Biological Disasters

National DisasterManagement Guidelines

Management ofBiological Disasters

National Disaster Management Guidelines—Management of Biological Disasters

A publication of:

National Disaster Management Authority

Government of India

Centaur Hotel

New Delhi – 110 037

ISBN: 978-81-906483-6-3

July 2008

When citing this report the following citation should be used:

National Disaster Management Guidelines—Management of Biological Disasters, 2008.

A publication of National Disaster Management Authority, Government of India.

ISBN 978-81-906483-6-3, July 2008, New Delhi.

The National Guidelines are formulated under the chairmanship of

Lt Gen (Dr.) J.R. Bhardwaj, PVSM, AVSM, VSM, PHS, (Retd.), Hon’ble Member, NDMA

in consultation with various stakeholders, regulators, service providers and specialists

in the subject field concerned from all across the country.

National DisasterManagement Guidelines

Management ofBiological Disasters

National Disaster Management AuthorityGovernment of India

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Contents v

Foreword ix

Acknowledgements xi

Abbreviations xii

Glossary of Common Terms xvi

Executive Summary xxiii

1 Introduction 1

1.1 History 1

1.2 Biological Agents as Causes of Mass Destruction 2

1.3 Sources of Biological Agents 3

1.4 Threat Perception 3

1.5 Zoonoses 4

1.6 Molecular Biology and Genetic Engineering 5

1.7 Biosafety and Biosecurity 6

1.8 Epidemics 7

1.9 Biological Disasters (Bioterrorism) 8

1.10 Impact of Biological Disasters 8

1.11 Regulatory Institution 9

1.12 Aims and Objectives of the Guidelines 9

2 Present Status and Context 11

2.1 Legal Framework 12

2.2 Institutional and Policy Framework 14

2.3 Operational Framework 21

2.4 Important Functional Areas 23

2.5 Genesis of National Disaster ManagementGuidelines—Management of Biological Disasters 28

Contents

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3 Salient Gaps 29

3.1 Legal Framework 29

3.2 Institutional Framework 29

3.3 Operational Framework 29

4 Guidelines for Biological Disaster Management 35

4.1 Legislative Framework 35

4.2 Prevention of Biological Disasters 37

4.3 Preparedness and Capacity Development 44

4.4 Medical Preparedness 54

4.5 Emergency Medical and Public Health Response 58

4.6 Management of Pandemics 62

4.7 International Cooperation 63

5 Guidelines for Safety and Security of Microbial Agents 65

5.1 Biological Containment 65

5.2 Classification of Microorganisms 66

5.3 Biologics 66

5.4 Laboratory Biosafety 67

5.5 Microorganism Handling Instructions 69

5.6 Countering Biorisks 70

6 Guidelines for Management of Livestock Disasters 73

6.1 Losses to the Animal Husbandry Sector due to Biological Disasters 73

6.2 Potential Threat from Exotic and Existing Infectious Diseases 74

6.3 Consequences of Losses in the Animal Husbandry Sector 74

6.4 Present Status and Context 75

6.5 Challenges 82

6.6 Guidelines for the Management of Livestock Disasters 83

7 Guidelines for Management of Agroterrorism 93

7.1 Dangers from Exotic Pests 93

7.2 Basic Features of an Organism to be used as a Bioweapon in theAgrarian Sector 95

7.3 Dangers from Indigenous Pests 95

7.4 Present Status and Context 95

7.5 Guidelines for Biological Disaster Management—Agroterrorism 104

CONTENTS

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8 Implementation of the Guidelines 108

8.1 Implementation of the Guidelines 109

8.2 Financial Arrangements for Implementation 112

8.3 Implementation Model 113

9 Summary of Action Points 117

Annexures 123

Annexure-A Characteristics of Biological Warfare Agents 123

Annexure-B Vaccines, Prophylaxis, and Therapeutics forBiological Warfare Agents 125

Annexure-C Patient Isolation Precautions 133

Annexure-D Laboratory Identification of Biological Warfare Agents 135

Annexure-E Specimens for Laboratory Diagnosis 137

Annexure-F Medical Sample Collection for Biological Threat Agents 138

Annexure-G OIE List of Infectious Terrestrial Animal Diseases 143

Annexure-H Disposal of Animal Carcasses: A Prototype 146

Annexure-I List of National Standards on Phyto-sanitary Measures 148

Annexure-J Important Websites 149

Core Group for Management of Biological Disasters 150

Contact Us 156

CONTENTS

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Vice ChairmanNational Disaster Management Authority

Government of India

FOREWORD

The preparation of national guidelines for various types of disasters, both natural and man-madeconstitutes an important component of the mandate entrusted to the National Disaster ManagementAuthority under the Disaster Management Act, 2005. In recent years, biological disasters includingbioterrorism have assumed serious dimensions as they pose a greater threat to health, environment andnational security. The risks and vulnerabilities of our food chain and agricultural sector to agroterrorism,which involves the deliberate introduction of plant or animal pathogens with the intent of underminingsocio-economic stability, are increasingly being viewed as a potential economic threat. The spectre ofpandemics engulfing our subcontinent and beyond poses new challenges to the skills and capacities of thegovernment and society. Consequently, the formulation of the national guidelines on the entire gamut ofbiological disasters has been one of our key thrust areas with a view to build our resilience to respondeffectively to such emerging threats.

The intent of these guidelines is to develop a holistic, coordinated, proactive and technology drivenstrategy for management of biological disasters through a culture of prevention, mitigation and preparednessto generate a prompt and effective response in the event of an emergency. The document containscomprehensive guidelines for preparedness activities, biosafety and biosecurity measures, capacitydevelopment, specialised health care and laboratory facilities, strengthening of the existing legislative/regulatory framework, mental health support, response, rehabilitation and recovery, etc. It specificallylays down the approach for implementation of the guidelines by the central ministries/departments, states,districts and other stakeholders, in a time bound manner.

The national guidelines have been formulated by members of the Core Group, Steering and ExtendedGroups constituted for this purpose, involving the active participation and consultation of over 243experts from central ministries/departments, state governments, scientific, academic and technicalinstitutions, government/private hospitals and laboratories, etc. I express my deep appreciations for theirsignificant contribution in framing these guidelines. I also wish to express my sincere appreciation forLt Gen (Dr.) J.R. Bhardwaj, PVSM, AVSM, VSM, PHS (Retd) for his guidance and coordination of theentire exercise.

New Delhi General NC VijJuly 2008 PVSM, UYSM, AVSM (Retd)

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MemberNational Disaster Management Authority

Government of India

ACKNOWLEDGEMENTS

National Disaster Management Guidelines—Management of Biological Disaster are formulated bythe untiring efforts of the core group members and experts in the field. I would like to express my specialthanks to all the members who have proactively participated in this consultative process from time-to-time. It is indeed the keen participation by the Ministry of Health and Family Welfare, Ministry of HomeAffairs, Armed Forces Medical Services, Ministry of Defence, Department of Health, Ministry of Railways,Ministry of Agriculture, various states and union territories, non-governmental organisations, and theprivate sector including corporate hospitals that has been so helpful in designing the format of thisdocument and provided valuable technical inputs. I would like to place on record the significant contributionmade by Lt Gen (Dr.) D. Raghunath, PVSM, AVSM (Retd), Lt Gen Shankar Prasad, PVSM, VSM(Retd), Dr. P. Ravindran, Dr. R.K. Khetarpal, Dr. S.K. Bandopadhyay, and other core group experts. Iam also thankful to the Director General, Indian Council of Medical Research and his team of medicalscientists from various laboratories for providing inputs related to research in biological disasters.

I would like to express my sincere thanks to the representatives of the other central ministries anddepartments concerned, regulatory agencies, Defence Research and Development Organisation,professionals from scientific and technical institutes, eminent medical professionals from leading nationalinstitutions like the National Institute of Communicable Diseases, National Institute of Virology, IndianVeterinary Research Institute, Defence Research and Development Establishment, Sir Dorabji TataCentre for Research in Tropical Diseases, National Bureau of Plant Genetic Resources, Indian Councilof Agricultural Research, National Institute of Disaster Management and consortiums of the corporatesector for their valuable inputs that helped us in enhancing the contents and overall presentation of theGuidelines.

The efforts of Maj Gen J.K. Bansal, VSM, Dr. Rakesh Kumar Sharma, Dr. Raman Chawla, and Dr.Pankaj Kumar Singh in providing knowledge-based technical inputs to the core group and knowledgemanagement studies of global best practices in Biological Disaster Management, are highly appreciated.

I would like to acknowledge the active cooperation provide by Mr. H.S. Brahma, Additional Secretaryand the administrative staff of the NDMA. I express my appreciation for the dedicated work of mysecretarial staff including Mr. Deepak Sharma, Mr. D.K. Ray, and Mr. Munendra Kumar during theconvening of various workshops, meetings and preparation of the Guidelines.

Finally, I would like to express my gratitude to General N.C. Vij, PVSM, UYSM, AVSM (Retd),Hon’ble Vice Chairman, NDMA, and Hon’ble Members of the NDMA for their constructive criticism,guidance and suggestions in formulating these Guidelines.

New Delhi Lt Gen (Dr) JR BhardwajJuly 2008 PVSM, AVSM, VSM, PHS (Retd)

MD DCP PhD FICP FAMS FRC Path (London)

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The following abbreviations and acronyms used throughout this document areintended to mean the following:

AFMS Armed Forces Medical ServicesAICRP All India Coordinated Research ProjectAIDS Acquired Immuno Deficiency SyndromeAIG Anthrax Immuno GlobulinAIIMS All India Institute of Medical SciencesANM Auxiliary Nurse MidwifeAPHIS Animal and Plant Health Inspection ServiceAPSV Aventis Pasteur Smallpox VaccineAQCS Animal Quarantine and Certification ServicesASCAD Assistance to States for Control of Animal DiseasesASF African Swine FeverASHA Accredited Social Health ActivistAVA Anthrax VaccineBCG Bacillus Calmette-GuérinBDM Biological Disaster ManagementBSE Bovine Spongiform EncephalopathyBSF Border Security ForceBSL Biosafety LevelBT BioterrorismBTWC Biological and Toxin Weapons ConventionBW Biological WarfareC&C Command and ControlCAC Codex Alimentarius CommissionCAM Crassulacean Acid MetabolismCBD Convention on Biological DiversityCBPP Contagious Bovine Pleuro-PneumoniaCBRN Chemical, Biological, Radiological and NuclearCDC Center for Disease Control and PreventionCGHS Central Government Health SchemeCHCs Community Health CentresCMO Chief Medical OfficerCRF Calamity Relief FundCRI Central Research InstituteCrPC Criminal Procedure CodeCSF Classical Swine FeverCSIR Council for Scientific and Industrial ResearchDADF Department of Animal Husbandry, Dairying and FisheriesDBT Department of Biotechnology

Abbreviations

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ABBREVIATIONS

DDMA District Disaster Management AuthorityDEBEL Defence Bioengineering and Electromedical LaboratoryDFRL Defence Food Research LaboratoryDGAFMS Director General Armed Forces Medical ServicesDGHS Director General Health ServicesDHO District Health OfficerDIP Destructive Insects and PestsDM Disaster ManagementDM Act Disaster Management ActDMSRDE Defence Materials and Stores Research and Development EstablishmentDNA Deoxyribonucleic AcidDoD Department of DefenceDPPQS Directorate of Plant Protection, Quarantine and StorageDPT Diptheria, Pertussis TetanusDRDE Defence Research and Development EstablishmentDRDO Defence Research and Development OrganisationEEE Eastern Equine EncephalitisEMR Emergency Medical ResponseEOCs Emergency Operations CentresEPA Environment Protection ActESIC Employees’ State Insurance CorporationEWS Early Warning SystemFAO Food and Agricultural OrganizationFDA Food and Drug AdministrationFMD Foot and Mouth DiseaseFMD-CP Foot and Mouth Disease-Control ProgrammeGDP Gross Domestic ProductGF-TADs Global Framework for Progressive Control of Transboundary Animal DiseasesGIS Geographic Information SystemGMOs Genetically Modified OrganismsGOARN Global Outbreak Alert and Response NetworkGoI Government of IndiaGPS Global Positioning SystemHEPA High Efficiency Particulate AirHIV Human Immunodeficiency VirusHPAI Highly Pathogenic Avian InfluenzaHRD Human Resource DevelopmentHSADL High Security Animal Disease LaboratoryIAN Integrated Ambulance NetworkICAR Indian Council of Agricultural ResearchICMR Indian Council of Medical ResearchICP Incident Command PostICU Intensive Care UnitIDSP Integrated Disease Surveillance ProgrammeIHR International Health RegulationsIPC Indian Penal Code

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ABBREVIATIONS

IPPC International Plant Protection ConventionIRCS Indian Red Cross SocietyISO International Standards OrganisationITBP Indo-----Tibetan Border PoliceIVC Act Indian Veterinary Council Act, 1984IVRI Indian Veterinary Research InstituteJALMA Japanese Leprosy Mission for AsiaKFD Kyasanur Forests DiseaseKIPM King Institute of Preventive MedicineKVKs Krishi Vigyan KendrasLBM Laboratory Biosafety ManualLMOs Living Modified OrganismsMFRs Medical First RespondersMHA Ministry of Home AffairsMoA Ministry of AgricultureMoD Ministry of DefenceMOEF Ministry of Environment and ForestsMoH&FW Ministry of Health and Family WelfareMoL&E Ministry of Labour and EmploymentMoR Ministry of RailwaysMPW Multi-Purpose WorkerMRSA Methicillin-Resistant Staphyllococcus aureusNADEC National Animal Disease Emergency CommitteeNADEPC National Animal Disaster Emergency Planning CommitteeNBC Nuclear, Biological and ChemicalNBPGR National Bureau of Plant Genetic ResourcesNCCF National Calamity Contingency FundNCMC National Crisis Management CommitteeNDDB National Dairy Development BoardNDMA National Disaster Management AuthorityNDRF National Disaster Response ForceNEC National Executive CommitteeNGOs Non-Governmental OrganisationsNIC National Informatics CentreNICD National Institute of Communicable DiseasesNICED National Institute of Cholera and Enteric DiseasesNIDM National Institute of Disaster ManagementNIV National Institute of VirologyNPRE National Project on Rinderpest EradicationNRHM National Rural Health MissionOECD Organisation for Economic Cooperation and DevelopmentOIE Office International des Épizooties (World Organisation for Animal Health)PCR Polymerase Chain ReactionPED Professional Efficiency DevelopmentPFS Plants, Fruits and SeedsPGIMER Post Graduate Institute of Medical Education and ResearchPHCs Primary Health Centres

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PHEIC Public Health Emergency of International ConcernPHFI Public Health Foundation of IndiaPPE Personal Protective EquipmentPPP Public-Private PartnershipPPR Peste des Petits RuminantsPQ Plant QuarantinePRA Pest Risk AnalysisPRIs Panchayati Raj InstitutionsPVOs Private Voluntary OrganisationsQRMTs Quick Reaction Medical TeamsR&D Research and DevelopmentRRCs Regional Response CentresRMRC Regional Medical Research CentreRRTs Rapid Response TeamsSARS Severe Acute Respiratory SyndromeSDMA State Disaster Management AuthoritySDRF State Disaster Response ForceSEB Staphylococcus Enterotoxin BSEC State Executive CommitteeSMX SulfomethoxazoleSOPs Standard Operating ProceduresSPS Sanitary and Phyto-SanitarySSB Sashastra Seema BalTADs Trans-Boundary Animal DiseasesTB TuberculosisTMP TrimethoprimUN United NationsUNDP United Nations Development ProgrammeUNICEF United Nations Children’s FundUS United StatesUSA United States of AmericaUSAMRIID US Army Medical Research Institute of Infectious DiseasesUSDA United States Department of AgricultureUSSR Union of Soviet Socialistic RepublicsUTs Union TerritoriesVAC Veterinary Aid CentreVATs Veterinary Assistance TeamsVBMs Valuable Biological MaterialsVCI Veterinary Council of IndiaVEE Venezuelan Equine EncephalitisVHFs Viral Hemorrhagic FeversWEE Western Equine EncephalitisWHO World Health OrganizationWHO-SEARO WHO-Regional Office for South-East AsiaWMD Weapons of Mass DestructionWTO World Trade OrganizationWW World War

ABBREVIATIONS

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Glossary of Common Terms

The definitions of common terms used in this document are intended to meanthe following:

AccountabilityAccountability ensures that Valuable Biological Materials (VBM), are tracked and controlled, as pertheir intended usage by formally associating specified material with the individual under whom thematerial is being used, so that he is responsible for the said material.

AgroterrorismAgroterrorism, is the malicious use of plant or animal pathogens to cause devastating disease in theagricultural sector.....

Anti-microbial SusceptibilitiesIt aims to identify whether bacterial etiology of concern is capable of expressing resistance to theanti-microbial agent that is a potential choice to develop a therapeutic agent. It includes methodsthat directly measure the activity of the anti-microbial agent against a bacterial isolate and directlydetect the presence of a specific resistance mechanism.

BacterinA suspension of killed or attenuated bacteria for use as a vaccine.

Biological AgentsThey are microorganisms such as viruses, bacteria or fungi that infect humans, livestock or crops andcause an incapacitating or fatal disease. Symptoms of illness do not appear immediately but onlyafter a delay, or ‘incubation period’, that may last for days or weeks.

Biological DisastersBiological disasters are scenarios involving disease, disability or death on a large scale amonghumans, animals and plants due to toxins or disease caused by live organisms or their products.Such disasters may be natural in the form of epidemics or pandemics of existing, emerging or re-emerging diseases and pestilences or man-made by the intentional use of disease causing agents inBiological Warfare (BW) operations or incidents of Bioterrorism (BT).

Biological DiversityThe variability among living organisms from all sources including terrestrial, marine and other aquaticecosystems and the ecological system.

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Biological LaboratoryA facility within which microorganisms, their components or their derivatives are collected, handledand/or stored. Biological laboratories include clinical laboratories, diagnostic facilities, regional andnational reference centres, public health laboratories, research centres (academic, pharmaceutical,environmental, etc.) and production facilities [manufacturers of vaccines, pharmaceuticals, largescale Genetically Modified Organisms (GMOs)] for human, veterinary and agricultural purposes.

BiomonitoringIt is the method of detection of biological agents based on properties like rapidity, reliability,sensitivity, and specificity so as to quickly diagnose the correct etiological agent from complexenvironmental samples before the spreading of illness on a large scale.

BioriskThe probability or chance that a particular adverse event (in the context of this document: accidentalinfection or unauthorised access, loss, theft, misuse, diversion or intentional release), possiblyleading to harm, will occur.

Biorisk AssessmentThe process to identify acceptable and unacceptable risks [embracing biosafety risks (risks ofaccidental infection)] and laboratory biosecurity risks (risks of unauthorised access, loss, theft,misuse, diversion or intentional release) and their potential consequences.

Biorisk ManagementThe analysis of ways and development of strategies to minimise the likelihood of the occurrence ofbiorisks. The management of biorisk places responsibility on the facility and its manager todemonstrate that appropriate and valid biorisk reduction (minimisation) procedures have beenestablished and implemented. A biorisk management committee should be established to assist themanager of the facility in identifying, developing and reaching biorisk management goals.

BiosafetyLaboratory biosafety describes the containment principles, technologies and practices that areimplemented to prevent the unintentional exposure to pathogens and toxins, or their accidentalrelease.

BiosecurityThe protection of high consequence microbial agents and toxins, or critical relevant information,against theft or diversion by those who intend to pursue intentional misuse.

BiotechnologyThe integration of natural and engineering sciences in order to achieve the useful application oforganisms, cells, parts thereof and molecular analogues for products and services. It includes anytechnological application that uses biological systems, living organisms, or derivatives thereof, tomake or modify products or processes for specific use. Biotechnology products includepharmaceutical compounds and research materials.

GLOSSARY OF COMMON TERMS

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Bioterrorism (BT)The intentional use of microorganisms, or toxins, derived from living organisms, to produce death ordisease in humans, animals or plants.

BioweaponBiological weapons include any organism or toxin found in nature that can be used to incapacitate,kill, or cause physical or economic harm. Biological weapons are characterised by low visibility, highpotency, substantial accessibility and relatively easy delivery methods.

BSL— Biosafety LevelA method for rating laboratory safety. Laboratories are designated BSL 1, 2, 3, or 4 based on thepractices, safety equipment, and standards they employ to protect their workers from infection by theagents they handle. BSL-1 laboratories are suitable for handling low-risk agents; BSL-2 laboratoriesare suitable for processing moderate risk agents; and BSL-3 laboratories can safely handle high-riskagents. BSL-4 laboratories are designated to hold WHO Risk group-IV organisms that pose themaximum risk as well as unknown emergent epidemic pathogens (WHO Risk Group-V).

ChemoprophylaxisThe administration of a chemical, including antibiotics, to prevent the development of an infection orthe progression of an infection to active manifest disease, or to eliminate the carriage of a specificinfectious agent to prevent transmission and disease in others.

Communicable DiseaseAn infectious condition that can be transmitted from one living person or animal to another through avariety of routes, according to the nature of the disease.

DisinfectantsDisinfectants are anti-microbial agents that are applied to non-living objects to destroymicroorganisms.

Droplet InfectionsPathogens resistant to drying may remain viable in the dust and act as a source of infection. Smalldroplets under 0.1 mm in diameter, evaporate immediately to become minute particles or dropletnuclei which remain suspended in air for long periods acting as a source of infection.

EpidemicsThe outbreak of a disease affecting or tending to affect a disproportionately large number ofindividuals within a population, community, or region at the same time.

EpidemiologyThe branch of medicine concerned with the incidence and distribution of diseases and other factorsrelating to health.


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EukaryoticOrganisms whose cells are organised into complex structures enclosed within their respectivemembranes and have a defined nucleus, e.g., animals, plants, fungi, and protists.

Genetic EngineeringA process of inserting new genetic information into existing cells through modern molecular biologytechniques in order to modify a specific organism for the purpose of changing one of itscharacteristics. This technology is used to alter the genetic material of living cells in order to makethem capable of producing new substances or performing new functions.

Genetically Modified Organisms (GMOs)Organisms whose genetic material has been altered using techniques generally known asrecombinant Deoxyribonucleic Acid (DNA) technology. Recombinant DNA technology is the ability tocombine DNA molecules from different sources into one molecule in a test tube. GMOs are often notreproducible in nature, and the term generally does not cover organisms whose genetic compositionhas been altered by conventional cross-breeding or by ‘mutagenesis’ breeding, as these methodspredate the discovery (in 1973) of recombinant DNA techniques.

HybridomaHybridoma are fused cells with continuous growth potential that have been engineered to produce asa single antibody.

ImmunisationThe process of inducing immunity against an infectious organism or agent in an individual or animalthrough vaccination.

Incubation PeriodThe interval between infection and appearance of symptoms.

Infectious DiseasesDiseases caused by microbes such as viruses, bacteria, and parasites in any organ of the body thatcan be passed to or among humans, animals and plants by several methods. Examples include viralillnesses, Human Immunodeficiency Virus (HIV)/Acquired Immuno Deficiency Syndrome (AIDS),meningitis, whooping cough, pneumonia, Tuberculosis (TB), and histoplasmosis, etc.

InsecticidesAn insecticide is a pesticide used against insects in all its developmental forms. They includeovicides and larvicides used against the eggs and larvae of insects. Insecticides are used fordomestic household purposes, and commercially in agriculture and industry.

Laboratory BiosecurityIt describes the protection, control and accountability for VBM within laboratories, in order to preventtheir unauthorised access, loss, theft, misuse, diversion or intentional release.


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LivestockDomestic animals kept or raised on a farm for use, sale or profit.

Molecular BiologyA branch of biological science that studies the biology of a cell at the molecular level. Molecularbiological studies are directed at studying the structure and function of biological macromoleculesand the relationship of their functioning to the structure of a cell and its internal components. Thisincludes the study of genetic components.

PandemicsA pandemic is an epidemic (an outbreak of an infectious disease) that spreads across a large region(for example, a continent), or even worldwide.

PathogensMicroorganisms that can cause disease in other organisms or in humans, animals and plants. Theymay be bacteria, viruses or parasites.

Personal Protective Equipment (PPE)Equipment worn or used by workers to protect themselves from exposure to hazardous materials orconditions. The major types of PPE include respirators, eye and ear protection gear, gloves, hardhats, protective suits, etc.

Phyto-sanitary MeasuresThe measures to achieve an appropriate level of sanitation and phyto-sanitary protection to safeguardhuman, animal or plant life or health as per the laid down standards are called phyto-sanitarymeasures.

Polymerase Chain Reaction (PCR)A technique for copying and amplifying the complementary strands of a target DNA molecule. It is anin vitro method that greatly amplifies, or makes millions of copies of DNA sequences that otherwisecould not be detected or studied.

ProkaryoticThe group of microorganisms that do not have a cell nucleus or any other membrane boundorganelles. They are divided into two domains—bacteria and archaea. They are mostly unicellular,except for a few which are multicellular.

QuarantineAny isolation or restriction on travel or passage imposed to keep contagious diseases, insects, pests,etc., from spreading.

Recombinant DNA TechnologyRecombinant DNA is a form of artificial DNA that is engineered through the combination or insertionof one or more DNA strands, thereby combining DNA sequences that would not normally occur


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together. This is an exclusively engineered technological process of genetic modification using theenzymes restriction endonucleases.

Sentinel SurveillanceSurveillance based on selected population samples chosen to represent the relevant experience ofparticular groups. It is a monitoring method that employs a surrogate indicator for a public healthproblem, allowing estimation of the magnitude of the problem in the general population.

StockpileA place or storehouse where material, medicines and other supplies needed in a disaster are kept foremergency relief.

SurveillanceContinuous observation, measurement, and evaluation of the progress of a process or phenomenonwith the view to taking corrective measures.

Terrestrial AnimalsTerrestrial animals are those which live predominantly or entirely on land.

ToxoidA toxoid is a bacterial toxin whose toxicity has been weakened or suppressed while otherproperties—typically immunogenicity, are maintained. Toxoids are used in vaccines as they inducean immune response to the original toxin or increase the response to another antigen.

TrainingThe act or process of teaching or learning a skill or discipline.

TriageTriage comes from the French verb trier which means literally to sort. In the current sense it is fromthe military system used from the 1930s, of assessing the wounded on the battlefield. The meaningin our context is—one is able to do the most good for the highest number of people in the light oflimited resources, especially during a mass casualty event. This concept prioritises those patientswho have an urgent medical condition but are most likely to survive if given medical attention assoon as possible.

TropismThe involuntary movement of an organism activated by an external stimulus wherein the organism iseither attracted to or repelled from the outside stimulating influence. An example is heliotropism, themovement of plants, where they turn towards the sun.

VaccineThe term is derived from the Latin word vacca which means cow, as the first vaccine againstsmallpox was derived from a cowpox lesion. It is a suspension of attenuated live or killedmicroorganisms (bacteria, viruses or rickettsiae), or fractions thereof, administered to induceimmunity and thereby prevent infectious diseases.


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Valuable Biological MaterialsBiological materials that require administrative control, accountability and specific protective andmonitoring measures in laboratories to protect their economic and historical (archival) value, and/orthe population from their potential to cause harm. VBM may include pathogens and toxins, as well asnon-pathogenic organisms, vaccine strains, foods, GMOs, cell components, genetic elements andextraterrestrial samples.

VectorA carrier, especially the animal or host, that carries the pathogen from one host to another, e.g.,mosquito spreading malaria using a human as host.

Vector controlMeasures taken to decrease the number of disease carrying organisms and to diminish the risk oftheir spreading infectious diseases.

Veterinary PractitionerA graduate of veterinary science registered with the Veterinary Council of India (VCI)/State VeterinaryCouncils.

VirulenceVirulence refers to the degree of pathogenicity of a microbe, or in other words the relative ability of amicrobe to cause disease. The word virulent, which is the adjective for virulence, is derived from theLatin word virulentus, which means ‘full of poison’.

VirusA minute infectious agent, smaller than bacteria, which is capable of passing through filters that canblock bacteria. They multiply only within a susceptible host cell.

ZoonosesDiseases that can be transmitted to people by animals and vice-versa.


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Background

Biological disasters might be caused byepidemics, accidental release of virulentmicroorganism(s) or Bioterrorism (BT) with the useof biological agents such as anthrax, smallpox,etc. The existence of infectious diseases have beenknown among human communities andcivilisations since the dawn of history. The classicalliterature of nearly all civilisations record the abilityof major infections to decimate populations, thwartmilitary campaigns and unsettle nations. Socialupheavals caused by epidemics have contributedin shaping history over the ages. The mutualassociation of war, pestilence and famine wasacknowledged and often attributed to divineinfluences, though a few keen observers realisedthat some infections were contagious. Thedevelopment of bacteriology and epidemiologylater, established the chain of infection. Along withnuclear and chemical agents, which are derivedfrom technology, biological agents have beenaccepted as agents of mass destruction capableof generating comparable disasters.

The growth of human society has rested largelyon the cultivation of crops and domestication ofanimals. As crops and animals became necessaryto sustain a divergent social structure, the depletionof these resources had far reaching consequences.Along with the growth of societies, crop and animaldiseases acquired more and more importance.

Epidemics can result in heavy mortalities inthe short term leading to a depletion of populationwith a corresponding drop in economic activity,e.g., the plague epidemics in Europe during themiddle ages or the Spanish influenza between1917–18. Infections like Tuberculosis (TB) might

Executive Summary

not kill in the short term but thrust nations towardssocio-economic disasters. Another example is theHuman Immunodeficiency Virus (HIV)/AcquiredImmuno Deficiency Syndrome (AIDS) epidemic inSub-Saharan Africa, that has wiped out the benefitsof improved health care and decimated theproductive segments of society leading to economicstagnation and recession.

Recently, some events experienced in Indiahave highlighted such issues. The outbreak ofplague in Surat which was relatively small,disrupted urban activity in the city, generated anexodus and lead to a massive economic fallout.The ongoing human immunodeficiency virus/acquired immuno deficiency syndrome epidemicin different parts of the country is leading to thediversion of substantial resources. The spread ofthe invasive weed Parthenium hysterophorus afterits accidental introduction into India has had widerepercussions on human and animal health, apartfrom depleting the fodder output.

Infectious agents are constantly evolving, oftenacquiring enhanced virulence or epidemicpotential. This results in normally mild infectionsbecoming serious. The outbreak of Chikungunyathat started in 2005 is one such example.

In recent times travelling has become easier.More and more people are travelling all over theworld which exposes the whole world to epidemics.As our society is in a state of flux, novel pathogensemerge to pose challenges not only at the point ofprimary contact but in far removed locations. TheMarburg virus illustrates this. The increasedinteraction between humans and animals hasincreased the possibilities of zoonotic diseasesemerging in epidemic form.

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Biological Warfare (BW) andBioterrorism (BT)

The historical association between militaryaction and outbreaks of infections suggest astrategic role for biological agents. The non-discriminatory nature of biological agents limitedtheir use till specific, protective measures couldbe devised for the ‘home’ troops. The advances inbacteriology, virology and immunology in the late19th century and early 20th century enabled nationsto develop biological weapons. The relative easeof production, low cost and low level of deliverytechnology prompted the efforts of many countriesafter World War (WW) I, which peaked during thecold war. The collective conscience of the world,however, resulted in the Biological and ToxinWeapons Convention which resolved to eliminatethese weapons of mass destruction. Despiteconsiderable enthusiasm, the convention has beena non-starter.

While biological warfare does not appear tobe a global threat, the use of some agents suchas anthrax by terrorist groups pose a serious threat.The ease of production, packaging and deliveryusing existing non-military facilities are majorfactors in threat perception. These artificiallyinduced infections would behave similar to naturalinfections (albeit exotic) and would be difficult todetect except by an effective disease surveillancemechanism. The threat posed by bioterrorism isnearly as great as that by natural epidemic causingagents.

Mitigation

The essential protection against natural andartificial outbreaks of disease (bioterrorism) willinclude the development of mechanisms for promptdetection of incipient outbreaks, isolation of theinfected persons and the people they have beenin contact with and mobilisation of investigational

and therapeutic countermeasures. In the case ofdeliberately generated outbreaks (bioterrorism) thespectrum of possible pathogens is narrow, whilenatural outbreaks can have a wide range oforganisms. The mechanism required however, toface both can be similar if the service providersare adequately sensitised.

The response to these challenges will becoordinated by the nodal ministry—Ministry ofHealth and Family Welfare (MoH&FW) with inputsfrom the Ministry of Agriculture (MoA) for agentsaffecting animals and crops. The support and inputof other ministries like Ministry of Home Affairs(MHA), Ministry of Defence (MoD), Ministry ofRailways (MoR) and Ministry of Labour andEmployment (MoL&E), who have their own medicalcare infrastructure with capability of casualtyevacuation and treatment, have an important roleto play. With a proper surveillance mechanism andresponse system in place, epidemics can bedetected at the beginning stage of their outbreakand controlled. Slowly evolving epidemics do notcause upheavals in society and will not come underthe crisis management scenario usually. They willbe tackled by ongoing national programmes likethe Revised National Tuberculosis ControlProgramme and National Air Quality MonitoringProgramme. There may, however, be specificsituations when the disaster response mechanismmay be evoked, e.g., an outbreak of Plasmodiumfalciparum malaria erupting after an exceptionallywet season in a previously non-endemic regionand epidemics occurring as a consequence of anattack of bioterrorism.

Epidemics do not respect national borders. Asinternational travel is easy, biological agents needto be tracked so that they do not enter new regionsacross the boundaries. This aspect has madeinternational collaboration crucial for epidemiccontrol. International organisations like the WorldHealth Organization (WHO), Food and AgriculturalOrganization (FAO), Office International des

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Épizooties (OIE) as well as some national agencieswith global reach, e.g., Center for Disease Controland Prevention (CDC), United States of America(USA) have an important role to play andcooperation with them is necessary.

Structure of the Guidelines

These Guidelines are designed to acquaint thereader with the basics of Biological DisasterManagement (BDM). They deal with the subject ina balanced and thorough manner and give theinformation required by organisations to formulateStandard Operating Procedures (SOPs) at variouslevels. It is also envisaged that these Guidelineswill be used for the preparation of national, stateand district biological disaster management plansas a part of ‘all hazard’ Disaster Management (DM)plans.

Chapter 1—Introduces the subject and providesthe background to these Guidelines. Thecharacteristics of naturally triggered outbreaks aredescribed and the potential for the use ofpathogenic organisms in strategic and tacticalmodes as well as the potential of bioterrorism arepresented. The mass destruction capability ofbiological agents in the context of disaster potentialis outlined. The characteristics of biological agentsused or developed as weapons have been listedin Annexure-A. The section on threat perceptionhas been written in the Indian context. The chapterdeals with modern concepts on zoonoses in abroad fashion and also indicates the impact of theadvances in molecular biology on this field. Thechapter touches on biosafety and biosecurity andthe evolution of epidemics In practice, though thecourse of action to deal with natural and artificialoutbreaks is similar as far as the infected individualsare concerned, subsequent action depends on thegenesis. Clues to distinguish the two modes havebeen included, along with an illustrative collation.The economic aspects of epidemics, which have

been well quantified in the context of deliberateaction, illustrate the impact of biological agents.

Chapter 2—Deals with the resources available toprepare for and face the threat of biologicaldisasters. The current laws and Acts that deal withmethods for the control of epidemics have beenenumerated. The Biological and Toxin WeaponsConvention has been discussed. The internationalagencies concerned with biological disasters andthe related activities of these agencies have beengiven. A note by the World Trade Organization(WTO) on the regulation of world trade has beenincluded. The concerns voiced at the Earth Summitheld in Brazil on the disruption of naturalecosystems that could result in biological disasters,the role of Interpol in enforcing the concernedregulations and the role of Non-GovernmentalOrganisations (NGOs) have been mentioned. Anaccount of the importance of the integrated diseasesurveillance project in biologicaL disastermanagement is given. The chapter mentions therole of the Armed Forces and Railways who have acountrywide infrastructure that can be used in suchdisaster situations.

Chapter 3—It is a reality check of the presentcapability to tackle biological disasters. The areasthat have to be addressed during the preparatoryphase are discussed. It also gives a shortdescription of the response to challenges that thecountry has faced in recent times, e.g., the Plaguein 1994 (Beed and Surat) and 2002 (HimachalPradesh) and the H5N1 outbreaks in poultry. Theperformance of the responding agencies has beenadequate in the epidemics but could be improvedupon to meet bigger challenges.

Chapter 4—Provides guidelines for individualstakeholders to prepare their respective DM plans.The chapter indicates the legislation that can beused, mechanics of disaster management andmajor modalities for preventing an epidemicsituation and recovering from it.

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The chapter also deals with the community aspectand preparation that is necessary for thesatisfactory control of an epidemic threat.

Chapter 5—Deals with guidelines for the safetyand security of microbial agents. The activities ofvarious countries for developing biologicalweapons have had one benefit—a clearerunderstanding of the hazards of handling virulentorganisms. The erstwhile method of bench top styleworking is now considered unsafe and is not likelyto be used in the 21st century. Natural pathogensfrom new areas or those that have demonstratedepidemic potential have to be handled inappropriately designed laboratories. This chapterdeals with the levels of pathogens and thecorresponding safe handling areas. The securityprotocol for valuable biological materials has beenpresented. Training requirements and resourcematerials are given in this chapter. The basicinformation necessary for preparing biosafetymanuals is also given.

Chapter 6—Deals with the effects of disasters onanimal husbandry. It discusses the present stateof animal husbandry in India, its vulnerability todisasters, the economic consequences of disastersand proposes a plan for dealing with suchsituations. The statutory and legal frameworkavailable in the country and internationally is alsomentioned. Global veterinary issues and the needto interact with various international agencies andneighbouring countries have been elucidated. Theintersection of public health and veterinary issuesalso finds a place in this chapter.

Chapter 7—Deals with the issue of crop diseasesthat have economic ramifications. The genesis ofthis issue and instances of inadvertent/illicit entryof some plant species and exotic pests have beendiscussed. The national and international regulatorymechanisms have also been described. The recenteffort by the government to provide theinfrastructure for plant quarantine and regulationof imported agricultural products has been

elaborated. Increased transnational traffic followingthe World Trade Organization agreements poses achallenge that the nation has to address. The stepsbeing taken have been discussed in this chapter.

Chapter 8—Rounds off the Guidelines to providea broad perspective on biological disasters. Thecomponents for a system necessary to prepare forand respond to the threats have been set out.

