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Lakshmy Ramakrishnan and Shravishtha Ajaykumar, “Strengthening India’s Health Preparedness Framework,” ORF Special Report No. 255, April 2025, Observer Research Foundation.
Between late 2019 and early 2020, the world witnessed the outbreak of a novel virus, SARS-CoV-2,[1] which soon escalated into a public health emergency. The World Health Organization (WHO) declared the respiratory virus a Public Health Emergency of International Concern (PHEIC) in late January 2020, triggering national governments worldwide to impose guidelines on personal protective hygiene, promote social distancing, and impose travel and movement restrictions. While the world has slowly recovered, the stringent government restrictions, owing to the lack of a specific streamlined plan to address pandemics, demonstrated our vulnerability to novel infectious diseases and their profound social, economic, and political impact.
In India, the COVID-19 pandemic was managed under the 1897 Epidemic Diseases Act[1] and the 2005 National Disaster Management Authority (NDMA) Act.[2] However, these Acts have limitations, as discussed in the 22nd Law Commission of India’s Comprehensive Review of the Epidemic Diseases Act 1897 and NITI Aayog’s Expert Committee Report.[3],[4] The NDMA Act lacks guidance for clinical management and public health responses to biological threats, while the colonial-era Epidemic Diseases Act is outdated. It fails to address emerging diseases and man-made threats, define the magnitude of infectious disease outbreaks, ensure appropriate data-sharing mechanisms from national to regional levels and across different sectors, allocate powers of implementation and control of health crises in a decentralised manner, and ensure the production, distribution, storage, and transportation of medical products and devices during emergencies.
In 2017, the National Centre for Disease Control and the Directorate General of Health Services, under the Ministry of Health and Family Welfare (MoHFW), drafted the Public Health (Prevention Control, and Management of Epidemics Bio-Terrorism and Disasters) Bill,[5] which introduced a four-tier health administration structure and defined key terms such as ‘epidemic’ and ‘bioterrorism’. A revised version of this bill was introduced in the Rajya Sabha (Upper House) in 2020 but was never passed in parliament.[6] The Law Commission’s 2024 report noted further gaps in the draft bill. Meanwhile, amendments to the Epidemic Diseases Act focused only on protecting healthcare workers from violence during the COVID-19 pandemic.
Both the Law Commission and NITI Aayog reports emphasised the need for India to establish a unified framework to address natural and man-made biological threats. Establishing a Public Health Emergency Management Act (PHEMA), as recommended in NITI Aayog’s Expert Committee Report, would provide comprehensive, preventive, and mitigative action plans[7] while enhancing India’s existing health framework.[8]
Indeed, the world continues to be susceptible to different infectious diseases to varying degrees, necessitating vigilance and a holistic governance approach for effective and timely response. For instance, Kerala’s response to recent NiV outbreaks was premised on lockdown measures akin to those used during the COVID-19 pandemic,[9] reflecting India’s tendency to handle small-scale outbreaks with emergency responses rather than long-term preparedness. Accordingly, there is a need to shift health security beyond public health interventions such as lockdown measures and towards sustained preventive strategies. In the case of the NiV, this would entail a One Health[2] approach, such as monitoring susceptible bat populations and developing medical countermeasures through public-private partnerships (PPP) and international collaborations.
As India envisions Viksit Bharat 2047, which emphasises effective governance, public health policies must be contextually calibrated.[c] This encompasses focusing on increasing the capacity of health systems to prevent, prepare for, and respond to different kinds of biological threats. India needs to develop a shared understanding of health security, biosecurity, and biosafety; strengthen the biotechnology innovation ecosystem through BioE3[d] and Bio-RIDE[e] policies; and foster international cooperation and diplomacy through mechanisms such as the US-India TRUST[f] initiative and Quad Bioexplore.[10],[11],[12],[13] This report analyses India’s COVID-19 response through a detailed literature survey and expert commentary, offering recommendations to bolster the country’s health preparedness framework.
Robust surveillance is crucial for managing infectious disease outbreaks[14] and was central to the COVID-19 response. Key aspects include genomic surveillance, monitoring epidemiological trends, and assessing clinical correlates.[15] India has partnered with international organisations and research institutions to bolster its modelling and risk assessment capabilities. Notably, the International Health Regulations (2005, IHR)[16] mandate countries to establish adequate surveillance systems, promptly notify WHO of any suspected PHEIC, and assess and respond to these threats to prevent their spread.[17]
For COVID-19, WHO recommended member states to monitor morbidity and mortality rates, identify Variants of Concern (VOC), recognise high-risk and high-priority settings, and track the status of vaccination.[18] Virological surveillance was carried out using molecular detection methods, including polymerase chain reaction (PCR), rapid antigen tests, and serological assays.[19] In India, the National Institute of Virology (NIV), under the Indian Council of Medical Research (ICMR), first detected COVID-19 in January 2020 and standardised the reverse transcriptase-PCR (RT-PCR) test.[20] By March 2021, 2,435 laboratories were conducting COVID-19 testing. Medical colleges were operationalised as COVID-19 testing centres by training initiatives led by the All India Institute of Medical Sciences (AIIMS) and the Post Graduate Institute of Medical Education and Research (PGIMER). The Integrated Disease Surveillance Programme (IDSP), under the National Health Mission, was instrumental in maintaining disease trends from the district, state, and central levels.[21] Data from the Integrated Health Information Platform (IHIP) supplemented IDSP with real-time information and GIS-based[g] data on outbreaks.[22] Under the PM-Ayushman Bharat Health Infrastructure Initiative, launched in 2021, regional centres for the NIV will be set up in the northeastern, western, and southern regions to further strengthen viral surveillance.[23],[24]
Although India’s surveillance system was well established, it lacked the integration needed to manage a pandemic-scale outbreak.[25] For instance, genomic surveillance was highly centralised and required greater inclusion of genomic data from state and local levels[26] to align with WHO’s decentralised strategies, ensuring wider geographic coverage and better demographic representation.
