (13 drugs) was specifically designated for a tropical disease (8). The situation has not changed much since then, with those for genetic disorders or cell and gene therapy (majority of them for cancer) taking away the major share of interest and funding resources in recent years (9). An anti-corona viral drug today is being pushed for early development with massive funding, biopharmaceutical companies up in the global north are working round the clock.

There has been a proliferation of global foundations, funds, action plans and big players (GAVI, PATH, WHO, UNICEF, Gates Foundation, MSF et al) striving to meet public health targets of disease control, elimination and eradication, articulated as MDGs and SDGs. As long as our healthcare system is not patient centric and fragmented into innumerable bureaucratic silos (communicable/noncommunicable diseases, tobacco, blindness, deafness, iodine, iron, thyroid, leprosy etc), it will continue to be hamstrung, and not just during epidemics. Further, our healthcare system is plagued by internal issues (or barriers) ─ no access to medicines, vested political interests, and out of pocket expenditure, a long list of ills (10). It shouldn’t therefore require a Covid-19 to stir the already shaken health system. In the fight against the diseases of poverty, Philip Stevens writes eloquently that wealth creation is the only solution (11). While we express gratitude for what has been handed down by the global North, it is time to find our own feet. As Covid-19 takes the spotlight, a plethora of infectious diseases appear to be here to stay. If Covid-19 is a public health emergency, shouldn’t the other communicable diseases with high burden also be?

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