The time lines proposed for the implementationof various activities in the Guidelines are consideredboth important and desirable, especially in the caseof non-structural measures for which no clearancesare required from central or other agencies. Preciseschedules for structural measures will, however,be evolved in the biological disaster managementplans that will follow at the central ministries/statelevel, duly taking into account the availability offinancial, technical and managerial resources. Incase of compelling circumstances warranting achange, consultation with the National DisasterManagement Authority (NDMA) will be undertaken,well in advance, for adjustment on a case-to-casebasis.

The Milestones for Implementation of theGuidelines are as Follows:

A) Short-term Plan (0–3 Years)

i) Regulatory framework.

a. Dovetail existing Acts, Rules andRegulations with the DisasterManagement Act (DM Act), 2005.

b. Enactment/amendment of any Act,Rule or Regulation, if necessary forbetter implementation of healthprogrammes across the country foreffective management of disasters.

ii) Prevention.

a. Strengthening of integratedsurveillance systems based onepidemiological surveys; detection

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and investigation of any diseaseoutbreak.

b. Establishment of Early Warning System(EWS).

c. Coordination between public health,medical care and intelligenceagencies to prevent bioterrorism.

d. Rapid health assessment, andprovision of laboratory support.

e. Institution of public health measuresto deal with secondary emergenciesas an outcome of biological disasters.

f. Immunisation of first responders andadequate stockpiling of necessaryvaccines.

iii) Preparedness.

a. Identifying infrastructure needs forformulating mitigation plans.

b. Equipping Medical First Responders(MFRs)/Quick Reaction MedicalTeams (QRMTs) with all materiallogistics and backup support.

c. Upgradation of earmarked hospitals forChemical, Biological, Radiologicaland Nuclear (CBRN) management.

d. Communication and networkingsystem with appropriate intra-hospitaland inter-linkages with stateambulance/transport services, statepolice departments and otheremergency services.

e. Mobile tele-health services.

f. Laying down minimum standards forwater, food, shelter, sanitation andhygiene.

g. Capacity development.

1) Knowledge management.

- Defining the role of public,private and corporate sector for

their active participation andtheir sensitisation thereof.

2) Human Resource Development(HRD).

- Strengthening of NationalDisaster Response Force(NDRF), medical firstresponders, medicalprofessionals, paramedics andother emergency responders.

- Development of humanresources for monitoring andmanagement of the delayedeffects of biological disastersin the areas of mental healthand psychosocial care.

3) Education and training.

- Imparting basic knowledge ofbiological disastermanagement through theeducational curricula at variouslevels.

- Knowledge management.

- Proper education and trainingof personnel, with the aid ofinformation networking systemsand conducting continuingmedical educationprogrammes and workshops atregular intervals.

h. Community preparedness.

1) Community awarenessprogramme for first aid.

2) Dos and Don’ts to mitigate theeffects of medical emergenciescaused by biological agents.

3) Defining the role of the communityas a part of the community disastermanagement plan.

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4) Organising community awarenessprogrammes for first aid andgeneral triage.

j. Hospital preparedness.

1) Preparation of hospital disastermanagement plans by all thehospitals including those in theprivate sector.

2) Developing a mechanism toaugment surge capacities torespond to any mass casualtyevent following a biologicaldisaster.

3) Identifying, stockpiling, supplychain and inventory managementof drugs, equipment andconsumables including vaccinesand other agents for protection,detection, and medicalmanagement.

k. Specialised health care and laboratoryfacilities.

1) Upgradation of existing biosafetylaboratories and establishing newones.

l. Scientific and technical institutions forapplied research and training.

1) Post-disaster phase medicaldocumentation procedures andepidemiological surveys.

2) Regular updation by adoptingactivities in Research andDevelopment (R&D) mode,initially by pilot studies.

B) Medium-term Plan (0–5 Years)

i) Prevention.

a. Strengthening of Integrated DiseaseSurveillance Programme (IDSP) and

early warning systems at regionallevels.

b. Incorporation of disaster specific riskreduction measures.

ii) Preparedness.

a. Institutionalisation of advancedEmergency Medical Response (EMR)system (networking ambulanceservices with hospitals).

iii) Capacity development.

a. Strengthening of scientific andtechnical institutions for knowledgemanagement and applied researchand training in management ofchemical, biological, radiological andnuclear disasters.

b. Continuation and updation of humanresource development activities.

c. Developing community resilience.

iv) Hospital preparedness.

a. Testing of various elements of theemergency plan through table topexercises, and mock drills.

v) Specialised health care and laboratoryfacilities.

vi) Implementing a financial strategy forallocation of funds for different national andstate/district-level mitigation projects.

vii) Ensuring stockpiling of essential medicalsupplies such as vaccines and antibiotics,etc.

C) Long-term Plan (0–8 Years)

The long term action plan will address thefollowing important issues:

i) Knowledge of biological disastermanagement should be included in the

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present curriculum of science and medicalundergraduate and postgraduate courses.

ii) Establishment of a national stockpile ofvaccines, antibiotics and other criticalmedical supplies.

iii) Initiation of relevant postgraduate coursesin biological disaster management.

iv) Training programmes in the areas ofemergency medicine and biologicaldisaster management shall be conductedfor hospital administrators, specialists,medical officers, nurses and other healthcare workers.

v) Public health emergencies with the potentialof mass casualties due to covert attacks ofbiological agents will be addressed in theplan through setting up of integratedsurveillance systems, rapid healthassessment systems, prompt investigationof outbreaks, providing laboratory supportand instituting public health measures.

vi) Quality medical care.

vii) Strengthening of the existing institutionalframework and its integration with theactivities of the National DisasterManagement Authority, state government/State Disaster Management Authority(SDMA), district administration/DistrictDisaster Management Authority (DDMA)and other stakeholders for effectiveimplementation.

viii) Establishing an information networkingsystem with appropriate linkages with stateambulance/transport services, state policedepartments and other emergency services.

ix) Strengthening of the National DisasterResponse Force, medical first responders,paramedics and other emergencyresponders. Identification and recognitionof training institutions for training of medicalprofessionals, paramedics and medical firstresponders.

x) Development of post-disaster medicaldocumentation procedures andepidemiological surveys.

These guidelines provide a framework foraction at all levels. The nodal ministry—Ministry ofHealth and Family Welfare will prepare an actionplan to enable all sections of the government andadministration machinery at various levels toprepare and respond effectively to biologicaldisasters. The sporadic occurrence of low gravitybiological disasters will be managed primarily bythe existing mechanism of response for medical,veterinary and agricultural services. In the currentscenario, the private sector is well entrenched inthe primary and tertiary health care sector and isgrowing at a rapid rate. It would be mutuallybeneficial for both the private sector andgovernment if this infrastructure can be used forbiological disaster management in a Public-PrivatePartnership (PPP) module. Also unlike the othertwo agents of mass destruction (nuclear andchemical), biological threats can be controlled toan extent—if protective systems are in place theinflux of infective agents would not have anydisastrous consequences. The implementation ofthese Guidelines through an action plan will leadto a state of preparedness, which should be ableto prevent biological disasters and if any suchsituation does occur, then will be managed properly.

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1

Introduction1Sickness and disease are important subjects

that have exercised human thought since the dawnof civilisation. It was realised that certain diseasescame in crops and spread from the afflicted to thehealthy. The concept of ‘contagion’ developed andthe earliest societies devised methods and systemsthat could contain the spread of such diseases toensure a reasonable level of health for thepopulace. The spread of agriculture anddomestication of animals led to economicdevelopment and the realisation that diseasesaffecting crops and livestock could also affect thewell-being of human societies as they becamemore complex, and populations increased. Theincrease of population also resulted in thecongregation of a large number of susceptiblepeople in limited spaces. The larger communitiesbecame vulnerable to food supply and trans-species migration of infectious agents. Infectiousagents with innate or acquired ability to spreadfrom person to person caused extensive morbidityor mortality. Medical and literary texts of ancientcivilisations describe such epidemics. Diseasesthat caused the largest disruption were plague(bubonic and pneumonic), louse-borne typhus, andsmallpox, because of their high mortality. Infectionslike malaria, dengue, and yellow fever thatdebilitated populations, led to economic disasters.Similar large-scale loss of livestock or crops alsoresulted in destruction of the social fabric.

During WW I, commanders tried to use theknowledge of infectious diseases to influence theirmilitary tactics. Until the development ofbacteriology and vaccinology, it was not possiblefor infectious agents to be used in situations wherethe combating armies were in contact, as, ‘own’

and ‘enemy’ troops were equally susceptible tothe disease usually. There were, however,circumstances when this was not the case and theuse of biological agents in combat conditions wasfeasible. Thus, there could be a natural or artificialspread of infections leading to the emergence ofthe definition of BW put forward by Prof. JoshuaLederberg as ’use of agents of disease for hostilepurposes’. This essentially simple definition is goodenough for dealing with the subject.

1.1 History

Biological disasters of natural origin are largelythe result of the entry of a virulent organism into acongregation of susceptible people living in amanner suited to the spread of the infection. Incrowded areas, anthrax spreads by spore dispersalin the air, small pox spreads by aerosols, typhusand plague spread through lice, fleas, rodents,etc. The average epidemic spreads locally anddies down if the contagion is localised, but therehave been instances where diseases have spreadwidely, even across national boundaries. Disastershave occurred when environmental factors wereconducive, e.g., Black Death occurred whenconditions were favourable for increase in thenumber of rats, and cholera attained a pandemicform when the causative agent entered urban areaswhich had inadequate sanitation facilities. Similarly,post WW I, the movement of population led to therapid spread of the Spanish influenza virus.

Short-duration infections with high mortalityrates harm societies by depleting their numbers.The longer duration infections, with varying

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immediate mortality, nevertheless, becomeimportant when they cause large-scale morbidityaffecting the productive capacity of the population.Malaria and tuberculosis are examples of suchinfections which, in the long run, are as importantas the more visible florid epidemics.

The extension of human activity and its contactwith a hitherto localised microbial environmentintroduces novel pathogens. The spread of Nipah,Hendra, Ebola, Marburg and Lassa fever virusesare examples of this phenomenon. In the case ofHIV, a sporadically occurring phenomenon—thatof transmission of the virus from chimpanzee toman—became a pandemic when it began to besexually transmitted, and has since become thelargest epidemic in history.

Human conflict resulting in large-scalepopulation movement, breakdown of socialstructures and contact with alien groups has alwaysgenerated a large number of infections. Until veryrecently, the number of casualties due to infectionsfar exceeded losses due to arms.

As a tactical manoeuvre, the introduction of acommunicable disease in the enemy camp hasbeen exercised by military commanders from theearliest times. Apart from prayers to gods to showerpestilence on the enemy, active measures werealso adopted. These were based on the observedlink between filth, foul odour, decay and disease/contagion. Filth, cadavers and animal carcasseshave been used to contaminate wells, reservoirsand other water sources up to the 20th century. Inthe Middle Ages, military leaders recognised thestrategic value of bubonic plague and used it bycatapulting infected bodies into besieged forts.Two such episodes, that of Kaffa (1346) andCarolstein (1422), have been identified as eventsthat probably initiated and perpetuated theinfamous Black Death which killed a third to halfof Europe’s population. There is documentation ofthe use of biological weapons during the Frenchand Indian wars in North America (1754–1767).

In the 20th century, the use of bioweaponsbecame more scientific as technology for thecultivation of pathogens and vaccinologydeveloped. During WW I, Germany developed abiowarfare programme to use bacteria to infect orcontaminate livestock and feed. There are alsoaccusations of German bioattacks on Italy (cholera)and Russia (plague). After WW I, many nationsundertook the development of bioweapons.Significant research efforts were also made by bothsides in WW II. Human pathogens like Bacillusanthracis, Botulinum toxin, Fracisella tularensis,Brucella suis, etc., and crop pathogens like RiceBlast, Rye Stem Rust, etc., were developed intobioweapons.

Post-WW II, the Cold War saw the seriousdevelopment of bioweapon programmes. Majorstate-sponsored research was carried out atestablishments like the US Army Medical ResearchInstitute for Infectious Diseases (USAMRIID) at FortDetrick, the British complex at Porton Down andBiopreparat in the Soviet Union. United States (US)President Nixon’s executive orders of 1969 and1970 terminated the US programme but itcontinued to maintain ‘defensive’ research. TheSoviet programme started around the 1920s andis believed to have continued unabated till thebreakup of the Soviet Union. The number ofcountries currently working on biological weaponsis estimated to be between 11 and 17 and includesponsors of terrorist activities. Even smaller groupshave now acquired bioterrorist capabilities.

1.2 Biological Agents as Causes ofMass Destruction

Whether naturally acquired or artificiallyintroduced, highly virulent agents have the potentialof infecting large numbers of susceptibleindividuals and in some cases establishinginfectious chains. The potential of some infectiousagents is nearly as great as that of nuclear weaponsand, are therefore, included in the triad of Weaponsof Mass Destruction (WMD): Nuclear, Biological

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and Chemical (NBC). The low cost and widespreadavailability of dual technology (of lowsophistication) makes BW attractive to even lessdeveloped countries. BW agents, in fact, are moreefficient in terms of coverage per kilogram ofpayload than any other weapons system. Inaddition, advances in biotechnology have madetheir production simpler and also enhanced theability to produce more diverse, tailor-made agents.Biological weapons are different from other WMDas their effects manifest after an incubation period,thus allowing the infected (and infectors) to moveaway from the site of attack. The agents used inBW are largely natural pathogens and the illnessescaused by them simulate existing diseases. Thediagnosis and treatment of BW victims should becarried out by the medical care system rather thanby any specialised agency as in the case of theother two types of WMD. Another characteristic ofsome of these attacks, e.g., smallpox, is theirproclivity to set up chains of infection.

The production and use of biological agentsis simple enough to be handled by individuals orgroups aiming to target civilians. Thus, BT isdefined by CDC as, ‘the intentional release ofbacteria, viruses or toxin for the purpose of harmingor killing civilians’.

1.3 Sources of Biological Agents

Theoretically, any human, animal or plantpathogen can cause an epidemic or be used as abiological weapon. The deliberate intention/actionto cause harm defines a biological attack. A well-known example is the incident in the USA wheremembers of a religious cult caused gastroenteritisby the use of Salmonella typhimurium. Theorganism causing the illness was such a commonnatural pathogen, that, only the confessionalstatements of the perpetrators (when the cult brokeup) revealed the facts. However, certaincharacteristics need to be present for an organismto be used as a potential biological agent for

warfare or terrorist attack. Of these, anthrax,smallpox, plague, tularemia, brucellosis andbotulinism toxin can be considered as leaders inthe field. It is the causative agents that have to becatered for in the context of BT at all times. Asalready mentioned, the use of agents that targetlivestock and crops could be as devastating ashuman pathogens, in terms of their probableeconomic impact on the community.

1.4 Threat Perception

The general perception that the actual threatof BT is minimal was belied by the anthrax attacksthrough the postal system in 2001 which followedthe tragic 9/11 events. BT, rather than BW, hasnow been perceived to be more relevant. Likewise,in agriculture, the inadvertent introductions of exoticspecies have had far-reaching consequences.Nevertheless, deliberate actions have not yet beenrecorded. Rapid advances in biotechnology andaggressive deliberate designs could open upopportunities for the hostile use of biologicalresources.

Anthrax, smallpox, plague and botulism areconsidered agents of choice for use againsthumans. Similarly, crop and livestock pathogenshave been identified in their respective fields.However, the perceptions change as public health,veterinary and crop practices evolve. A diseasethat has been eliminated from a communityautomatically becomes a BW weapon as herdimmunity wanes. This is the case with smallpox,which was once an endemic infection. In theveterinary field, the elimination of rinderpest inIndia, without parallel eradication in neighbouringcountries, makes it a potential agent. Thecharacteristics of various BW agents is given inAnnexure-A.

In the case of India it is generally believed that:

i) BW agents are unsuitable for attackingmilitary formations as troops would, most

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likely, be protected, while the attackingforces would need to be immunised; hencethe surprise element would be lost. Shouldthe defending troops be dispersed inmountainous or desert regions, a BW attackwill not be effective in such terrain andatmospheric conditions. Theoretically, ofcourse, a bioattack can be launchedagainst discrete targets like naval bases,island territories or isolated military facilitieswith a greater probability of success.

ii) Bioweapons such as anthrax are more likelyto be used by terrorists, possiblyencouraged by state or non-state actors,against vulnerable populations or industrialcentres. Terrorists are capable ofmanufacturing bioweapons of lowermilitary efficiency that will be adequateagainst civilian targets, especially to causepanic. In this context BW agents havegained the status of bioweapons ratherthan WMD.

iii) Consciousness is increasing about the factthat apart from human targets, bioweaponscould be used to attack agricultural cropsand livestock. Recently in India, aninfection of avian flu in a limited area,required the mass culling of birds, causingmassive losses to commercial poultryenterprises, thus highlighting theirvulnerability to attack and the potential ofnatural epidemics to cause economiclosses.

iv) An overloaded urban infrastructureconsequent to rapid urbanisation, alongwith population movement, is the largesthazard the country faces. Natural outbreakscan occur easily, as also selectivelyintroduced pathogens. The social disruptionthat can occur was clearly evident duringthe Surat plague epidemic in 1994.

Biological research is rapidly changing theepidemiology of infectious diseases, therebyaltering the threat perceptions which have to bereviewed periodically in the long and short term.International organisations (e.g., WHO, FAO, etc.)have a major role to play. National surveillancemechanisms should be upgraded to be able toprovide useful inputs. Intelligence reports basedon epidemiological information, intent to harm, andtechnological developments can give an idea ofthe threat. Based on these inputs, threatperceptions can be qualified.

1.5 Zoonoses

WHO defines zoonoses as ‘diseases andinfections naturally transmitted between non-humanvertebrate animals and human beings’. Emergingzoonotic diseases are ‘zoonosis that is newlyrecognised or newly evolved or that has occurredpreviously but shows an increase in incidence orexpansion in geographical, host or vector range’.A catalogue of 1,415 known human infectionsrevealed that 62% were of zoonotic origin. Ananalysis of emerging infectious diseases revealed75% of them to be of zoonotic origin. Bacteria,viruses and parasites can spread from a wildlifereservoir. Fungi do not normally adopt this route.

Historically, plague, rabies and possibly someviral diseases like the West Nile virus, have beendescribed as zoonoses. The transmission ofzoonotic infections may be by the following means:

i) By direct transmission as in tularemia (byinhalation) or bites as in rabies (inoculation)or contact with infected material as in HIVtransmission through mucosal breaches.

ii) Ingestion of infected animal products usedfor food e.g., milk (brucellosis), pork(trichiniosis, tapeworms), lamb and goat(anthrax), etc.

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iii) Through the bites of insect vectors e.g.,plague, West Nile virus, Lyme borrelliosis, etc.

Changes in the epidemiology of zoonosesoccur constantly, either due to natural causes whenthe distribution of the animal reservoir or vectorvaries, or due to anthropogenic causes when humanactivity changes the environment. Thus, in the caseof Lyme borrelliosis, reforestation increased thevector population (ticks). Similarly, deforestationand monkey migration increased human–tickinteraction to precipitate the Kyasanur ForestsDisease (KFD) outbreaks in South India. Nationalor international wildlife trade for food or pets bringtogether different species from varied sources intothe human environment permitting re-assortmentof genes and the emergence of novel pathogens.It is this type of interaction that is believed to havetriggered the Severe Acute Respiratory Syndrome(SARS) outbreak in South China and thereby causedthe evolution of a new influenza strain with thepotential of causing an epidemic.

Arthropod vectors play an important role in thetransmission of zoonoses as well as some non-zoonotic infections. Viral infections such as WestNile, dengue, etc., and bacterial infections suchas filarial, dracunculosis, etc., are transmitted byvectors. Vectors transmit the infection by amplifyingthe pathogen, e.g., malaria, dengue, etc., and byintroducing it in a bite, or by direct implantation asin louse-borne typhus, or ingestion of the infectedvector as in dracunculosis.

Zoonotic infections are not easy to controlunless the epidemiology is well-established andspecific activities favouring the transmission areidentified and addressed. Thus, the discovery ofthe involvement of the trombiculid mite in thetransmission of scrub typhus permitted a specificmethod of control to be adopted. However, suchsuccess is unusual. Prevention of human contactwith the source of infection will be the true remedy,though not often feasible.

1.6 Molecular Biology and GeneticEngineering

The discovery of the Polymerase ChainReaction (PCR) in 1983 by Kary Mullis has been amajor advancement in biotechnology. The resultanttechnologies have stimulated the development ofdiagnostics, enhanced the understanding of thegenetic configuration of living beings and enabledthe construction of the complete genomes of alarge number of living forms. Thus, the geneticconfiguration of several viruses, bacteria (includingmore than 100 pathogens), protozoa and higherplants and animals are now known and have beenpublished. We are now in a position to follow geneactivities in different situations; e.g., we now havethe complete genomes of the three componentsof the falciparum malaria cycle: man (Homosapiens), the vector (Anopheles gambiae) and thepathogen (Plasmodium falciparum). Theimplications of this in the field of infectiousdiseases are immense—elucidation of theprocesses of infection, defining vaccine targetsand identifying sites for therapeutic processes cannow be attempted proactively. These advanceshave been assessed to be comparable to thediscovery of antibiotics as far as their impact oninfectious disease control is concerned. Only theearliest impacts are currently being felt.

It is now possible to diminish (or enhance) thevirulence of pathogens, change their anti-microbialsusceptibilities or even their tropism. Simple viralmolecular structures can be modified even in silico.The results are largely predictable, though somesurprises may arise during experimentation. Theexperiment to devise an immuno-contraceptive inmice using the ectromelia virus (with addedinterleukin-4), which resulted in an unexpectedenhanced virulence, is a case in point. The poliovirus has now been synthesised and the productproved to be viable. Other viruses are also on thesynthetic path, i.e., intentional synthesis of wildstrains. Another achievement has been the

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reconstitution of the Spanish influenza virus of 1918from laboratory preserved tissue and infectedcadavers frozen in permafrost.

As has happened in the case of other majortechnological advancements particularly in nuclearand chemical technology, there is considerablescope for ‘dual use’ in molecular and genetictechnology and the benefits may be overshadowedby the perverted uses that may accrue. In thisrespect, the areas of concern are brieflysummarised below:

i) Modifying organisms to change theirantigenic profile to render existing vaccinesineffective. Examples could be changingthe surface antigens of the smallpox virusto make it resistant to standard vaccination.Likewise, the introduction of plasmids intoSalmonellae may change their antigenicprofile.

ii) Change of the antibiotic susceptibilitypattern of the pathogen. The introductionof R-factor plasmids or chromosomaldeterminants may result in phenotypicmodification that renders the organismsresistant to useful antibiotics. This can beachieved in Yersinia pestis, Bacillusanthracis or Brucellae by transformation ortransduction. If virulence remains intact, theresultant outbreaks can be disastrous.

iii) The identification of virulent genes andislands in bacteria defines DeoxyribonucleicAcid (DNA) segments that can betransferred to marginally virulent or avirulentorganisms and render them stronglyvirulent. In essence, this is a laboratoryduplication of natural processes.

iv) The initiation of infection is stronglydependent upon the pathogen being ableto adhere to the susceptible host tissue.The specificity of the process determinesthe infectivity range and is usually dictatedby the configuration of the surface

glycoproteins antigens. The host range maybe amplified or modified by changing thegenes determining surface attachmentmotifs.

v) Enhancing the release of a virus or additionof newer characteristic can result in asimultaneous change in the transmissioncharacteristics of the organism.

vi) In vitro processing of pathogens may altertheir surface characteristics enabling themto avoid detection or even change theirsurvival profile; e.g., introduction of a novelgene into Bacillus anthracis could result ina robust pathogen if the introduced genesremain active in spores.

vii) Some experiments designed to use viralgenomes to introduce biologically effectiveinfectious genetic material in a dormantstate may result in changing the profile ofpopulations in a manner suitable formolecular manipulation. While suchclandestine genetic attacks are fictional atpresent, biotechnology has advancedadequately to make it feasible. Amycoplasma genome (Mycoplasmagenitalis) has been synthesised. This is thefirst free living microorganism to be createdin vitro.

The spread of biotechnology and geneticengineering has added novel dimensions to bothBW and BT. This technology is largely availablelegitimately and is being actively researched tosharpen its thrust. Its potential for good can easilybe distorted by unethical manipulation.

1.7 Biosafety and Biosecurity

The threat posed to laboratory and otherinvestigators studying pathogenic organisms hasbecome evident after cultivation of these agentsbecame possible. The history of infectious diseasesis studded with accounts of workers who

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succumbed to the diseases they studied. The latestexample is that of Carlos Urbani who died of SARS.Organised BW programmes laid the foundation ofbiosafety. The different biosafety classes have beendefined as Biosafety Level (BSL) 1–4 and thenecessary standards for the correspondinglaboratory and other precautions have been laiddown. Thus, laboratory designs to study the variouslevels have been defined to safeguard the interestsof the laboratory worker, the treatment facility andthe community at large. This aspect has been abeneficial spin-off from BW activities. These aredealt with in greater detail in Chapter 4.

1.8 Epidemics

The introduction of a pathogen capable ofestablishing a transmission chain into a susceptiblepopulation will result in an epidemic. In nature,the initial primary infection(s) are followed byrounds of secondary and tertiary infections and soon. A natural epidemic starts to wane when thenumber of susceptibles decreases or thetransmission chain is interrupted. In classical viralexanthemata (e.g., measles), epidemics peter outwhen the population becomes totally (or at least90%) immune. In the case of arthropod-borneepidemics (e.g., dengue or Japanese encephalitis),the onset of cooler weather (decreased mosquitobreeding) interrupts the outbreaks. In some cases,essentially individualistic infections may adapt tohuman activity or ecological changes. The ongoingHIV/AIDS epidemic is an example of such aphenomenon. Deliberate introduction of pathogenscan largely mimic natural outbreaks. However, aclose examination of the characteristics may offera clue to the artificiality. These clues areenumerated below:

(A) Epidemiologic Clues

i) Greater case load than expected, of aspecific disease.

ii) Unusual clustering of disease for ageographic area.

iii) Disease occurrence outside the normaltransmission season.

iv) Simultaneous outbreaks of differentinfectious diseases.

v) Disease outbreak in humans afterrecognition of the disease in animals.

vi) Unexplained number of dead animals orbirds.

vii) Disease requiring an alien vector.

viii) Rapid emergence of genetically identicalpathogens from different geographic areas.

(B) Medical Clues

i) Unusual route of infection.

ii) Unusual age distribution or clinicalpresentation of a common disease.

iii) More severe disease symptoms and higherfatality rate than expected.

iv) Unusual variants of organisms.

v) Unusual anti-microbial susceptibilitypatterns.

vi) Single case of an uncommon disease.

(C) Miscellaneous Clues

i) Intelligence reports.

ii) Claims of the release of an infectious agentby an individual or group.

iii) Discovery of munitions or tampering.

iv) Increased numbers of pharmacy orders forantibiotics and symptomatic relief drugs.

v) Increased number of emergency calls.

vi) Increased number of patients with similarsymptoms to emergency departments andambulatory health care facilities.

Experience with the highly pathogenic avianinfluenza virus (H5N1) in West Bengal in January2008 is a good example of the economic and healthissues, and actions needed to control epidemics

INTRODUCTION


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and epizootics. The death of a large number offree range poultry in eastern India activatedsurveillance. The cause of the epizootic wasidentified and preventive action was initiated. Therewas initial reservation and lack of cooperation bythe community which depended heavily on poultryfor nutrition and income, as well as the inertia ofother stakeholders (including medicalprofessionals). However, once the gravity wasrealised, action was initiated and communityparticipation was forthcoming. The outbreak wasprobably triggered by trans-border illegal poultrytrade. The reporting of outbreaks in all the countriesbordering India has made the establishment ofregional surveillance networks a high priority issue.These will be coordinated by the internationalagencies FAO and WHO. The potential of suchoutbreaks to initiate a new influenza strain withpandemic potential would challenge the medicalinfrastructure of all the nations.

1.9 Biological Disasters (BT)

Events in the recent past have shown that thethreat of BT is real. ‘The arguments advanced todefer consideration of the issues related tobioterrorism have been “without validity” and wecannot delay the development and implementationof strategic plans for coping with civilianbioterrorism’. Reconstructed scenarios in the caseof attacks by the more likely BT agents reveal twopatterns. In the case of anthrax and botulinum toxinwhich have high initial effect but no secondarycases, the scenario is similar to chemical attacks.However, when the pathogen used has the ability toset up secondary cases, and probably an epidemic,the scenario is far more complex. The preparationand action have to be tailored appropriately.

Bioweapons are particularly attractive toterrorist groups because of the ease of theirproduction and also their low cost. They have beentermed ‘the poor man’s nuclear bomb’ since it is

estimated that a large-scale operation, against acivilian population with casualties, may cost about$ 2,000 per sq. km with conventional weapons, $800 with nuclear weapons, $ 600 with nerve gasweapons and $ 1 with biological weapons. Therehave been numerous documented attempts at BT.Biological agents are more efficient in terms ofcoverage per kilogram of payload than any otherweapons system. Terrorism by means ofweaponised biological agents such as anthrax isno longer a theoretical concept. Anthrax sporescan be milled to an unexpectedly fine degree—100 times smaller than the human strain in sizeand easily inhaled deep into the lungs. Even thedelivery system for weaponised anthrax need notbe sophisticated. Accidental release of anthraxbacilli from a bioweapons unit at Sverdlovsk [inthe former Union of Soviet Socialist Republics,(USSR)] and an outbreak of salmonellosis in Dallas,Oregon, in 1984 are well known incidents. Thepostal dissemination of anthrax spores (after 9/11)caused 22 cases, including 5 deaths, and ‘usheredin the transition from table top bioterrorismexercises to real world investigation and response’.The crucial role of well trained, alert health careproviders like Larry Bush, the infectious diseasesphysician from Florida, USA, who diagnosed thefirst case promptly, is underlined by this outbreak.

1.10 Impact of Biological Disasters

Dispersal experiments have been attemptedusing non-pathogenic Bacillus globigii, which hasphysical characteristics similar to Bacillusanthracis. The variables in dissemination have beenworked out and the impact of bioterrorist attacksestimated. The dispersal experiments showed thatan attack on the New York subway system wouldkill at least 10,000 people. WHO studies show thata 50 kg dispersal on a population of 500,000 wouldresult in up to 95,000 fatalities and over 125,000people being incapacitated. Other experimentshave also shown similar disastrous outcomes.

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In the case of smallpox, the emergence ofsecondary cases at the rate of 10 times the numberof primarily infected subjects, would add to theburden. There would also be a demand for large-scale vaccination from meagre stocks and noongoing production. Inevitably, epidemics wouldbreak out and social chaos would ensue.

The economic impact of BT would be a majorburden that could transcend the medicalconsequences. It has been estimated that the useof a lethal agent like Bacillus anthracis would causelosses of $26.2 billion per 100,000 personsexposed, while a less lethal pathogen, e.g.,Brucella suis would cause $477.7 million. The studyalso shows that a post-attack prophylaxisprogramme will be cost-effective, thereby justifyingexpenditure on preparedness measures. The majoreconomic losses that occurred due to the falloutof the 1994 Surat plague epidemic of natural originis an example of the larger ramifications of BT/BW. A BT attack on agriculture can cause asmuch economic loss as an attack on human beings.The spread of the Parthenium hysterophorus weed,which entered India in the late 1950s along withimported wheat, affected the yield of fodder cropsand became a crop pest. This is an excellent casestudy on how an inadvertent entry of exotic pestscan occur and lead to adverse consequences inthe long term. With properly equipped emergencycrews, designated meteorological experts to trackthe movement of airborne particles, stockpiling ofprophylactic and therapeutic antibiotics, and amechanism for going rapidly to emergency mode,the estimated casualties can be reduced to just5–10% of the normal casualty rates. This analysissuccinctly expresses the need for, and value of, aproper response to BT.

1.11 Regulatory Institution

There is need for an agency that canincorporate stakeholders and experts to overseethis aspect on a continuing basis. The National

Science Advisory Board for Biosecurity set up bythe US Department of Health and Human Sciencescould be emulated in our country. A model planwill be prepared by the nodal ministry with thehelp of an advisory committee, which will beupdated periodically. The perceived threat wouldbe the basis for anticipating and executing action.The advisory committee would have strong linkswith NDMA.

1.12 Aims and Objectives of theGuidelines

Under Section 6 of the DM Act, 2005, NDMAis inter alia mandated to issue guidelines forpreparing action plans for holistic and coordinatedmanagement of all disasters. The Guidelines onmanagement of biological disasters will focus onall aspects of BDM, including BT, with a focus onprevention, mitigation, preparedness, medicalresponse, and relief.

The Guidelines will form the basis for centralministries/departments concerned and states toevolve programmes and measures to be includedin their action plans. MoH&FW is the nodal ministryfor the said issue. The health services of otherimportant line ministries with important roles to playare MoD, MoR and Employees’ State InsuranceCorporation (ESIC) of the MoL&E. The private sectoris also encouraged to participate in BDM byadoption of the PPP model. The approach to befollowed will emphasise a preventive approachsuch as immunisation of first responders andstockpiles of medical countermeasures basedupon risk reduction measures by developing arigorous medical management framework to reducethe number of deaths during biological disasters,both intentional and accidental. This is to beachieved through strict conformity with existing andnew policies and proactive involvement of allstakeholders. It will include the development ofspecialised measures pertaining to themanagement of biological disasters.

INTRODUCTION


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The important underlying objectives would beto educate the persons concerned, whether inactual contact in the field or not, in the diagnosis,treatment and organisation of relief measures; tolay down the procedures to successfully combatepidemics; to provide a ready source of basicinformation on the subject to influencepreparedness and execution of relief measures atall levels; and to provide the basis for preparationof BDM protocols at various levels.

In addition, the Guidelines will be utilised bythe following responders and service providers:

i) District administrators in coordination withChief Medical Officers (CMOs) and otherhealth care providers will use these

Guidelines for the development of BDM inthe ‘all hazard’ district DM plans.

ii) All hospitals (government, local bodies,NGOs, private and others) will developBDM as part of their hospital DM plans usingthese Guidelines.

iii) State medical management plans coveringmacro issues of capacity development andmicro issues pertaining to more vulnerabledistricts will be developed based on theseGuidelines.

iv) All stakeholders connected directly orindirectly with BDM will make use of theseGuidelines to mitigate the effects of suchdisasters.

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2 Present Status and Context

After Independence, India accorded significantpriority to the control and elimination of diseasesposing a major public health burden. Successfuleradication, elimination, and control of major killerdiseases also contributed in sustaining socio-economic growth, reflecting the improvement ofhealth in its people. This led to an epidemiologicaland demographic transition. The notable successstories are eradication of smallpox in 1975, a highlycontagious endemic disease that accounted for athird of all deaths in the 18th and 19th centuries.Malaria is another major public health problemwhich had caused absenteeism leading to a fall ineconomic production with over 75 million casesannually in the early 1950s, which has now beensuccessfully brought down to a load of about twomillion cases annually; and plague, which hadassumed epidemic proportions in the early tomid 19th and 20th centuries, has nearly beeneliminated.

The outbreak of plague in Surat (1994) after agap of 28 years, with over 1,000 suspected casesand 52 deaths, caused widespread panic and massexodus of people from the affected areas. Thisoutbreak badly affected commerce, trade andtourism. The SARS outbreak in 2003 caught theattention of the world, establishing how laxity ininfection control practices could result in thespread of a disease from a single hospital case toa global pandemic in less than three months.Though India reported only three probable (thattoo imported cases), the panic created by themedia was unprecedented. Similarly, the outbreakof avian influenza among poultry in small pocketsof Nandurbar and Jalgaon districts of Maharashtraand adjoining districts of Gujarat and Madhya

Pradesh (2006) saw the poultry industry plummet.A still greater threat is the possibility of avianinfluenza (H5N1) or the circulating seasonalinfluenza virus undergoing a major antigenic shiftto become a pandemic virus that may kill millions.The 1918 influenza pandemic killed an estimated7 million people in India.

Slow, evolving epidemics such as HIV/AIDS(5.1 million estimated cases in the year 2004) alsohave the potential to cause socio-economicdisruption as has been witnessed in some Africancountries. Emerging and reemerging diseases,notably SARS, avian influenza, Nipah virus,leptospirosis, dengue, Chikungunya and Rickettsial,are also posing serious threats. So are the spreadof drug-resistant TB, drug-resistant malaria andother drug-resistant diseases that may emerge inthe future. Environmental changes and their effectscan impact the ecological system with potentialfor new emerging causative agents, notably higherincidences of zoonotic diseases.

Another facet of biological disasters in theIndian context is the emerging threat of BT andBW. Though biological agents have been usedsince ancient times for inflicting damage on theenemy, there is no direct evidence that such agentshave been used in the wars involving India.However, the threat remains as our adversaries andterrorist outfits are capable of adopting advancedtechnologies to cause damage.

In this context, the subsequent sections reviewthe existing policies, and the legal, institutional,and operational framework for managing biologicaldisasters in India and identifying the critical gaps.


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2. 1 Legal Framework

According to the constitution, health is a statesubject. The primary responsibility of dealing withbiological disasters rests with the state government.There are a number of legislations that control andgovern the nation’s health policies. The governmentcan enforce these legislations to contain the spreadof diseases. Some of the commonly used legalinstruments are discussed below.

2.1.1 Legislation that Supports Health Actionat Grass-root Level

The 73rd Constitutional Amendment onPanchayati Raj Institutions (PRIs) provides forsetting up of a three-tiered structure of localgovernance at district, block and village level.Health is a subject matter that can be acted uponby PRIs. The amendment mandates setting up ofhealth and sanitation committees in each village,the most peripheral body at the grass-root level,to take decisions on health matters for the community.

The municipal Acts are civic Acts that governthe civic responsibilities of local bodies such asmunicipalities and municipal corporations. The Actsprovide for the provision of safe drinking water,hygiene and sanitation, food safety, notification andcontrol of diseases, and public health concerns,including containment of outbreaks.

2.1.2 State and District Level

The Epidemic Diseases Act (Act 111 of 1897)provides for ‘better prevention and spread ofdangerous epidemic diseases’. This Act, still inforce, provides the states the authority to designateany of its officers or agencies to take measures forthe prevention and control of epidemics.

Relevant provisions under the Indian PenalCode (IPC) and Criminal Procedure Code (CrPC)can be invoked to detain and question persons

involved in criminal acts, which includes BT in itsambit. Other provisions under this Act can beapplied for establishing law and order, enforcingquarantine, etc.