To enhance data management, the National Informatics Centre (NIC) worked with the Ministry of Health and Family Welfare (MoHFW) to form a Special Surveillance System (S3) that formed a centralised data source of COVID-19-related data, including surveillance information from state and district levels, contact tracing, quarantining, patient management, and logistics.[27] S3 data was integrated with Aarogya Setu—a Bluetooth-based contact-tracing app—and CoWIN[h] for vaccine dissemination.
The Indian SARS-CoV-2 Genomics Consortium (INSACOG)—a joint venture between the Union Ministry of Health, the Department of Biotechnology (DBT), the Council for Scientific and Industrial Research (CSIR), and ICMR—enabled nationwide genomic surveillance of SARS-CoV-2, linking genomic variations with epidemiological trends.[28]
The pandemic posed unprecedented challenges in data management, such as predicting disease pathways in hotspots, epidemiological monitoring, genomic surveillance of VOC, and leveraging genomic information for clinical management and countermeasure development. The lack of a unified data portal in India impeded seamless data management and subsequent pandemic response. India has multiple data portals, including the IDSP under the IHIP and ICMR’s COVID-19 Sample Collection Tests, which were useful. However, unifying these platforms would enhance decision-making processes.[29] For instance, the IDSP data needed to incorporate health data from the private sector, which serves up to 60 percent of the population’s medical and laboratory needs.[30]
INSACOG’s utility across India remained limited owing to capacity constraints.[31] Coordination between public and private healthcare sectors (primary and secondary) was limited, and genome sequencing faced logistical challenges in the transportation and coordination of samples to specific laboratories. While the INSACOG network has expanded from 28 laboratories in 2021 to 54 at present, further scaling is necessary.[32],[33],[34] Data gaps, especially in rural or marginalised communities, restrict effective response strategies.[35] A comprehensive, integrated data portal combining clinical, epidemiological, genomic, serological, and immunological data could support predictive models and early warning systems (EWS),[36] shifting from siloed approaches to coordinated responses. Enhanced data-sharing and coordination between laboratory-based and hospital-based sentinel genomic surveillance can aid in understanding long-term implications, geographic distribution of diseases, risk factors, genetic evolution, and health systems impacts.[37] While the IHR does not specifically mention predictive modelling, it aligns with IHR’s goals[38] by forecasting disease trends, assessing infection spread, and informing public health responses. Incorporating artificial intelligence (AI) with early warning systems could further strengthen India’s predictive capabilities through real-time biological threat assessments, environmental analysis, and population movement tracking. Studies by the Gates Foundation and NITI Aayog highlight AI’s potential for high-quality data collection and improved outbreak preparedness.[39]
India has recognised the importance of One Health in mitigating emerging and re-emerging zoonotic diseases, particularly with periodic outbreaks of dengue and NiV. India’s One Health initiatives are under the ‘One Earth, One Health’ framework, including the One Health Mission and National Action Plan 2.0 to tackle antimicrobial resistance (AMR). The National Institute of One Health in Nagpur has also been launched. The National Animal Disease Referral Expert System (NADRES), a GIS-based, remote-sensing disease surveillance system, monitors livestock across states and union territories (UTs).[40] However, there is a need to integrate the systematic collection of livestock disease data nationwide to formulate predictive models and enhance EWSs.[41] To enhance One Health surveillance measures, a network of BSL-3[i] and BSL-4 laboratories, along with repositories of bacterial and viral pathogens, should be maintained for plants, animals, and humans. This biorepository would help identify potential epidemic or pandemic threats and can aid in developing innovative technologies.[42]
In addition to pathogen surveillance, a One Health approach also requires understanding the environment and the ecosystem, including the interaction between soil, water, organisms, chemicals, and anthropogenic factors. The One Health Joint Plan of Action (2022-2026)[j] outlines six interdependent actions aimed at ensuring sustainable food and health systems, reducing global disease threats, and managing ecosystems more effectively.[43] The action plan calls for understanding antimicrobial resistance (AMR), monitoring organic pollutants and wastewater, and surveying animals like bats that host zoonotic outbreaks. However, in India, investments in these areas—particularly for animal and environmental health—remain limited, leading to resource constraints.[44] The operationalisation of One Health also requires consideration of cultural and social aspects, such as human and animal behaviour, forest health, stressors that trigger zoonotic spillover, food safety in meat processing industries, and managing zoos, petting zoos, and wildlife sanctuaries. For instance, addressing NiV outbreaks requires context-specific responses that account for factors contributing to viral spillover.[45] Interaction with social scientists can aid in implementing preventive health measures with a One Health perspective.