2.1.3 National Level

The Water (Prevention and Control of Pollution)Act, 1974, provides for the prevention and controlof water pollution and the maintenance or restorationof the wholesomeness of water. It provides for thecreation of central, state, or joint boards for theprevention and control of water pollution, and forsuch purposes empowers them to obtaininformation, inspect any site, take samples foranalysis and take punitive action against thepolluter. For this, the rules were laid down in theWater (Prevention and Control of Pollution) Rules,1975.

The Air (Prevention and Control of Pollution)Act, 1981, and the Rules (1983) provide for theprevention, control and abatement of air pollutionand establishing boards for such purpose andassigning powers and functions to them relatingto air pollution.

The Environmental (Protection) Act, 1986, andthe Rules (1986) provide for protection of theenvironment and empowers the government to takeall such measures as it deems necessary orexpedient for the purpose of protecting andimproving the quality of the environment andpreventing, controlling and abating environmentalpollution. This Act also provides for the BiomedicalWaste (Management and Handling) Rules, 1998with a view to controlling the indiscriminate disposalof hospital/biomedical wastes. These rules applyto hospitals, nursing homes, veterinary hospitals,animal houses, pathological laboratories, and bloodbanks generating biomedical waste.

The Disaster Management Act (DM Act), 2005,provides for the effective management of disastersand for all matters connected therewith or incidental

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thereto. It provides for an institutional andoperational framework at all levels for disasterprevention, mitigation, preparedness, response,recovery, and rehabilitation. This includes settingup of NDMA, SDMA, DDMA, National ExecutiveCommittee (NEC), NDRF, and National Institute ofDisaster Management (NIDM). It also clearly spellsout the role of central ministries. It empowers thedistrict authorities to requisition by order any officeror any department at the district level or any localauthority, to take such measures for the preventionor mitigation of disaster, or to effectively respondto it, as may be necessary, and such officer ordepartment shall be bound to carry out such orders.For the purpose of assisting, protecting or providingrelief to the community in response to anythreatening disaster situation or disaster, the districtauthority is also empowered to (a) give directionsfor the release and use of resources available withany department of the government and the localauthority in the district; (b) control and restrictvehicular traffic to, from and within, the vulnerableor affected area; (c) control and restrict the entryof any person into, his movement within anddeparture from, a vulnerable or affected area; and(d) procure exclusive or preferential use ofamenities from any authority or person. Theseprovisions imply that for biological disasters,necessary quarantine measures will be legallyinstituted using private sector health facilities alsofor comprehensive patient care.

The Public Health Emergencies Bill beingdrafted by MoH&FW is intended to replace theEpidemic Diseases Act, 1897 and provides foreffective management of public health emergencies,including BT. The draft is presently being modifiedafter seeking comments from the states.

2.1.4 International

International Health Regulations [IHR (2005)]

IHR (2005) adopted by the World HealthAssembly on 23 May 2005 came into force on 15

June 2007. The purpose and scope of IHR (2005)is to prevent, protect against, control and providea public health response to the international spreadof disease and to avoid unnecessary interferencewith international traffic and trade. A legally bindinginternational agreement, it seeks to protect against,control and provide a mechanism to initiate a publichealth response to the threat or spread of diseasecausing a Public Health Emergency of InternationalConcern (PHEIC), including that of biological,chemical or radio-nuclear origin.

Under IHR (2005), Member States are requiredto strengthen their core capacity to detect, reportand respond rapidly to public health events and tonotify WHO, within 24 hours, of all events that mayconstitute a PHEIC. It also provides for routineinspection and control activities at internationalairports, seaports, and certain ground crossings.WHO will provide clear guidelines on the outbreakverification process, technical and logisticalsupport upon request, and Member States will alsobe eligible for support from the Global OutbreakAlert and Response Network (GOARN), which willbe mandated to conduct global surveillance andintelligence gathering to detect significant publichealth risks. WHO will also assist in settlinginternational public health differences bynegotiation, mediation, conciliation and arbitration.

Biological and Toxin Weapons Convention(BTWC)

The Biological and Toxin Weapons Convention,which came into force on 26 March 1975, providesfor prohibition of the development, production andstockpiling of bacteriological (biological) and toxinweapons and for their destruction. BTWC now has146 States Parties, including the five permanentmembers of the United Nations (UN) SecurityCouncil but not including 48 WHO Member States.India is signatory to the BTWC. Each signatory ofthe BTWC undertakes never in any circumstancesto develop, produce, stockpile or otherwise acquireor retain:

PRESENT STATUS AND CONTEXT


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i) Microbial or other biological agents, ortoxins whatever their origin or method ofproduction, of types and in quantities thathave no justification for prophylactic,protective or other peaceful purposes.

ii) Weapons, equipment or means of deliverydesigned to use such agents or toxins forhostile purposes or in armed conflict.

If any signatory feels threatened, it may lodgea complaint with the Security Council of the UN.Such a complaint should include all possibleevidence confirming its validity, as well as a requestfor its consideration by the Security Council. EachState Party to this Convention also undertakes toprovide or support assistance, in accordance withthe UN Charter, to any Party to the Conventionwhich so requests, if the Security Council decidesthat such Party has been exposed to danger as aresult of any violation of the Convention.

2.2 Institutional and Policy Framework

2.2.1 National Disaster Management Authority

With the objective of providing for effectivemanagement of disasters, the DM Act, 2005 wasenacted on 26 December 2005. The Act seeks toinstitutionalise mechanisms at the national, stateand district levels, to plan, prepare and ensure arapid response to both natural calamities and man-made disasters/accidents. The Act mandates: (a)the formation of a national apex body, the NDMA,with the Prime Minister of India as the Chairperson,(b) creation of SDMAs, and (c) coordination andmonitoring of DM activities at district and locallevels through the creation of district and local levelDM authorities.

The NDMA is responsible to (a) lay downpolicies on DM; (b) approve the National Plan; (c)approve plans prepared by the ministries ordepartments of the Government of India (GoI) inaccordance with the National Plan; (d) lay down

guidelines to be followed by state authorities indrawing up the state plan; (e) lay down guidelinesto be followed by the different ministries ordepartments of GoI for the purpose of integratingmeasures for the prevention of disaster and themitigation of its effects in their development plansand projects; (f) coordinate the enforcement andimplementation of the policy and plans for DM; (g)recommend provision of funds for the purpose ofmitigation; (h) provide such support to othercountries affected by major disasters as may bedetermined by the central government; (i) take suchother measures for the prevention of disaster, orthe mitigation, or preparedness and capacitybuilding for dealing with the threatening disastersituation or disaster as it may consider necessary;and (j) lay down broad policies and guidelines forthe functioning of NIDM. NDMA is assisted by theNEC, consisting of secretaries of 14 ministries andChief of the Integrated Defence Staff of Chiefs ofthe staff committee, ex officio as provided underthe DM Act, 2005.

NDMA is, inter alia, responsible forcoordinating/mandating the government’s policiesfor disaster reduction/mitigation and ensuringadequate preparedness at all levels. Coordinationof response to a disaster when it strikes and post-disaster relief and rehabilitation will be carried outby NEC on behalf of NDMA.

NDMA has been supporting various initiativesof the central and state governments to strengthenDM capacities. NDMA proposes to acceleratecapacity building in disaster reduction andrecovery activities at the national level in some ofthe most-vulnerable regions of the country. Thethematic focus is on awareness generation andeducation, training and capacity development formitigation, and better preparedness in terms ofdisaster risk management and recovery atcommunity, district and state levels. Strengtheningof state and district DM information centres foraccurate and timely dissemination of warning isalso in progress.

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2.2.2 National Crisis Management Committee(NCMC)

The NCMC, under the Cabinet Secretary, ismandated to coordinate and monitor response tocrisis situations, which include disasters. TheNCMC consists of 14 union secretaries of theconcerned ministries including the Chairman,Railway Board. NCMC provides effectivecoordination and implementation of response andrelief measures in the wake of disasters.

2.2.3 National Disaster Response Force

The DM Act, 2005 has mandated theconstitution of the NDRF for the purpose ofspecialised response to a threatening disastersituation or disaster. The general superintendence,direction and control of the force is vested in andexercised by the NDMA and the command andsupervision of this force is vested in the DirectorGeneral of NDRF. Presently, NDRF comprises ofeight battalions with further expansion to beconsidered in due course. These battalions havebeen positioned at eight different locations in thecountry based on the vulnerability profile. This forceis being trained and equipped as a multi-disciplinary, multi-skilled force with state-of-the-art equipment. Each of the eight NDRF battalionswill have three to four states/Union Territories (UTs)as their area of responsibility, to ensure promptresponse during any disaster. Each of thesebattalions will have three to four Regional ResponseCentres (RRCs) at high vulnerability locations wheretrained personnel with equipment will be pre-positioned. NDRF units will maintain close liaisonwith the state administration and be available tothem proactively, thus avoiding long proceduraldelays in deployment in the event of any seriousthreatening disaster situation. Besides, NDRF willalso have a pivotal role in community capacitybuilding and public awareness. NDRF is alsoenjoined with the responsibility of conducting thebasic training of personnel from the State DisasterResponse Forces (SDRFs), police, civil defence,

home guards and other stakeholders in disasterresponse.

2.2.4 Ministry of Health and Family Welfare

MoH&FW is the nodal ministry for handlingepidemics. The decision-making body is the CrisisManagement Group under the Secretary(MoH&FW), which is advised by the TechnicalAdvisory Committee under Director General HealthServices (DGHS). The Emergency Medical ReliefDivision of the Directorate General of HealthServices is the focal point for coordination andmonitoring. The National Institute of CommunicableDiseases (NICD) is the nodal agency forimplementing IHR (2005) and for investigatingoutbreaks. The NICD/Indian Council of MedicalResearch (ICMR) provide teaching/training,research and laboratory support. Most states havea regional office for health and family welfare andthe regional director liaises with the stategovernment for effective management of biologicaldisasters.

MoH&FW is vested with the responsibility offraming the national health sector guidelines,providing guidance and technical support forcapacity development in surveillance, earlydetection of any outbreak and supporting the statesduring outbreaks in terms of outbreakinvestigations, deployment of Rapid ResponseTeams (RRTs), manpower and logistic support forcase management, etc.

The National Health Policy, 2002, whileobserving that the decentralised public healthoutlets have become practically dysfunctional, hadadvocated developing the public health capacitywithin the states up to the grass-root level to providequality public health services.

There are various national health programmesrun by the DGHS, MoH&FW, either as a centralsector scheme or in partnership with the stategovernment. Some of these programmes, such as



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the National TB Programme, National Vector BorneDisease Control Programme, National Programmefor Control of Iodine Deficiency Disorders andNational AIDS Control Programme which have theirnetworks throughout the country, run as verticalprogrammes, merging horizontally with servicedelivery at the grass-root level and have focusedstrategic approach with inbuilt components forsurveillance and monitoring. Many of theseprogrammes were successful in achieving theirobjective to control/prevent major biologicaldisasters—malaria, smallpox and AIDS are primeexamples. These programmes often dwell onrenewed strategies for emerging threats such asdrug-resistant TB, HIV-TB co-infection, drug-resistant malaria, etc. The experience gained fromthe controlling of malaria came handy in preventingthe dengue and Chikungunya outbreaks. In fact,the rich experience gained in managing nationalprogrammes will remain the backbone of managingfuture public health threats.

The National Rural Health Mission (NRHM)2005–12 strives to strengthen health delivery atthe grass-root level by placing a village healthworker—Accredited Social Health Activist (ASHA),in each village, supported by the Village Healthand Sanitation Committee. The Primary HealthCentres (PHCs), the Community Health Centres(CHCs), and the district hospitals are beingstrengthened for ensuring minimum public healthstandards for health care delivery. Oncestrengthened, the primary health care system willbe in a position to assess vulnerabilities, detectearly warning signs, feed information into thenational surveillance system and help the districthealth officials in case management.

The Central Government Health Scheme(CGHS) and central government run hospitalsprovide general and specialised medicalprofessionals for clinical management of cases.

2.2.5 Ministry of Home Affairs

MHA is the nodal ministry for BT and partnerswith MoH&FW in its management. MHA isresponsible for assessing threat perceptions,setting up of deterrent mechanisms and providingintelligence inputs. MoH&FW will also provide therequired technical support.

2.2.6 Ministry of Defence

The Armed Forces have a hospital networkacross the country which can support clinical casemanagement. Further, they have the capacity toevacuate casualties by ambulance, ship, andaircraft. MoD is the nodal ministry for coordinatingwar related matters and they have also the capacityfor managing the aftermath of BW. MoD providestransportation for RRTs and supports supply chainmanagement. The Armed Forces Medical Services(AFMS) have mobile field hospitals which can bemoved to the affected areas for treatment at thesite. Well-equipped ambulances are available forevacuation of patients to hospitals. The hospitalsunder AFMS are spread out across the entire lengthand breadth of the country. Medical andparamedical staff are well trained to handlepatients who are victims of any disaster. Trainingis imparted at the time of induction and refreshercourses are conducted regularly. The role of theArmed Forces is discussed below:

i) The Armed Forces by their inherentorganisation, infrastructure, training,leadership, communications, etc., aresuitable as first responders in any national-level calamity or disaster.

ii) Response to a bioterrorist attack will be nodifferent from the response to any othersituation, except for a few peculiarities,which must be identified and suitablycatered for.

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iii) Since this type of disaster will be moretowards the management of providingimmediate medical assistance, the MoDwill coordinate and provide assistance asfirst responders that will be orchestrated bythe Director General Armed Forces MedicalServices (DGAFMS). These will be in theform of earmarking command-wiseresponses, relating to assigned areas ofresponsibilities. Basically, the following maybe included:

a. Upgrade necessary infrastructure anddevelop capacity to respondadequately.

b. Training of earmarked medicalpersonnel in the management ofcasualties occurring on account of anybiological attack, as these will bedifferent in nature to war casualties orcasualties on account of any otherdisaster.

c. Earmarking of command-wise firstresponders from all medical resourcesof the Army, Navy and Air Force.

d. Create adequate stockpile ofnecessary vaccines such as anthraxvaccine under various commands witha mechanism to turn over the stocksheld.

e. Conduct periodic exercises to ensureefficacy of response plans.

f. Immunise adequate number of firstresponders in each command.

g. 25 hospitals have been earmarked fortreating casualties caused bybiological agents.

Defence Research and DevelopmentOrganisation (DRDO): Many establishments ofDRDO are deeply involved in developing facilitiesfor management of biological disasters. Research

is being carried out in the field of vector control,biomarkers and vaccine development. DRDO isalso imparting training to trainers for themanagement of biological disasters.

2.2.7 Ministry of Agriculture

MoA is the nodal ministry for all actions to betaken for biological disasters related to animals,livestock, fisheries and crops. Under MoA, theDepartment of Animal Husbandry, Dairying andFisheries (DADF) deals with diseases of animalsand livestock, including their quarantine, and theDepartment of Agriculture and Cooperation in MoAdeals with crop diseases and the Directorate ofPlant Protection, Quarantine and Storage (DPPQS)deals with pests. Besides, there is a Departmentof Agricultural Research and Education under whichthe Indian Council of Agricultural Research (ICAR)functions as an apex body for research onagriculture and allied sciences. ICAR has KrishiVigyan Kendras (KVKs) in many districts of thecountry, which work closely with the localcommunity on all agriculture related issues. MoAwill attend to biological disasters involvingagricultural crops, poultry and cattle. It will sendteams of experts, collect samples and get themdiagnosed. It will mobilise the local machinery onoperational aspects.

2.2.8 Other Supporting Ministries

In the context of biological disasters, theDepartment of Drinking Water Supply (Rajiv GandhiDrinking Water Mission), and the UrbanDevelopment Ministry/Rural Development Ministry(National Sanitation Campaign) play a key role inthe provision of potable water, hygiene andsanitation. The Indian Railways have their ownindependent medical capabilities, including tertiarycare hospitals, across the nation. A wide networkof trained manpower is an asset available with thisorganisation. It also has the potential for



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conducting mass evacuation of the affectedcommunity. ESIC (MoL&E) caters to 4% of thepopulation and has secondary and tertiary carehospitals in major industrial townships.

2.2.9 Institutions supporting Management ofBiological Disasters

NICD, under the administrative control of theDirectorate General of Health Services, MoH&FW,has various technical divisions and manyspecialised laboratories. The institute has threetechnical centres, viz., Centre for Epidemiologyand Parasitic Diseases, Advanced Centre for HIV/AIDS and Related Diseases, and Centre for MedicalEntomology and Vector Management; and fourtechnical divisions—Biochemistry andBiotechnology, Microbiology, Training andMalariology, and Zoonosis. Each centre/division hasseveral sections and laboratories (moleculardiagnosis, cholera, hepatitis, polio, TB, HIV/AIDS,rabies, plague, leptospirosis, kala-azar, malaria,filaria, intestinal parasite, mycology, etc.) dealingwith a wide range of communicable and a fewnon-communicable diseases. The functions of theInstitute broadly cover three areas—trained healthmanpower development, outbreak investigations,specialised services and operational/appliedresearch. It provides teacher training in fieldepidemiology. Advanced laboratory work issupported by a BSL-3 laboratory. NICD is also thenational focal point for IHR (2005).

Indian Council of Medical Research (ICMR),New Delhi: It is the apex body in India for theformulation, coordination and promotion ofbiomedical research. Among others, the Council’sresearch priorities include control and managementof communicable diseases, and drug and vaccineresearch (including traditional remedies). It has anetwork of organisations spread across the country.The National Institute of Virology (NIV), Pune, is anapex laboratory of international standards capableof viral genomic characterisation, monitoring of viral

strains, production of diagnostic kits, and vaccineresearch.

National Institute of Cholera and Enteric Diseases(NICED), Kolkata: It is an ICMR institutionspecialising in diarrhoeal diseases and providesexpertise in tackling national emergencies causedby epidemics of cholera and other diarrhoealdiseases.

National Institute of Epidemiology, Chennai: It isanother ICMR institution with the vision ofbecoming a centre of excellence in the field ofepidemiology concentrating on goal-orientedprogrammes of national relevance, operationalresearch, health systems research, teaching andfield epidemiology training.

Vector Control Research Centre: This ICMRinstitution is involved in developing methods forrapid response and disaster management withreference to vector-borne disease outbreaks.

All India Institute of Hygiene and Public Health,Kolkata: It is among the oldest public healthinstitutions in India involved in public healthteaching, training and research. It runs regularpostgraduate training programmes in public health,environmental health, public health engineering, etc.

Indian Council of Agricultural Research (ICAR):This is a premium research institution in the fieldsof Agriculture, Animal Science and Fisheries. Fordetails, refer to Chapter 7 of the document.

Defence Research and DevelopmentOrganisation (DRDO): It has an extensive networkof laboratories in the various disciplines of biologicalscience. These laboratories have developedexpertise in various aspects relevant to this subject.These are:

Defence Research and DevelopmentEstablishment (DRDE): DRDE (under MoD) is

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engaged in research on hazardous chemicals andbiological agents as well as associatedtoxicological problems. It has developed diagnostickits for certain biological agents. It also impartstraining in the medical management of chemicalwarfare/terrorism and BW/BT. The DefenceMaterials and Stores Research and DevelopmentEstablishment (DMSRDE), Kanpur, is anotherDRDO institution that specialises in themanufacture of protective suits, gloves and boots.The Defence Bioengineering and ElectromedicalLaboratory (DEBEL), Bangalore, manufactures facemasks, canisters, NBC filter fitted casualtyevacuation bags, etc., based on the technologyprovided by DRDE. The Defence Food ResearchLaboratory (DFRL) specialises in all aspects of foodpreparation, security and quality.

Council for Scientific and Industrial Research(CSIR): It is one of the world’s largest R&Dorganisations having linkages to academia, R&Dorganisations and industry. CSIR’s 38 laboratoriesform a giant network that embraces areas asdiverse as aerospace, biotechnology, drugs andtoxicology.

Department of Biotechnology (DBT): DBT hassignificant achievements in the growth andapplication of biotechnology in the broad areas ofagriculture, health care, animal sciences,environment, and industry. DBT also has alaboratory network throughout the country.

The Public Health Foundation of India (PHFI):It is an autonomous institution set up in 2005 toredress the limited institutional capacity in Indiafor strengthening training, research, and policydevelopment in the area of public health. It is aPPP venture and its mission is to benchmarkquality standards for public health education,establish public health institutes of excellence,undertake public health research andadvocate public policy linked to broader publichealth goals.

Vaccine Production CentresThe public health load in the country including thatof vaccine-preventable diseases, gives high priorityto vaccine manufacturing both in the public andprivate sectors. The country is not only self-reliantin this sector but also supplies vaccines to othercountries and international organisations such asWHO and United Nations Children’s Fund(UNICEF). Notable among them are the oral polio;Diphtheria, Pertussis and Tetanus (DPT); measles;Bacillus Calmette-Guérin (BCG); yellow fevervaccine; anti-rabies; meningococcal; and smallpoxvaccines. It also manufactures immunoglobulinsand antiserums for tetanus, rabies and snake bite.India has the R&D facility coupled with latesttechnology to manufacture second- and third-generation cell culture vaccines. It is one amongthe six countries in the world, identified by WHOfor manufacturing avian influenza vaccine that canbe scaled up for manufacture of pandemicinfluenza vaccine. Notable vaccine manufacturesare the Central Research Institute, Kasauli; HaffkineInstitute, Mumbai; Pasteur Institute, Coonoor; BCGLaboratory, (Guindy) Chennai, and NIV, Pune, allin the government sector and the Serum Instituteof India, Shanta Biotech, Biological Evans andBharat Biotech in the private sector.

Drug Manufacturing UnitsThe Indian pharmaceutical sector is a leadingindustry and a major player in the global market.The products range from basic essential drugs tothird-generation antibiotics, anti-retroviral drugs,immuno-modulators and anti-cancer drugs. TheDrug Controller General of India and drugcontrollers in the states ensure good manufacturingpractices under the ambit of the Drugs andCosmetics Act. These drug manufacturing unitsare both in the government and private sectors.

2.2.10 State Level

The SDMA is vested with the powers forplanning, preparedness, mitigation, and response



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to disaster events, including biological disasters,in the concerned states. SDMA is assisted by theState Executive Committee (SEC). The state planis prepared by SEC based on the guidelines issuedby NDMA and SDMA. The latter will also assist thedistricts in preparing and executing the districtplan.

Health being a state subject, there is wide inter-and intra-state differential in terms of public healthassets, functioning of the public healthdepartments, teaching and training institutions, andpublic health research. Tamil Nadu, AndhraPradesh, Maharashtra and Gujarat are creating theirown public health institutions. In addition, themedical colleges are an important resource bothfor public health and medical services. Thepreventive and social medicine (community health)departments have regular outreach services intothe community. The laboratory services of medicalcolleges augment the laboratory surveillance underIDSP. Apart from providing clinical services, themedical colleges also act as sentinel sites forsurveillance.

Many states have established SDMAs. Gujarat,Maharashtra, Andhra Pradesh, etc., have preparedDM plans. Other states are in the process ofestablishing SDMAs and preparing their DM planswhich will be in accordance with the DM Act, 2005.State health management plans will form animportant component of state DM plans. Statessuch as Gujarat have developed epidemic controlprogrammes as well.

2.2.11 District Level

DDMA will be the focal point of planning fordisasters in the respective districts. The DistrictHealth Officer (DHO)/CMO of the district is amember of the DDMA. Under the CMO/DHO, thereare programme officers for immunisation, TB andmalaria. Under the IDSP, a surveillance/IDSP officerat the district level is envisaged. The peripheralunits that provide preventive and promotive health

care are the PHCs and sub-centres spread acrossthe districts, established on the norms of one PHCfor 30,000 population and one sub-centre for 5,000population (3,000 in hilly areas). These are the basicunits from where public health information isgenerated and public health service is delivered.

2.2.12 Local Level

At the local level, the local DM committee(village DM committee) is expected to be trainedand empowered as first responders. Anganwadiworkers/ASHA/Auxiliary Nurse Midwife (ANM) of thevillage/sub-centre will be the peripheral healthservice delivery point, keeping a watch on diseaseoutbreaks and notifying the village health andsanitation committee and the PHC.

Urban municipal corporations and councilslook after public health, hospital services, drinkingwater, sanitation, disposal of dead bodies, and othercivic functions related to health.

2.2.13 Non-governmental Organisations

NGOs perform a variety of services andhumanitarian functions, bring citizens’ concerns tothe attention of the government, monitor policies,and encourage political participation at thecommunity level. They provide analysis andexpertise, serve as early warning signals and helpmonitor and implement international agreements.Some are organised around specific issues, suchas human rights, the environment, or health. Theirinvolvement, as of now, in the prevention andcontrol of the health consequences of biologicaldisasters is very limited and would depend ongovernment seeking partnership and offering a fairplaying field.

The Indian Red Cross Society (IRCS) has 655branches at the state/district/divisional/sub-district/taluka levels spread throughout the country,together with its national headquarters at NewDelhi. It has 90 blood banks and promotes blood

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donation camps. Red Cross volunteers aremotivated and if given adequate training, cancomplement the primary health care facilities forcase management in home settings during majorbiological disasters.

2.2.14 Role of International Organisations

(A) World Health Organisation (WHO)

WHO provides advocacy, guidelines, trainingand technical support in health related matters.WHO India Office, WHO-Regional Office for South-East Asia (WHO-SEARO), FAO and WorldOrganisation for Animal Health (OIE) provideassistance if the biological disaster involvesagriculture or animal health.

WHO contributes to global health security inthe specific field of outbreak alert and responseby: (i) strengthening national surveillanceprogrammes, particularly in the field ofepidemiology and laboratory techniques; (ii)disseminating verified information on outbreaks ofdiseases, and whenever needed, following up byproviding technical support for response; and (iii)collecting, analysing and disseminating informationon diseases likely to cause epidemics of globalimportance. Several BW related diseases fall underWHO surveillance. . . . . Guidelines on specific epidemicdiseases, as well as on the management ofsurveillance programmes, are available in printedand electronic form.

(B) World Trade Organisation (WTO)

Refer to Chapter 7 of the document

(C) Interpol

i) Interpol has an environmental laboratorywith multi-disciplinary staff consisting ofengineers, chemists, scientists andtechnicians. Member States are providedwith a full range of environmental testingservices including field monitoring, ambient

air quality, chemistry, stationary sourcestesting, etc. They maintain state-of-the-artequipment, employ professionals andimplement a comprehensive quality controlplan.

ii) At the request of Member States, theCommand and Coordination Centre basedat Lyon (France), is mobilised to facilitatethe coordination of any large-scale disastermanagement. The Centre gives priority tosuch events, provides services round theclock, and circulates information to allconcerned anywhere in the world. It alsohas direct access to all Interpol facilities,e.g., DNA finger printing, etc. Interpol alsoreleases specific resources for disasterssuch as staff, equipment and premises.

iii) The coordinating agency for Interpol in Indiais the Central Bureau of Investigation throughwhich all the above facilities can beobtained.

2.3 Operational Framework

2.3.1 Central Level

At the national level, NDMA is the authority forproviding National Guidelines on management ofbiological disasters, including biowarfare and BT.Being the nodal ministry for epidemics, MoH&FWadvocates on policy issues and lays down a nationalplan. It supports the states in terms of advocacy,capacity building, manpower and logistics.IDSP, which is described in detail in theforegoing paragraphs will be the backbone fordisease surveillance and detection of early warningsigns.

In a crisis situation, the Crisis ManagementGroup of MoH&FW takes decisions for controllingthe outbreak. If the crisis has the potential for socio-economic disruption or involvement of a numberof states/districts and central ministries, the NCMCcoordinates the response. The technical inputs are



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provided by the Technical Committee under DGHS.Within MoH&FW, the Emergency Medical Reliefdivision coordinates all such actions that requireinterface between MoH&FW, other centralministries, the state(s) and other institutions bothin the public and private sectors. The control roomfunctions from the Emergency Medical Reliefdivision and from NICD. Multi-disciplinary RRTsfrom NICD and institutions under ICMR, managepublic health problems and provide necessarylaboratory support. Major central governmenthospitals and institutions such as CGHS provide alarge pool of medical manpower for casemanagement. The Central Medical Stores Depotsand some of the Public Sector Undertakings haveexpertise in handling material logistics and supportthe states with drugs, disinfectants andinsecticides. The vaccine production centressupply vaccines as required.

For epidemics which threaten to spread acrossthe states and tend to be endemic, or from anendemic situation to an epidemic outbreak,MoH&FW decides on the strategic approach fortheir control/elimination. They draw up variousprogrammes in consultation with WHO on variousrelevant issues. Diseases of international publichealth concern are required to be notified to WHOas per the requirement under IHR (2005). Thedisease trend is monitored on a day-to-day basistill it ceases to be a public health problem.

The agriculture ministry would attend tobiological disasters involving the agriculture/poultry/cattle segment.

In the context of biological disasters, theDepartment of Drinking Water Supply and the RuralDevelopment Ministry play key roles in the provisionof potable water, chlorination of water and waterquality monitoring. MHA/MoD/Ministry of CivilAviation would support airlift of RRTs/clinicalsamples and logistics. The Armed Forces also havethe capacity for managing the aftermath of BWand provide technical inputs for managing BT.

In case of surge capacity for clinical casemanagement, the hospital facilities of theArmed Forces, Railways and ESIC can be used.The Indian Railways has mass evacuation potentialas well.

2.3.2 State Level

Under the provisions of the DM Act, 2005,SDMAs will advice the state on biological disastersand approve the plan of the state government andprovide guidelines to act upon. In states which areyet to establish the SDMA, the state healthdepartment is the nodal agency responsible forplanning and to be in a state of preparedness.This includes capacity development in terms ofsurveillance, early detection, and rapid responseand containment of any outbreak. In case of abioterrorist attack, epidemiological clues have tobe delineated to establish the nature of the attack.The state health department is to prepare SOPs ininstituting the public health response. In crisissituations, the state health department has todepute the RRTs, conduct clinical andepidemiological investigations, and institute publichealth measures to contain the outbreak.

2.3.3 District and Sub-district Level

DDMA is the authority to plan and execute theDM programme at the district level. In districtswhere DDMA is yet to be constituted, the districtcollector assumes the prime responsibility. He isvested with powers under IPC and various otherenactments to direct and mobilise resources forcontainment of the outbreak. He also decides onthe help required from outside agencies andcommunicates the requirement to state authorities.The preparedness measures, of which surveillanceis the major functional component, is beingsupported under IDSP. The district level RRTs arealso trained, and the communication hub at thedistrict level uses terrestrial and satellite linkages.Under IDSP, it is envisaged that by 2009 all thedistricts would acquire such capabilities.

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All major outbreaks, man-made or natural, ifnot detected early and contained, spread and soongo beyond the coping ability of the districtadministration, requiring support from the state/centre. The primary health care system has to playa crucial role in detecting the early warning signs.The village health functionaries [ASHA/Anganwadiworker/ANM/Multi-Purpose Worker (MPW)] interfacewith the community and are advantageously placedto report public health events to the peripheralpublic health services outlets such as sub-centresand PHCs. The functioning of the public healthsystem at the grass-root level is of paramountimportance in picking up early signals and actingrapidly, as is the presence of a communicationnetwork for bi-directional flow of information.

The district health setup includes hospitalfacilities such as district hospitals, sub-districthospitals, CHCs and PHCs. Public health supportis provided by the DHO and other officers relatedto public health work such as the immunisationofficer and district officers for TB and malaria. Thenetwork of PHCs and the network of sub-centresis the backbone of the public health system throughwhich the public health measures are instituted—be it event-based, house-to-house surveillance,provision of safe drinking water throughchlorination, vector control measures, masschemoprophylaxis, sanitation measures, home careor referral of critical patients. The DHO/CMOmobilises medical officers from the PHCssupported by health workers from the sub-centresfor field work. The teams are constituted usuallyon population norms, covering the entire affectedarea. Reinforcements, if required, are arranged bythe state governments from other districts, medicalcolleges and from central government institutions.

2.3.4 NGOs/Private Sector

NGOs play a major role in all disasters but arelargely conspicuous by their absence in biologicaldisasters. At the district level, the district collectorwould coordinate all the activities of NGOs.

However, there is poor networking and it needs tobe improved. 70% of health services are providedby the private sector but their presence is mainlyin urban areas. Private hospitals are betterorganised and equipped. However, in masscasualty incidents, their utilisation leaves much tobe desired. The DM Act, 2005 provides enoughpowers for the DDMA to call for the services oforganisations which can contribute to effectivemanagement of any disaster.

2.4 Important Functional Areas

2.4.1 Human Health Surveillance

In biological disasters, surveillance is the keystrategy to detect early warning signals and has tohave components to include human, animal andplant surveillance. Till 1999, when the NationalCommunicable Disease Surveillance programmewas launched, there was no organised system fordisease surveillance. It was expanded to coverabout 100 districts in three states. The lessonslearned were reviewed and MoH&FW initiated theIDSP with World Bank support.

(A) Integrated Disease Surveillance Programme

Launched in 2004, the IDSP intends to detectearly warning signals of impending outbreaks andhelp initiate an effective response in a timely manner.It is also expected to provide essential data tomonitor the progress of ongoing disease controlprogrammes and help allocate health resourcesmore efficiently. It is a decentralised, state-basedsurveillance programme, using an integratedapproach with rational use of resources for diseasecontrol and prevention. Data collected under theIDSP also provides a rational basis for decision-making and implementing public health interventions.

Specific objectives of the IDSP:

i) To establish a decentralised state-basedsystem of surveillance for communicable



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and non-communicable diseases so thattimely and effective public health action canbe initiated in response to health challengesin the country at the state and nationallevels.

ii) To improve the efficiency of the existingsurveillance activities of disease controlprogrammes and facilitate sharing ofrelevant information with the healthadministration, community and otherstakeholders so as to detect disease trendsover time and evaluate control strategies.

The project is intended for surveillance of alimited number of health conditions and risk factorskeeping in view the local vulnerabilities; integratedisease surveillance at the state and district levels;improve laboratory support; strengthen data quality;and, analyse and link them to action. The projectenvisages a transnational training programme, toinvolve communities and other stakeholders,particularly the private sector. Integral to the IDSPis an IT network which aids the national electronicdisease surveillance system. The strengthening ofthe laboratory network with standard biosafetypractices would mean that selected district andstate level laboratories would have specific culturefacilities.

All the states/UTs are to be covered in a phasedmanner by 2009. For project implementation,surveillance units have been set up at the central,state and district levels. Surveillance committeesat the national, state and district levels wouldmonitor the project. Nine training institutes wereidentified to conduct training of the state anddistrict surveillance teams. Training modules havebeen developed for this purpose. Training of state/district surveillance teams has been completed fornine states in Phase-I. A total of 605 master trainershave been trained in 13 of the 14 Phase-II states.States are organising training programmes formedical officers, health workers, and laboratorytechnicians at the district and CHC/PHC levels.

Training manuals for medical officers, healthworkers and district level laboratory technicianshave been dispatched to the states. The financialand administrative component is also beingstrengthened by training of accountants in financialmanagement and training of data entry operatorsin data management.

Once fully implemented, syndromic reportingwould have the advantage of detecting possibleunusual events. The call centre concept beingimplemented by the IDSP would help any medicalprofessional or general public to inform the IDSPabout any unusual event through a toll free number.The RRT in each district would investigate thesuspected situation. Till such time the informationmanagement system becomes fully operational,authentic baseline data may not be available andepidemic threshold levels cannot be determined.

2.4.2 Epidemiological Assessment

One of the major inputs for successfulmanagement of biological disasters is acquiringthe capability of rapid epidemiological assessment,identifying assessment tools such as mapping, useof Geographic Information System (GIS) and GlobalPositioning System (GPS), vulnerabilityassessment, risk analysis, and use of mathematicalmodels. This would help in strategic decision-making for public health interventions. ICMR isusing such tools in a limited way. GIS has alsobeen used to some extent in leprosy, immunisation,TB, and malaria programmes.

2.4.3 Environmental Assessment

Environmental assessment and strategicinterventions are increasingly becoming a priorityissue. Climate change is creating an enablingenvironment conducive for vector-borne andzoonotic diseases. This is also due to the destructionof habitats of wild animals which increasinglyinterface with the human population. Areas which

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require attention are water quality monitoring, foodsafety and security, vector control, animal healthsurveillance, sanitation and solid wastemanagement, and safe disposal of hazardousmaterials, including biomedical waste, etc.

2.4.4 Laboratory Support

Prior to the appearance of avian influenza, thehealth sector had only one BSL-3 laboratory at NIV,Pune. Now in addition, NICD, Delhi; JapaneseLeprosy Mission for Asia (JALMA), Agra; andNICED, Kolkata (both ICMR institutions), have BSL-3 laboratories. Additional BSL-3 laboratories arebeing set up at the Regional Medical ResearchCentre (RMRC), Dibrugarh (Assam); and KingInstitute of Preventive Medicine (KIPM), Chennai,Tamil Nadu, to complement the NICD/ICMR avianinfluenza network. BSL-3 laboratories are underconsideration for Central Research Institute (CRI),Kasauli; Haffkine Institute, Mumbai; and DRDE,Gwalior. The existing BSL-3 lab at NIV, Pune, hasbeen upgraded to BSL-3+ and another BSL-4laboratory is being established by ICMR at Pune.The MoA has one BSL-4 laboratory at the HighSecurity Animal Disease Laboratory (HSADL) atBhopal. The DADF is planning to instal four BSL-3laboratories for avian influenza and other emergingdiseases. The Centre for Molecular Biology hasfour BSL-3 laboratories and a BSL-4 laboratory isalso under consideration. A portable laboratory hasbeen developed by DRDO in collaboration withWHO and is available with NICD, Delhi, for suchdisaster situations.

Under IDSP, the laboratories within PHCs,CHCs, district hospitals and medical colleges arebeing upgraded to establish a national network oflaboratories. The National Laboratory AccreditationBoard sets the minimum standards to be followedby laboratories across the nation. Major issuesremain regarding biosecurity, indigenous capabilityof preparing diagnostic reagents and qualityassurance.

2.4.5 Immunisation

Vaccination if available against a biologicalagent, can offer good protection to the ‘at-risk’population. As a strategic measure, anthrax vaccinecan also be given to personnel who are at highrisk of exposure, e.g., hospital functionaries, ArmedForces personnel, first responders of NDRF,veterinarians and laboratory workers. Thesepractices are factored into preparedness measures.Prime examples are the vaccine preparedness forpandemic influenza and stockpiling anthrax andsmallpox vaccines for a potential threat ofbioterrerist attack with the smallpox virus. Anthraxvaccine can also be administered post exposurein combination with appropriate antibiotics suchas ciprofloxacin.