Sharing genomic sequence data, epidemiological factors, climate variability, and environmental factors with partnering countries under Quad and the US-India TRUST initiative can greatly aid joint health preparedness. Bioinformational diplomacy—or the sharing of biological information between countries—can also contribute to developing predictive models and EWSs.
The characterisation of biological samples requires enhanced biocontainment facilities. India plans to expand the number of BSL-4 and BSL-3 laboratories. The country’s first BSL-4 laboratory, established in 2013 at NIV-Pune in collaboration with the Department of Science and Technology (DST),[46] was followed by two more BSL-4 labs opened in the Defence Research and Development Organisation (DRDO) and Gwalior.[47] To effectively manage risks, comprehensive risk assessment frameworks need to be developed for human, animal, and plant health, as well as the environment (e.g., wastewater analysis). These can be managed through a centralised risk assessment committee.[48] Enhanced cloud computing and cyber approaches can be applied to improve data-sharing capabilities and block timelines, enabling real-time information sharing.[49] A national biosecurity framework can adopt global benchmarks to ensure best practices (Table 1).
| Organisation | Takeaways |
| National Security Commission on Emerging Biotechnology (NSCEB), USA[50] | Developing risk assessments at the intersection of biotechnology and emerging technologies (e.g., AI), oversight of gene synthesis, and assessment of wastewater to predict biological threats. |
| Centers for Disease Control and Prevention (CDC), US[51] | Employment of culture-independent diagnostic tests (CIDTs), which rapidly identify pathogens but lack detailed information on bacterial strains and antibiotic resistance. Adopting nanopore sequencing technologies provides a portable, cost-effective alternative to traditional next-generation sequencing (NGS), making it ideal for remote outbreak investigations. |
| UK Health Security Agency, UK[52] | The extensive use of real-time genomic sequencing, environmental monitoring, and AI-based predictive models to map and predict the spread of outbreaks across different regions. |
| National Institute of Infectious Diseases (NIID), Japan[53] | The National Epidemiological Surveillance of Infectious Diseases (NESID) Program focuses on genomic surveillance. It entails a structured communication and reporting system between national and local governments. |
| Australian National Disease Surveillance System (ANDSS), Australia[54] | Using real-time genetic information, AI-based predictive modelling, and ML-based technologies can serve as early warning networks. Australia has developed a national strategy integrating advanced technologies and inter-agency collaboration for practical biological risk assessment. |
Source: Authors’ own, based on various open sources
Landscaping studies to understand biological risks from an Indian perspective are required.[55] Low-resource settings, differential healthcare systems across the nation, diversity in flora and fauna, biological ecosystems, high population density, and climate change place different regions of India at differential levels of risk. In addition, the deliberate use of biological agents as weapons requires an understanding of new risks, such as those posed by the convergence of new and emerging technologies (e.g., artificial intelligence) and synthetic biology or biotechnology.[56] Red-teaming exercises and gene synthesis monitoring can be included to mitigate the threat of deliberate biological agent release by malevolent actors and to regulate the use of dual-use technologies.[57]
India relied on imported COVID-19 diagnostic kits during the initial months of the pandemic. However, increased demand prompted domestic manufacturers to enter the development arena. The National Biomedical Resource Indigenisation Consortium (NBRIC)–an initiative formed by DBT and the Centre for Cellular and Molecular Platforms (C-CAMP)—spearheaded the development of diagnostics and vaccines by identifying the nation’s specific needs.[58]
India witnessed an unprecedented rate of indigenous diagnostics development during the pandemic. At the onset of COVID-19 in 2020-2021, NIV Pune was the only laboratory in the country capable of detecting the virus. Notably, in the period of maximum severity, a comprehensive network of 3,000 laboratories (Viral Research and Diagnostic Laboratories) was set up by ICMR. RT-PCR tests were employed as the diagnostic tool, while, Enzyme-linked Immunosorbent Assay (ELISA) facilitated robust surveillance mechanism for populations who had developed immunity or were in the latter stages of infection. NIV Pune developed India’s first antibody-testing kit—ELISA-based,[59] which was later produced commercially in partnership with Zydus Cadila Ltd, reinforcing the ‘Make in India’ initiative during the crisis. ICMR’s COVID-19 Sample Collection System was the repository for RT-PCR and rapid antigen tests.[60] India initially was deficient in materials, including N95 masks, PPE (personal protective equipment), and reagents such as viral transport medium (VTM).[61] Partnerships with the start-up community and private sector helped bridge these gaps, while DRDO developed technologies to aid in sanitisation against COVID-19.[62]
NIV Pune and Bharat Biotech International Pvt Ltd jointly developed COVAXIN, India’s whole inactivated virus vaccine,[63] under Mission COVID Suraksha, a key initiative of the Atmanirbhar Bharat programme. Technical and financial support for pre-clinical and clinical phases of vaccine development was provided to other COVID-19 vaccines as well: ZyCoV-D®—the world’s first DNA vaccine for Covid, CORBEVAXTM—the nation’s protein sub-unit vaccine, GEMCOVAC™19—India’s indigenously developed mRNA vaccine, and iNCOVACC—India’s indigenously developed intranasal COVID-19 Vaccine.