2.4.6 Chemoprophylaxis

Use of medication as a public health strategyto prevent disease has been in practice. Stockpilingof doxycycline for an attack of plague (natural orterror strike), oseltamivir (Tamilflu) for avian flu andrifampicin/ciprofloxacin for meningococcalmeningitis are essential. With a strongpharmaceutical manufacturing base, mobilisationof millions of doses of chemoprophylactic agentsis possible in the Indian context at short notice.

2.4.7 Nutrition

A factor accentuating the spread of disease inIndia is the poor nutritional standard of thepopulation, especially children. Nutrition forpreschool children is supported by the IntegratedChild Development Scheme, and for school goingchildren under the midday meal programmes.

2.4.8 Medical and Public Health Services

The network of PHCs and sub-centres is thebackbone of the public health system throughwhich public health measures are instituted. The



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capacity. In a crisis situation, there is furtherincapacitation due to tedious procurementprocedures. Inventory management/supply chainmanagement concepts are not followed. However,the Indian pharmaceutical sector is capable ofmeeting enhanced requirements at times of suchdisasters.

After the sporadic outbreak of avian influenza,a central stockpile of PPE, ventilators, automaticanalysers and oseltamivir has been maintained.

NRHM (2005–12) strives to strengthen healthdelivery at the grass-root level by placing a villagehealth worker, i.e., ASHA, in each village, supportedby the village health and sanitation committee. ThePHC would have a medical officer and 24x7services provided by nurses. The CHC wouldprovide basic specialities, including 24x7emergency services. The district hospitals are beingstrengthened for health care delivery. Under thehealth system projects funded by the World Bank,the hospital systems at district and sub-districtlevels are being strengthened in terms ofinfrastructure. Under the Pradhan Mantri’sSwasthya Suraksha Yojna, tertiary care institutionsare being strengthened.

2.4.9 Information Technology

IDSP is establishing linkages with all districtand state headquarters, and all governmentmedical colleges on a Satellite Broadband HybridNetwork. 84 sites have already been made activeby the Indian Space Research Organisation andthe requisite equipment has been installed at allthese sites. The network, on completion, will enable800 sites on a broadband network, 400 sites (outof these 800) will have dual connectivity withsatellite and broadband. The National InformaticsCentre (NIC) has been entrusted the task of settingup and managing of the information technologynetwork. NIC is also establishing a ‘diseaseoutbreak monitoring call centre’ that would receive

primary health care systems interface with thecommunity and are advantageously placed todetect early warning signs and report public healthevents. There are 23,109 PHCs providingpreventive, promotive and limited curative services.The rural network of PHCs and sub-centresprovides substantial help in biological disasterswhen field interventions are required.

The CHC (1/100,000 Population) is the grass-root level functional hospital with 30 beds wherebasic specialties are envisaged. But a substantialnumber of CHCs do not have a full complement ofbasic specialties and the services are highlyskewed towards reproductive health. The districthospitals, planned to provide secondary level care,have on an average 200–250 beds but show wideinter- and intra-state variation. In some states, theyare suitable even for medical teaching/training.

In poorly performing states, 30–50% of thehospital beds are in rural hospitals, and are poorlymaintained. Even 60 years after independence, thecountry cannot meet the standards set by theMudaliar Committee in the 1950s—that of one bedper 1,000 population. Infectious diseases hospitalsand isolation facilities in the district hospitals, evenif existing, are the most neglected. Emergencysupport systems (including critical care support)and specialised capabilities for CBRNmanagement in these hospitals are grosslyinadequate/non-existent. Most district levelhospitals, taluka hospitals and CHCs are notequipped to handle mass casualty incidents.Emergency support systems (including critical caresupport) in these hospitals are grossly inadequate.Another critical area in mass casualty events is thedisposal of dead bodies. Even in the best of theurban settings, these facilities are lacking.

State-run hospitals have limited medicalsupplies. Even in a normal situation, the patienthas to buy medicines. There is no stockpile ofdrugs, vaccines, PPE, and diagnostics for surge

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disease outbreak related calls from across thecountry on a toll free number. The network isintended for distance learning, data transmissionand video-conferencing as a part of tele-medicineinitiatives.

The reach of mobile telephony has changedthe face of telecommunication in India. Mostpreviously inaccessible areas are now covered byone or the other network. It is essential that therebe an efficient communication system, includingprovision of satellite telephones, especially ininaccessible areas to support outbreakinvestigations and response. Establishment ofEmergency Operations Centres (EOCs) at all stateheadquarters is under consideration by theMoH&FW.

2.4.10 Risk Communication and CreatingCommunity Awareness

The community will be greatly empowered ifthe risk is communicated to the community. Ourcountry has vast experience in the health sectorfor instituting behavioural change through effectivecommunication. Given the level of literacy in somestates, communication strategies, to be successful,need planning, trained manpower, anunderstanding of communications protocols,messaging and the media, as also the ability tomanage the flow of information. The reach of visualand print media to a substantial section of thepopulation ensures that messages in the contextof biological disasters can be delivered to theminstantaneously and further sustained through theaudio/print media. Activities at the local level couldinclude street plays, dramas, folk theatres, postercompetitions, distribution of reading material,school exhibitions, etc. It has been seen thatcreating awareness in the community not onlyempowers them to act accordingly, butalso alleviates fear and lessens the psychologicalimpact.

2.4.11 Community Participation

Presently, community participation isinadequate in biological disasters due to theintrinsic fear of community members of contractingthe disease. However, communicating the risk,strict following of infection control protocols andencouragement from the government to NGOs andself-help groups, especially for institutingpreventive measures, would ensure communityparticipation. Containment of avian influenza inMaharashtra, Gujarat and Madhya Pradesh sawsubstantial involvement of the PRIs. This culturehas to be taken forward to involve other NGOs,self-help groups, resident welfare associations,vyapar mandals, etc. Areas where the districtauthorities partner with these organisations caninclude health education, chlorination and waterquality monitoring, sanitation, vector control, drugdistribution, documentation and data managementduring mass casualty incidences, disposal of deadbodies, and provision of psycho-social care.

2.4.12 Mental Health Services andPsycho-social Care

Disease outbreaks instil fear, cause anxiety andaffect a large population, and usually leave a trailof human agony that requires psycho-socialinterventions. The country possesses richexperience and adequate expertise in providingmental health services and psycho-social care,including training of manpower and service delivery.The National Mental Health Programme has acommunity based approach delivering servicesthrough the District Mental Health Programme.Successful community based innovative micromodels at the grass-root level, incorporatingcontextual realities and cultural practices wereadopted during major disasters such as the Orissacyclone, Gujarat earthquake and more recentlyduring the Indian Ocean tsunami recovery andrehabilitation process.



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2.4.13 Research and Development

ICMR is the apex body for medical research inIndia. DRDO also contributes to basic and appliedresearch in the biomedical field. ICMR and DRDOhave established the capacity for basic andapplied research in the area of molecular biology,genomic studies, epidemiological, and healthsystem research. Private establishments areexcelling in the area of drugs and vaccines andhave established their global presence.

Areas requiring attention are—operationalresearch in forecasting, using trend analysis,mathematical modelling, GIS based modelling formolecular research on potential geneticallyengineered BT agents, genomic studies, specificbiomarkers, new treatment modalities andadvanced robotic tools.

2.5 Genesis of National DisasterManagement Guidelines—Management of BiologicalDisasters

One of the important roles of NDMA is to issueguidelines to ministries/departments and states toevolve programmes and measures in their DM Planfor holistic and coordinated management ofdisasters as identified in the DM Act, 2005.

In this direction, a National Workshop onBiological and Chemical Disasters was convenedby NDMA at its headquarters in New Delhi between22–23 February 2007 as part of a nine-stepparticipatory and consultative process to evolvethe National Disaster Management Guidelines—Management of Biological Disasters. Stakeholdersfrom various ministries/departments of GoI (Health,Home Affairs, Defence, and Agriculture), Interpol,R&D organisations/Institutes [ICMR, ICAR, CSIR,Bhabha Atomic Research Centre, NICD, DRDO,NIDM, All India Institute of Medical Sciences(AIIMS), Sir Dorabji Tata Centre for Research in

Tropical Diseases, Indian Veterinary ResearchInstitute (IVRI), etc.], professional institutions anda large number of professionals, NGOs, regulatorybodies, experts, and stakeholders in the field ofBDM participated in the deliberations.

During the workshop, the present status of themanagement of biological disasters, including BT,in the country was discussed and important gapswere identified. The workshop also identifiedpriority areas for prevention, mitigation andpreparedness of biological disasters and providedan outline of comprehensive guidelines to beformulated as a guide for the preparation of actionplans by ministries/departments/states.

A Core Group of Experts comprising majorstakeholders as well as state representatives wasconstituted under the chairmanship of Lt. Gen. (Dr.)J. R. Bhardwaj, PVSM, AVSM, VSM, PHS (Retd),Member, NDMA to assist in preparing theGuidelines. Several meetings of the Core Groupwere held to review the draft versions of theGuidelines in consultation with concernedministries, regulatory bodies and other stakeholdersto evolve a consensus on the various issuesregarding the guidelines. During thesedeliberations, the core group felt that guidelinesfor the management of plant and animal pathogensshould be taken up as a separate section in theseguidelines. The various recommendations of thesteering group and outcome of the workshopproceedings—‘Pandemic Preparedness BeyondHealth’, held in April 2008 were also incorporatedin these Guidelines.

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The extensive experience of dealing withepidemics in diverse conditions does instilconfidence in dealing with biological disasters.However, post-epidemic reviews of such situations,notably the Surat plague outbreak in 1994 and thesubsequent one in Himachal Pradesh in 2001, theSARS outbreak of 2003, the avian influenza outbreakin 2006 and the Nipah outbreak in 2001 and 2007,have emphasised the need to strengthen thesurveillance and public health delivery system inIndia. Current and emerging needs call for amechanism to address the health impact of climatechange, global warming, urbanisation, andpopulation growth, all of which may be the triggerand/or enabling factors for biological disasters. Thischapter identifies the important gaps and scopefor improvement in the legal, institutional andoperational framework to institute preparednessand put forth robust response.

3.1 Legal Framework

The Epidemic Diseases Act was enacted in1897 and needs to be repealed. This Act does notprovide any power to the centre to intervene inbiological emergencies. It has to be substitutedby an Act which takes care of the prevailing andforeseeable public health needs includingemergencies such as BT attacks and use ofbiological weapons by an adversary, cross-borderissues, and international spread of diseases. Itshould give enough powers to the central and stategovernments and local authorities to act withimpunity, notify affected areas, restrict movementor quarantine the affected area, enter any premisesto take samples of suspected materials and sealthem. The Act should also establish controls over

Salient Gaps3biological sample transfer, biosecurity andbiosafety of materials/laboratories.

3.2 Institutional Framework

In the MoH&FW, public health needs to beaccorded high priority with a separate AdditionalDGHS for public health. In some states, there is aseparate department of public health. States thatdo not have such arrangements may also have totake initiatives to establish such a department. Theapex institution, NICD, is not geared to addressthe impact of environment changes, changingcommunicable disease spectrum (emerging andre-emerging diseases), obligations under IHR(2005), and to make optimal use of newertechnologies. This would require a facelift in termsof infrastructure and human resources. Similarpublic health institutions are conspicuous by theirabsence in most of the vulnerable states. Even thebest performing states do not have their own publichealth institution of eminence.

3.3 Operational Framework

3.3.1 Policy and Plans

At the national level, there is no policy onbiological disasters. The existing contingency planof MoH&FW is about 10 years old and needsextensive revision. All components related to publichealth, namely apex institutions, fieldepidemiology, surveillance, teaching, training,research, etc., need to be strengthened. Thepreventive and social medicine departments ofmedical colleges which churn out postgraduates


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in the speciality with focus on academics, need tobe oriented for public health management/administration.

For implementing IHR (2005), core capacityneeds to be developed for surveillance, bordercontrol at ports and airports, quarantine facilities,etc. India needs to maintain a level ofepidemiological intelligence to keep a track on ouradversaries’ biowarfare programmes. This appliesto terrorist outfits using available in-house facilitiesto develop such weapons. A coordinated actionplan of the intelligence agencies, MoH&FW andMoD needs to be put in place to gather intelligenceand develop appropriate defence and deterrencestrategies.

In almost all the states, state policies, plansand guidelines are non-existent. Each state needsto have a public health institution which wouldcollect epidemiological intelligence, shareinformation with the IDSP, provide for outbreakinvestigations and be capable of managingoutbreaks. Within the state also it has beenobserved that interaction is lacking between thestate health authorities and the local bodies, someof which have enormous civic functions to perform,including public health. The limited capacities ofthe Mumbai Municipal Corporation were evidentin the wake of floods in Mumbai in 2005, the SuratMunicipal Corporation fared no better during thefloods in 2006 and the plague outbreak in 1994.Under the DM Act, 2005, DDMA is the authority toplan and execute the DM programme at the districtlevel. In a substantial number of districts a DDMAis yet to be constituted.

3.3.2 Command Control and Coordination

At the operational level, Command and Control(C&C) is identifiable clearly at the district level,where the district collector is vested with certainpowers to requisition resources, notify a disease,inspect any premises, seek help from the Army,state or centre, enforce quarantine, etc. However,

there is no concept of an incident command systemwherein the entire action is brought under the ambitof an incident commander with support from thedisciplines of logistics, finance, and technicalteams, etc. There is an urgent need for establishingan incident command system in every district.

Unlike the Emergency Medical Relief Division(of DGHS) which coordinates and monitors all crisissituations, there is no such mechanism in thestates. There is a need to establish EOCs in allstate health departments with an identified nodalperson for coordinating a well orchestratedresponse.

One of the lessons learned during the plagueoutbreak in Surat in 1994 and avian influenza in2006 is the need to strengthen coordination withother sectors like animal health, home department,communication, media, etc., on a continuous basisfor the management of outbreaks of this nature.

3.3.3 Human Resources

There is a shortage of medical and paramedicalstaff at the district and sub-district levels. There isalso an acute shortage of public health specialists,epidemiologists, clinical microbiologists andvirologists. There have been limited efforts in thepast to establish teaching/training institutions forthese purposes. PHFI, NICD and ICMR areresponsible for filling up these gaps. NICD hasstarted a masters course on Public Health.However, more efforts are needed in this direction.

There have been limited efforts to train hospitalmanagers in managing mass casualty incidents,and this was mainly from 1996 onwards throughWHO projects. The emphasis was on the districthospitals to have their own DM plans.

3.3.4 Surveillance

The IDSP does not reach the grass-root leveland hence needs to be restructured. It should have

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international networking with generic or diseasespecific networks (FluNet, Dengue Net, etc.) whichpresently do not exist. This would facilitate globalmonitoring of emerging and re-emerging diseases.Environmental surveillance and animal healthsurveillance needs to be an integral part of theIDSP. Areas which require attention are waterquality monitoring, food safety and security, vectorcontrol, zoonotic sanitation and solid wastemanagement, safe disposal of hazardous materials,including biomedical waste, etc.

The project should imbibe operational researchtools such as mapping, use of GIS and GPS,vulnerability assessment, risk analysis and use ofmathematical models. Simple issues such as casedefinitions and epidemics, threshold levels needto be established or adapted to suit Indianrequirements. As of now the system is not able todetect early warning signs and generate data fromwhich epidemiological intelligence can beextracted and used in decision-making. A reasonfor the spread of the Surat plague was the failureto detect early warning signs due to suddenecological changes that might have created aspillover of sylvatic plague into the domesticenvironment, as had happened following the 1993earthquake in Maharashtra.

3.3.5 Laboratories

Biosafety laboratories are required for theprompt diagnosis of the agents for effectivemanagement of biological disasters. There is noBSL-4 laboratory in the human health sector. BSL-3 laboratories are also limited. Major issues remainregarding biosecurity, indigenous capability ofpreparing diagnostic reagents and qualityassurance. There is need for using sophisticatedreal time PCR methods for rapid diagnosis ofbiological agents through environmental sampling,particularly those that have the potential to be usedas agents of BT. Other areas that need to bestrengthened include developing DNA probes,sensors, markers, etc.

A need also exists for strengthening thenetworking of laboratories so that their expertisecan be utilised quickly. During the plague outbreakin 1994, isolated strains had to be processed ininternational reference laboratories because ofinadequate laboratory facilities. Since then a lot ofprogress has been made. Today, the country hasthe capability of doing viral characterisation throughgenomic studies. Some laboratories under ICMRare of international standards. The identificationand development of at least one central referencelaboratory to the standards of a WHO referencelaboratory for influenza or HIV, is essential.

3.3.6 Primary Health Care

A network of sub-centres, PHCs and CHCs isthe backbone of primary health care which isfundamental for detecting early warning signs ofany impending outbreak in the community andinstituting public health measures at the communitylevel. At the village level, informed health workersare needed to keep a watch on adverse healthevents. NRHM is yet another valiant attempt atestablishing an ASHA worker in each village. Twoyears into the project, ASHA workers are yet totake root.

Failing to establish village health workers, thesub-centres (one for 5,000 population) manned byMPWs/ANM are the existing first level of contactbetween a health functionary and the community.There are 142,655 sub-centres with about 2.1 lakhhealth workers. There is almost 50% vacancy inthe position of male health workers. As BDMrequires community based surveillance and casemanagement, the health workers are the mainstay.Using the existing manpower would affect otherfunctions assigned to them such as immunisationand maternal health. A substantial number of CHCsdo not have a full complement of basic specialties.For all PHCs and CHCs, the district hospital is thefirst referral hospital for providing secondary care.Most district level hospitals, taluka hospitals andCHCs are not equipped to handle mass casualty


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incidents. Isolation facilities and critical carefacilities are lacking in them. In poorly performingstates, 30–50% of their beds are in rural hospitalswhich are poorly maintained. Specialisedcapabilities for CBRN management in thesehospitals are grossly inadequate/do not exist.

3.3.7 Transportation

As on date, all modes of transport are used inthe event of disasters, be it personal vehicles,trucks, tractors, tempos or even bullock carts.

The major gaps are as follows:

i) Lack of an Integrated Ambulance Network(IAN) and there is no ambulance systemwith advanced life-support facilities that iscapable of working in biological disasters.

ii) Sub-optimal usage of resources in theprivate sector.

iii) No accreditation/standard for ambulancesin India.

3.3.8 Hospital Facilities

Health care facilities are mainly restricted tourban areas and there is a palpable urban–ruraldivide as only 10.3% medical beds are availablefor 70% of the rural population. An estimate of theWorld Health Report indicates the requirement of80,000 beds every year for the next five years thatcan be fulfilled only with the proactive involvementof private players in the medical field.

Government hospitals/medical collegehospitals in major cities and state capitals have,on an average, more than 500 beds. Such facilitiesare available, within 100–150 km in the betterperforming states. Even in these hospitalsemergency departments/critical care facilities areinadequate. However, surge capacity exists tomanage mass casualty incidents but they are notequipped to handle CBRN disasters (except those

in the catchment areas of nuclear facilities). Thesehospitals have a significant scope for expansionand advancement. All hospitals are required toadopt procedures of quality accreditation. On theother hand, the country has world-class hospitalsin the private sector. Their interface with thegovernment and their utilisation in managing masscasualty incidents need to be strengthened.

The major pillars for supporting effective masscasualty management that need to bestrengthened include pre-hospital care, pre-established incident command system,harmonisation of the concept of triage,communication network, transportation of masscasualties and upgradation of a medical setup tohandle mass casualties.

3.3.9 Stockpile of Drugs/Vaccines/Disinfectants/Insecticides/PPE

State-run hospitals have limited medicalsupplies. Even in normal situations, a patient hasto buy medicines. There is no stockpile of drugs,important vaccines like anthrax vaccine, PPE ordiagnostics for surge capacity. In a crisis situationthere is further incapacitation due to tediousprocurement procedures. Inventory management/supply chain management concepts are notfollowed. Protection, detection, decontaminationequipment are not available with most firstresponders. Decontamination, decorporation andCBRN treatment modalities are also grosslyinadequate.

3.3.10 Psycho-social Care

There are some critical deficiencies in theprovision of psycho-social care. The routine trainingof medical undergraduates, nurses and healthworkers for mental health services is grosslyinadequate. There is virtually no emphasis on themental health aspects of disasters even in theroutine postgraduate training in psychiatry.

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Although there have been efforts to providecommunity based psycho-social care during theearly phases after a disaster, these services areusually withdrawn within a few weeks/months. Theessence of any psycho-social care is the trainingof community workers to meet the needs of thecommunity and this needs to be built into thesystem as a measure of all-time preparedness.

3.3.11 Training

There is a need to create public health teachingand training institutions in every state. Fieldepidemiology training for public healthprofessionals and training for field workers needsto be augmented to make the field staff fullycompetent to support outbreak investigation andresponse. There is need to identify and train RRTsin all the districts to respond to any threat ofoutbreak. The training programmes in BDM areinadequate for doctors, nurses and paramedics.The orientation of clinical doctors to the detectionof suspected cases and detection of early warningsignals of disease may help in instituting rapidresponse to an outbreak situation. This requirespreparation of guidelines/standard treatmentprotocols and wider dissemination of the same.Web based resource networks and knowledgenetworks need to be created for easy access to allstakeholders.

3.3.12 Risk Communication

During the plague outbreak in Surat, there wasa mass exodus of people from the affected areas.The outbreak affected trade and tourism. Similarly,during the avian influenza outbreak among poultryin 2006, people stopped eating chicken, leadingto a downturn in the poultry industry. Effectivecommunication of the risks to the communityempowers them to mitigate the risk. The availableprint and visual media need to be put to use foreffective communication. Appropriate

communication materials and media plans are tobe worked out in advance.

3.3.13 Community Participation and the Roleof NGOs

An empowered community contributes tocommunity action which is of prime importance inmanaging biological disasters. NGOs have beenvery active in mass casualty incidents such asearthquake, tsunami, fire, etc., however, thisvoluntarism is missing when it comes to biologicaldisasters. Perhaps, the fear of acquiring thedisease keeps the community and the NGOs atbay.

3.3.14 Role of the Media

The role of the media is very important. Theyare often not provided with the correct information,resulting in the spread of incorrect informationwhich adds to the panic. The media should beused constructively to educate the community inrecognising symptoms and reporting them early iffound. The cooperation of the community may beensured through judicious handling of the media.

3.3.15 Documentation

The areas of research and documentation needto be conceptualised and practiced all across thenation. The practice of documenting diseaseoutbreaks and its scientific analysis is lacking inthe country. There may be success stories which ifdocumented and analysed may become bestpractices that can be adopted globally.

3.3.16 Financial Resources

DM has earmarked funds for emergencyresponse which the state can operate, namely theCalamity Relief Fund (CRF) and the NationalCalamity Contingency Fund (NCCF). However, the


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disasters for which CRF and NCCF can be utilisedare defined. Biological disasters do not fall intothis category. The states have no other funds whichcan be utilised for the containment of outbreaks.This has to be corrected. Biological disasters must

be brought under the purview of CRF/NCCF. Also,under the provisions of the DM Act, 2005, theNational Disaster Response Fund will be created,and adequate funds will also be earmarked for thecontainment of biological disasters from this fund.

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4 Guidelines for BiologicalDisaster Management

DM involves a planned and systematicapproach towards understanding and solvingproblems in the wake of a disaster. Biologicaldisasters, be they natural or man-made, can beprevented or mitigated by proper planning andpreparedness. The Guidelines will address allaspects of BDM, including prevention, mitigation,preparedness, response, relief, rehabilitation andrecovery. All important stakeholders includingMoH&FW for natural biological disasters, MHA forBT, MoD for BW, and MoA for animal health andagroterrorism, along with the community, medicalcare, public health and veterinary professionals,etc., shall prepare themselves to achieve thisobjective. All concerned central ministries anddepartments of health in the states will prepare forthe management of biological disasters based onthe Guidelines and will constitute the nationalresource for management of mass casualty eventsarising out of biological disasters, including warfareand terrorism. The nodal ministry shall also lay downclear policies and plans including appropriate legal,institutional and operational framework thataddresses all aspects of DM. The preparednessand response plan is to be prepared at thecentre, state and district levels with the roleand responsibilities of various stakeholdersclearly defined. Disaster plans will be preparedby the nodal central ministries, state anddistrict authorities on the basis of theguidelines issued by the national and stateauthorities. Sectoral coordination would ensureappropriate communication, command andcontrol.

4.1 Legislative Framework

The policies, programmes and action plansneed to be supported by appropriate legalinstruments, wherever necessary, for effectivemanagement of biological disasters. The importantmeans to develop a robust though flexible legalframework include:

4.1.1 Legal Framework

i) It includes implementation of IHR (2005)which is needed for prevention, mitigationand control of the spread of diseasesinternationally.

ii) The legal instruments are required tosupport the operational framework formanaging prevailing and foreseeable publichealth concerns such as BT attacks, use ofbiological weapons by adversaries andcross-border issues.

iii) Enough power will be given to the centralgovernment, state governments and localauthorities to act with impunity, notify theaffected area, restrict movements orquarantine the affected area, enter anypremises to take samples of suspectedmaterials and seal them.

iv) The Act will also establish controls overbiological sample transfer, biosecurity andbiosafety of materials/laboratories.

For achieving the above objectives, theexisting Acts, rules, regulations, etc., at various


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levels will be reviewed and amended by the nodalministry/state governments/local authorities, andnew Acts enacted and Rules laid down tostrengthen the management of biological disastersat the centre, state and district levels.

4.1.2 Policy, Programmes, Plans andStandard Operating Procedures

The concerned ministries would evolve plansfor prevention, mitigation, preparedness andresponse to biological disasters based on theguidelines prepared by the national authorities. Theprogrammes and plans to achieve the objectivesset in the policy would be laid down withappropriate budgetary provisions.

Health is a state subject. The primaryresponsibility of managing biological disastersvests with the state government. The centralgovernment would support the state in terms ofguidance, technical expertise, and with human andmaterial logistic support. All the states will developtheir own policies, plans and guidelines formanaging biological disasters in accordance withthe national guidelines and those laid down bySDMAs.

4.1.3 Institutional and OperationalFramework

The MoH&FW would continue to be the nodalministry for managing biological disasters.

The institutional and operational frameworkincludes:

i) NCMC and NEC will coordinate all thedisasters including those of biologicalorigin. The secretaries of NDMA and allimportant ministries, including the nodalministry, will be members of thesecommittees.

ii) The intelligence and deterrence required forhandling BT calls for an appropriate role of

MHA as the nodal ministry for handling it.The management structure needed toachieve the expected results will beidentified and strengthened. This may bein the form of an appropriate crisismanagement structure, committees, taskforces and technical expert groups withinthe ministry.

iii) The public health division in DGHS needsto be strengthened and the responsibilityfor developing technical expertise shouldbe vested with an officer of appropriateseniority.

A public health institution of eminence,matching international standards needs to becreated, for which the following measures arerequired:

i) The existing apex institution, NICD, will bestrengthened to address the impact ofenvironment changes, the changingcommunicable disease spectrum(emerging and re-emerging diseases), BTand meeting obligations under IHR (2005).This would require a facelift in terms ofinfrastructure and human resource inputs.

ii) All existing public health institutionsproviding technical expertise in the area offield epidemiology, surveillance, teaching,training, research, etc., need to bestrengthened. For implementing IHR (2005),core capacity needs to be developed forsurveillance, border control at ports andairports, quarantine facilities, etc.

iii) Each state will strengthen its public healthinfrastructure, including public healthinstitutions which would collectepidemiological intelligence, shareinformation with IDSP, provide for outbreakinvestigations and manage outbreaks.

iv) Hospitals will develop capabilities to attendto mass casualties and public healthemergencies with isolation facilities. In the

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districts, DDMAs will provide the requisitemanagement structure for district DM,factoring in the requirements for managingbiological disasters.

v) The strategic approach for management ofbiological disasters given in the precedingpoints would only succeed with responsibleparticipation of the government, privatesector, NGOs and civil society.

A sound infrastructure is necessary for medicalcountermeasures, creating awareness among thepublic, raising human resources, logistic supportand R&D for evolving novel technologies.

4.2 Prevention of BiologicalDisasters

Prevention and preparedness shall focus onthe assessment of biothreats, medical and publichealth consequences, medical countermeasuresand long-term strategies for mitigation. Theimportant components of prevention andpreparedness would include an epidemiologicalintelligence gathering mechanism to deter a BW/BT attack; a robust surveillance system that candetect early warning signs, decipher theepidemiological clues to determine whether it isan intentional attack; and capacity building forsurveillance, laboratories, and hospital systems thatcan support outbreak detection, investigation andmanagement. A multi-sectoral approach will beadopted involving MoH&FW, MHA, Ministry ofSocial Welfare, MoD and MoA. A biological disasterresponse plan is to be evolved based on thisstrategic approach by the nodal ministry.Preventive measures will be useful in reducingvulnerability and in mitigating the post-disasterconsequences. Pre-exposure immunisation(preventive) of first responders against anthrax andsmallpox must be done to enable them to helpvictims post-exposure. The important means forprevention of biological disasters include thefollowing:

4.2.1 Vulnerability Analysis and RiskAssessment

Vulnerability analysis and risk assessmentneeds to be carried out at the macro and microlevels for existing diseases with epidemic potential,emerging and re-emerging diseases, and zoonoticdiseases with potential to cause human diseases,etc., so that appropriate preventive strategies andpreparedness measures explained in the foregoingparagraphs are instituted appropriately.

Important buildings and those housing vitalinstallations need to be protected against biologicalagents wherever deemed necessary. This may bedone through security surveillance, prevention, andrestricting the entry to authorised personnel onlyby proper screening, and installing High EfficiencyParticulate Air (HEPA) filters in the ventilationsystems to prevent infectious microbes fromentering the circulating air inside critical buildings.

Those exposed to biological agents may notcome to know of it till symptoms manifest becauseof the varied incubation period of these agents. Ahigh index of suspicion and awareness among thecommunity and health professionals will help inthe early detection of diseases.

When exposure is suspected, the affectedpersons shall be quarantined and put underobservation for any atypical or typical signs andsymptoms appearing during the period ofobservation. Health professionals who areassociated with such investigations will haveadequate protection and adopt recogniseduniversal precautions. It often may not be possibleto evolve an EWS. However, sensitisation andawareness will ensure early detection.

It is pertinent to develop adequate counter-terrorism measures against BT activities of terroristgroups by deterrents such as destruction of theirfunding mechanisms and continuing surveillanceat all levels.

GUIDELINES FOR BIOLOGICAL DISASTER MANAGEMENT


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4.2.2 Environmental Management

Disease outbreaks are mostly due towaterborne, airborne, vector-borne and zoonoticdiseases. Environmental monitoring can helpsubstantially in preventing these outbreaks.Integrated vector management also needsenvironmental engineering for elimination ofbreeding places, supported with biological andchemical interventions for vector control. Biologicalevents with mass casualty potential may result ina large number of dead bodies requiring adequatedisposal procedures. The following measures willhelp in the prevention of biological disasters:

i) Water supply

A regular survey of all water resources,especially drinking water systems, will becarried out by periodic and repeatedbacteriological culture for coliformmicrobes. In addition, proper maintenanceof water supply and sewage pipeline willgo a long way in the prevention of biologicaldisasters and epidemics of waterborneorigin such as cholera, hepatitis, diarrhoeaand dysentery.

ii) Personal hygiene

Necessary awareness will be created in thecommunity about the importance ofpersonal hygiene, and measures to achievethis, including provision of washing,cleaning and bathing facilities, andavoiding overcrowding in sleeping quarters,etc. Other activities include makingtemporary latrines, developing solid wastecollection and disposal facilities, and healtheducation.

iii) Vector control

Vector control is an important activity whichrequires continuous and sustained efforts.Cooperation of the community is veryessential for a successful integrated vector

management programme. The importantcomponents of vector control programmesare:

a. Environmental engineering work andgeneric integrated vector controlmeasures.

b. Elimination of breeding places bywater management, draining ofstagnant pools and not allowing waterto collect by overturning receptacles,etc.

c. Biological vector control measuressuch as use of Gambusia fish, is animportant measure in vector control.

d. Outdoor fogging and control of vectorsby regular spraying of insecticides.

e. Keeping a watch on the rodentpopulation and detection of earlywarning signs such as sudden fall intheir numbers could preempt a plagueepidemic. Protection against rodentscan be achieved by improvingenvironmental sanitation, storing foodin closed containers and early and safedisposal of solid wastes. Killing ofrodents associated with diseases suchas plague and leptospirosis wouldrequire the use of rodenticides like zincphosphides, digging and filling up ofburrows, etc.

iv) Burial/disposal of the dead

Dead bodies resulting from biologicaldisasters increase risk of infection if notdisposed off properly. Burial of a largenumber of dead bodies may cause watercontamination. With due consideration tothe social, ethnic and religious issuesinvolved, utmost care will be exercised inthe disposal of dead bodies.

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4.2.3 Prevention of Post-disaster Epidemics

India needs to maintain the necessary level ofepidemiological intelligence to pick up earlywarning signals of emerging and re-emergingdiseases of epidemic/pandemic potential. Thiswould also require advance knowledge of theactivities of our adversaries in developing apotential BW ensemble and its potential use duringwar and by terrorist outfits using available in-housefacilities to develop such weapons. A coordinatedaction plan of the intelligence agencies, MHA,MoH&FW and MoD will be developed and put inplace to gather intelligence and developappropriate deterrence and defence strategies.

i) The risk of epidemics are higher after anytype of disaster, whether natural or man-made. These include waterborne diseasessuch as diarrhoea/dysentery, typhoid andviral hepatitis, or vector-borne diseasessuch as scabies and other skin diseases,louse-borne typhus and relapsing fever.

ii) In certain natural disasters like floods,earthquakes, etc., disturbance of theenvironment increases the risk of rabies,snake bites and other zoonotic diseases.Preventive measures will be taken to dealwith such eventualities by keeping reservesof adequate stocks of anti-rabies vaccineand anti-venom serum.

4.2.4 Integrated Disease SurveillanceSystems

The IDSP will be operationalised at all districtlevels to detect early warning signals for institutingappropriate public health measures. Thesurveillance team will monitor the probable sources,modes of spread, and investigate the epidemics.The surveillance programme will also be integratedwith the chain of laboratories of GoI includingDRDO, ICMR, AFMS, and state governments/private laboratories. There is an urgent requirementof such systems to perform real-time monitoring

with information shared at the various levels of thehealth care system. Information of epidemics canbe anticipated much in advance whereepidemiologic assessment of surveillance dataexists.

i) The existing Integrated Disease SurveillanceSystem will be rapidly expanded to coverthe entire country.

ii) The state and district IDSP units will betrained to acquire the capabilities of usingstandard case definition, regular datacollection and analysing data to detect earlywarning signs and take actions to mitigateany outbreak.

a. The state epidemiological cell underDGHS will develop a simple format,depending upon the level ofknowledge at each level on which datawill be collected daily.

b. Irrespective of the data collected, thebasic principle of surveillance willremain the same, i.e., use of standardcase definition, maintaining regularityof the reports and taking action on thereports.

iii) The surveillance could be active, passive,laboratory based or sentinel (collecting datafrom identified sentinel sites such ashospitals or health centres), or acombination of all of these to suit publichealth requirements.

iv) Surveillance at airports, ports and bordercrossings will be strengthened withappropriate controls. IDSP needs to networkwith international surveillance networks suchas GOARN, with support from WHO.Stringent inspection methodologies will alsobe made. The list of biological agents forexport control as identified by the AustraliaGroup is given as a ready reference on theirwebsite (www.australiagroup.net/en/biological_agents.html).



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v) Detection and containment of an outbreakwould entail four basic steps:

a. Recognition and diagnosis by primaryhealth care practitioners: Medicalclinicians, including privatepractitioners, will report any unusualincidence of infectious disease orsyndrome (an undiagnosed cluster ofsymptoms) with similar symptoms.Clinical laboratories would thenattempt to identify the disease causingagent from the patient’s blood, urineor other specimens.

b. Communication of surveillanceinformation to public health authorities:Physicians and infectious diseasesspecialists who detect any unusualpattern of disease incidents, such asseveral patients with the samesymptoms, shall report theirobservations to local or state publichealth departments.

c. Epidemiological analysis of thesurveillance data: Epidemiologistsfrom the health department shallinterpret the surveillance data to makea tentative diagnosis and determinethe source of the outbreak, the modeof transmission and the extent ofexposure. They would then makerecommendations for appropriatetreatment and public health measuresto contain the outbreak. The role ofprivate care providers shall also bedefined.

d. Delivery of appropriate medicaltreatment and public health measures:Infected individuals need to betreated. Quarantine and vaccination oftheir contacts and possibly exposedpersons would be needed in situationswhere secondary spread isanticipated.

vi) Rapid Response Teams (RRTs): There willbe RRTs at the national, state and districtlevels who would be trained under IDSP.If the disease is suspected to be of vectorborne origin the RRT would comprise of anepidemiologist/public health specialist,physician, paediatrician, microbiologist (ortrained pathologist), and entomologist. Anyoutbreak at the district level will beinvestigated by the district RRT anddepending upon the report, the state/national RRT will be deployed. The RRTwill be well-versed with the natural historyof the disease as also in interpreting theepidemiological clues that would suggestan intentional outbreak.

vii) Confirmation of the specific type ofmicroorganism(s) by the laboratorynetwork.

viii) The emerging threats of Methicillin-Resistant Staphyllococcus aureus (MRSA)will also be included in the surveillanceprogramme.

Confirming the type of microorganism causingthe disease and testing its sensitivity to differentdrugs is necessary for the management ofbiological disasters. Therefore, it may be necessaryto identify specific laboratories that are capable ofsupporting the integrated surveillance system.

Disasters such as floods, cyclones, tsunamisand earthquakes require active event basedsurveillance to be established for detection of earlywarning signals. The existing state epidemiologycell/IDSP unit will be equipped with suchsurveillance systems if need be. MoH&FW willdepute RRTs, which will establish a post-disastersurveillance mechanism till such time recoverytakes place which can take four to six months.Special attention will be given to disease/injurysurveillance, water quality monitoring and vectorsurveillance.

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4.2.5 Pharmaceutical Interventions:Chemoprophylaxis, Immunisation andOther Preventive Measures

i) Health care workers will be equipped withgloves, impermeable gowns, N-95 masksor powered air-purifying respirators. Theymust clean their hands prior to donning PPEfor patient contact. After patient contact,they must remove the gown, leg and shoecovering, gloves, clean hands immediately,then proceed to the removal of facialprotective equipment (i.e., personalrespirators, face shields, and goggles) tominimise exposure of their mucousmembranes with potentially contaminatedhands. After the removal of all PPE theymust clean their hands again.

All manufacturers of antibiotics,chemotherapeutics and anti-virals will belisted and their installed capacityascertained. The centre/state governmentswill ensure availability of all such drugs andanti-toxins that are needed to combat abiological disaster. State governments wouldalso enter into annual rate contracts for allsuch essential drugs that are required formanaging biological disasters. Drugs thatcan be used for mass chemoprophylaxiswill be stocked. Medical stores/organisations/depots will be identified ineach state that will follow scientific inventorymanagement for keeping a minimum stockof identified drugs and vaccines. Suchcentres will also stockpile requisitequantities of PPE, laboratory reagents,diagnostics and other consumables.

ii) Aerosols are the most common method ofdelivery for biological agents. This isbecause the most lethal biological agents(anthrax, plague, smallpox and tularemia)are efficiently delivered by aerosol methods.Of the potential biological disaster agents,only plague, smallpox, and Viral

Hemorrhagic Fevers (VHFs) spread readilyfrom person to person by respiratoryaerosols and require more than standardinfection control precautions (gown, maskwith eye shield, gloves). Recognition of theclinical syndromes associated with variousbiological disaster agents will be useful toolsfor physicians to identify early victims andrecognise patterns of disease. In general,tularemia, plague and anthrax causerespiratory pneumonia like illnesses. Plaguewould most likely progress very rapidly tosevere pneumonia with copious watery orpurulent sputum production, hemoptysis,respiratory insufficiency, sepsis and shock.Inhalational anthrax would be differentiatedby its characteristic flu like symptoms,radiological findings of prominentsymmetric mediastinal widening andabsence of bronchopneumonia. Also,anthrax patients would be expected todevelop fulminating, toxic, and fatal illnessdespite antibiotic treatment. Milder formsof inhalational tularemia could be clinicallyindistinguishable from Q fever. Medicalpersonnel taking care of these patients willwear a HEPA mask in addition to standardprecautions pending the results of acomplete evaluation. Involvement ofmeteorological expertise will be needed totrack aerosol clouds.

iii) Recognition of the clinical syndromesassociated with viruses causing VHFs suchas Filoviridae: Ebola and Marburg,Arenaviridae: Lassa fever and New WorldArena viruses, Bunyaviridae: Rift Valleyfever, Flaviviridae: yellow fever, Omskhemorrhagic fever and KFD. Symptomsinclude high fever, headache, malaise,arthralgias, myalgias, nausea, abdominalpain, and non-bloody diarrhea; temperature>101°F (38.3°C) of >3 weeks duration;severe illness, and no predisposing factorsfor hemorrhagic manifestations; and at least



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two of the following hemorrhagic symptoms:hemorrhagic or purple rash, epistaxis,haematemesis, hemoptysis, blood in stoolsin the absence of any other establishedalternative diagnosis.

iv) Biotoxins generated from various microbialagents have the potential to contaminatewater and food and could be easilyimplanted in large populations through thismode. Therefore, it is necessary to havesufficient checks at places where thesesources are located. There will be anadequate on-site contingency plan todetect any escape and arrangements forwarning.

v) Chemotherapy: Doxycycline is consideredan initial chemoprophylactic broad-spectrum drug of choice in cases ofrespiratory illnesses due to strains ofBacillus anthracis, Yersinia pestis,Francisella tularensis, Coxiella burnetii andBrucellae. Other tetracyclines andfluoroquinolones might also be considered.There is no approved anti-viral drug for thetreatment of VHFs. However ribavirin willbe considered initially as an anti-viral agentof choice in an outbreak due to VHFs. Thereis no effective post-exposure prophylaxisavailable in the form of vaccines or anti-viral drugs. Vaccinations are currentlyavailable for anthrax, tularemia, plague, Qfever and smallpox. Immune protectionagainst ricin and staphylococcal toxins maybe feasible in the near future. Peopleconsidered potentially exposed to VHFs andall persons in contact with the patientsdiagnosed with VHF will be placed undermedical surveillance which will continue for21 days after the deemed potentialexposure of the patients.

vi) It is possible that more than one means ofdelivery and several agents may be presentsimultaneously in a biological disaster.

Zoonotic transmission of biological agentsto humans is another likely possibility.Brucelloisis, glanders and melioidosis affectdomestic and wild animals which, likehumans, acquire the diseases frominhalation or contaminated injuries. Naturalreservoirs for Q fever include sheep, cattle,goats, cats, certain wild animals (includingrodents), and ticks. Humans becomeinfected with F tularensis by various modes,including bites by infective arthropods,handling infectious animal tissues or fluids,direct contact with or ingestion ofcontaminated water, food or soil, andinhalation of infective aerosols. Plagueoccurs most commonly in humans whenthey are infected by fleas. VHFs aretransmitted to humans via contact withinfected animal reservoirs or arthropodvectors. Adequate preventive measuressuch as PPE will be adopted.

vii) Legitimate access to important researchand clinical material must be preserved.Prevention of unauthorised entry/exit ofbiological materials can be achieved byadopting adequate detection methods suchas x-rays and other scanning methods toidentify microorganisms, plant pathogensand toxins at international airports, ports,etc. Suitable assessment of the personnel,security, specific training and rigorousadherence to pathogen protectionprocedures are reasonable means ofenhancing biosecurity. All such measuresmust be established and maintainedthrough regular risk and threat assessments,reviews and updating of procedures.Checks for compliance with theseprocedures with clear instructions on roles,responsibilities and remedial actions will beintegral to biosafety programmes andnational standards for biosecurity. Thesubject is of prime importance and is dealtwith in detail, in Chapter 5.

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viii) Immunisation/vaccination programmes

India has a sizeable capability, built overthe years, for implementation of its universalimmunisation programme for six vaccinepreventable diseases. It is capable of massvaccination campaigns in disaster settings.Mass vaccination campaigns andprophylaxis programmes could be usefulwhen indicated in diseases like tetanus,measles, typhoid, cholera, viral hepatitis,etc. Appropriate influenza vaccination,depending on the causative strain, may beconsidered when the situation demands it.Such campaigns may be required inpandemic influenza and BT attacks usingsmallpox virus or for any other emergingbacterial or viral etiologies. MoH&FW willlay down a clear vaccination policy, have astockpile of vaccines, identify and train thevaccinators and have cold chainmanagement. Capacity will be developedin the pharmaceutical sector for creating aviable high-tech infrastructure for vaccineresearch and production. Immunisationprogrammes under continuous monitoringand reporting mechanisms will be aneffective preventive strategy. The details ofimmunoprophylactic and chemoprophylactictherapies to be administered duringepidemiological out-breaks and biologicaldisasters are shown in Annexure-B(Reference: http://www. usamriid.army.mil/education/bluebook.html).

Specific immunisation programmes will beinitiated for laboratory personnel who arelikely to come in contact or work withinfectious agents.

4.2.6 Non-pharmaceutical Interventions

(A) Social Distancing Measures

Spread of communicable diseases in manyconditions can be controlled or prevented by

reducing direct contact with patients. Socialdistancing measures such as closure of schools,offices and cinemas is recommended to preventthe gathering of large numbers of people at oneplace. Further, there could be a ban on culturalevents, melas, etc. Entry to railway stations andairports could be restricted. There is evidence tosuggest that social distancing measures, if properlyapplied, can delay the onset of an epidemic,compress the epidemic curve and spread it over alonger time, thus reducing the overall health impact.Social distancing measures, if required to beimplemented in the context of an epidemic, maybe voluntary or legally mandated. In either case,the public will be made aware of the action takenand its purpose.

(B) Disease Containment by Isolation andQuarantine Methodologies

The spread of communicable diseases in manyconditions can be controlled or prevented byisolation and quarantine, thereby reducing directcontact with patients. Other preventive measuresare vector control, rodent and mosquito control,and food and environmental control. It includes:::::

i) Isolation refers to isolating suspected casesin hospital settings. In the case of biologicaldisasters such as pandemic influenza whichaffects millions, home isolation may haveto be recommended to those who can betreated at home.

ii) Quarantine refers to not only restricting themovements of exposed persons but alsothe healthy population beyond a definedgeographical area or unit/institution (airportand maritime quarantine) for a period inexcess of the incubation period of thedisease. Restrictions in the movement ofthe affected population is an importantmethod to contain communicable diseases.The status of the law and order mechanismof the state and district is an important factorin helping health authorities in this regard.



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The precautions to be undertaken whileisolating patients of biological disasters areprovided in Annexure-C.

4.2.7 Biosafety and Biosecurity Measures

Strict compliance with biosafety andbiosecurity provisions at all levels will deny thepossibility of terrorists reaching facilities where suchmicroorganisms are stocked and available. Thiswill act as a second layer of defence and reducethe possibility of any bioterrorist activity. Theimportant components of biosafety and biosecuritymeasures are explained below.

i) Microorganisms are handled extensively inmedical, agricultural and veterinary fieldsand in research laboratories. They are alsoused for the preparation of enzymes, seraand reagents which have commercial valueand are handled exclusively by commercialmanufacturers. Any contingency plan would,therefore, remain incomplete unless all suchorganisations/institutions where they arehandled are also brought within its purview.There must be a system for inventory controlin the laboratories dealing with bacteria,viruses or toxins which can be a source ofpotential causative agents for biologicaldisasters. Therefore, specific informationabout organisms and toxins handled indifferent laboratories will be documentedby the respective laboratories/organisationsand secured.

ii) Within the laboratory, dangerous pathogensmust be housed inside secure incubators,refrigerators or storage cabinets when notin use. For research and clinicallaboratories, the laboratory supervisor willbe responsible for establishing a methodfor identifying authorised users of thelaboratory and for establishing effectivemechanisms for controlling access to thelaboratory and detection of unauthorisedindividuals.

iii) It may be necessary to develop a systemof inventory for effective contingencyplanning. Bacteria and toxins are frequentlyexchanged between countries for researchand training programmes. Though there isa system of checks for bulk import, smallamounts of organisms packed in smallcontainers can easily be brought into thecountry. The existing system designed tocontrol these exchanges will be examined,strengthened and implemented properly.

Issues regarding biosafety and biosecuritymeasures are dealt with in detail in Chapter 5.

4.2.8 Protection of Important Buildings andOffices

Protection of important buildings againstbiological agents wherever deemed necessary, canbe done by preventing and restricting entry toauthorised personnel only, by proper screening.Installing HEPA filters in the ventilation systems ofthe air conditioning facilities will prevent infectiousmicrobes from entering the air circulating insidecritical buildings. The post-exposure approach willinclude effective decontamination and safetyprocedures.

4.3 Preparedness and CapacityDevelopment

Preparedness will focus on assessment ofbiothreats, medical and public healthconsequences, medical countermeasures andlong-term strategies for mitigation. An importantaspect of medical preparedness in BDM includesthe integration of both government and privatesectors. A sound infrastructure is necessary bothfor medical countermeasures and R&D for evolvingnovel technologies. The important components ofpreparedness include planning, capacity building,well-rehearsed hospital DM plans, training ofdoctors and paramedics, and upgradation of

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medical infrastructure at various levels to reducemorbidity and mortality. A multi-sectoral approachwill be adopted to deal with any outbreak ofinfectious diseases—for this the involvement ofMoH&FW, MHA, Ministry of Social Justice andEmpowerment, MoD and MoA is essential. Abiological disaster response plan is to be evolvedon the basis of the national guidelines with dueparticipation of health officials, doctors, variousprivate and government hospitals, and the publicat the national, state and district levels. There isneed to establish institutes similar to NICD in eachstate of the country. Central and state governmenthealth departments also need to be equipped withstate-of-the-art tools for rapid epidemiologicalinvestigation and control of any act of BT. Theimportant components of preparedness arediscussed in the ensuing paragraphs.

4.3.1 Establishment of Command, Controland Coordination Functions

At the operational level, C&C is clearlyidentifiable at the district level, where the districtcollector is vested with certain powers to requisitionresources, notify diseases, inspect any premises,seek help from the Army, state or centre, enforcequarantine, etc. The incident command systemneeds to be encouraged and instituted so that theoverall action is brought under the ambit of anincident commander who will be supported bylogistics, finance, and technical teams etc. TheEmergency Medical Relief Division (of DGHS) atthe centre coordinates and monitors all crisissituations. Such a mechanism needs to bedeveloped in the states also. EOCs will beestablished in all the state health departments withan identified nodal person as Director (EmergencyMedical Relief) for coordinating a well orchestratedresponse.

4.3.2 Capacity Development

Capacity development requires the all-rounddevelopment of human resources and infrastructure

for the establishment of a well-focused andfunctional organisation and the creation of asupportive socio-political environment. Attention isto be given to the development of infrastructuralfacilities in terms of trained manpower, mobility,connectivity, knowledge enhancement andscientific up-gradation for all stakeholdersconcerned with the management of biologicaldisasters. Capacity development is an importantcomponent of preparedness for the managementof biological disasters which includes the following:

(A) Human Resource Development

i) The DHO will establish a centralised systemfor data collection from village to sub-centrelevel by the village health guide, from sub-centre to PHC level, and from PHC to DHOby the PHC in-charge. The development ofa simple format to collect this informationfrom lower level, PHC, district, state andcentral level will also be made. The DHO,in consultation with the stateepidemiological cell, will develop a simpleformat for daily data collection, dependingupon quantum of information available ateach level. This format must be simple andinformative.

ii) Control rooms will be nominated/established at different levels in order toget all the relevant information and transmitit to the concerned official. The addressesand telephone numbers of the districtcollector, DHO, hospitals, specialists fromvarious medical disciplines like paediatrics,anaesthesia, microbiology etc., and a listof all stakeholders from the private sectorwill be available in the control room.

iii) The shortfall of public health specialists,epidemiologists, clinical microbiologistsand virologists will be fulfilled over astipulated period of time. Teaching/traininginstitutions for these purposes will beestablished. Till then PHFI, NICD and ICMRwill fill this gap to some extent. The



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microbiology and preventive and socialmedicine departments of medical collegeswould orient their teaching/training towardspublic health management/administration.This calls for a review of the curriculum ofpublic health teaching at the graduate andpostgraduate levels by the Medical Councilof India. The immediate deficiency ofspecialists will be met by conducting short-term training courses for medical officers.

(B) Training and Education

i) The necessary training/refresher training willbe provided to medical officers, nurses,emergency medical technicians,paramedics, drivers of ambulances, andQRMTs/MFRs to handle disasters due tonatural epidemics/BT.

ii) It is important that medical and publichealth specialists are able to identify theepidemiological clues that differentiate anatural outbreak from an intentional one. Inview of this, structured BT related educationand web-based training will be given forgreater awareness and networking ofknowledge so that they are able to detectearly warning signs and report the same tothe authorities, treat unusual illnesses, andundertake public health measures in timeto contain an epidemic in its early stage.

iii) Refresher training will be conducted for allstakeholders at regular intervals. Anadequate number of specialists will bemade available at various levels for themanagement of cases resulting from anoutbreak of any epidemic or due to abiological disaster.

iv) There is a need to evolve standardisedtraining modules for different medicalresponders/community members forcapacity building in the area of disastermanagement and to create adequatetraining facilities for the same.

v) Selected hospitals will develop trainingmodules and standard clinical protocols forspecialised care, and will execute theseprogrammes for other hospitals. Table-topexercises using different simulations will beused for training at different levels followedby full-scale mock drills twice a year.

vi) A district-wise resource list of all thelaboratories and handlers who are workingon various types of pathogenic organismsand toxins will be prepared.

vii) BDM related topics will be covered in thevarious continuing medical educationprogrammes and workshops of educationalinstitutions in the form of symposia,exhibition/demonstrations, medicalpreparedness weeks, etc. The Dos andDon’ts for various natural and man-madedisasters are to be made as a part ofcommunity education programmes.

viii) Biological disaster related education shallbe given in various vernacular languages.Simple exercise models for creatingawareness will also be formulated at thedistrict level.

ix) Biological disaster plans will be rehearsedas a part of training every six months.

x) Knowledge of infectious diseases,epidemics and BT activities will beincorporated in the school syllabi and alsoat the undergraduate level in medical andveterinary colleges.

(C) Community Preparedness

Community members including public andprivate health practitioners are usually the firstresponders, though they are not so effective dueto their limited knowledge of BDM. These peoplewill be sensitised regarding the threat and impactof potential biological disasters through publicawareness and media campaigns. The areas whichneed to be emphasised are:

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i) Risk communication to the community

a. Community education/awarenessabout various disasters anddevelopment of Dos and Don’ts.

b. The public will be made aware of thebasic need for safe food, water andsanitation. They will also be educatedabout the importance of washinghands, and basic hygiene andcleanliness. The community will alsobe given basic information about theapproach that health care providerswill adopt during biological disasters.

c. Toll-free numbers and a reward systemfor providing vital information aboutany oncoming biological disaster byan early responder or the public willbe helpful.

d. Definition of predisposing existingfactors, endemicity of diseases,various morbidity and mortalityindices. The availability of such datawill help in planning and executingresponse plans.

ii) Community participation

a. Providing support to public healthservices, preventive measures such aschlorination of water for controlling thepossibility of epidemics, sanitation ofthe area, disposal of the dead, andsimple non-pharmacologicalinterventions will be mediated throughvarious resident welfare associations,ASHA/ANM, village sanitationcommittees, and PRIs.

b. Community level social workers whocan help in rebuilding efforts, createcounselling groups, define morevulnerable groups, take care of culturaland religious sensitivities, and also actas informers to local medicalauthorities during a biological disaster

phase, will be created after propertraining and education.

c. NGOs and Private VoluntaryOrganisations (PVOs) will be involvedin educating and sensitising thecommunity.

d. Supporting activities like street shows,dramas, posters, distribution ofreading material, school exhibitions,electronic media, and publicity, etc.,will be undertaken.

A legally mandated quarantine in a geographicarea, isolation in hospitals, home quarantine ofcontacts, and isolation management of less severecases at homes would only be possible with activecommunity participation.

(D) Documentation

The experiences of various drills, the lessonslearnt from them, and best practices so developedwill be shared with all stakeholders/serviceproviders. SOPs for their proper documentation andscientific analysis based upon the identifiedindicators specific to biological disasters will be made.

(E) Research and Development

It is essential to develop new research methodsand technologies which will facilitate rapididentification and characterisation of novel threatagents. Research pertaining to the developmentof new treatment modalities, specific biomarkersand advanced robotic tools needs overall reviewand upgradation to meet global standards.Innovative technologies will enhance the ability torespond quickly and effectively. This will requiretargeted and balanced fundamental research, aswell as applied research for technologydevelopment to acquire medical capabilities.

i) The recent development of geneticengineering techniques led to the



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production of many types of bacteria andviruses in research laboratories. In mostcases, detailed information about thediseases caused by them is not known. Earlydetection in such a situation becomes verydifficult. Examples of novel biologicalthreats that could be produced through theuse of genetic engineering technologyinclude:

a. Microorganisms resistant to antibiotics,standard vaccines and/ortherapeutics. They are also able toelude standard diagnostic methods.

b. Viral vectors such as adenovirus andvaccinia, as well as naked or plasmidDNA can be engineered for the solepurpose of delivering foreign genesinto new cells.

c. Innocuous microorganisms geneticallyaltered to possess enhanced aerosoland environmental stabilitycharacteristics which are able toproduce a toxin, poisonous substance,or endogenous bio-regulator.

ii) In view of the above biological threats, thenecessary interventions will be taken careof by establishing a national instituteresponsible for biodefence research. Theroles and responsibilities of this institute willbe:

a. Integrate and take a directionalapproach to the study of infectiousdisease outbreaks due to natural andman-made biological disasters.

b. Maintain a database of infectiousagents and the newly emergingmicrobial pathogens of BW/BTimportance.

c. Coordinate with the nodal institutionsof the country identified as researchcentres by ICMR such as AIIMS, NewDelhi; PGIMER, Chandigarh; NICD,

Delhi; NIV, Pune; DRDE, Gwalior; andIVRI, Mukteshwar.

d. Development of capacities to evaluatethe determinants for assessment ofthreat based upon the researchinterventions undertaken.

e. Institutions under MoH&FW/ICMR shallacquire the capability for developingmathematical models/forecastmodels/secular trend models toidentify and assess biological threatsto the local community and developindicators that govern their conversioninto a high consequence scenario.

f. The determinants of the threat levelinclude information about the variousbiological organisms and toxinsproduced as well as the populationunder probable threat. The instituteswill develop mechanisms for theassessment of threat.

iii) Operational research

Operational research would focus onresearch models to estimate the probablepublic health consequences of variousthreat scenarios and the specific medicalcountermeasures that will be adopted, andshall incorporate various assessmentcriteria to assess existing preparedness,modes for its optimal utilisation, enhancedrequirements due to higher levels ofincidence and the development of short-and long-term mitigation strategies. Themitigation strategies will then be taken upin a ‘mission mode approach’ for testing,evaluation and upgradation.

iv) Long-term research

Long-term research would focus on noveldetection technologies, better ways tomanage biological agents and developmentof novel broad-spectrum antibiotics,vaccines, and laboratory diagnostics.

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4.3.3 Critical Infrastructure

The existing infrastructure of the health ministry,MoD and AFMS will be suitably upgraded to enableit to support BDM activities.

(A) Network of Laboratories

A network of laboratories will be created/existing laboratories strengthened at the local,state, regional and national levels to support IDSPand to enhance diagnostic skills. The existingpublic health service and medical collegelaboratories in both government and private sectorswill be strengthened for confirmation ofmicroorganisms, testing their sensitivity and othermolecular level studies. Central ministries/departments of health will focus on the following:

i) Some institutes will be nominated as referrallaboratories including NICD, Delhi, and NIV,Pune, for investigation of viruses; NationalInstitute of Cholera and Enteric Diseases(NICED), Calcutta, CRI, Kasauli and NICD,Delhi, for investigation of bacteria; andIndian Institute of Toxicology Research,Lucknow for investigation of toxins.

ii) Existing disease specific surveillancelaboratories (influenza surveillance network)would also be strengthened to cater toinvestigation of diseases with suspectedviral etiologies.

iii) All identified laboratories in the network needto follow biosafety norms and be classifiedaccording to the biosafety level. As apexinstitutions, efforts will be made to have aBSL-4 laboratory at NIV, Pune, and NICD.There will be at least one BSL-3 laboratoryto represent each region.

iv) Manufacturing facilities for standarddiagnostic reagents need to be identifiedand encouraged in the pharmaceutical sector.

v) In the context of BW/BT, the most importantstep in biodefence strategy is to evolve a

test for rapid detection and identificationof the causative agent. The conventionalmicrobiological methods viz., culture andimmuno-diagnosis or serology take a longtime (hours to days) and are too slow whenrapid diagnosis is required to confirm earlywarning signs.

vi) The identified apex/regional biosafetylaboratories will establish a mobiledetection system relying on technologiessuch as bioluminescence andbiofluorescence (detection of BW agentsthrough fast reacting bio reportermolecules).

vii) There is a need to have national biodefenceresearch centres where the latest molecularand other diagnostic facilities will beavailable to identify such geneticallymutated microorganisms and also maintaina national database of all such organisms.Meanwhile, one of the ICMR and DRDOlaboratories shall be designated for thepurpose.

viii) Provisions for adequate licensing andscrutiny and strict enforcement ofbiosecurity and biosafety will be ensuredin food processing plants, storagewarehouses, potable water reservoirs, andresearch laboratories.

ix) Efforts are required to upgrade diagnosticlaboratories attached to medical institutionsat the state level. Responsibilities of theselaboratories include the following:

a. Types of facilities and their levels ofworking.

1) District laboratories to diagnosepathogens and their drugsensitivity.

2) Medical college laboratories toconfirm diagnosis and provideguidance in case of any doubt.



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3) State referral laboratories: Onelaboratory in each state will beidentified by the respective stategovernments as a state referrallaboratory. Such a laboratory maybe located in a medical collegeor if medical college does notexist in the state, then in agovernment hospital.

4) National referral laboratories: Theresponsibility of national referrallaboratories will be to help ininvestigation, isolation andcharacterisation of organisms andto provide guidance from time totime. Depending upon the typesof organisms handled, there wouldbe different norms in terms oflocation and capabilities.

b. Other requirements of laboratories

1) There is a requirement for sufficientspace with easy to clean walls,ceilings and floors, adequateillumination, bench topsimpervious to water and resistantto disinfectants, acids, andalkaline or organic solvents.

2) Safety systems to prevent fire andelectrical emergencies,Emergency shower and eye washfacilities, first aid rooms, properwaste disposal facilities,autoclaves, steriliser, incinerators,facilities for treating waste waterfrom laboratories are some othermandatory requirements.

x) Creating a chain of public healthlaboratories with at least one such laboratoryin each district. This includes:

a. A referral system to be developed atthe state and national level withadvanced facilities for cultures andantibiotic sensitivity.

b. In some states, the departments ofpreventive medicine in medicalcolleges may be upgraded to servethis purpose.

c. This network will also be an integralpart of the IDSP. These laboratories willhave basic capabilities to collect anddispatch samples to the referrallaboratory to isolate and detectmicroorganisms. For details, refer tothe section on biosafety laboratoriesin Chapter 5.

(B) Biomonitoring

i) The most important step in biodefencestrategy is the rapid detection andidentification of causative agents. Detectionis the unspecific demonstration of increasedconcentrations of microorganisms in aparticular environment whereasidentification is the species determinationof the detected microorganisms. An attackby BW agents is difficult to detect owing tothe inherent intrinsic properties of theorganism, such as aerosolised transmissionof small-pox and other viruses causingvesicular skin eruptions. Their earlydetection and identification is critical forearly implementation of specificcountermeasures.

ii) Detection systems for BW agents will havethe properties of rapidity, reliability,reproducibility, sensitivity and specificity soas to quickly diagnose the correct etiologicalagent from complex environmental samplesbefore their widespread dissemination. Itis essential to develop portable detectorsand other devices based upon the needassessment analysis.

iii) Molecular techniques are useful in the earlydetection and identification. Capacitybuilding is required to establish laboratorieshaving molecular facilities to detect BW

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agents, especially Genetically ModifiedOrganisms (GMOs) which are difficult todetect by routine conventionalmicrobiological techniques. Environmentalsamples (air, water, soil, etc.) may have lowconcentrations of the microorganisms andmay not be detectable to enable analysis.The most important recent development inbiodefence strategies is the on-linedetection of possible BW agents throughfast reacting bio reporter molecules.

iv) Bioluminescence and biofluorescence:::::Various bioreporter molecules have beenidentified as signal generating systems. Thebiochemical reaction of organismsgenerates light which can be detected byconventional photo detectors.

v) Biosensors: It is a type of probe in whichthe biological component interacts with ananalyte which is then detected by anelectronic component and translated into ameasurable electronic signal. It is a reliabledetection system for microbes with highselectivity and sensitivity. It can be of threetypes i.e., immunosensors, nucleic acidsensors and laser sensors and can be usedin the laboratory for detection. Biosensortechnology is the driving force in thedevelopment of various bio chips for thedetection of pesticides, allergens, gaseouspollutants, and microorganisms inenvironmental samples.

vi) Bioprobes: These are based on the sensormonitor properties of biological entities.Bees, beetles and other insects are beingused as sentinel species in collecting realtime information about the presence oftoxins or similar threats. Biodetection canalso be done through the development ofbiorobots.

vii) Molecular and other recent techniques: Withadvances in molecular biology, it is nowpossible to identify the specific disease

producing gene of a microorganism withoutculturing it. Polymerase Chain Reaction(PCR) can detect the presence of thespecific nucleic acid (DNA/Ribonucleic acidi.e., RNA) of the microorganism in 3–4 hoursat extremely low concentrations. Theadvantage with this method is thatidentification can be made from non-livingorganisms. Loop mediated isothermalamplification technique for qualitative andquantitative detection of microorganisms isthe latest advancement in rapid andaccurate identification of BW agents in fieldconditions. Other variations andmodifications of PCR are the newermethods for the detection and identificationof BW agents. Laboratory confirmation forthe presence of an agent is generally givenon the basis of two or three supportive testsin the absence of a culture of the organisms.The test will be able to differentiate theorganism from other closely related species.The reliability of the rapid tests dependsupon its sensitivity to identify normal andgenetically altered strains. The quality ofsample collection would also affect theresults of these tests. Other moderntechniques for rapid detection and directidentification of the suspected BW agentsare flowcytometry, fluorescent activated cellsorter, gas chromatography, massspectrometry, gas chromatography-massspectrometry and liquid chromatography-mass spectrometry, which can detectcertain metabolites or chemical componentsof organisms.

(C) Technical and Scientific Institutions

Central/state/district authorities will identify anddefine the technical institutions and laboratoriesengaged in various scientific, research andtechnical advancements in detection andidentification of various microbiological agents (BT



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causative agents), exotic pathogenic microbes andgenetically modified agents. These institutes willact as professional guiding resource centres andfunction as referral centres. Some of thelaboratories will be designated as national referrallaboratories. A suspected outbreak of any epidemicor BT will be addressed to the designatedlaboratory for proper and quick identification. Someof the important functions of these identifiedlaboratories include:

i) Identification and assessment of thebiological threats to the local communityand development of indicators to governtheir conversion into a high consequencescenario. The determinants of threat includeinformation about the various biologicalorganisms and toxins produced as well asthe population under the probable threat.The institutes will develop a mechanism forassessment of the threat.

ii) These institutes will also develop researchmodels to estimate the probable publichealth consequences of a threat scenarioand the specific medical countermeasuresfor each biological agent.

iii) The medical countermeasures that need tobe adopted will incorporate the variousassessment criteria to assess the existingpreparedness, the modes for its optimalutilisation, the enhanced requirement dueto higher levels of incidence and thedevelopment of short- and long-termmitigation strategies.

iv) The mitigation strategies will then be takenup in the ‘mission mode approach’ fortesting, evaluation and upgradation. Testingwill also be done through mock drills.

v) Based upon the mitigation strategies, theshort-term and long-term goals ofacquisition of various facilities, infrastructureand development of newer counter actingtechnologies will be defined. In addition,there will be a need to achieve self-

sufficiency in certain areas, especially forsecurity purposes against BT as well asthreats arising out of the continuousdevelopment of novel strains ofmicroorganisms.

vi) All the activities will be in harmony with eachother and at the various laboratoriesidentified at all levels.

vii) The institutes will develop models basedon a ‘preventive strategy’ intended to reducevulnerability and to mitigate post-disasterconsequences. The strategy will includepublic health preparedness, long-termfocus on novel detection technologies,newer ways to manage different kinds ofbiological agents and development of novelbroad-spectrum antibiotics, vaccines andbiological system specific medicalcountermeasures, for example, to managethe hemopoietic syndrome, etc. The idealmedical countermeasures for biologicalagents will be highly effective for post-exposure prophylaxis and earlysymptomatic treatment with an excellentsafety profile.

(D) Communication and Networking

Communication is a vital component of DM.The existing communication systems are vulnerableto failure during disasters, thus it is important todevelop strategies to protect these systems andupgrade them and make them more resilient sothat they can survive during disasters. The majorguidelines include:

i) Emergency communications network:Establishment of control rooms at thedistrict, state and central levels andinclusion of private practitioners in thenetwork through the IDSP. There will beterrestrial and satellite based hubs for fail-safe communication both vertically andhorizontally.

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ii) Health network: All hospitals will beconnected with IAN and QRMTs. They willhave an intra-hospital horizontal network.Dedicated telephone numbers shall bemade available to hospitals. The networkshall also be integrated with police, fire andother helpline services.

iii) Mobile tele-health: Mobile tele-health isanother concept of tele-medicine that canbe used for disasters by putting diagnosticequipment and information communicationtechnology together on a vehicle to getconnectivity from the affected site toadvanced medical institutes where suchconnectivity already exists. Such systemsmay be placed in known disaster proneareas or could be moved at the onset ofdisasters. Such systems will be developedat the regional levels.

iv) Communication through print and electronicmedia: The print and electronic media arethe first reporting agencies in any disaster,thus they need to be integrated into thecommunication network so that correctinformation can be disseminated to thepublic. Normally there is panic in anybiological disaster situation. The mediastrategy/plan for DM will address measuresto allay public anxiety and fears arising outof outbreaks in general and BT in particular.Correct information disseminated by themedia is useful for educating thecommunity at times of disasters. The mediawill be coordinated by an earmarked officerof appropriate seniority.

v) NGOs as part of the BDM network: NGOsand PVOs will be involved for communityeducation and sensitisation. NGOs as ofnow have played a limited role in biologicaldisasters as compared to hydrological orseismic disasters. They could play a role inrumour surveillance, reporting of events,implementation of non-pharmaceutical

interventions, sensitisation of the publicthrough the supporting role of the media,etc.

vi) Role of international organisations: Underthe IHR, WHO is the nodal agency that willgive information of any outbreak of diseasein the neighbourhood. WHO also providestechnical advocacy on communicabledisease alerts and response, providestechnical experts, helps in capacitydevelopment through training, andlaboratory support through WHO referencelaboratories wherever required. Otherorganisations that provide technicalexpertise include CDC, OIE and FAO.

E) Public-private Partnership

The private sector has substantial infrastructurecapabilities and is engaged in R&D for variousproducts which is a part of biodefence research.Government technical agencies like DRDO andICMR laboratories may collaborate with the privatesector for developing more efficient biodefencetools such as vaccines. The private sector has thepotential to play a major role in the nation’spreparedness by integrating its capacities withgovernmental organisations such as DRDE andNICD. Some of the important recommendationsinclude the following:

i) Adoption of international best practices willbe encouraged in combating biologicaldisasters.

ii) International pharmaceutical agencies andother technical laboratories that areengaged in the field of research andupgradation of specialised technologies forproduction of various vaccines like anthraxand smallpox and newer drugs, will becollaborated with for meeting the peakrequirements of vaccines and drugs duringbiological disasters.



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iii) Sourcing and procurement ofcountermeasures currently available withmanufacturing capacities in a ready stateto enable their continuous supply.

iv) Developing a contemporary system basedon PPP for stockpiling, distribution and coldchain system for sophisticated diagnostickits, vaccines and antibiotics.

v) Collaborations can be made to establishinfrastructure facilities required for response,as mutually decided by the government andthe private sector. Possibilities will also beexplored for investments by the privatesector in the area of R&D, which can bedecided upon the need of government.

Private sector facilities are required to beincluded in district-level DM plans andcollaborative strategies shall be evolved at thedistrict level for the utilisation of their manpowerand infrastructure. Private medical and paramedicalstaff must be made part of the resource. Communitybased social workers can assist in first aid, psycho-social care, distribution of food, water, andorganisation of community shelters under theoverall supervision of elected representatives ofthe community.

4.4 Medical Preparedness

Medical preparedness will be based on theassessment of biothreat and the capabilities tohandle, detect and characterise the microorganism.Specific preparedness will include pre-immunisation of hospital staff and first responderswho may come in contact with those exposed toanthrax, smallpox or other agents. It further relatesto activities for management of diseases causedby biological agents, EMR, quick evacuation ofcasualties, well-rehearsed hospital DM plans,training of doctors and paramedics and upgradationof medical infrastructure at various levels whichwill reduce morbidity and mortality. Medical

preparedness will also entail specialised facilitiesincluding chains of laboratories supported byskilled human resource for collection and dispatchof samples. The major aspects of medicalpreparedness are explained in the ensuingparagraphs.

4.4.1 Hospital DM Plan

Hospital planning will include both internalhospital planning, and for hospitals being part ofthe regional plan for managing casualties due tobiological disasters. The major features will includethe following:

i) Hospital disaster planning will consider thepossibility that a hospital might need to beevacuated or quarantined, or divert patientsto other facilities.

ii) The plan will be ‘all hazard’, simple to readand understand, easily adaptable withnormal medical practices and flexibleenough to tackle different levels and typesof disasters.

iii) The plan will include capacity development,development of infrastructure over a periodof time and be able to identify resourcesfor expansion of beds during a crisis.

iv) The plan will be based on the needassessment analysis of mass casualtyincidents. There will be a triage area andemergency treatment facilities for at least50 patients and critical care managementfacilities for at least 10 patients.

v) The quality of medical treatment of serious/critical patients will not be compromised.The development plan will aim at thesurvival and recuperation of as manypatients as possible.

vi) Hospitals will plan to recruit a sufficientnumber of personnel, including doctors andparamedical staff, to meet the patients’needs for emergency care.