While sufficient competencies in research and industry sectors were demonstrated during the pandemic, strengthening public-private partnerships (PPPs) remains crucial to enhancing the value of product development.[64] Although indigenous technologies, such as diagnostic kits, were linked to relevant industrial partners, these linkages lacked a structured framework to address health crises.[65] A systematic approach is necessary to connect translational research, such as vaccine development, with bulk manufacturers.
Start-ups played a crucial role in the development of affordable PPE, but supply chains were interrupted owing to an inability to predict market demand and a lack of integration in operations. Additionally, pre-clinical testing was restricted by limited animal house facilities and restricted access to biological samples and infrastructure. The regulatory approval of new technologies (diagnostic kits and vaccines) could not address emergency authorisation, severely impacting the pandemic response.
To address these challenges, harmonisation of international regulatory guidelines for emergency authorisations is needed. A dedicated PPP framework for emergency preparedness could help by strengthening supply chain resilience, streamlining regulatory approvals for essential medical countermeasure, including standardised protocols, creating a dedicated funding mechanism for scaling up countermeasures manufacturing, incorporating capacity-building measures to promote innovation in vaccine, diagnostics, and therapeutics (VDTs), and facilitating MoUs for data-sharing and technology transfer.
The new biotechnology policies, Bio-E3 and Bio-RIDE, will facilitate the development of commercially relevant technologies to address health crises.[66],[67] In conjunction with the Promotion of Research and Innovation in Pharma MedTech Sector (PRIP) and performance-linked incentives, these new ventures can boost India’s bioeconomy and strengthen supply chains.[68] Infectious disease outbreaks have been described as “low frequency, high-impact supply chain-disruptive events”.[69] The quality of diagnostic tests is critical for epidemiological surveillance and clinical management. However, despite the availability and development of platform technologies, large-scale production requires resilient supply chains—something that was absent during the COVID-19 pandemic. Procuring biological materials and chemical reagents was also a challenge.
To circumvent such issues, India can focus on the domestic production of these materials and reagents while establishing regulations that necessitate their production during health emergencies under pre-approved, standardised protocols. Additionally, international collaborations can facilitate regulatory reforms and establish globally recognised guidelines for emergency authorisations.
Preparedness includes not only pathogens with pandemic potential but also transient infectious diseases like the NiV and mpox (formerly monkeypox).[70] Prophylactic measures—pre- and post-exposure vaccines, immunoglobulin-based therapies, and monoclonal antibodies—are primary contenders. Considering diseases such as dog-mediated rabies, which also requires a One Health perspective, these three prophylactics are essential. However, access to these technologies by low- and middle-income countries (LMICs) is limited owing to structural inequities and large-scale production of these technologies is seldom necessary, discouraging industrial investments.
The pandemic exposed vaccine distribution constraints and supply chain vulnerabilities. These structural inequities expand into vaccines, diagnostics, and therapeutics that are used for other disease conditions as well. Targeted funding towards developing vaccine platform technologies, data and knowledge-sharing, and streamlining regulatory processes and clinical trials are essential to enhance preparedness towards diseases that do not pose pandemic potential but require adaptability to biologically similar or similarly acting pathogens. These efforts should be reinforced at the bilateral and multilateral levels, including discussions on the proposed pandemic treaty and political action. Additionally, collaborations through the Bio-5 Biopharmaceutical Supply Chain Consortium, Quad BioExplore, and the US-India TRUST initiative can be leveraged to strengthen pharmaceutical supply chains and foster innovative research and development of medical countermeasures.
Healthcare systems faced severe challenges during the pandemic.[71] The normative adaptive capability of health systems addresses the dynamic needs of patients through structural reorganisation and resource allocation. However, the pandemic overwhelmed these systems, making it difficult to balance the needs of COVID-19 patients and those with chronic diseases or oncological conditions. Hospitals also struggled to segregate COVID-19-infected and non-infected patients at the ward level.[72],[73]
Containment efforts required reallocating funds, medical and nursing professionals, hospital beds, healthcare services, and intensive-care unit (ICU) beds to COVID-19 patients, placing non-COVID-19 patients with underlying conditions at a massive disadvantage.[74] While telemedicine helped improve healthcare services, the upsurge in hospitalisation and direct hospital consultations strained routine medical services. Primary healthcare, which must address non-communicable diseases like cardiovascular disease and cancer, was severely impacted. Other chronic conditions, such as tuberculosis, were left under-resourced and understaffed,[75] exacerbating the treatment gap. Studies found that primary healthcare centres were largely unable to address routine health concerns.[76]
Health systems can adapt to an organisational triage system that ensures adequate, standardised medical care across different healthcare needs.[77] This includes implementing measures to address routine medical care (e.g., ophthalmic care), urgent care or trauma care (e.g., road accident injuries, tuberculosis treatment), and surge scenarios (e.g., pandemics like COVID-19). The COVID-19 pandemic posed unique challenges, including a high number of infections, an initially unknown aetiology, limited therapeutic and prophylactic measures, and the need for specialised care involving PPE and isolation protocols.[78] Beyond treatment, healthcare systems also require organised treatment and information management to determine whether existing infrastructure can meet specific treatment requirements and to track patients for purposes such as contact tracing. Developing specific tools like a surge capacity plan can improve response capabilities. This would involve hiring more resource personnel, designating dedicated physical spaces for addressing the crisis, and stockpiling essential medical supplies. These measures would enable health systems to manage epidemics or pandemics effectively while ensuring continued care for other medical interventions.[79]
The COVID-19 pandemic highlighted key areas where India handles a health crisis, specifically in health data surveillance, PPPs, and healthcare systems preparedness for disease surges. To address gaps in the existing health framework and move towards a single biological threat approach, India can implement the following recommendations. These range from larger international collaboration efforts to specific actions that the MoHFW and the Department of Biotechnology (DBT), under the Ministry of Science and Technology, can take.
Further, the DBT should be the base for India to continue building international partnerships in health research, surveillance, and response. Using existing coalitions such as the Quad BioExplore or US-India TRUST initiative, and regional blocs like the Indo-Pacific Centre for Health Security, India can both contribute to and benefit from shared knowledge, resources, and good practices. Sustained partnerships can facilitate joint preparedness exercises, ensuring that India can access global and regional support during health emergencies, ultimately enhancing global and national disease preparedness, and enabling rapid, coordinated responses.
A dedicated PPP framework should facilitate the development and manufacturing of medical countermeasures through pre-approved stadnardised protocols, technology transfer agreements with the private sector, and streamlined regulatory approvals. This would ensure the timely utilisation of platform technologies by the public and private sectors.
Clinical management at the hospital level requires surge-capacity plans that incorporate specific strategies to manage unanticipated surges.
India’s response to the COVID-19 pandemic and subsequent NiV outbreaks highlighted gaps in the healthcare regime. While India has enhanced its approach to healthcare since, gaps remain, such as the need for standardisation in surveillance, data management, and knowledge and resource sharing, including private sector partners and handling unprecedented surges. The MoHFW and DBT must strengthen their health preparedness framework to address these challenges.
India can adopt a unified framework for sharing disease surveillance data across clinical, research, and industry partners, facilitating the production of medical countermeasures and the adoption of public health measures. A strong modelling and forecasting system, alongside a national biosecurity framework, will bolster India’s preparedness to address emerging and re-emerging zoonotic viruses, vector-borne diseases, and antimicrobial resistance, which collectively require a One Health approach. Sustained cooperation with international partners can foster resilience and solidarity in the face of health threats.
The authors would like to acknowledge the expert opinions shared by Dr Rajni Kant Srivastava (Indian Council of Medical Research), Dr William Selvamurthy (Amity University), Dr Gagandeep Kang (Gates Foundation), Dr Rajib Dasgupta (Jawaharlal Nehru University), Dr Anand Krishnan (All India Institute of Medical Sciences), Dr Chandrakant Lahariya (Foundation for People-centric Health Systems), Dr Meru Sheel (University of Sydney), Dr Suryesh K Namdeo (Department of Science and Technology – Policy Research Centre), Ms Carmen Shaw (US National Academies Science Engineering Medicine) during a roundtable conference held at Observer Research Foundation, New Delhi.
[1] The virus responsible for the COVID-19 pandemic.
[2] ‘One Health’ refers to a unified approach that addresses the health of people, animals, and the environment. It is an important component in identifying and responding to biological threats.
[c] India’s aspirations to become a developed nation by 2047.
[d] Biotechnology for Economy, Environment, and Employment.
[e] Biotechnology Research Innovation and Entrepreneurship Development.
[f] Transforming Relations Utilising Strategic Technologies.
[g] Geographic information system.
[h] Government of India’s vaccine registration portal; COVID Vaccine Intelligence Network.
[i] Biosafety level.
[j] A report jointly prepared by the Quadripartite of the Food and Agriculture Organisation (FAO), United Nations Environment Programme (UNEP), World Organisation for Animal Health (WOAH), and World Health Organisation (WHO).