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vii) It is essential that all hospital DM plans havethe command structure clearly defined,which can be extrapolated to a disasterscenario, with clear-cut job definitions whenan alert is sounded. Emergency servicesprovided must be integrated with otherdepartments of the hospital.

viii) The hospitals will submit data on theircapabilities to the district authorities andon the basis of the data analysis, the surgecapacities will be decided by the districtadministration.

ix) There is no universal hospital DM planwhich can be implemented by all hospitalsin all situations. Therefore, on the basis oftheir specific considerations, each hospitalwill develop a disaster plan specific to itself.The plan shall be available with the districtadministration and tested twice a year bymock drills.

x) The hospital DM plan will cater for theincreased requirement of beds,ambulances, medical officers, paramedicsand mobile medical teams during a disaster.The additional requirement of disease-related medical equipment, disaster-relatedstockpiling and inventory of emergencymedicines will also be factored into thehospital DM plan. The DM plan must bestrengthened by associating the privatemedical sector.

xi) Although the number of private hospitalsare increasing, they are not appropriatelyplanned to manage casualties resulting froman outbreak of any epidemic or biologicaldisaster. There is a need for networkingbetween public and private hospitals andhospital DM plans need to be updated atthe district/state level through frequentmock drills. Firm administrative policies willbe in place for developing such plans atthe hospital level.

xii) The registration and accreditation policy willmake it mandatory to have a hospital DMplan.

xiii) The existing infectious diseases hospitalswill be remodelled to manage diseases withmicroorganisms that require a high degreeof biosafety, security and infection controlpractices. There will be one such hospitalin each state capital. In addition, the districthospitals and medical colleges will haveisolation wards to manage such patients.Also, identified hospitals in vulnerablestates will be strengthened for managingCBRN disaster victims by putting in placedecontamination systems, critical careIntensive Care Units (ICUs) and isolationwards with pressure control and lamellarflow systems. The infectious controlpractices include the following:

a. When dealing with biologicalemergencies, the health workersassociated with the investigation ofsuch exposures will have adequatepersonal protection.

b. Depending upon the risk, the level ofprotection will be scaled up from useof surgical masks and gloves, toimpermeable gowns, N-95 masks orpowered air-purifying respirators. Theywill follow laid down SOPs for use ofPPE. Infection control practices will befollowed at all health care facilities,including laboratories.

c. Of the potential biological disasteragents, only plague, smallpox andVHFs are spread readily from personto person by aerosols and requiremore than standard infection controlprecautions (gowns, masks with eyeshields, and gloves).

d. The suspected victims and those whohave been in contact with them will



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be advised to follow simple publichealth measures such as using masks/handkerchief tied over the nose andmouth, frequent washing of hands,staying away from other people by atleast a metre, etc.

xiv) Every hospital has two major facets,administration and clinical care.Administrative activities involve setting thehospital disaster plan into action andnominating a nodal medical officer in theplan who will be in charge of emergenciesand trauma care. The nodal officer will beresponsible for getting updated information,initiating administrative action andcoordinating with the heads of variousclinical facilities. To handle biologicaldisasters, a hospital DM plan will have thefollowing facilities:

a. Medical and paramedical staff: It isimportant to train medical staff andparamedics properly in universalsafety precautions, use of PPE,communication, triage, barrier nursing,and collection and dispatch ofbiological samples. A team ofspecialists must be made available tohandle infectious diseases affectingvarious body systems and they will besuitably immunised against agentssuch as anthrax and smallpox.

b. Expansion of casualty area: If thehospital casualty ward is unable toaccommodate a large number ofcasualties, provision will be made touse the patients’ waiting hall, dulyreoriented, to receive the casualties.Each major hospital will cater to atleast 50 additional patients at timesof disaster.

c. Isolation wards: Many biologicalagents cause infective diseases ofvarious body systems which can

spread the infection to other patients.Therefore, adequate number ofisolation wards are required to beplanned with surge capacity toaccommodate a large number ofpatients. If required, side rooms,seminar rooms, other halls can beimprovised for this purpose.

d. Security arrangements: Hospitalsecurity staff will prepare SOPs toprevent overcrowding of hospitals byvisitors, relatives, VIPs, and the mediaat the time of a disaster. Help of thedistrict administration will be sought,if required.

e. Identification of patients: The processwill start at the time of giving first aidand triage. A system of labelling andidentifying patients during spotregistration by giving a serial numberto the patient and putting anidentification tag around the wrist canbe done. In mass casualties, it can besupplemented by giving colour codedtags, such as red for serious patients,yellow for moderately serious patients,blue for those in need of observationand black for the dead.

f. Brought dead: All those brought indead and patients who die whilereceiving resuscitation will besegregated and shifted to the mortuarythrough a separate route. Temporarymortuary facilities will be created tocater for a mass casualty incidence.

g. Diagnostic services: All laboratoriesand radio diagnostic services will bekept fully operational and utilised asand when required. These services willbe available within the emergencytreatment areas.

h. Communication: Both extramural andintramural communication facilities will

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be made available. These can befurther augmented by the use ofmobile phones.

i. Medical supplies: Adequate supply ofessential drugs and non-drug itemswill be made available for at least 50patients in the emergency complexitself for immediate use. Additionally,hospital medical stores will haveadequate buffer stocks.

j. Blood bank services: The services willcater for an adequate supply of safeblood and its components. Voluntaryblood donations will be encouragedto fulfil the increased demand ofblood.

k. Other logistic support: Adequate,uninterrupted supply of water andelectricity will be ensured for propermanagement of casualties.

The laying down of public health standardsfor hospitals and strengthening of CHCs acrossthe nation for basic specialities on 24x7 basis underNRHM by GoI are steps in the right direction tostrengthen medical care facilities in rural areas.NRHM initiatives will be expedited to reach everynook and corner of the country.

4.4.2 Mobile Hospitals and Mobile Teams

States will acquire and locate at least onemobile hospital at strategic locations. Thesehospitals can be attached to earmarked hospitalsfor their use in non-disaster periods. These will bemanned by trained manpower and perform thefollowing functions:

i) To be mobilised to the disaster site formanagement of cases at times of anyepidemic outbreak or biological disaster.

ii) Provide on-site medical treatment tocasualties as per triage and evacuationguidelines. The teams will also make a

complete assessment of the situation andtransmit information to the appropriateauthorities.

iii) Additional medical teams will be mobilisedto assist in handling the large number ofcasualties in the wake of a mass casualtyevent.

iv) Adequate stock of medical stores, includingessential drugs, will be stocked and madeavailable to the medical teams.

v) The stocking of emergency medical storesshall be done by the state government.Brick of medical stocks capable of treating25/50/100 casualties will be kept ready tomove with the QRMTs at short notice.

vi) Drills will be conducted at regular intervalsby mobile hospitals and mobile teams tokeep them in a functional mode at all times.

4.4.3 Stockpile of Antibiotics and Vaccines

Government medical stores at the centre andstates will stock sufficient quantities of essentialdrugs, antibiotics and vaccines based on the riskassessment. State and local public healthauthorities have to develop plans for distributingand administering these materials. There is a needto have a supply of readily available anthrax,smallpox and other vaccines, which will beadministered rapidly in the event of an outbreak tocontain the spread of the disease. All firstresponders will be vaccinated in an impendingdisaster situation.

A regular review of the shelf life and adequacyof the available stock of vaccines and medicinesis essential. The pharmaceutical industry in thecountry will be kept updated with the threatperception of biological disasters and for possibleneed for drugs and vaccines in the event of a majordisaster. A plan will be prepared to define theavailability of antibiotics, anti-virals, vaccines, seraand other drugs from private pharmaceutical



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companies who will be able to supply these itemsat short notice.

4.4.4 Public Health Issues

i) The abrupt onset of large numbers ofacutely ill persons, and rapid progressionin a relatively high proportion of cases withupper respiratory symptoms affecting,among others, young healthy adults andchildren should alert medical professionalsand public health authorities. Such anoccurence indicates a critical andunexpected public health event which canbe the beginning of a biological disaster.

ii) A strong public health infrastructure witheffective epidemiologic investigatingcapabilities, practical training programmes,and preparedness plans is essential toprevent and control outbreaks of diseases,whether natural or man-made. A publicrelations officer will give information to thepublic, press, radio and other organisationsas per the health policy. Panic is a criticalelement in a disaster and, therefore, DMplans will address measures to allay publicanxiety and fear arising out of BT. Acomplete ban on the press or media is notthe right approach in such circumstances.The media is very useful for disseminatingproper information and educating thecommunity during a disaster.

iii) Availability of safe food, clean water, andminimum standards of hygiene andsanitation will be ensured. Vulnerablegroups such as children, pregnant women,the aged and patients suffering fromdiseases like HIV/AIDS will be given specialattention.

iv) The routine training of medicalundergraduates, nurses and health workersfor mental health services is grosslyinadequate. There is virtually no emphasis

on the mental health aspects of disasterseven in the routine postgraduate trainingin psychiatry. There is a need for coordinatedtraining services and monitoring at thedistrict and state levels.

v) Most victims at the scene of a disaster sufferfrom psycho-social problems. Somepeople, including relief workers, maydevelop post-traumatic stress disorders.The plan will involve community level socialworkers who can help victims of psycho-social problems.

4.5 Emergency Medical and PublicHealth Response

4.5.1 C&C for Medical and Public HealthResponse

C&C would follow a bottom-up approach. Fordisasters manageable at the district level, C&Cwill be activated at the Incident Command Post(ICP) and at the district.

i) For biological disasters affecting manydistricts, C&C will also be activated at thestate headquarters. For disasters affectinga number of states, C&C will be at thecentre (in the nodal ministry) involving, ifrequired, the NCMC, the NDMA and NEC.

ii) The central RRTs will be activated byMoH&FW. NICD will be the nodal agencyfor outbreak investigations. Thecoordination, logistics and monitoring willbe supported by the Emergency MedicalRelief division of MoH&FW. The responseplan of the MoH&FW will be activated. Thecontrol room in the C&C structure would, ifrequired, function on 24x7 basis.

iii) Progress will be monitored by the nodalministry. For BT, the same modalities willbe activated by MHA.

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iv) MoH&FW would support MHA’s activitiesand NICD would conduct the outbreakinvestigations. Faced with a BW situation,the MoD will be the nodal ministry and allactions as per the War Book will be put inplace.

4.5.2 Emergency Medical Response

A biological disaster can lead to mass casualtyincidences, both intentional or otherwise. Thedevelopment of infectious diseases depends onvarious factors such as type of agents, incubationperiod, immune status of individuals, amount ofinfectious agent entering the body, etc. However,a large number of cases arising in a short span oftime may require prompt establishment of medicalposts near the incident site. EMR at the site woulddepend upon the quick and efficient response ofRRTs/MFRs deputed from the district, reinforcedby those from the state and the centre. They wouldtriage the patient, provide basic life-support ifrequired at the site, and transport patients to thenearest identified health facility along withcollection and dispatch of biological andenvironmental samples. If the incident commandsystem is implemented then the RRT/MFR will beintegrated with the ICP and function under theoverall directions of the incident commander.Important components of an EMR plan are asfollows:

i) Pre-hospital care shall be established andoperationalised using a trained medicalforce. EMR at the site will depend uponthe quick and efficient response of MFRs.

ii) MFRsmust be trained in the use of PPE andin collection and dispatch of samples fromair, water, food and biological materials. Thestandards for detection and basic life-support (airway maintenance, ventilationsupport, anti-shock treatment andpreparation for transportation) will also bedeveloped. EMR will be integrated with ICPand will function under the overall directions

of the incident commander (see AnnexuresD-F).

iii) There will be periodic mock drills forchecking response time and reducing it toa minimum. Periodic training and refreshertraining schedules will also be prepared.

iv) The medical posts shall provide evacuationservices, specialised health care, food,shelter, sanitation, etc. These will coordinatewith other functionaries involved in search,rescue, helplines and informationdissemination, transport, communication,power and water supply, and law and order.

v) SOPs for providing hospital care and acommand control centre with the districtcollector as supreme head, will be laid downand rehearsed using mock exercises.

vi) The nodes of communication will bedovetailed with emergency services of thedistrict. Inter-hospital and inter-servicescommunication will be established at alllevels.

vii) Mechanisms for checking the status ofcoordination in planning, operations andlogistic management will be developed.

4.5.3 Transportation of Patients

Occurrences of mass casualties are unlikelyin the case of biological disasters. Developmentof infectious diseases depends on various factorssuch as type of agent, incubation period, immunestatus of the individual, amount of infectious agententering the body, etc. Therefore, patients will arriveat hospitals sporadically, in an unpredictablemanner, while many will go to private physicians.An exhaustive ambulance system, as required forother disasters, may not be needed here. However,ambulances must have the provision for collectionof stool, vomitus, etc. Adequate intravenous fluidand antibiotics must be made available in additionto other emergency drugs, during transportation.



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4.5.4 Treatment at Hospitals

In case of an epidemic outbreak or bioterroristattack, the hospital DM plan will be activated. Aspecialised team or RRT consisting of clinician,epidemiologist, microbiologist and nurse will bemade available for patient care in the hospital.The activation of a hospital DM plan includes someof the following important functions:

i) Patients requiring decontamination(especially in the context of a BT attackusing aerosols) will be decontaminated.Thereafter, they will be triaged and thoserequiring critical care will be managedaccordingly.

ii) Patients requiring isolation will be kept inisolation rooms/wards. The RRT shall assessthe patient load and if required, the hospitalsurge capacity will be increased. Thoserequiring treatment at referral centres willbe transferred. Till such time definitivediagnosis is not available, patients will beprovided empirical treatment based onpresumptive diagnosis.

iii) Triage of patients will involve prioritisationbased on the assessment by the clinicalteam. Initially, diagnosis will be done onclinical basis and treatment will be givenaccordingly.

iv) Supportive treatment will be givenimmediately with the help of advancedequipment like ventilators for respiratoryparalysis caused by botulinum toxin.Samples of various body fluids like blood,sera, urine, stool and sputum will be takenand dispatched to the laboratory for earlyculture and identification, characterisation,and antibiotic sensitivity test of isolates.

v) Depending upon the type of infectivedisease involving various systems likerespiratory tract or gastrointestinal tract, thepatient will be directed to different wardsfor isolation or quarantine.

vi) Clinical suspicion and epidemiologicalinvestigation of such situations must besupported by definitive diagnosis by highquality laboratory tests. Laboratorydiagnosis is the mainstay on which furtherresponse will be determined.

vii) Establishing a diagnosis and detectionsystem and identifying causative agents willbe the most important response to abiological disaster. This procedure ofidentifying a disease agent in theenvironment is far more complex thanidentifying chemicals or toxins. Thedetection will be carried out by usingstandard laboratory tests of suspectedsamples collected from the environment,i.e., swabs and wipes from suspectedsurfaces, air samples, soil, food, and water.

viii) Once the diagnosis has been confirmed byculture and antibiotic sensitivity oforganisms, a bacterial infection will betreated with appropriate antibiotics. In caseof viral infections an anti-viral agent likecyclovir may be used.

ix) Administration of immunomodulators whichenhance the immunity of the body to fightinfection are useful for treating infections.

x) Other supportive treatment like IV fluid,vitamins and proper nutrition, along withnursing care, will be ensured.

The hospitals would, throughout the crisis,follow strict infection control practices. If the surgecapacity is exceeded, the services of privatehospitals and nursing homes will be requisitioned.Institutions such as the Indian Medical Associationand other professional bodies would also beapproached.

4.5.5 Domiciliary Care

Not all patients will be needing hospital care.Those who can be treated at home will be given

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necessary treatment as an outpatient and thenasked to report in case of deterioration of thesymptoms. Institutions like IRCS are capable ofproviding large numbers of trained volunteers andtheir resources will be tapped. Equally importantwill be the involvement of NGOs for suchpurposes.

4.5.6 Public Health Response

(A) Outbreak Investigation

An RRT will be deployed for outbreakinvestigation. A standard case definition will befollowed, the guiding principle being to identify asmany suspect cases as possible. There will besituations in which the RRT would have to lay downits own case definition. The suspect cases will beidentified and if the situation so warrants, all thecontacts will be traced and kept under observation/quarantine. Line listing of all cases and contactswill be prepared. The requisite clinical sampleswill be taken and transported to the nearestidentified laboratories.

(B) Instituting Public Health Measures

Surveillance mechanisms will be activated and,if need be, active house-to-house surveillance willbe followed, especially if the strategy is to stampout the disease in the formative stages of theepidemic. Pharmaceutical and non-pharmaceuticalinterventions appropriate to the situation will beimplemented. Other public health measurespertaining to drinking water, sanitation and vectorcontrol (depending upon the nature of the outbreak)shall be followed. Patients need to be providedappropriate treatment on outpatient basis or inidentified hospitals, depending upon the severityof the case. Public health units, primary health carepoints and hospitals need to follow standardinfection control practices. For diseases amenableto immunisation, an appropriate immunisationstrategy will be followed.

Appropriate orders will be issued under theenabling legal instrument to mandate isolation andquarantine. Central to the success of quarantinewill be making available all essential services inthe quarantined area. A large number of policeand security personnel may have to be deployedfor restricting the movement of people beyond thedefined geographic area. The authorities at thedistrict level would also issue, if the situation sowarrants, appropriate orders for implementingsocial distancing measures. The success of non-pharmaceutical interventions lies in the activecooperation of the civil society. Village committees,resident welfare associations and PRIs wouldsupplement the efforts of the government in diseasecontainment.

(C) Risk Communication

The risk will be conveyed to the communitythrough simple and precise messages. It might bedone using all available communication channelsincluding word of mouth communication. Todisseminate information to a wider audience in ashort span of time, print/visual media may be used.Effort will be made to prevent/reduce panic amongthe public and create awareness about adoptingrisk reduction/health seeking behaviour.

(D) Psycho-social Care

Biological disasters of rapid onset and highmortality would create mass hysteria and panicamong the public. It might induce mass exodusfrom the affected area thereby spreading thedisease further. The movement of such populationinto unaffected communities could result in strongresentment among communities not yet affected.Those families subjected to bereavement of therenear and dear ones would also reflect in higherpsycho-social morbidity. MoH&FW through itsmental health institutions and NGOs would provideadequate psycho-social care.



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(E) Post-outbreak Surveillance

Even after the control of a natural/intentionaloutbreak, there would be heightened surveillanceto detect fresh cases. The public will be informedto report fresh cases to the health authorities. Theremight even be a reward system for those who reporta fresh case, especially in situations where activehouse-to-house or sentinel surveillance is notpossible/sustainable in the longer run. There couldalso be serological studies to assess immunelevels. Laboratories might also conduct laboratorybased surveillance using a sampling framework.

(F) Media

An identified person, knowledgeable about theevent will be designated to address the media aspart of the district DM plan. As far as possible, theinformation sharing has to be transparent. Themedia would also have the obligation of reportingthe event correctly and not sensationalising theissue, so that it does not create panic among thepublic.

(G) Inter-sectoral Coordination

Response to a biological disaster might requirecoordination between a number of departments,namely animal health sector, human health, home,defence, intelligence, civil aviation, tourism,shipping, and transport. MoH&FW wouldcoordinate between all these departments forappropriate actions that need to be taken by theconcerned departments. The identified task groupwould meet on a regular basis till the crisis is over.

(H) Monitoring

MoH&FW/MHA would closely monitor at thecentral level, any event that needs attention andtake it to its logical conclusion. All importantstakeholders, including NCMC and NDMA, will bekept informed of the situation. Daily situationalreports will be sent to all concerned. The

appropriate authorities will be informed if help frominternational agencies is required.

(I) Evaluation

Once the outbreak has been contained, theentire process will be reviewed. The gaps/bottlenecks in implementing the plan will beidentified and addressed. The lessons learned andthe best practices adopted will be documentedfor future reference.

The success of the management of biologicaldisasters, including BT, will depend upon thecoordinated response of fully prepared RRTs/MFRs,including medical teams of specialists backed upby suitable communication, updated IDSP, and anadequate chain of laboratories and hospital carefacilities.

4.6 Management of Pandemics

Epidemics arising in one part of the world arenowadays rapidly disseminated to other areas dueto rapid transportation. The recent epidemic ofSARS is one such instance. Infected individuals(or even vectors) can travel to far removed parts ofthe would before they manifest clinical features.Biological disasters, including BT, is a specificcategory of disaster that travels across borders byvirtue of human or logistic functions that seekinternational cooperation to mitigate its effects.This issue directly concerns international biosafetyand biosecurity norms.

The exchange of health intelligence hasbecome important and international responsibilitiesoften transcend national compulsions. IHR (2005)holds a member country to be duty bound toimprove its public health capabilities to preventand control the spread of any such disease withinthe country and prevent it from spreading beyondits borders. The wide disparity between nations intheir capacity to tackle epidemics would mean that

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competent medical teams from one nation wouldneed to work in another country, thereby raisingsovereignty issues. These matters have to beviewed in a global perspective. Internationalagencies like WHO, FAO and OIE have a presencein all countries and coordinate such activities.

WHO has already developed and built animproved event management system to managepublic health emergencies. It has also developedstrategic operations at its Geneva headquartersand regional offices around the world, which areavailable round-the-clock to manage emergencies.WHO has also been working with its partners tostrengthen the GOARN, which brings togetherexperts from around the world to respond todisease outbreaks. The support to the internationalcommunity is in the form of supply ofepidemiological information and action on acquiredinfections. The interface between national andinternational agencies is normally well defined.

A competent central office in the country underthe aegis of the nodal ministry (MoH&FW) whichhas access to national-level data and is equippedto transmit relevant information to the stakeholders,is needed. Surveillance of and remedial actionagainst threats need to be rapidly evolved to satisfyboth national and international needs.

The ongoing surveillance for avian influenza isan example of such interaction. The internationalagency, in this case WHO, not only supportsdesignated national laboratories but also stockpilesappropriate prophylactic and therapeutic agents.Thus, in the case of avian influenza (bird flu)stockpiles of oseltamivir and vaccine for combatingoutbreaks are available for dispatch to affectedregions. Nevertheless, national capability toanticipate, detect, mitigate and control exoticpathogens needs to be in place. A properlyfunctioning epidemiological mechanism capableof immediately preparing an action plan for themanagement of any emergency would effectively


combat the threat. However, the capacity to identifyand address exotic pathogens is required to bebuilt. MoH&FW will prepare a comprehensive planbased on the above guidelines, which will beactivated at the time of an alert, on the occurrenceof a pandemic.

Pandemic preparedness is not restricted to thehealth sector alone. It has been extended to covernon-health stakeholders also, thereby requiringoverall preparedness measures. It is pertinent toidentify all the essential service providers and tomake adequate provisions for their businesscontinuity during pandemic or biological disastersituations. The issues of advocacy and guidance,planning at each level, linkages between variousemergency functionaries, community awarenessspecific to pandemic preparedness, multi-sectoralcoordination and capacity development using PPPwill be developed in the plans. The mechanism forregional level cooperation to address non-healthissues will be developed. The ‘all hazard’ plans sodeveloped will be practiced through mockexercises. To address this vital issue with respectto the existing scenario in the Southeast Asianregion, NDMA had organised an internationalconference in which various Indian experts anddelegates from international agencies participated.The deliberations during this conference have beendeveloped as a comprehensive report—'PandemicPreparedness beyond Health' (please visitwww.ndma.gov.in for the same). Therecommendations of these deliberations are to beconsidered while developing the plans and carryingout other preparedness measures.

4.7 International Cooperation

International cooperation is a necessaryelement in the management of pandemics. Thevarious activities that will be undertaken to enhanceharmony in the functioning of an internationalregime in the management of biological disastersare as follows:


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i) Establishment of an adequate mechanismto enhance the level of interaction betweenthe various state and non-state actors thatare required to work in tandem during suchevents.

ii) The development of provisions for strictcompliance of existing international treaties/conventions at various levels

iii) A web-based forum for continuousinteraction of experts to develop necessarystrategic measures that need to beintegrated with present global practices.

iv) A national web-based forum on the samelines also needs to be developed that wouldinteract with international forums forexchange of information.

v) The forum will also conduct workshops,seminars and conferences for directinteraction and exchange of ideas.

vi) The forum will also promote the officialinteraction of state actors to evolve newpolicies and programmes in the changingdynamics of any global threat of BT.

vii) Interaction between various pharmaceuticalcompanies, NGOs, state and non-stateactors will allow the exchange oftechnologies that exist in other nations.

viii) The stockpiling of various vaccines andessential drugs to combat newly emergingthreats under the guidance of global healthorganisations will become cost-effective byregional level planning. This, in turn, willenhance the inherent capability of themember nations to respond to such attacks.

ix) In order to achieve the development ofdeterrence against newly developingGMOs, international-level researchcollaboration is essential.

x) Joint international mock exercises may beconducted, based on the vulnerability

assessment of different areas to enhancethe level of coordination between variousnational and global players.

xi) The management of pandemics requires thepooling of medical logistics, trained humanresources and other essentials at theinternational level.

xii) The management of pandemics alsorequires a transparent and collaborativeapproach wherein the affected countries willmake a combined effort to mitigate theimpact.

Success in managing biological disastersdepends upon the level of coordination betweenvarious stakeholders, their medical preparedness,knowledge, and awareness of their responsibilities.Such a process is highly complex at theinternational level and requires the initiation andcoordination of pre-determined plans in theimmediate phase.

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5 Guidelines for Safety andSecurity of Microbial Agents

‘A safe and healthful laboratory environment is(also) the product of responsible institutionalleadership. National codes of practice foster andpromote good institutional leadership inbiosafety’Emmet Barkley, WHO

Disease diagnosis, human or animal sampleanalysis, epidemiological studies, scientificresearch and pharmaceutical developments—allof these activities are carried out in biologicallaboratories in the government and private sectors.Biological materials are handled worldwide inlaboratories for numerous genuine, justifiable andlegitimate purposes, where small and large volumesof live microorganisms are replicated, cellularcomponents extracted and many othermanipulations are undertaken for purposes rangingfrom educational, scientific, medical and health-related to mass commercial and/or industrialproduction. Among them, an unknown number offacilities, large and small, work with dangerouspathogens, or their products, every day.Technological advances have enabled anincreasing number of people to cultivate, studyand modify pathogenic organisms. This,unfortunately, also permits dual use of thetechnology. Under these circumstances it isnecessary for legitimate laboratories dealing withpathogenic (or potentially pathogenic) microbesto ensure that there is no intentional removal ofagents. These measures are dealt with under theterm biosecurity. Biosafety is the term used to coverlaboratory activities designed to protect thelaboratory worker from infection by the organismshandled by him. Laboratory biosafety is the termused to describe the containment principle,

technologies and practices that are implementedto prevent unintentional exposure to pathogens andtoxins and their accidental release.

5.1 Biological Containment

Biological containment, which ensures thatinfectious microorganisms remain in the laboratory,is the principal feature that distinguishescontainment laboratories from basic laboratories.A variety of overlapping integrated engineeringsystems are installed in a containment laboratoryto prevent uncontrolled escape of infectiousmicroorganisms from the building, to safeguardthe health of the surrounding community, to preventunintentional spread of disease among man andanimals, by man to man, animal to animal, animalto man, and man to animal transfer, and to preventfalse laboratory reports due to cross contamination.

In addition to the engineering system, a positiveattitude of employees towards biological safety,and their adherence to approved guidelines, areessential for total biocontainment. To summarise,biological security is the end product of theinteraction of the built facility with its managementand operational philosophies and the environmentin which it operates.

Recent developments in molecular biology,including recombinant DNA technologies, havechanged the age-old scenario of microbiology.Incorporation of foreign genes in the host gene,utilising prokaryotic or eukaryotic cells might poseseveral problems of biosafety. An increasinglyimportant consideration in biotechnology researchand applications is that workers in these fields


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(molecular biology) are not necessarily trained inmicrobiological techniques, including safe handlingof pathogens.

5.2 Classification of Microorganisms

Microorganisms are classified on the basis ofthe risks levels that their handling entails. This isdifferent when human/animal/plant specimens,GMOs, environmental isolates and experimentalanimal samples are dealt with. Each of thesecategories requires specific guidelines. Thescheme for risk based classification ofmicroorganisms is intended to provide a methodfor defining the minimal safety conditions that arenecessary when using these agents. It designatesfive classes of hazardous agents such as RiskGroup I, II, III, IV and V. Each country should drawup a classification by risk group of the agentsencountered in that country. The organisms notencountered in the country may be considered asspecial category (Risk Group V). The followingclassification is in conformity with the classificationof human and animal pathogens.

5.2.1 Risk Group-I: Low individual andcommunity risk

This group includes agents of no or minimalhazard under ordinary conditions of handling, thatcan be used safely in the laboratory without specialapparatus or equipment and using techniquesgenerally acceptable for non-pathogenic materials.

5.2.2 Risk Group-II: Moderate individual riskand limited community risk

This class includes agents that may producediseases of varying degrees of severity resultingfrom accidental inoculation or infection or othermeans of cutaneous penetration. Effectivetreatment and preventive measures are availableand the risk of spread is limited. These agents canusually be adequately and safely contained byordinary laboratory techniques.

5.2.3 Risk Group-III: High individual risk andlow community risk

A pathogen that usually produces serioushuman/animal diseases but does not ordinarilyspread from one infected individual to other.

5.2.4 Risk Group-IV: High individual risk andhigh community risk

Agents that usually produce serious human oranimal diseases and may be readily transmittedfrom one individual to another directly or indirectly.They need stringent conditions for theircontainment. Precautions are needed whenentomological experiments are conducted in thesame laboratory areas.

5.2.5 Risk Group: Special category

Foreign human/animal pathogens that are notpresent in a country and need stringentcontainment facilities for handling.

5.3 Biologics

Biologics derived by recombinant DNAtechniques or developed from hybridomas may beclassified into three broad categories based onthe biological characteristics of the new productand the safety concerns they present.

5.3.1 Category-I

This category includes inactivated recombinantDNA-derived vaccines, bacterins, bacterin-toxoids,virus subunits or bacterial subunits. Thesenonviable or killed products pose no infectiousrisks.

5.3.2 Category-II

This category includes products which havebeen modified by the addition of one or moregenes. Precaution must be taken to ensure that

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the deletion or addition of genetic materials doesnot impart increased virulence, pathogenicity andenhanced survival period of these organisms, thanthose found in natural or wild type forms. Thegenetic information added or deleted must specifycharacterised DNA segments, including base pairanalysis, amino acid sequence, restriction enzymesites, as well as phenotypic characterisation of thealtered organisms.

5.3.3 Category-III

This category includes live vectors which carryforeign genes that code for immunising antigensand/or immuno-stimulants. Live vectors may carrymore than one recombinant derived foreign genessince they can carry large numbers of new geneticinformation. They are also efficient for infectingand immunising target animals. Currently used livevectors are vaccinia and other pox viruses, bovinepapilloma virus, adenoviruses, simian virus-40 andyeasts.

5.4 Laboratory Biosafety

Animal experimentation with pathogensrequires facilities to ensure appropriate levels ofenvironmental quality, safety and care. Laboratoryanimal facilities are extensions of the laboratoryand in some institutions are integral to andinseparable from the laboratory. Biosafety levelsrecommended for working with infectious agentsin vivo and in vitro are comparable.

The three basic elements of containingmicroorganisms in a laboratory are laboratorypractices and techniques, safety equipment(primary containment barrier) and facility design(secondary containment barrier). Incorporation ofthese elements into a laboratory is required for safehandling of human and animal pathogens,including recombinant organisms of various riskgroups. These form the basis for classification oflaboratories. Four BSLs, in ascending order, aredescribed for laboratories dealing with

microorganisms of Risk Groups I, II, III and IV. Theselaboratories are designated as BSL 1, 2, 3 and 4.The descriptions of BSL 1–4 are parallel to thoseof P 1–4 in the National Institute of Health, USA,guidelines for research involving DNA technologyand are consistent with the general criteria used inassigning agents to classes 1–4 in the classificationof pathogens on the basis of risks.

5.4.1 Biosafety Level-1 (BSL-1)

Such a laboratory is suitable for handling RiskGroup-I organisms and is referred to as a basiclaboratory. Undergraduate and teachinglaboratories come under this category. Thelaboratory is not separated from the general trafficin the building. The work is generally carried outon open bench-tops without the use of primarycontainment equipment. However, good laboratorypractices and techniques should be followed whilehandling organisms.


This category of laboratory is suitable forcarrying out work on Risk Group-II organisms. Thelevel of biosafety is similar to that of BSL-I. Besidesfollowing good laboratory practices andtechniques, some additional aspects like closingthe doors when work is in progress and adherenceto a biosafety manual should be adopted. Safetyequipment like biological safety cabinets (Class Ior II) or other protective devices should be usedwhen the procedures involved could createaerosols.


BSL-3 laboratories are suitable for undertakingwork with Risk Group-III organisms. The laboratoriesunder this category include clinical, diagnostic,research or production facilities where infectiousagents, which may cause serious/lethal diseases,are used. Laboratory workers have special trainingin carrying out the work and are supervised by

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scientists. Infectious materials are handled inbiological safety cabinets (Class I, or II). Thelaboratory has special design features of negativeair pressure with restricted access zones, sealedpenetrations and directional air flow.

Enforcement of biosafety guidelines, includingdecontamination of materials in the laboratory, arecritical elements in the handling of pathogens. Thesafety equipment used in this category of laboratoryare biosafety cabinets (Class I, II, III) or acombination of personal protective or physicalcontainment devices, e.g., clothing, masks, gloves,respirators, centrifuge safety cups, sealedcentrifuge rotors and animal isolators. For BSL-3laboratories, the design features should be suchthat the infectious agents handled in the laboratoryshould not escape into the environment. Thelaboratory is separated from unrestricted trafficwithin the building. Physical separation of thelaboratory from access corridors will be providedby clothing changes, showers, air locks and otheraccess facilities. Table tops shall be impervious towater and resistant to acid, alkali, solvents andheat. A sink will be located near the laboratory exitwhich is elbow or foot operated. Exhaust air filteredthrough the HEPA filters of biosafety cabinets willbe discharged directly to the outside or through abuilding exhaust system having thimbleconnections.


BSL-4 laboratories are suitable for carrying outwork with Risk Groups-IV and V (exotic) pathogenswhich pose serious threats to the human and animalpopulation. Personnel working in the laboratoryhave specific training in procedures of handlinghigh-risk pathogens and understand the functionof various biosafety equipment and design of thelaboratory. A safety department will formulate thebiosafety rules and regulations, which will befollowed strictly. Good laboratory practices mustbe followed to ensure safe handling of organismsat the workplace to avoid spillage, aerosol

generation, cross contamination and accidentalinfection of the workers. In addition, the two-personrule should apply, whereby no individual worksalone within the laboratory. A system shall be setup for reporting laboratory accidents andexposures, employee absenteeism and medicalsurveillance of laboratory associated illnesses.

All the procedures within the facility will becarried out in Class III biological safety cabinets orin Class I and II biological safety cabinets inconjunction with a ventilated life-support system.

The BSL-4 laboratory has specific designfeatures. It should be such that organisms handledin the laboratory do not escape into the environmentthrough man, material, air or water (effluent). Toachieve this, the laboratory should be undergraded negative air pressure and should havearrangements for sterilisation of outgoing materialsby autoclaving (both steam and ethylene oxide),formalin fumigation (air locks), surfacedecontamination (dunk tank), effluent treatment(steam sterilisation) and air filtration system withHEPA filters.

When pathogens of high-risk groups havingzoonotic importance are handled, the personnelwill wear a one-piece positive pressure suit whichis ventilated by a life-support system. A speciallydesigned suit area shall be provided in thelaboratory facility. Entry to this area shall be throughan air lock fitted with airtight doors. A chemicalshower should be provided to decontaminate thesurface of the suit before the worker leaves the area.

Normally, the requirements for biosafety andbiosecurity are congruent. However, it is worthwhilenoting that such laboratories may be performingclandestine research in which case these twoactivities will be in conflict. In any case, eachinstitution will:

i) Recognise that laboratory security is relatedto but differs from laboratory safety.

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ii) Control access to areas where biologicagents or toxins are used and stored.

iii) Know who is in the laboratory area.

iv) Know what materials are being brought intothe laboratory area.

v) Know what materials are being removedfrom the laboratory area.

vi) Have an emergency plan.

vii) Have a protocol for reporting incidents.

5.5 Microorganism HandlingInstructions

Microorganisms should always be handled inappropriate facilities. Thus, it will be wrong tohandle a Category III organism in a BSL-2 facility.This is probably not possible in the country atpresent since an adequate number of containmentfacilities do not exist. A dilemma arises whensamples from outbreaks are being studied. In thesecases it will be prudent to handle the samples atthe highest containment level appropriate to thesuspected infective agent. Once the aetiologicalagent is identified it will be handled in theappropriate facility.

The purpose of this part of the document is todefine the scope and applicability of ‘laboratorybiosafety’ recommendations, narrowing themstrictly to human, veterinary and agriculturallaboratory environments. The operational premisefor supporting national laboratory biosecurity plansand regulations generally focuses on dangerouspathogens and toxins. In this document, the scopeof laboratory biosecurity is broadened byaddressing the safekeeping of all ValuableBiological Materials (VBM), including not onlypathogens and toxins, but also scientifically,historically and economically important biologicalmaterials such as collections and reference strains,pathogens and toxins, vaccines and otherpharmaceutical products, food products, GMOs,non-pathogenic microorganisms, extraterrestrial

samples, cellular components and geneticelements. This is done in order to raise awarenessof the need to secure collections of VBM. Throughmicrobiological risk assessments performed as anintegral part of an institution’s biosafetyprogramme, information is gathered regarding thetype of organisms available at a given facility, theirphysical location, the personnel who require accessto them, and the identification of those responsiblefor them. Laboratory biosecurity risk assessmentshould further help establish whether this biologicalmaterial is valuable and warrants tighter securityprovisions for its protection, that presently may beinsufficient through recommended biosafetypractices. This approach underlines the need torecognise and address the ongoing responsibilityof countries and institutions to ensure a safe andsecure laboratory environment.

5.5.1 Laboratory Biosecurity Measures

It will be based on a comprehensive programmeof accountability for VBMs that includes:

i) Regularly updated inventories with storagelocations.

ii) Identification and selection of personnel withaccess.

iii) The planned use of VBM.

iv) Clearance and approval processes.

v) Documentation of internal and externaltransfers within and between facilities.

vi) Inactivation and/or disposal of theunwanted/surplus material.

5.5.2 Institutional Laboratory BiosecurityProtocols

These protocols should include how to handlebreaches or near-breaches in laboratory biosecurity,including:

i) Incident notification.

ii) Reporting protocols.



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iii) Investigation reports.

iv) Recommendations and remedies.

v) Oversight and guidance through thebiosafety committee.

The protocols should also include how tohandle discrepancies in inventory results, anddescribe the specific training to be given, and theminimal training that personnel must be requiredto follow. The involvement, roles and responsibilitiesof public health and security authorities in the eventof a security breach should also be clearly defined.

5.6 Countering Biorisks

5.6.1 Accountability for VBM

While it is difficult to mitigate theconsequences of theft of VBM, i.e., possiblemisuse, diversion, etc., after they have left a givenfacility, it is easier to minimise the probability ofsuch an event happening, by establishingappropriate controls to protect VBM fromunauthorised access or loss. Unauthorised accessis the result of inappropriate or insufficient controlmeasures to guarantee selective access. Lossesof VBM often result from poor laboratory practicesand poor administrative controls to protect andaccount for these materials. It is important toestablish practical, realistic steps that can be takento track and safeguard VBM. Indeed,comprehensive documentation and description ofVBM retained in a facility may represent confidentialinformation, as much as records anddocumentation of access to restricted areas.However, such documentation may prove useful,for example, to help discharge a facility frompossible allegations. For useful reference, it isrecommended that such records be collected,maintained and retained for some time before theyare eventually destroyed.

Specific accountability procedures for VBMsrequire the establishment of effective controlprocedures to track and document the inventory,use, manipulation, development, production,transfer and destruction of these materials. Theobjective of these procedures is to know whichmaterials exist in a laboratory, where they arelocated, and who has the responsibility for themat any given point in time. To achieve this,management should define:

i) Which materials (or forms of materials) aresubject to material accountability measures.

ii) Which records should be kept, by whom,where, in what form and for how long.

iii) Who has access to the records and howaccess is documented.

iv) How to manage the materials throughoperating procedures associated with them(e.g., where they can be stored and used,how they are identified, how inventory ismaintained and regularly reviewed, and howdestruction is confirmed and documented).

v) Which accountability procedures will beused (e.g., manual log book, electronictables, etc.).

vi) Which documentation/reports are required.

vii) Who has responsibility for keeping track ofVBMs.

viii) Who should clear and approve the plannedexperiments and the procedures to befollowed.

ix) Who should be informed of and review theplanned transfer of VBMs to anotherlaboratory.