[1] Law Commission of India, A Comprehensive Review Of the Epidemic Diseases Act, 1897, Government of India, 2024, https://cdnbbsr.s3waas.gov.in/s3ca0daec69b5adc880fb464895726dbdf/uploads/2024/02/20240212724768593.pdf
[2] India Code, Disaster Management Act, 2005, Government of India, 2005, https://www.indiacode.nic.in/handle/123456789/2045?sam_handle=1
[3] Law Commission of India, A Comprehensive Review of the Epidemic Diseases Act, 1897
[4] NITI Aayog, Future Pandemic Preparedness and Emergency Response a Framework For Action, Government of India, 2024, https://www.niti.gov.in/sites/default/files/2024-09/Report-of-the-Exper-Group--Future-Pandemic-preparedness-and-emergency-response_0.pdf
[5] Digital Sansad, “The Public Health (Prevention, Control and Management of Epidemics, Bio-Terrorism and Disasters) Bill, 2017,” Government of India, https://sansad.in/getFile/BillsTexts/RSBillTexts/Asintroduced/pub%20health-E-13320.pdf?source=legislation
[6] Digital Sansad, “The Public Health (Prevention, Control And Management Of Epidemics) Bill, 2020,” Digital Sansad, Government of India, https://sansad.in/getFile/BillsTexts/RSBillTexts/Asintroduced/pub%20health-E-13320.pdf?source=legislation
[7] Manish Tewari, “India’s Fight Against Health Emergencies: In Search of a Legal Architecture,” Observer Research Foundation, May 2023,
[8] Sanket Koul, “NITI Aayog Group Proposes Separate Law To Tackle Public Health Crises,” Business Standard, September 12, 2024, https://www.business-standard.com/health/niti-aayog-group-proposes-separate-law-to-tackle-public-health-crises-124091200287_1.html
[9] Lakshmy Ramakrishnan, “Nipah Virus: The Need For Contextually-Situated Public Health Responses,” Observer Research Foundation, May 2024, https://www.orfonline.org/expert-speak/nipah-virus-the-need-for-contextually-situated-public-health-responses
[10] Ministry of Science and Technology, Government of India, https://pib.gov.in/PressReleaseIframePage.aspx?PRID=2048569
[11] Ministry of Science and Technology, Government of India, https://pib.gov.in/PressReleasePage.aspx?PRID=2056001
[12] US Embassies and Consulates in India, Government of the United States of America, https://in.usembassy.gov/united-states-india-joint-leaders-statement/
[13] Prime Minister’s Office, Government of India, https://pib.gov.in/PressReleasePage.aspx?PRID=2057460
[14] Jillian Murray and Adam L. Cohen, “Infectious Disease Surveillance,” International Encyclopedia of Public Health (2017), https://doi.org/10.1016/B978-0-12-803678-5.00517-8
[15] World Health Organization, Public Health Surveillance For COVID-19: Interim Guidance, 2022, World Health Organization, https://www.who.int/publications/i/item/WHO-2019-nCoV-SurveillanceGuidance-2022.2
[16] WHO, International Health Regulations, 2019, World Health Organization, https://www.who.int/health-topics/international-health-regulations#tab=tab_1
[17] “Public Health Surveillance For COVID-19: Interim Guidance”
[18] “Public Health Surveillance For COVID-19: Interim Guidance”
[19] Brendon Sen-Crowe, Mark McKenney, and Adel Elkbuli, “COVID-19 Laboratory Testing Issues and Capacities As We Transition To Surveillance Testing and Contact Tracing,” The American Journal of Emergency Medicine, (2021), https://doi.org/10.1016/j.ajem.2020.05.071
[20] Indian Council of Medical Research, Government of India, https://www.icmr.gov.in
[21] Ministry of Health and Family Welfare, “Integrated Disease Surveillance Programme,” Government of India, https://idsp.mohfw.gov.in
[22] Ministry of Health and Family Welfare, “IDSP Segment Of Integrated Health Information Platform,” Government of India, https://idsp.mohfw.gov.in/index4.php?lang=1&level=0&linkid=454&lid=3977
[23] “30,000 Critical Care Beds, Regional Centres For National Institute of Virology Are Among Plans under PM-ABHIM: V.K. Paul,” The Hindu, October 26, 2024, https://www.thehindu.com/sci-tech/health/30000-critical-care-beds-regional-centres-for-national-institute-of-virology-are-among-plans-under-pm-abhim-vk-paul/article68799626.ece
[24] Expert’s opinion from roundtable conference.
[25] NITI Aayog, Future Pandemic Preparedness and Emergency Response a Framework For Action, Government of India, 2024, https://www.niti.gov.in/sites/default/files/2024-09/Report-of-the-Exper-Group--Future-Pandemic-preparedness-and-emergency-response_0.pdf
[26] Siddharth Singh Tomar and Krishna Khairnar, “Challenges of SARS-CoV-2 Genomic Surveillance in India during Low Positivity Rate Scenario,” Frontiers in Public Health 11(2023), https://doi.org/10.3389/fpubh.2023.1117602
[27] National Informatics Centre, “Integrated Core COVID-19 Management,” Government of India, https://informatics.nic.in/uploads/pdfs/f48a53c0_9_integrated_covid.pdf
[28] Department of Biotechnology, “Indian SARS-CoV2 Genomics Consortium,” Government of India, https://dbtindia.gov.in/insacog#:~:text=INSACOG%20is%20a%20multi%2Dlaboratory,Integrated%20Disease%20Surveillance%20Programme%20(IDSP
[29] Expert’s opinion from roundtable conference.
[30] “Future Pandemic Preparedness and Emergency Response a Framework for Action”
[31] “Future Pandemic Preparedness and Emergency Response a Framework for Action”
[32] Ministry of Health and Family Welfare, Government of India, https://pib.gov.in/PressReleasePage.aspx?PRID=1733310
[33] “Future Pandemic Preparedness and Emergency Response a Framework for Action”
[34] Department of Biotechnology, “Indian SARS-CoV2 Genomics Consortium,” Government of India, https://dbtindia.gov.in/insacog#:~:text=INSACOG%20is%20a%20multi%2Dlaboratory,Integrated%20Disease%20Surveillance%20Programme%20(IDSP
[35] Angel N. Desai et al., “Real-time Epidemic Forecasting: Challenges and Opportunities,” Health Security, 2019, https://doi.org/10.1089/hs.2019.0022
[36] Expert’s opinion from roundtable conference.
[37] WHO, Global Influenza Surveillance and Response System (GISRS), World Health Organization, 2025, https://www.who.int/initiatives/global-influenza-surveillance-and-response-system
[38] “UK Health Security Agency,” Government of the United Kingdom, https://www.gov.uk/government/organisations/uk-health-security-agency
[39] Pragya Yadav, “Strengthening Genomic Surveillance For Vector Borne Diseases In India,” The Bill and Melinda Gates Foundation, https://gcgh.grandchallenges.org/grant/strengthening-genomic-surveillance-vector-borne-diseases-india; “Future Pandemic Preparedness and Emergency Response a Framework for Action”
[40] H. B. Chethan Kumar et al., “Animal Disease Surveillance: Its Importance & Present Status In India,” The Indian Journal of Medical Research (2021), https://doi.org/10.4103/ijmr.IJMR_740_21
[41] “Future Pandemic Preparedness and Emergency Response a Framework for Action”
[42] Expert’s opinion from roundtable conference.
[43] World Health Organization, Food and Agriculture Organisation of the United Nations, World Organisation for Animal Health and United Nations Environment Programme, One Health Joint Plan of Action (2022‒2026): Working Together For the Health Of Humans, Animals, Plants and the Environment, World Health Organization, 2022, https://www.who.int/publications/i/item/9789240059139
[44] Expert’s opinion from roundtable conference.
[45] Lakshmy Ramakrishnan, “Nipah Virus: The Need For Contextually-Situated Public Health Responses,” Observer Research Foundation, May 2024, https://www.orfonline.org/expert-speak/nipah-virus-the-need-for-contextually-situated-public-health-responses
[46] Ministry of Health and Family Welfare, Government of India, https://pib.gov.in/newsite/PrintRelease.aspx?relid=93017
[47] P Naveen, “From DRDO, Powerful Step in India’s Biosecurity,” The Times of India, November 11, 2024, https://timesofindia.indiatimes.com/city/bhopal/drdo-boosts-indias-biosecurity-with-new-bsl-4-laboratory-and-detection-facility/articleshow/115191760.cms
[48] Shravishtha Ajaykumar, “Biosecurity Blueprint For India,” Observer Research Foundation, August 17, 2024, https://www.orfonline.org/expert-speak/biosecurity-blueprint-for-india
[49] US Centers for Disease Control and Prevention, “AMD: Exploring New Technologies,” Government of United States of America, https://www.cdc.gov/advanced-molecular-detection/php/what-we-do/new-tech.html
[50] National Security Commission on Emerging Biotechnology, Government of United States of America, https://www.biotech.senate.gov/press-releases/press-release-national-security-commission-on-emerging-biotechnology-applauds-u-s-house-passage-of-biosecure-act/
[51]US Centers for Disease Control and Prevention, “AMD: Exploring New Technologies,” Government of United States of America, https://www.cdc.gov/advanced-molecular-detection/php/what-we-do/new-tech.html
[52] UK Health Security Agency, “UK Health Security Agency,” Government of the United Kingdom, https://www.gov.uk/government/organisations/uk-health-security-agency
[53] Infectious Disease Surveillance Center, “Infectious Disease Surveillance System in Japan,” National Institute of Infectious Diseases, https://www.niid.go.jp/niid/images/epi/nesid/nesid_en.pdf
[54] Australian Government Department of Health and Aged Care, “National Notifiable Diseases Surveillance System (NNDSS),” Government of Australia, https://www.health.gov.au/our-work/nndss
[55] Expert’s opinion from roundtable conference.