5.6.2 Transport of Materials

The use and storage of VBM should be limitedto clearly identified areas. The only VBM permittedoutside a restricted area should be those that are

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being moved from one location to another forspecific, authorised reasons. Transport securityendeavours to provide a measure of security duringthe movement of biological materials outside ofthe access-controlled areas in which they are keptuntil they arrive at their destination. Transportsecurity applies to biological materials within asingle institution and also between institutions.Internal material transport security includesreasonable documentation, accountability andcontrol over VBM moving between secured areasof a facility, as well as internal delivery associatedwith shipping and receiving processes. Externaltransport security should ensure appropriateauthorisation and communication between facilitiesbefore, during and after external transport, whichmay involve a commercial transportation system.The recommendations of the UN Model Regulationsfor the Transport of Dangerous Goods providescountries with a framework for the development ofnational and international transport regulations andinclude provisions addressing the security ofdangerous goods, including infectious substances,during transport by all modes. Based on theserecommendations, each country has to evolve itsown regulations appropriate to its national situation.

5.6.3 Elements of a Laboratory BiosecurityPlan

Laboratory biosecurity should specificallyaddress the policies and procedures associatedwith physical biosecurity, staff security,transportation security, material control andinformation security. It should also includeemergency response protocols that addresssecurity related issues, such as specific instructionsconcerning situations when outside responders maybe called (fire brigade, emergency medicalpersonnel or security personnel), including theprotocol to follow once on site and the scope ofauthority of all the parties involved. It is importantfor the laboratory security plan to anticipate themost likely situations that would require exceptional

access. Just as training is essential for goodbiosafety practices, it is also essential to train forgood biosecurity practices, particularly inemergency situations. Hence, regular training ofall personnel on security policies and procedureshelps ensure correct implementation. A nationalsystem of periodically validated certification ofpersonnel will be desirable.

Laboratory biosecurity describes both aprocess and an objective that is a key requirementfor public health and welfare. It requiresconsideration of the reason for developingregulations, what the objects of the regulations are,how regulations are written, who developsregulations, and who pays for their developmentand application. It includes the generation andsharing of scientific knowledge, and involvesbioethical considerations such as transparency ofdecision-making, public participation, confidenceand trust, and responsibility and vigilance inprotecting society. Effective laboratory biosecurityis a societal value that underwrites publicconfidence in biological science.

5.6.4 Training

Laboratory biosecurity training, complementaryto laboratory biosafety training and commensuratewith the roles, responsibilities and authorities ofstaff, should be provided to all those working at afacility, including maintenance and cleaningpersonnel, staff involved in ensuring the securityof the laboratory facility and to external firstresponders. Such training should help understandthe need for protection of VBM and equipmentand rationale for the laboratory biosecuritymeasures adopted, and should include a reviewof relevant national policies and institution-specificprocedures. Training should provide for protection,assurance and continuity of operations. Proceduresdescribing the security roles, responsibilities andauthority of personnel in the event of emergenciesor security breaches should also be provided during



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training, as well as details of security risks judgednot significant enough to warrant protectionmeasures. The biorisk management plan shouldensure that laboratory personnel and externalpartners (police, fire brigade, medical emergencypersonnel) participate actively in laboratorybiosecurity drills and exercises, conducted atregular intervals, to revise emergency proceduresand prepare personnel for emergencies.

Training should also provide guidance on theimplementation of codes of conduct and shouldhelp laboratory workers understand and discussethical issues. Training should also include thedevelopment of communication skills amongpartners, improvement of productive collaboration,and endorsement of confidentiality or ofcommunication of pertinent information to and fromemployees and other relevant parties. Trainingshould not be a one-time event—it should beoffered regularly and taken recurrently. It shouldrepresent an opportunity for employees to refreshtheir memories and to learn about newdevelopments and advances in different areas.Training is also important in providing occasionsfor discussion and bonding among staff members,and in strengthening of team spirit among membersof an institution.

5.6.5 National Code of Practice forBiosecurity and Biosafety

A national code of practice for biosecurity andbiosafety needs to be prepared and promulgated.Based on such a code of practice, accreditationof laboratories with respect to the handling ofmicrobial material will be undertaken at the nationallevel. Only accredited laboratories will be permittedto undertake outbreak investigations,epidemiological analysis and vaccine research. Anetwork of such laboratories is required for a countryof India’s size. The network for human (medical),veterinary and agricultural infections would probablyhave to be independent, but points of contact will

be essential as both the hosts and pathogens willbe subject to similar life processes and also interactwith each other. An overseeing National Committeefor Microbial Activities needs to be set up tocoordinate the field and gradually build up thelaboratory infrastructure to develop the nationalcapacity to deal with the issues. The ability tohandle biological disasters, be they natural or man-made, could be built into the system. Personnelmanagement will be crucial for the success of theactivity and will be a mandate for the committee.Some of the international guidelines that could formthe basis for the development of the nationalguidelines are:

(A) Laboratory Biosafety

i) WHO – Laboratory Biosafety Manual (LBM),3rd Edition.

(B) Laboratory Biosecurity

i) WHO – LBM, 3rd Edition.

ii) WHO – Biorisk Management. Laboratorybiosecurity.

iii) Organisation for Economic Cooperation andDevelopment (OECD) — SecurityRequirements for Biological ResourceCentres.

C) Transport of Infectious Substances

i) UN Recommendations on the Transport ofDangerous Goods: Model Regulations.

ii) International Civil Aviation OrganisationRequirements/International Air TransportAssociation Standards.

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6 Guidelines for Managementof Livestock Disasters

Agriculture and allied sectors account for about24% of India’s Gross Domestic Product (GDP). Ofthis, animal husbandry and dairy accounts for about25% and fisheries a shade over 4%. Livestock alsoprovide gainful employment to the rural poor andwomen. These figures actually represent a steadyflow of essential food products, draught animalpower, manure, employment, income and exportearnings. Distribution of livestock wealth in Indiais more egalitarian, compared to land. Hence, fromthe equity and livelihood perspectives, it isconsidered an important component in povertyalleviation programmes.

In sheer numbers, India is second in cattle andfirst in buffalo population of 185 million and 98million respectively, second in goat with 124million, third in sheep with 61 million and seventhin poultry with 489 million. The livestock sectorproduced approximately 98 million tonnes of milk,44 billion eggs, 48.5 million kg of wool, and 6million tonnes of meat in 2004–05. The total exportearnings from livestock, poultry and relatedproducts was US $ 1080.82 million in 2003–04,out of which the leather sector accounted for54.24% and meat and its products accounted for35.78%. The fisheries sector’s contribution is noless impressive, either, with 6.4 million tonnes offish production during the same period.

The livestock revolution provides a significantopportunity for livestock farmers in the poorerregions to partake in economic activity and mayprovide a way for many of them to escape poverty.However, for this to occur there is need for anincrease in the quantity and quality of animalproducts for trade at the local level and for a

significant improvement in the livestock sectorcomplying with the rules of international trade inanimals and its products. In our country not onlydo livestock provide milk, meat, draught power,transport, manure, hides, wool, etc., but animalsalso provide a relatively safe investment option andgive the owner social security.

6.1 Losses to the Animal HusbandrySector due to BiologicalDisasters

6.1.1 Losses due to Natural Disasters

Natural disasters have negative economicconsequences in the livestock sector, particularlyin developing countries. Droughts, earthquakes,floods, ice storms, wildfires, cyclones, tsunamis,etc., create havoc with human and livestockpopulation. These lead to a negative impact onthe infrastructure of our country by reducing animportant source of income in rural areas andhindering the distribution of foods and goods.

6.1.2 Losses due to Infectious Diseases inAnimals

With increasing globalisation, the persistenceof Trans-boundary Animal Diseases (TADs)anywhere in the world poses a serious risk to theworld’s animal, agriculture and food security andjeopardises international trade. Furthermore,animal production and marketing under formaltrade schemes tends to institutionalise and protectsystems that are increasingly demanding in bothquality and sanitary product innocuity. Recentanimal health emergencies, including Foot and


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Mouth Disease (FMD) and bird flu have highlightedthe vulnerability of the livestock sector to seriousdamage by epidemic diseases and its reliance onefficient animal health services and practices atall levels. The significance of animal diseases(including zoonoses) on human health and welfareis also being increasingly recognised.

At both local and international levels, thepresence of animal diseases has a significantnegative impact on opportunities for trade. Indeveloped countries, trends in the livestock industryhave seen an increase in scales of operation, areduction in the number of holdings, and asubstantial increase of the importance of livestockand livestock product markets, and higherfrequency and speed of movement of animals andanimal products. As a consequence, theintroduction of infectious diseases to susceptibleanimals causes increasingly heavy losses in bothdeveloped and developing countries. Although thesmall holding pattern of livestock rearing in Indiaoffers relative advantages over the intensive farmingsystem in minimising losses due to TADs, the lossabsorption capacity, as in other non-industrialisednations, is less.

6.2 Potential Threat from Exotic andExisting Infectious Diseases

Among the eight to ten globally recognised,most harmful TADs which can inflict enormouslosses on livestock of a country or region in a shortspan of time, five are existing in the country, e.g.,FMD, PPR, Newcastle disease, hog cholera andbluetongue. Of these, there are official controlprogrammes against the first four to minimise lossesto livestock. India has been successful recently ineradicating rinderpest, another dreaded trans-boundary infection which used to devastate cattleand other ruminants for centuries. Although it wasexotic until recently, Highly Pathogenic AvianInfluenza (HPAI), commonly referred to as bird flu,

has already invaded the country on two occasionsin successive years, 2006 and 2007. Through highalacrity and timely intervention, it has been possibleboth times to control this dreaded infection withpotential for a human pandemic, within a relativelyshort period of time. India has also been successfulin the past in eradicating another dreaded infectionof the equine species, i.e., South African horsesickness, which invaded the country in the early1960s and is still present in the list of TADs. Theremaining TADs, e.g., vesicular stomatitis, Africanswine fever and transmissible gastro-enteritiscontinue to be a threat to Indian livestock as wellas scores of other microbial infections with potentialfor quick spread and mass mortality. Added to thethreat potential to livestock population is thezoonotic dimension of several animal diseasessuch as anthrax, brucellosis, West Nile fever, TB,Japanese encephalitis, bird flu, rabies, etc.

6.3 Consequences of Losses in theAnimal Husbandry Sector

Be it animal disease or a natural disaster, theconsequences of loss of livestock in large numbersare predictable. These are primarily:

i) Food scarcity due to shortage of animalorigin food, e.g., milk, meat and eggs.

ii) Economic crisis due to escalation of foodprices (the value of milk output in India isequal to the combined value of paddy andwheat produced).

iii) Environmental contamination leading toepidemics due to massive animal mortality.

iv) Loss of valuable germ-plasm andbiodiversity.

v) Loss of employment starting from primaryproducers, down the food processing andmarketing chain.

vi) Loss of traction power, shortage of manure.

vii) Emotional shock to animal owners.

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6.4 Present Status and Context

Central and state governments, voluntaryagencies and international organisations areworking towards reducing the impact of disastersand minimising the loss of animal life andproduction on account of natural disasters andinfectious diseases. These efforts are mainlydirected in developing shelter and providing forprophylaxis and treatment, and feed and fodderfor disaster impact reduction. . . . . The issues ofcompensation due to loss in livestock followingnatural calamities are generally handled by therevenue departments of state governments on thebasis of the estimation of losses made by theanimal husbandry departments. A compensationmechanism for losses due to infectious diseasesdoes not exist, unless covered under someinsurance scheme.

6.4.1 Legislative and RegulatoryFramework

(A) National

The veterinary services are backed by suitablecentral and state legislations.

i) National Legislation:

a. The Indian Veterinary Council Act, 1984regulates veterinary practices in thecountry.

b. The Livestock Importation(Amendment) Act, 2001 providesmodalities of International AnimalHealth Certification.

c. The Livestock Importation Act, 1898,as amended in 2001, regulates entryof livestock and livestock products.

These importations are allowed subject tofulfillment of health/quarantine requirementsspecified by the GoI that are developed dependingupon the disease status of the exporting country

and the species of livestock/type of product to beimported.

ii) State Laws:

At state level each state enforces either itsown animal disease control Act or in casethe state does not have an Act, the Act of aneighbouring state is enforced forprevention and control of infectiousdiseases. Some of the state Acts areenumerated below:

a. The Goa, Daman & Diu Diseases ofAnimals Act, 1974.

b. The Gujarat Diseases of Animals(Control) Act, 1963.

c. The Himachal Pradesh Livestock andBirds Diseases Act, 1968 andHimachal Pradesh Livestock and BirdsDiseases, Rules, 1971.

d. The Jammu and Kashmir AnimalDiseases (Control) Act Svt. 2006, (1949).

e. The Madhya Pradesh Cattle DiseasesAct, 1934 and Madhya Bharat AnimalContagious Diseases Act, 1959.

f. The Bombay Animal ContagiousDiseases (Control) Act, 1948.

g. The Orissa Animal ContagiousDiseases Act, 1949.

h. The Punjab Livestock and Birds DiseasesAct, 1948 and Punjab ContagiousDiseases of Animals Rules, 1953.

i. The Rajasthan Animal Diseases Act,1959 and Rajasthan Animal DiseasesRules 1960.

j. The Bengal Diseases of Animals Act, 1944.

k. The Andhra Pradesh Cattle DiseasesAct, 1866; Andhra Pradesh CattleDiseases (Extension and Amendment)Act, 1961; Bye Laws made underAndhra Pradesh Cattle Diseases Act,1866.

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l. The Karnataka Animal DiseasesControl Act, 1961: Karnataka Diseases(Control) Rules, 1967.

m. The Madras Rinderpest Act, 1940.

n. The Madras Cattle Diseases Act, 1866.

o. The Kerala Prevention and Control ofAnimal Diseases Act, 1967.

Note: The UTs of Andaman and NicobarIslands and Lakshadweep do not have any animaldisease legislation. However, in the Andaman andNicobar Islands and Lakshadweep islands therespective directors of animal husbandry havepowers related to the control and elimination ofinfectious diseases of livestock.

The various state Acts provide that if an animalis believed to be affected with a scheduled disease,the owner should report the fact to the nearestveterinary practitioner. The Acts also provide forisolation of infected animals, disposal of carcassesand infected material by burial or burning,disinfection of premises and vehicles, banning ofcattle fairs and markets or congregation of animalsduring any outbreak. Non-compliance with theprovisions of the law is deemed a cognisableoffence and punishable with fine or imprisonment,or both. With a view to preventing the transmissionof infection to disease free areas, the Acts providethat animals should move to such areas onlythrough prescribed routes and before entering thearea, animals should be held for observation in atemporary quarantine station where, if necessary,they should be vaccinated and marked. The stateActs also provide for safeguarding eradicated ordisease-free areas from where a particular diseasehas been eliminated, by regulating the entry oflivestock into such an area and observing suchprecautions as may be necessary to maintain the‘eradicated’ or ‘free’ status against a particulardisease. Thus, there are adequate legal provisionsin all the states of India for the prevention andcontrol of animal diseases.

(B) International

Several of the UN organisations as well as inter-governmental organisations provide the frameworkfor development of the animal husbandry sector inmember countries, including marketing,international trade, food safety and regionalcooperation. These are:

i) Food and Agriculture Organization (FAO)

FAO is primarily responsible for theestablishment of guidelines andrecommendations on good agriculturalpractices for the management of animaldiseases and zoonoses. It is involved in thedevelopment of programmes andcoordination of activities with other relevantorganisations for the effective preventionand progressive control of important animaldiseases, including the promotion ofcollection and analysis of information on thenational distribution and impact of thesediseases, and provision of relevanttechnical assistance, particularly todeveloping countries.

ii) World Organisation for Animal Health

The need to fight animal diseases at theglobal level led to the creation of the OfficeInternational des Epizooties (OIE) throughan international agreement signed on 25January, 1924. In May 2003, the Officebecame the World Organisation for AnimalHealth but kept its historical acronym OIE.OIE is the inter-governmental organisationresponsible for improving animal healthworldwide. It is recognised as a referenceorganisation by the WTO and as of May2007, had a total of 169 Member Countriesand Territories. OIE maintains permanentrelations with 35 other international andregional organisations and has regional andsub-regional offices in every continent.

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The organisation is placed under theauthority and control of an InternationalCommittee consisting of delegatesdesignated by the governments of allmember countries. The day-to-dayoperations of OIE is managed at itsheadquarters in Paris and placed under theresponsibility of a Director General electedby the International Committee. Theheadquarters implements the resolutionspassed by the International Committee,which have been developed with thesupport of Commissions elected by thedelegates.

OIE is primarily responsible for theestablishment of standards, guidelines andrecommendations relevant to animaldiseases and zoonoses in accordance withits Statutes and as defined in the WTO-Sanitary and Phyto-Sanitary (SPS)Agreement (refer to Chapter 7). Its mandateincludes development and updating ofinternational science-based referencestandards and validation of diagnostic testspublished in the Terrestrial Animal HealthCode, Aquatic Animal Health Code, Manualof Diagnostic Tests and Vaccines forTerrestrial Animals, and Manual ofDiagnostic Tests for Aquatic Animals. TheOIE list of infectious diseases of terrestrialanimals is provided in Annexure-G.

iii) International Health Regulation (IHR)

The revised IHR that was adopted by theWorld Health Assembly in 2005 is aninternational legal instrument that came intoforce on 15 June 2007, replacing the earlierIHR. The purpose and scope of IHR (2005)is to prevent, protect against, control andprovide a public health response to theinternational spread of disease in ways thatare commensurate with and restricted topublic health risks, and which avoidunnecessary interference with international

traffic and trade. IHR (2005) is legallybinding on all WHO member states.

iv) Codex Alimentarius Commission (CAC)

The CAC was established in 1963 by FAOand WHO to develop food standards,guidelines and related texts such as codesof practice under the Joint FAO/WHO FoodStandards Programme. The main purposeof this programme is to protect thehealth of consumers, ensure fair tradepractices in the food trade, and promotecoordination of all food standards workundertaken by international governmentsand NGOs. The Codex Alimentarius systempresents a unique opportunity for allcountries to join the internationalcommunity in formulating and harmonisingfood standards and ensuring their globalimplementation. It also allows them a rolein the development of codes governinghygienic processing practices andrecommendations relating to compliancewith those standards.

V) The Global Framework for ProgressiveControl of Trans-boundary Animal Diseases(GF-TADs)

This is a joint FAO/OIE initiative whichcombines the strengths of bothorganisations to achieve agreed commonobjectives. GF-TADs is a facilitatingmechanism which will endeavourto empower regional alliances in thefight against TADs, to provide forcapacity building and to assist inestablishing programmes for the specificcontrol of certain TADs based on regionalpriorities.

The overall objective of GF-TADs is to limitthe ravages of animal diseases on thelivelihoods of livestock-dependent peoplearound the world and to promote safe andhealthy trade through strengthening local



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and national capabilities. FMD wasidentified as the principal animal diseaseof global concern in all the consultationscarried out during the preparation of thisprogramme. In order to obtain the necessaryinformation for the promotion of earlyprevention and early reaction, closeinteraction among national animal healthservices for achieving a sound regionalunderstanding of disease occurrence isrequired. GF-TADs will rely on the action ofcountries’ veterinary services and those ofregional, specialised animal healthorganisations. Since international animalhealth monitoring is able to single outgeographical dynamics of diseaseoccurrence only when countries report thepresence of diseases, GF-TADs intends tocontribute to the strengthening of nationalstructures and mechanisms to fulfil suchreporting functions effectively.

vi) Existing International Warning Systems forDiseases

OIE has an information system that includesthe dissemination of early warningmessages whenever epidemiologicallysignificant events are officially reported toits Central Bureau, within hours of theirreceipt. This alert system is aimed atdecision-makers, enabling them to takenecessary preventive measures as quicklyas possible.

In order to improve transparency and animalhealth information quality, OIE has also setup an animal health information search andverification system for non-officialinformation from various sources on theexistence of outbreaks of diseases that havenot yet been officially notified to the OIE.

FAO, through the emergency preventionsystem priority programme established in1994, developed an early warning andresponse system aimed at disease

containment, based on official OIE data,ground information stemming from fieldprojects, collaborators, consultancymissions or personal contacts and providesanalyses of the situation, disseminatedthrough bulletins, electronic messages andother reports.

WHO has developed an outbreak trackingand verification system for human diseases,which, for zoonotic diseases such as RiftValley fever, brucellosis, TB, rabies andfood-borne diseases, will be shared withOIE and FAO in GF-TADs.

6.4.2 Prevention and Preparedness: NationalScenario

Animal husbandry and veterinary services is astate subject and falls within the purview of thestate government. As a consequence each stategovernment and UT has its own department ofanimal husbandry and veterinary services.Veterinary services are provided at state veterinaryhospitals, dispensaries and mobile veterinaryclinics which are staffed by veterinary graduatesholding a degree in veterinary science and animalhusbandry recognised by the Veterinary Councilof India (VCI) and State Veterinary Councils.Prevention of animal diseases, control andsurveillance is also an important function of thestate veterinary services.

Subjects such as animal quarantine, preventionof inter-state transmission of diseases, regulatorymeasures for quality of biologicals and drugs,import of biologicals, livestock, livestock productsand control of diseases of national importance arethe responsibilities of the central government.

The DADF of the MoA handles the centralanimal health services. The central governmentformulates schemes and policies for the controland eradication of diseases in the country.


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India has about 47,000 registered veterinarypractitioners engaged in different activities. Morethan 70% of the registered veterinary practitionersare in the state government services. The countryhas 8,720 veterinary hospitals and polyclinics,17,820 veterinary dispensaries, and 25,433Veterinary Aid Centres (VACs) and mobile veterinaryclinics totalling 51,973 centres. In addition, thereare border posts which besides their border dutiesalso work as disease reporting posts. Thus the totalnumber of disease reporting posts is 52,390. Thesedisease reporting units form the backbone of thedisease surveillance system and have an effectivecoverage. There are 51,973 animal diseasereporting units in 641,169 villages in India. 86,073veterinary personnel (24,767 veterinary graduatesand 61,306 veterinary field assistants) look afterthe animal health aspects. Thus, for animal diseasesurveillance, disease reporting and veterinary cover,on an average one disease reporting post catersto the needs of 12.33 villages, 5,464 bovines (cattleand buffaloes) and 3,499 sheep and goats.However, in the event of any disaster, these servicesare often found wanting.

(A) National Veterinary Services

The provision of these services is theresponsibility of the DADF of the MoA. Subjectssuch as animal quarantine, providing healthregulatory measures for import/export of livestockand livestock products, animal feeds, etc., andprevention of inter-state transmission of animaldiseases and control of diseases of nationalimportance are the responsibilities of the centralgovernment.

The central government has a specialresponsibility for safeguarding against any newdisease threatening to enter the country. In theevent of an emergency in the livestock sector, theDADF activates its National Animal DiseaseEmergency Committee (NADEC) to monitor,evaluate and issue necessary guidelines to handle

the emergency. At the state level, a similarcommittee, i.e., the state animal diseaseemergency committee is activated. All importantstakeholders, including specialists in the subjectare members of these committees.

(B) Sub-national Veterinary Services

The provision of veterinary services falls withinthe purview of the state governments. Veterinaryservices are provided at state veterinary hospitalsand dispensaries, and mobile veterinary clinics.Immunisation against prevalent endemic animaldiseases, animal disease reporting, surveillanceand controlling disease outbreaks are importantfunctions of the state veterinary service. Deliveryof veterinary services at state level is done both byfield and laboratory services of each state and UT.

There is an inbuilt disease surveillance systemin the country. Administratively, each statecomprises of several districts. Each district isdivided into tehsils/talukas, which are furtherdivided into villages. A village is the smallestadministrative unit at the grass-root level.

There is a well-knit infrastructure ofgovernment veterinary services units at each level.Broadly, state headquarters and large district townshave veterinary polyclinics, each districtheadquarter has a veterinary hospital and eachtehsil headquarter has a veterinary dispensary.Veterinary assistant surgeons/veterinary officerswho are veterinary graduates head all theseinstitutions. At the village level, veterinary servicesare provided by VACs. Each VAC caters to theneeds of about 5–10 villages. VACs are headedby veterinary field assistants who are non-graduate,para-veterinary personnel. They are given one totwo years of training after matriculation in state-run government veterinary training schools. Theyimpart preliminary veterinary services to farmersand administer preventive vaccination to livestockagainst prevalent infectious diseases.



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A VAC is the first disease information unit atthe grass-root level. Under the provisions of statedisease control acts, a livestock owner or any othergovernment or private personnel functioning in thearea having knowledge about the onset of aninfectious disease in livestock is supposed to informthe VAC. The VACs communicate disease outbreakinformation to the veterinary dispensary/hospital,which in turn passes on the information to thedistrict veterinary officer and which further flows tothe director of veterinary services. The state directorsends a monthly report to GoI. Reporting of diseaseas per the OIE list of diseases is presently animportant function of this disease surveillancesystem.

There are 250 disease investigationlaboratories in India for providing diseasediagnostics services. Many states have diseaseinvestigation laboratories at the district level. Eachstate has a state-level laboratory which is wellequipped and has specialist staff in variousdisciplines of animal health.

Beside the state disease investigationlaboratories there is one central and five referralregional disease diagnostics laboratories fundedby the DADF. Each state agriculture university/veterinary college also has disease diagnosticfacilities. At the national level, the IVRI, and speciallyits Centre for Animal Disease Research andDiagnostics based at Izatnagar (Bareilly) and theDisease Diagnostic Laboratory of the National DairyDevelopment Board (NDDB) at Anand, Gujarat, arehighly specialised laboratories providing diseasediagnostic services. In order to monitor ingress ofexotic diseases, a state-of-the-art laboratory existsat HSADL, Bhopal with BSL-4 standards. By andlarge, all state-level laboratories, regionaldiagnostic laboratories, laboratories of ICAR/NDDBand HSADL are capable of diagnosing animaldiseases.

(C) Animal Disease Management

In order to control diseases in economicallyimportant livestock and to undertake the obligatoryfunctions related to animal health in the country,GoI is implementing a scheme for livestock healthand disease control with the following components:

i) Assistance to States for Control of AnimalDiseases (ASCAD)

Under this component, assistance isprovided to state governments/UTs for thecontrol of economically important diseasesaffecting livestock and poultry by way ofimmunisation, strengthening of existingstate veterinary biological production units,strengthening of existing state diseasediagnostic laboratories, holding workshops/seminars and in-service training toveterinarians and para-veterinarians. Theprogramme is being implemented on a75:25 sharing basis between the centre andthe states, however, 100% assistance isprovided for training and seminars/workshops. The states are at liberty tochoose the diseases for immunisation asper the prevalence and importance of thedisease in their state/region. Besides this,the programmes envisage collection ofinformation on the incidence of various live-stock and poultry diseases from states/UTsand compile the same for the whole country.

ii) National Project on Rinderpest Eradication(NPRE)

The objective of this scheme is tostrengthen veterinary services and eradicateRinderpest and Contagious Bovine Pleuro-Pneumonia (CBPP) and to obtain freedomfrom these infections following the pathprescribed by OIE. The country has gainedthe status of ‘Freedom from Rinderpest andCBPP Infections’. However, surveillance isstill carried on.

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iii) Foot and Mouth Disease Control Programme(FMD-CP)

To prevent economic losses due to FMDand develop herd immunity in cloven-footedanimals, FMD-CP is being implemented in54 specified districts of the country since2003–04 as part of the Tenth Plan with 100%central funding for cost of vaccines,maintenance of cold chain and otherlogistic support to undertake vaccination.The state governments are providing otherinfrastructure and manpower for theprogramme. Six-monthly vaccination drivesare carried out in the identified districts.The programme has considerably reducedlosses due to this infection in the areaswhere it is being implemented.

iv) Professional Efficiency Development (PED)

The objective of this scheme is to regulateveterinary practice and maintain a registerof veterinary practitioners as per theprovisions of the Indian Veterinary CouncilAct, 1984 (IVC Act). In order to upgrade theskill of veterinarians, a Continuing VeterinaryEducation Programme has been initiated.

Under the Central Sector Scheme of theDirectorate of Animal Health, schemes forAnimal Quarantine and CertificationServices, Disease Diagnostic Laboratories(central/regional laboratories) and theNational Veterinary Biological ProductsQuality Control Centre (Institute of AnimalHealth) are functioning.

v) Animal Quarantine and CertificationServices (AQCS)

While efforts have been made to ensurebetter livestock health in the country,simultaneous efforts are equally necessaryto prevent entry of any disease into thecountry from outside through the import oflivestock and livestock products. With thisobjective in view, four AQCS Stations, one

each at Mumbai, Kolkata, Delhi andChennai, have been established. Thesestations are equipped to deal with allimports into the country.

vi) Functions of AQCS in India:

a. Quarantine/testing of importedlivestock and livestock products.

b. Export certification of livestock/livestock products as per therequirements of the importing countryand as prescribed in the TerrestrialAnimal Health Code, OIE.

c. Implementation of various provisionsof the Livestock Importation Act, 1898(as amended in 2001).

(vii) National Veterinary Biological ProductsQuality Control Centre (Institute of AnimalHealth)

In order to ensure the quality of veterinarybiologicals used in the country for theprevention and control of infectiousdiseases, GoI has established the NationalVeterinary Biological Products QualityControl Centre at Baghpat, Uttar Pradesh,which is expected to start functioning soon.The institute has the following objectives:

a. To recommend licensing ofmanufacturers of veterinary vaccines,biologicals, drugs, diagnostics andother animal health preparations in thecountry.

b. To establish standard preparations foruse as reference materials in biologicalassays.

c. To ensure quality assurance of theveterinary biologicals both producedindigenously and through imports.

(vii) Livestock Insurance Scheme

Apart from the regular health schemes, theLivestock Insurance Scheme has also been



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formulated with the twin objectives ofproviding a protection mechanism tofarmers and cattle rearers against anyeventual loss of their animals due to deathand to demonstrate the benefit of theinsurance of livestock to the people andpopularise it with the ultimate goal ofattaining qualitative improvement inlivestock and their products. This centrallysponsored scheme has been implementedon a pilot basis in 2005–06 and 2006–07during the Tenth Five-Year Plan in 100selected districts. Under the scheme,crossbred and high yielding cattle andbuffaloes are being insured at their currentmarket price.

6.4.3 Research and Development inLivestock Health

The development of therapeutics andprophylactics against animal health problems, aswell as developing best practices for diseasemanagement, disease epidemiology andsurveillance for diseases are done primarily by ahighly specialised laboratory under specialisedanimal science institutions like ICAR. Besides theseinstitutions, state agricultural and veterinaryuniversities, NDDB and several private sectorestablishments are also involved in thedevelopment of vaccines or diagnostics for livestockdiseases.

6.4.4 Production of Veterinary Biologicals andPharmaceuticals

Vaccines are manufactured both in the privatesector as well as in the state-run biologicalproduction centres. The quality aspects of themanufacturing plants are regulated by the DrugController of India under MoH&FW. Compared tothe number of livestock and poultry, as well as thenumber of diseases that are prevalent in thecountry, the infrastructure for such production is

inadequate. In the event of increased demand tomeet the ideal standards of livestock healthmanagement, production facilities will be foundwanting in terms of capacity and also in terms ofgood manufacturing practices with the state-controlled units.

6.5 Challenges

DM in livestock, be it due to infectious diseasesor natural calamities, is inadequately addressedin the country. The professional and otherstakeholders dealing with livestock are notadequately trained in this vital aspect of livestockmanagement. The course curricula of veterinaryand animal sciences do not adequately addressthis. Infectious disease control in livestock,particularly the existing ones, is well covered duringtraining in universities. The capacity for timelydetection of an exotic disease which has thepotential of becoming a disaster, and itssubsequent management so that it can beminimised, will require to be built up. A case inpoint is the recent incursion of bird flu into thecountry. Vital time were lost in its first experiencein the country where the disease was initiallyconfused with another existing disease in poultrywith almost similar clinical manifestations. Througha series of training programmes, people have beentrained to handle a possible emergency in case ofany further occurrence of bird flu. However,simultaneous occurrences in several places in thecountry could still seriously stretch resources. It isessential that adequate stress be given to qualitymanpower development in the management ofdisease-related emergencies in livestock.

6.5.1 Existing Gaps in Animal DisasterManagement

The following gaps could thus be identified inthe management of disasters in livestock, be itdue to natural calamities, diseases or an act ofwar:

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i) Inadequate trained manpower for DM: Theexisting livestock health management setupat both the state and central levels consistsof veterinary professionals trained in routinemanagement of animal diseases. There isa need to train veterinary professionals inthe comprehensive management of animalemergencies of disastrous proportions. Aseparate force of trained volunteers shouldalso be raised at the state and district levelsto assist veterinary professionals inmanaging animal emergencies.

ii) Inadequate training facility for staff in themanagement of disasters: At present, thetraining given to veterinary professionals isprimarily in routine diseases management.Training objectives are confined to themanagement of endemic diseases only, noorganised training is provided in themanagement of large-scale epidemics/pandemics such as bird flu, etc. In view ofemerging animal pandemics such as birdflu, FMD, etc., there is an urgent need toinstitutionalise specialised training in themanagement of large-scale animalemergencies.

iii) Inadequate biosecured laboratories forhandling dangerous pathogens: Presentlythere is only one laboratory at HSADL,Bhopal, with BSL-4 standards. The recentexperience with the bird flu outbreakrevealed the inadequacy to cater for anepidemic/pandemic. There is a need toestablish more regional laboratories of BSL-4 level to cater to emerging contingencies.

iv) Lack of mobile veterinary laboratories/clinicsto work at the emergency site: In case ofepidemics occurring in remote and isolatedplaces, on-the-spot primary diagnosis is acrucial aspect of emergency measures.Valuable time wasted in getting thediagnosis done at far-off laboratories canbe saved with the availability of mobilediagnosis laboratories in the districts.

v) Inadequate inter-state disease andemergency disease reporting system: Theexisting routine and paper-based diseasereporting system is both time-consumingand ineffective in managing disease controland containment. The existing systemshould be replaced with a wide areanetwork-based disease reporting systemthroughout the country.

vi) Lack of policy in border areas regardingthe movement of livestock in and aroundneighbouring countries where the bordersare porous: The existing quarantinefacilities, especially along the internationalborders with Nepal, Bhutan, Myanmar andBangladesh are grossly inadequate inpreventing the spread of TADs. The varioussecurity forces guarding these borders couldbe utilised by giving them the necessarypolicy backup, training and infrastructure.

vii) Inadequate preparedness for animal DM atthe district and state levels: Presently,animal health emergencies are not cateredfor in DM plans in many states and districts.As a policy guideline, inclusion ofcontingency measures for managing animalemergencies should be made mandatory.

viii) Lack of a national policy for therehabilitation of the animal husbandry sectorafter a disaster: Post-disaster rehabilitationof both disaster-struck animals as well asfarmers is of paramount importance due tothe obvious health and economicimplications. There is a need to lay downpolicies for systematic and organisedmanagement of rehabilitation efforts.

6.6 Guidelines for the Managementof Livestock Disasters

6.6.1 Risk and Vulnerability Assessment

Disasters that could lead to an emergencysituation in the animal husbandry sector may arise



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primarily due to the following four categories ofrisks:

i) Natural disasters: Flood, drought, cyclone,tsunami, earthquake, etc.

ii) Infectious diseases: Zoonotic and non-zoonotic.

iii) Fodder poisoning.

iv) Miscellaneous: War (conventional war, BWor BT).

(A) Natural Disasters

India is vulnerable to most types of naturaldisasters and its vulnerability varies from region toregion and a large part of the country is exposedto these natural hazards which often turn intodisasters, causing a significant disruption of thesocial and economic life of communities arisingfrom the loss of life and property, includinglivestock. The risk factors required to be includedin the risk assessment analysis with respect to agroup of natural disasters are listed below:

i) Cyclic Drought and Famine

a. Breeding capacity.

b. Fertility.

c. Pregnancy and lactation.

d. Population drift due to

- heavy economic losses

- scarcity of feed and fodder

ii) Tsunami, heavy snowfall and rain, flood

a. High mortality rate among livestockdue to drowning (generally they arenot set free to move to highland areas,making them vulnerable to thesituation).

b. Unavailability of clean drinking water.

c. Outbreak of diseases due to improperdisposal of carcasses.

d. Public health problems.

iii) Earthquake

a. Injured livestock lead to problems oftheir maintenance.

b. Death or desperation of the ownersleads to neglect of the livestockthereby increasing the indirect losses.

The above factors will be used to define thesteps of risk and vulnerability assessment. Themajor recommendations for district/state authoritiesinclude:

i) Development of ‘multi-hazard’ risk andvulnerability mapping of the districts.

ii) Development of demographic maps of areaswith dense/scarce population of livestock.

iii) Other factors that compound/reduce thecontained risk, including variable climaticconditions and availability of medicallogistics.

(B) Infectious Diseases

Emergency animal diseases are not always thesame as exotic or foreign animal diseases.Outbreaks of infectious diseases are of many types:

i) Any unusual outbreak of an endemic diseasein exponential frequency causing significantchange in the epidemiological pattern ofthat particular disease.

ii) The appearance of a previously unknowndisease in a particular region.

iii) Animal health emergencies caused due tonon-disease events, for example, a majorchemical residue problem in livestock or afood safety problem such as hemorrhagicuraemic syndrome in humans caused bythe contamination of animal products byverotoxic strains of E. coli.

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iv) Deliberate introduction of exoticmicroorganisms in a targeted region.

A risk analysis will enumerate the mitigationstrategy to be outlined for the prevention of suchlivestock diseases:

i) Mitigation measures will be developed,based on the risk assessment analysis, tocontrol the spread of such diseases.

ii) Mapping will be done of infectious diseasesendemic to the area and level of prevalencein the past.

iii) Surveillance mechanisms will be set up todetect exotic microorganisms to preventoutbreaks and high priority diseases thatmay lead to national emergencies.

iv) Large-scale epidemics which may occurdue to the introduction of a new disease orinfectious agent or uncontrolled movementof animals resulting in mixing of thesusceptible and infected population, haveto be checked.

v) Genetic mutation in an otherwise innocuousinfectious agent, climatic changes ordisruption of the environment necessitatechanges in husbandry and DM practices.Routine monitoring/surveillance of fieldflocks will be undertaken, particularly inseasons which are conducive to suchepidemics.

vi) The vaccination status of all livestock willbe periodically checked.