[56] Lakshmy Ramakrishnan, “A Framework For Effective Risk Assessment Of AI-Biotechnology Convergence,” Observer Research Foundation, December 17, 2024, https://www.orfonline.org/research/a-framework-for-effective-risk-assessment-of-ai-biotechnology-convergence
[57] Shravishtha Ajaykumar, “Emerging Technologies In the Development and Delivery Of CBRN Threats,” Observer Research Foundation, December 27, 2024, https://www.orfonline.org/research/emerging-technologies-in-the-development-and-delivery-of-cbrn-threats
[58] Department of Biotechnology, “Indian IVDs: Industry Through the Pandemic,” Government of India, https://dbtindia.gov.in/sites/default/files/uploadfiles/Indian%20IVDs%20Industry%20Through%20the%20Pandemic%20E-Brochure-23rd%20Dec%202020.pdf
[59]Ministry of Health and Family Welfare, Government of India, https://pib.gov.in/PressReleasePage.aspx?PRID=1622766#:~:text=Harsh%20Vardhan%20said%2C%20“The%20robust,of%20the%20ELISA%20test%20kits
[60] Indian Council of Medical Research, “COVID-19 Sample Collection Management System,” Indian Council of Medical Research, https://covid19cc.nic.in/icmr/Login.aspx
[61] Expert’s opinion from roundtable conference.
[62] India Science, Technology and Innovation Portal, “Efforts Made By DRDO In Nation’s Fight Against COVID-19,” Government of India, https://www.indiascienceandtechnology.gov.in/COVID-19-the-pandemic/efforts-made-drdo-nation’s-fight-against-COVID-19
[63] Ministry of Science and Technology, Government of India, https://www.pib.gov.in/PressReleasePage.aspx?PRID=1894167
[64] Expert’s opinion from roundtable conference.
[65] “Future Pandemic Preparedness and Emergency Response a Framework for Action”
[66] Ministry of Science and Technology, Government of India, https://pib.gov.in/PressReleaseIframePage.aspx?PRID=2048569
[67] Ministry of Science and Technology, Government of India, https://pib.gov.in/PressReleasePage.aspx?PRID=2056001
[68] Ministry of Chemicals and Fertilizers, Government of India, https://pib.gov.in/PressReleaseIframePage.aspx?PRID=2038957
[69] Oliver Vandenberg et al., “Considerations For Diagnostic COVID-19 Tests,” Nature Reviews Microbiology (2021), https://doi.org/10.1038/s41579-020-00461-z
[70] Expert’s opinion from roundtable conference.
[71] Roberta Troisi et al., “The Other Side Of The Crisis: Organizational Flexibility In Balancing COVID-19 and Non-COVID-19 Health-Care Services,” BMC Health Services Research (2022) https://doi.org/10.1186/s12913-022-08486-1
[72] Jaffar A. Al-Tawfiq et al., “Changes In Healthcare Managing COVID and Non–COVID-19 Patients During the Pandemic: Striking the Balance,” Diagnostic Microbiology and Infectious Disease (2020) https://doi.org/10.1016/j.diagmicrobio.2020.115147
[73] Frederick G.P. Welt et al., “Catheterization Laboratory Considerations During the Coronavirus (COVID-19) Pandemic,” Journal of the American College of Cardiology (2020), https://doi.org/10.1016/j.jacc.2020.03.021
[74] Maria Vargas et al., “Logistic and Organizational Aspects Of a Dedicated Intensive Care Unit For COVID-19 Patients,” Critical Care (2020), https://doi.org/10.1186/s13054-020-02955-x
[75] Nirav Nimavat et al., “COVID-19 Pandemic Effects on the Distribution of Healthcare Services in India: A Systematic Review,” World Journal of Virology (2022), https://doi.org/10.5501/wjv.v11.i4.186
[76] Rajiv Raman et al., “Impact On Health and Provision Of Healthcare Services During the COVID-19 Lockdown In India: A Multicentre Cross-Sectional Study,” BMJ Open (2021), https://doi.org/10.1136/bmjopen-2020-043590
[77] Expert’s opinion from roundtable conference.
[78] Expert’s opinion from roundtable conference.
[79] Md. K. Hasan et al., “Hospital Surge Capacity Preparedness In Disasters and Emergencies: A Systematic Review,” Public Health (2023), https://doi.org/10.1016/j.puhe.2023.09.017
The views expressed above belong to the author(s). ORF research and analyses now available on Telegram! Click here to access our curated content — blogs, longforms and interviews.
Lakshmy is an Associate Fellow with ORF’s Centre for New Economic Diplomacy. Her work focuses on the intersection of biotechnology, health, and international relations, with a ...
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Shravishtha Ajaykumar is an Associate Fellow at the Centre for Security, Strategy, and Technology. Her research areas include Chemical, Biological, Radiological, and Nuclear (CBRN) strategy ...
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