(C) Fodder Poisoning

Nitrate accumulation in plants leads to nitrate/nitrite poisoning which is a potential danger tograzing animals with pigs being most susceptible,followed by cattle, sheep and horses. In order tokeep a check on such cases, awareness amongthe local community must be created so that theytake proper care of their animals and prevent themfrom eating poisonous toxic materials. Based on

the above approach, the following activities willbe undertaken:

i) Listing of the various poisonous materials,including braken fern, Lantana camara,parthenium, rati (Abrus prectorus), dhatura(thorn apple), kaner (oleandar); cyanogenicplants like immature maize, sorghumbanchari, cereal affected with egrot, Indiapea; nitrate and nitrite containing plants,etc.; and the measures to prevent theavailability of such materials to livestock.

ii) Exotic/cross breeds are more susceptibleto damage under drought conditions thanindigenous breeds. Livestock owners willbe made aware of how to take proper careof these exotic/cross breeds.

iii) Certain areas will be demarcated for fodderproduction, especially of Crassulacean AcidMetabolism (CAM) varieties of plants,particularly in desert areas. Pastures shouldalso be developed for migratory sheep andgoat and clean grain made available forpigs and poultry.

(D) Trans-boundary Animal Diseases

TADs are a major cause of economic losses tothe livestock industry and are those infectiousdiseases which could spread fast and have thepotential to cause considerable mortality or lossesin productivity. TADs have the capability to seriouslyaffect earnings from export of livestock or itsproducts.

A TAD epidemic such as avian influenza (birdflu) or FMD has the same characteristics as othernatural disasters—it is often a sudden andunexpected event, has the potential to cause majorsocio-economic consequences of nationaldimensions and even threaten food security, mayendanger human life, and requires a rapid national-level response. The following diseases are ofimmense importance from both animal husbandryand public health perspectives:



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i) Non-zoonotic diseases

a. FMD*

b. Peste des Petits Ruminants (PPR)*

c. Rinderpest

d. Vesicular stomatitis

e. African Swine Fever (ASF)

f. Classical Swine Fever (CSF)*

g. Contagious Bovine Pleuropneumonia(CBPP)

ii) Diseases with known zoonotic potential

a. Anthrax*

b. Bovine Spongiform Encephalopathy(BSE)

c. Brucellosis (B. melitensis)*

d. Crimean Congo hemorrhagic fever

e. Ebola virus

f. Food-borne diseases

g. Highly Pathogenic Avian Influenza(HPAI)*

h. Japanese encephalitis*

i. Marburg hemorrhagic fever

j. New World screwworm

k. Nipah virus

l. Old World screwworm

m. Q fever

n. Rabies*

o. Sheep pox*/goat pox*

p. Tularemia

q. Venezuelan equine encephalomyelitis

r. West Nile virus

(* indicates presence of the disease in India)

Almost all the diseases mentioned above havethe potential to assume epidemic proportions, yeta few important ones that have been endemic in

India and could possibly play havoc with thenational economy as well as public health are FMD,rinderpest, PPR and avian influenza (H5N1).

The major recommendations to contain theseendemic diseases which have epidemic potentialare as follows:

i) Strict quarantine inspection and testing willbe undertaken for any form of importedgermplasm prior to release.

ii) In case of avian influenza, special care willbe taken during the migratory season toprevent mixing of wild and domesticpopulation of birds.

Exotic animal diseases have managed to enterIndia a number of times causing severe loss to thelivestock industry. A risk analysis will monitor theemergence and re-emergence pattern of exoticdiseases:

i) HPAI emerged in two instances though ithas been stamped out of indigenousterritory.

ii) Exotic diseases like bluetongue in sheep,infectious bovine rhinotracheitis in cattle,PPR in sheep and goat or infectious bursaldisease in poultry have now becomeendemic in the country. Effective vaccinesare available in our country to managethese livestock diseases.

iii) Exotic diseases prevailing in othercountries which have a higher vulnerabilitypotential of re-emergence in Indianlivestock, for example rinderpest, which isstill prevalent in some parts of Africa andis one of the most dreadful infections ofcattle until recent times.

iv) Presently, Indian livestock is vaccinatedagainst serotypes ‘O’, ‘A’ and ‘Asia 1’, butis highly vulnerable to world serotypes ‘C’,‘SAT 1’, ‘SAT2’ and ‘SAT 3’ and theantigenic variants of existing serotypes thatrequire constant surveillance.

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The risk management practices based on theseprevailing risk factors will include:

i) Check on the unhindered movement ofanimals across the states; incursion of anynew infectious disease that could causeserious losses of livestock.

ii) Diseases like HPAI with an inherent zoonoticpotential will be kept under constantsurveillance.

iii) Risk maps will have trend maps withperiodic shift patterns, time intervals of re-emergence and consequencemanagement analysis of increase/reductionin the overall risk due to the introduction ofexotic breeds.

iv) Human disease surveillance data andprobabilities of shift from livestock tohumans or vice versa will be mapped todefine the areas that require adoption ofappropriate mitigation strategies.

(E) Miscellaneous Causes

India may have remained blissfully unaware ofthe losses in livestock due to the Bhopal gastragedy or the consequences of arsenic or othertoxic elements that may not only cause acute lossof livestock but are also potentially hazardous forpublic health as livestock produce is directly relatedto the human food chain. The impact of majoraccident hazard units such as nuclear reactors andhazardous waste dumping sites are examples ofslow and impending livestock disaster situations.The major recommendations include:

i) Development of risk management plans forincident site contamination levels andecological studies to define the routing ofthe various toxins to livestock.

ii) Regular health surveys of the livestock ofthese regions by an assigned authority,based on mutually agreed mechanismsbetween the public and private sectors.

iii) Ensuring the availability of emergency kitswith farmers and people living in the vicinityof known hazardous factories/nuclearlaboratories, etc.


A large number of farmers in rural India sufferloss of livestock due to various diseases. It isessential to prevent and mitigate such losses bycapacity development in the following areas:

i) Immediate relief in terms of emergency aidthrough Veterinary Assistance Teams (VATs),temporary makeshift shelters andemergency provision for water and feedpackages. A disaster often impacts thesurroundings, altering the landscape’scharacter, feel, smell, look and layout. It isimportant to provide an alternative shelter,clean and uncontaminated water andensure that damaged grain and mouldy hayor feed or forage that may have beencontaminated by chemicals or pesticidesis not consumed by them.

ii) Infrastructure for disposal of dead animals:Burial/disposal methods of animalcarcasses and other products (tissues) ofanimal origin will continue to be animportant and necessary concern. Thepurpose of a ‘secure’ burial is to physicallyisolate wastes from the environment and toprevent contamination of water and air. Atthe village level, some suitable land shouldbe identified beforehand, for any emergingcontingency. Ideally, incineration facilitiesfor proper disposal of animal carcasses areessential as specific disease controlmeasures during epidemics.

iii) Infrastructure for containment of epidemics:Any attempt to contain an emergingpandemic virus at its source is a demandingand resource-intensive operation. Thefeasibility of rapid containment depends on



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the number of contacts of the initial casesand the ability of government authorities toensure basic infrastructure and essentialservices to the affected population. Theinfrastructure for various services includingshelter, power, water, sanitation, food,security, and communications will bedeveloped to maintain strict infectioncontrol in isolation/quarantine facilities.Training of first responders for proper cullingof birds by animal husbandry teams isessential to prevent the spread of bird flu.

iv) Organised rehabilitation packages forlivestock livelihood: A programme thatdelivers a comprehensive package ofcombined services including restocking,shelter construction and income-raisingactivities; water and sanitationinterventions; health, nutrition andpsychological stress amelioration witheducation and disaster preparedness, willbe undertaken.

a. Building infrastructure for diseaseforecasting: Disease surveillanceshould utilise modern computing andcommunication technology to convertdata into useable information quicklyand effectively. Accurate and efficientdata transfer with rapid notification tokey partners and constituents is criticalfor effectively addressing the threat ofemerging diseases.

b. Training of farmers on mitigation ofdisaster losses: Villagers (livestockfarmers, including women) should begiven intensive DM training. This willinclude preparation for post-earthquake, flood, cyclone and firesituations. The objective of theprogramme is to help build, within ashort period of time, a mechanism thatcan respond to natural calamities andfacilitate early recovery. Outcomes ofthe training should include better

coordination with relief and rescueefforts of government andhumanitarian agencies so as to avoidthe mismanagement that oftenhampers relief operations followingnatural disasters.

c. Awareness programme on accidentaland man-made chemical/biologicaldisasters: A well-organised trainingprogramme of veterinary professionalsas well as administrative officials inlivestock emergency management isthe need of the hour. A brief module inthe form of a workshop should beorganised to apprise the concernedparties of the emerging threatperceptions and theircountermeasures. The trainingfacilities available with KVKs as wellas agriculture universities should beutilised.

d. Enhancement of the capabilities ofemergency field and laboratoryveterinary services, especially forspecific high-priority livestock diseaseemergencies. Accurate and timelylaboratory analysis is critical foridentifying, tracking and limitingthreats to livestock health. The nationalnetwork of animal health laboratorieswill be strengthened for a moreefficient livestock health system andaugmentation of its capacity torespond effectively to livestock healthdisasters.

6.6.3 Inter-departmental Support

Several essential government services, otherthan MoA, will be invaluable during crisis tomitigate impact on the animal husbandry sector.These include, inter alia:

i) Defence forces (notably the Army and AirForce) which can provide support for such

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activities, including transportation ofpersonnel and equipment to disaster ordisease outbreak sites, particularly whenthese are inaccessible to normal vehicles;provision of food and shelter; protection ofdisease control staff in areas with securityproblems and provision of communicationfacilities between national and local diseasecontrol headquarters and field operations.

ii) Veterinary professionals of the Army andvarious forces guarding the border, viz.,Assam Rifles, Border Security Force (BSF),Indo-Tibet Border Police (ITBP) andSashastra Seema Bal (SSB) will be trainedand co-opted in the containment of TADs.

iii) Police or security forces for assistance inthe application of necessary disease controlmeasures such as enforcement ofquarantine and livestock movement, controlmeasures, and protection of staff ifnecessary.

iv) Public works department, for provision ofearth-moving and disinfectant-sprayingequipment, and expertise in the disposalof slaughtered livestock in eradicationcampaigns.

v) National or state emergency services forlogistics support and communications.Defence forces and various paramilitaryforces will be equipped and entrusted toprovide necessary logistics andcommunication backup in case ofemergency.

vi) Revenue Department services forcompensation against losses. A uniformpolicy for compensation that has necessarylegislative backing will be entrusted to theRevenue Department to ensureimplementation.

vii) Liaison with, and involvement of, relevantpersons and organisations outside thegovernment animal health services who alsohave a role in animal health emergency

preparedness planning. This would include,inter alia, the National VeterinaryAssociation, livestock industry groups,national/state authorities and Departmentsof Finance, Health and Wildlife.

6.6.4 Livestock Management duringDisasters

The following preparations are essential formanagement of animals during disasters:

i) Development of flood, cyclone and othernatural calamity warning systems. Inprinciple, an EWS would make it possibleto avoid many adverse economic andhuman costs that arise due to thedestruction of livestock resources every year.Reliable forecasting would also allow stategovernments to undertake more efficientrelief interventions. Other tools that mayprovide early warning signals include fieldmonitoring and remote sensing systems.Ideally, field monitoring should providemonthly flows of information on theavailability of water and the general stateof crop and livestock production. Usefulproduction parameters include marketingtrends, particularly the balance of tradebetween livestock and grain foods, andanthropomorphic measures such as themean arm circumference of children underfive. Remote sensing, which relies onimagery satellites, is a valuable tool whenused in conjunction with field monitoring.These tools will be integrated to developan effective EWS.

ii) Establishment of fodder banks at the villagelevel for storage of fodder in the form ofbales and blocks for feeding animals duringdrought and other natural calamities is anintegral part of disaster mitigation. Thefodder bank must be established at a securehighland that may not be easily affectedby a natural calamity. A few fodder banks



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will be developed as closed facilities toprevent them from getting contaminated.

iii) Supply of feed ingredients at nominal costfrom the Food Corporation of India: Mostgrain rations for cattle and sheep provideenough protein to maintain a satisfactory10–12% level. But when we feed livestockin emergency situations—mostly low-proteinmaterials such as ground ear corn, grainstraws or grass straws—a proteinsupplement is needed. Adequate reservesas per the availability of resources will bedeveloped.

iv) Conservation of monsoon grasses in theform of hay and silage during the flushseason greatly help in supplementingshortage of fodder during emergenciessuch as drought or flood. The objective isto preserve forage resources for the dryseason (hot regions) or for winter (temperateregions) in order to ensure continuous,regular feed for livestock. It is an importantdisaster mitigation strategy.

v) Development of existing degraded grazinglands by perennial grasses and legumes.As a majority of the population in drought-prone areas depends on land-basedactivities like crop farming and animalhusbandry, the core task for developmentwill be to promote rational utilisation of landfor supplementing fodder requirementsduring emergencies.

vi) Provision of free movement of animals forgrazing from affected states to theunaffected reduces pressure on pasturesand also facilitates early rehabilitation ofthe affected livestock. In emergencysituations, the presence of livestock canexacerbate conflict when refugees withanimals compete for reduced forage andwater resources. To prevent this, what istechnically known as emergency de-stocking programme, will be instituted. This

programme provides for the intentionalremoval of animals from a region before theydie.

viii) Treatment and vaccination of animalsagainst contagious diseases in floodaffected areas. Routine prophylacticvaccination of livestock in flood-prone areasignificantly reduces the severity of thepost-disaster outbreak of any endemicdiseases. Since animals affected by floodsare prone to pick up infectious diseases,vaccination and veterinary camps will beset up to treat and immunise livestockagainst various diseases. The creation of acommunity based animal health caredelivery system may significantly reducelivestock deaths in a region. Vaccinationprogrammes and primary animal health carewill prevent some of the drastic lossesassociated with the onset of rains.

ix) Provision of compensation on account ofdistressed sale of animals and economiclosses to farmers due to death or injury oflivestock. Compensation for animals andother property affected by an emergencydue to an animal disease outbreak is anintegral part of the strategy for eradicatingor controlling disease. A legislation thatprovides the power to destroy livestock andproperty, and ultimately determines theprocess by which compensation is to bepaid, will be enacted and implemented bythe respective legislative bodies.

6.6.5 Disposal of Dead Animals duringDisasters

Carcasses can be a hazard to the environmentand other animals and require special handling.To minimise soil or water contamination and therisk of spreading diseases, guidelines for propercarcass disposal must be followed. Disposaloptions include calling a licensed collector to

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remove dead stock or burial in an approved animaldisposal pit. Alternatives include incineration andburial. Burial avoids air contamination associatedwith burning carcasses and is economical. Sincethe heat in the pile eliminates most pathogens,burial can also improve the biosecurity of farmingoperations.

A plan for the disposal of dead livestock shouldaddress selection of the most appropriate site ineach village or cluster of villages for burial orburning, disinfection process, provision of costsfor burial or burning, material and equipmentrequired for burial and burning, etc. A prototypeguideline for disposal of livestock is provided forreference (Annexure-H).

6.6.6 Strategy for Emergency Management

i) There will be efforts to prevent anemergency, reduce the likelihood of itsoccurrence or reduce the damaging effectsof unavoidable hazards long before anemergency occurs. Flood and fire insurancepolicies for farms are important mitigationactivities.

ii) It is pertinent to develop plans regardingwhat to do, where to go, or who to call forhelp before an event occurs—actions thatwill improve chances of successfullydealing with an emergency. These includepreparedness measures such as postingemergency telephone numbers, holdingdisaster drills and installing warningsystems.

iii) Efforts need to be made to respond safelyto an emergency by convertingpreparedness plans into action. Seekingshelter from a cyclone or moving out of thebuildings during an earthquake are bothresponse activities. The GoI Action Plan formanagement of the outbreak of bird flu isan example of the effective handling of anoutbreak of livestock disaster in the country.

iv) A comprehensive strategy for recoveryactions to bring back normalcy, includingassistance for repairs and other losses willbe identified in DM plans.

Safety is an important aspect of a responseplan and every action plan will enumeratedifferent responding activities to beundertaken for the effective managementof livestock disasters. The response planwill be rehearsed to remove the plausibleanomalies in actions.

6.6.7 Steps for Prevention, Mitigation andPreparedness

DM plans at all levels will include thefollowing important measures:

i) Public awareness about natural disastersthat different regions and the country aremost likely to experience and theirconsequences on the livestock sector.

ii) Provisions to establish adequate facilitiesto predict and warn about the disastersperiodically, including forecasting diseaseoutbreaks. This could only be achieved bya well networked surveillance mechanismthat proactively monitors emerginginfections and epidemics.

iii) Development and implementation ofrelevant policies, procedures and legislationfor management of disasters in the animalhusbandry sector. The livestock healthinfrastructure in India, modelled to provideroutine veterinary cover, needsreorganisation in view of emergingepidemics/challenges. The existing animalhusbandry policies will be revisited and ifrequired, modified to cater to changingrealities.

iv) Mobilise the necessary resources, e.g.,access to feed, water, health care, sanitationand shelter, which are all short-termmeasures. In the long term, resettlement



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programmes, psycho-social, economic andlegal needs (e.g., counselling,documentation, insurance) are required tobe undertaken.

v) Another long-term strategy is required toreadjust the livestock production system inthe country from a biosecurity point of viewso that in the event of the entry of any new,dangerous pathogen, the losses could beminimised by segregation.

vi) Initiation of PPP in livestock emergencymanagement, especially in the field ofvaccine production, will go a long way incombating animal health emergencies ofinfectious origin. Similar partnership in feedmanufacturing as well as livestockproduction will minimise the losses due toother livestock emergencies.

vii) Commissioning of risk assessments onhigh-priority disease threats andsubsequent identification of those diseaseswhose occurrence would constitute anational emergency.

viii) Appointment of drafting teams for thepreparation, monitoring and approval ofcontingency plans. Implementation ofsimulation exercises to test and modifyanimal health emergency plans andpreparedness are also necessary.

ix) Assessment of resource needs and planningfor their provision during animal healthemergencies.

x) Central/state governments will develop/establish an adequate number of R&D andbiosafety laboratories in a phased mannerfor dealing with animal pathogens.

xi) A dedicated establishment, preferablyunder DADF, may be entrusted with theoverall monitoring of the national state ofpreparedness for animal healthemergencies.

xii) Development of active disease surveillanceand epidemiological analysis capabilitiesand emergency reporting systems.

xiii) A computer-based national grid ofsurveillance and disease reporting shouldbe developed for timely detection andcontainment of any emergent epidemic.

xiv) An intelligence cell—Central Bureau ofHealth Intelligence under DGHS should beraised to assist the proposed NationalAnimal Disaster Emergency PlanningCommittee (NADEPC).

xv) Immunisation of all persons who are likelyto handle diseased animals such as anthraxinfected cattle and animals.


The need for strategic research to mitigate risksof biological disasters in livestock—a vitalcomponent of the human food chain—is in no waydifferent from risks to humans. The world is slowlymoving towards the ‘one health: animal health andpublic health’ concept, as it has been seen thatmost newly emerging human epidemics in the lastdecade in various parts of the world had originatedin livestock or other animals and birds. Therefore,the requirements of R&D efforts for livestock DMare similar these discussed in Chapter 4. Researchinstitutions of ICAR, defence organisations, ICMR,DBT and CSIR will identify areas of potential threatand disasters in livestock and fisheries and readjusttheir research priorities to address these concernsto be in readiness for any eventuality.

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Guidelines for Management ofAgroterrorism7

The agricultural sector comprising of cropplants and animals are susceptible to a largenumber of diseases and pests in nature, some ofwhich assume epidemic proportions due to theappearance of more severe or virulent strains/races/biotypes of the pests in a given area under certainfavourable conditions, causing huge economiclosses. The present chapter, mainly focuses on thedisease/pest outbreaks in the agrarian sector whichare deliberately brought about by malafideintentions. The key difference between naturalepidemics and those that are deliberately inducedis an element of vigilance that needs specialattention by intelligence agencies for themanagement of agroterrorism.

Agroterrorism is clearly not aimed at agricultureper se but at crippling the economy. Indeed,agroterrorism certainly has a number of advantagesfor the perpetrator over the more anticipated formsof BW aimed directly at humans. The agents aregenerally not hazardous to man and so can beproduced and carried with minimal risk. Thetechnical and operational challenges are reduced,since the pathogens rapidly reproduce and areeasily disseminated—such as by walking in a fieldwith contaminated shoes, hiring a crop duster toinfect wheat fields, wiping a cow’s nose with aninfected handkerchief. All these actions could easilygo unnoticed yet be sufficient to spread disease.Moreover, the trend of planting monocultureshaving a high degree of genetic homogeneity, theconcentration of a single crop in one region andthe intensive rearing of animals all aid in the spreadof disease. The targets are vulnerable and thesecurity levels low.

Agroterrorists could release damaging insects,viruses, bacteria, fungi or other microbes asbioweapons that are mainly aimed at wiping outcrops or farm animals. They also could attempt topoison processed foods. Although theconsequences of an agroterrorism attack aresubstantial, relatively little attention has beenfocused on this threat worldwide. Agricultural andfood industries—the most important industries inthe world are most vulnerable to disruption. It isalso an easy way to cause huge damage whencompared to other terrorist attacks, and thecapabilities that terrorists would need for such anattack are not considerable. The incidences ofagroterrorism in Colorado during WW II, attackson Cuban crops, the citrus tanker disease in Floridaand deliberate attacks in Sri Lanka are some ofthe cited examples.

7.1 Dangers from Exotic Pests

In the past, a number of plant and animaldiseases and pests have been introduced throughimport of seeds/planting materials/livestock andlivestock products and many of them have becomeestablished and continue to cause economic lossesevery year. In the case of crops, the importantdiseases include bunchy top in banana, potatowart, downy mildew in sunflower, chickpea blight,San Jose scale in apple, coffee berry borer, theinvasive weed Lantana camara and more recentlythe biotype ‘B’ of whitefly Bemisia tabaci (mostefficient vector of the tomato leaf curl virus). Thediseases affecting animals include infectiousbovine rhinotracheitis, PPR, blue tongue, equine


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infectious anaemia, infectious bursal disease, reoand adeno viruses, etc.

The banana bunchy top disease was recordedfor the first time in 1943 in Kottayam District in theerstwhile princely State of Travancore (now Kerala).The disease was believed to have come from SriLanka (then Ceylon). An eradication programmeinitiated in the 1950s met with little success as thevirus spread through the aphid vector, viz.,Pentalonia nigronervosa. Subsequently, the diseasespread to Assam, Kerala, Orissa, Tamil Nadu andWest Bengal. The central government issued adomestic quarantine notification in 1959 prohibitingtransportation of banana planting material from theabove states to any other state/UT. However, in theabsence of effective implementation of domesticregulatory measures, the disease continued tospread to other states and its incidence wasreported from most banana-growing areas of thecountry. Of late, the banana bunchy top diseasehas completely wiped out the hill banana cultivationin the lower Palani Hills area of Tamil Nadu.

The coffee berry borer (Hypothenemus hampei)was first reported in the Gudalur area of NilgirisDistrict in Tamil Nadu in 1990. The pest wasbelieved to have been introduced through infestedcoffee beans brought by Sri Lankan repatriatessettled in Gudalur area. Surveys carried out in 1992have revealed incidence of the pest in coffeegrowing areas of Wyanad District of Kerala andKodagu (Coorg) District of Karnataka. The centralgovernment issued a notification in 1992 prohibitingthe movement of coffee beans (seeds) and plantingmaterial from Nilgiris, Wyanad and KodaguDistricts. With the removal of restrictions on thepooling of coffee by the Coffee Board andintroduction of the free sale quota, the pestcontinued to spread to newer areas due tounrestricted movement of infested berries to curingplaces located outside these three districts. Theinfested area was about 10,000 ha in 1993 and

the incidence of berry borer damage as high as60–70% in a few badly managed plantations inByrambada area of Kodagu District. Late harvestingalso aggravated the buildup of berry borerpopulation. Recently, the incidence of berry borerhas been reported from the coffee growing areasof lower Palani Hills.

The damage potential of dangerous pests anddiseases which have not yet been reported fromIndia is high especially if misused or mishandled.These can cause immense harm to human beingsand ecosystems on a large scale, which is an issueof great concern. Thus, the agricultural economyis vulnerable to serious threats from exotic pests.

Diseases that have the potential to be used asbioweapons are listed below:

(A) Bacterial and Fungal Pathogens

i) Bacterial wilt and ring rot in potato(Clavibacter michiganensis sub sp.sepedonicus).

ii) Fire blight in apple and pear (Erwiniaamylovora).

iii) Black pod in cocoa (Phytophthoramegakarya).

iv) Powdery rust in coffee (Hemelia coffeicola).

v) Sudden death in oak (Phytophthoraramorum).

vi) South American leaf blight in rubber(Microcyclus ulei).

vii) Vascular wilt in oil palm (Fusariumoxysporum f sp. elaedis).

viii) Soybean downy mildew (Peronosporamanshurica).

ix) Blue mold in tobacco (P. hyocyami sub sp.tabacina).

x) Tropical rust in maize (Physopella zeae).

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(B) Virus, Viroid and Phytoplasma

i) Barley stripe mosaic virus.

ii) Coconut cadang-cadang (Viroid).

iii) Palm lethal yellowing (Phytoplasma).

(C) Plant Parasitic Nematodes

i) Pine wood nematode (Bursaphelenchusxylophilus).

ii) Red ring nematode in coconut(Rhadinaphelenchus cocophilus).

(D) Insect Pests

i) Mediterranean fruit fly (Ceratitis capitata).

ii) Cotton boll weevil (Anthonomus grandis).

iii) Russian wheat aphid (Diuraphis noxia).

7.2 Basic Features of an Organismto be used as a Bioweapon in theAgrarian Sector

For an organism to be used as a bioweapon,it should possess certain basic characteristics.These include high adaptability to a wide range ofecological conditions and easy amenability formass production and discrete packaging with nospecial requirements of storage, etc. The organismshould also have a strong competitiveness, highrate of propagation to be able to spread far andwide with minimum inoculum, and also have theability to propagate persistently. The organismshould also affect a key crop grown over largeareas so as to cause significant losses to the targetcountry or to an important agro-industry.

7.3 Dangers from Indigenous Pests

Apart from the threat of exotic destructiveagricultural pests, their strains/isolates/biotypesreported also have a potential for use asbioweapons comprising viruses such as rice tungrobacilliform virus with four variables isolated from

South Asia; rice tungro spherical virus whose Indianisolate is different from Southeast Asian isolates;cotton leaf curl virus which causes severe damagein Pakistan but has limited distribution in India;groundnut bud necrosis virus having a wide hostrange; banana bunchy top virus with five identifiedstrains; and tobacco streak virus, citrus tristezavirus and mungbean yellow mosaic virus whichhave reported several strains. The pathogenscausing serious diseases where variability has beenreported are cereal rusts caused by Pucciniatriticina (whose spores are airborne of which anumber of virulent pathotypes are known), rice blast(Pyricularia oryzae, where a high degree ofvariability has been reported), Bulkholderiasolanacearum (whose race 2 is not known in India)and Xanthomonas campestris pv malvacearum (ofwhich the most virulent pathovar in Africa, XcmN,is not known in India). The insects where biotypeshave been reported include Bemisia tabaci (a highlypolyphagous pest which attacks more than 600host plant species has 16 known biotypes); brownplant hopper (Nilaparvata lugens, where biotypesfrom India differ from those in other Asian countries);rice gall midge (Orseolia oryzae, has six biotypesknown from India) and red flour beetle (Triboliumcastaneum, whose strains show variability in thelevel of pesticide resistance). Several races havealso been reported for nematodes like Meloidogyneincognita, M. javanica/M. arenaria and Heteroderaavenae.

7.4 Present Status and Context

The economy of India is largely linked to thegrowth of agriculture as it is a predominantlyagrarian country. Indian agriculture has made rapidprogress in taking the annual foodgrain productionfrom 51 million tonnes in the early 1950s to 200million tonnes at the turn of the century, therebymaking the country self-reliant in food production.However, the liberalisation of world trade inagriculture since the establishment of WTO in 1995has brought in many challenges apart from opening

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up new vistas for growth and diversification ofagriculture. We need to sustain food security alongwith economic and environmental security.

Under the present scenario of liberalised tradein agriculture, there is an increasing likelihood of anumber of serious exotic pests gaining entry andestablishment through bulk imports. Among theseare moko wilt in banana, which has seriouslythreatened banana cultivation in Central and SouthAmerica. Further, lethal yellowing of coconut isanother dreadful disease which was responsiblefor the loss of more than half a million coconutpalms in Jamaica, which was worst affected andcreated havoc in the Caribbean region. Cadang-cadang is another destructive disease in coconutreported from Philippines and Guam. The red ringnematode causes serious losses to coconut andother palms in tropical America. The SouthAmerican leaf blight in rubber is another diseaseof quarantine concern which, so far, is not knownto have occurred in Southeast Asia, but is still aserious concern to rubber producing countries inthis region. Coffee berry disease is of sufficientconcern to India and has caused serious losses incoffee production in African countries. Further, twodestructive pathogens of cocoa, viz., swollen shootvirus and witches’ broom though not known to haveoccurred yet in India, are of sufficient concern tococoa production in the country. Likewise thereare many pests that attack plants against, whichwe need to safeguard our country.

It may be mentioned that a number ofdestructive pests/diseases have recently beenintercepted in quarantine, which highlights the riskof introduction of these pests/diseases throughindiscriminate imports. The interceptions in plantsinclude insects like Anthonomus grandis onGossypium sp from USA, Ephestia elutella onTriticum aestivum from Italy, nematodes likeDitylenchus dipsaci in Allium cepa from England,Heterodera schachtii in Beta vulgaris fromGermany; pathogens like Peronospora manshuricain Glycine spp from several countries and viruses

like cowpea mottle virus on Vigna unguiculata fromthe Philippines and Alfalfa mosaic virus on Vignaunguiculata from Nigeria.

7.4.1 Legislative and Regulatory Framework

The legislative and regulatory framework at thenational and international level for the managementof agroterrorism activities are discussed in thefollowing sections.

(A) National

i) Destructive Insects and Pests Act, 1914

The quarantine law was enacted for the firsttime in India in 1914 as the DestructiveInsects and Pests (DIP) Act. A gazettenotification entitled ‘Rules for Regulating theImport of Plants etc., into India’ waspublished in 1936. Over the years, the DIPAct has been revised and amended severaltimes. However, it was further amended tomeet the emerging scenario of liberalisedtrade under WTO.

The DIP Act (1914) provides for thefollowing:

a. It prohibits or regulates the import intoIndia or any part thereof or any specificplace therein or any article or class ofarticles.

b. It also prohibits or regulates the exportfrom a state or the transport from onestate to another state in India of anyplants and plant materials, diseasesor insects, likely to cause infection orinfestation.

c. It authorises the state government tomake rules for the detention,inspection, disinfection or destructionof any pest or class of pests or of anyarticle or class of articles, in respectof which the central government hasissued notifications.

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In 1984, a notification was issued under theDIP Act, namely Plants, Fruits and Seeds(Regulation of Import into India). The order,popularly known as the PFS Order, wasrevised in 1989 after the announcement ofthe New Policy on Seed Development byGoI in 1988, proposing major modificationsfor smooth quarantine functioning. The newpolicy covered the import of seeds, plantingmaterials of wheat, paddy, coarse cereals,oil seeds, pulses, vegetables, flowers,ornamentals and fruit crops. Whileliberalising imports, care has been takento ensure that there is absolutely nocompromise on plant quarantinerequirements. Though there are severalrequirements under the PFS Order, 1989,the most important are:

a. No consignment would be importedinto India without a valid import permitissued by the concerned competentauthority: (a) for bulk consignments theimport permit issued by the PlantProtection Advisor to GoI; (b) forimporting germplasm of agri-horticultural crops, the Director of theNational Bureau of Plant GeneticResources (NBPGR) is authorised byGoI to issue import permits, both forgovernment institutions as well asprivate seed companies; (c) for forestplants, the Forest Research Institute,Dehradun; and (d) for the remainingplants of economic and generalinterest, the Botanical Survey of India,Kolkata. No consignment will beimported unless accompanied by anofficial phyto-sanitary certificate issuedby an official agency of the exportingcountry.

b. Seeds/planting materials requiringisolation growing under detention, tobe grown in an approved post-entryquarantine facility.

c. Import of soil, earth, sand, compost,plant debris accompanying seeds/planting materials is not permitted.Besides, hay, straw or any othermaterial of plant origin are not to beused as packing material.

d. Special conditions for import of plants,seeds for sowing, planting andconsumption mentioned underSchedule II (Clause 4) of the Order.

ii) Plant Quarantine (Regulation of Import intoIndia) Order, 2003.

With liberalised trade under the WTOAgreements, there has been a pressingneed for complying with international phyto-sanitary regulations. Therefore, to fill in thegaps in the existing PFS Order, viz.,regulating the import of germplasm/GMOs/transgenic plant material; live insects/fungiincluding biocontrol agents etc.; and to fulfilIndia’s obligations under the internationalAgreements, the Plant Quarantine (PQ)(Regulation of Import into India) Order, 2003came into force from 1 January 2004. Underthis Order, the need for incorporation ofadditional/special declarations for freedomof imported commodities from quarantineand alien pests on the basis of standardisedPests Risk Analysis, particularly for seed/planting materials, is also taken care of.

Under the PQ Order, 2003, the scope ofplant quarantine activities has beenwidened with the incorporation of additionaldefinitions. The salient features of the Orderare:

a. Pest Risk Analysis (PRA) has beenmade a precondition for imports.

b. Prohibition has been imposed on theimport of commodities with weeds/alien species contamination as perSchedule VIII; and restriction on theimport of packaging material of plantorigin, unless treated.



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c. Provisions have been included forregulating the import of soil, peat andsphagnum moss; germplasm/GMOs/transgenic material for research; liveinsects/microbial cultures andbiocontrol agents and timber andwooden logs.

d. Agricultural imports have beenclassified as (a) Prohibited plantspecies (Schedule IV); (b) Restrictedspecies where import is permitted onlyby authorised institutions (Schedule V);(c) Restricted species permitted onlywith additional declarations of freedomfrom quarantine/regulated pests andsubject to specified treatmentcertifications (Schedule VI) and ; (d)Plant material imported forconsumption/industrial processingpermitted with normal Phyto-sanitaryCertificate (Schedule VII).

e. Additional declarations have beenspecified in the Order for import of 400agricultural commodities, specificallylisting 600 quarantine pests and 61weed species (now 31 as perAmendment III of the PQ Order, 2003).

f. Notified points of entry have beenincreased to 130 from the existing 59.

g. Certification fee and inspectioncharges have been rationalised.

So far, 10 amendments of the PQ Order,2003, have been notified to WTO revisingdefinitions, clarifications regarding specificqueries raised by quarantine authorities ofvarious countries, with revised lists of cropsunder Schedules IV, V, VI, and VII. Therevised list under Schedule VI and VII nowinclude 411 and 284 crops/commodities,respectively (www.plantquarantineindia.org).Besides, NBPGR has also conducted a PRAfor 95 species which have been notified

under Schedule VI of the PQ Order, 2003,after vetting by DPPQS.

iii) Environment Protection Act (EPA), 1986

In the UN Conference on the HumanEnvironment held at Stockholm in 1972, inwhich India participated, it was urged thatall countries should take appropriate stepsfor protection and improvement of thehuman environment. Consequently, the EPAwas enacted in 1986 to protect and improvethe environment and prevent hazards tohuman beings, other living creatures, plantsand property.

The Environment (Protection) Rules, 1989came later for the purpose of protecting andimproving the quality of the environmentand preventing and abating environmentalpollution. In its various schedules, relevantprovisions have been made for themanagement and handling of hazardouswastes; rules for manufacture, storage andimport of hazardous chemicals; and rulesfor the manufacture, use, import/export andstorage of hazardous microorganisms,genetically engineered organisms or cells.It empowers the central government toprohibit or restrict the handling of hazardoussubstances, including their export andimport in different areas either in qualitativeor quantitative terms because of its potentialto cause damage to the environment, humanbeings, other living creatures, plants andproperty. Both living modified organisms(LMOs) and invasive alien species arecovered under EPA, however, it does notstate in clear terms the modality forrestriction and prohibition of these potentialthreats to the environment.

iv) Biological Diversity Act, 2002

The Biodiversity Act primarily addresses theissue of access to genetic resources andassociated knowledge of foreign

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individuals, institutions or companies, andequitable sharing of benefits arising out ofthe use of these resources and knowledgeto the country and the people. In order tosafeguard the interests of the people ofIndia the proposed exceptions are:

a. Free access to biological resources foruse within India for any purpose otherthan commercial use.

b. Use of biological resources by vaidsand hakims.

c. Free access to the Indian citizens touse biological resources within thecountry for research purposes.

d. Collaborative research throughgovernment sponsored or governmentapproved institutions subject to theoverall policy guidelines and approvalof the central government.

There is need to take care of the provisionsof the PQ Order, 2003 while dealing withthe ‘Regulation of Access to BiologicalDiversity’—prepare a list of pests which havea wide host range to predict their impact onbiodiversity and have a mechanism for in-country movement of disease-free material,including those for research.

v) GM Crops

Genetic engineering tools and recombinantDNA technology have led to thedevelopment of transgenic or geneticallymodified crops with a novel combinationof genetic materials.

Biosafety framework in India:

The GM crops developed throughbiotechnological applications are passedthrough a stringent regulatory frameworkbefore its approval by the GoI. The Ministryof Environment and Forests (MoEF) and DBTare the nodal agencies for implementation

of the above-mentioned regulations. Thereare six statutory bodies involved:

a. Recombinant DNA AdvisoryCommittee under DBT to recommendappropriate safety regulations inrecombination research, use andapplications.

b. The Institutional Biosafety Committeeto prepare site-specific plans for theuse of genetically engineeredmicroorganisms.

c. Review Committee on GeneticManipulation under DBT to oversee allresearch and field trials on LMOs.

d. The Genetic Engineering ApprovalCommittee under MoEF to considerproposals related to the release ofgenetically engineered organisms intothe environment.

e. The State Biotechnology CoordinationCommittee to inspect, investigate andtake punitive action in case ofviolations of safety and controlmeasures in the handling of geneticallyengineered organisms.

f. The District Level Committee tomonitor safety regulations ininstallations engaged in the use ofgenetically modified organisms andtheir applications in the environment.

vi) Disaster Management Act, 2005

Refer to Chapter 2 of this document.

(B) International

i) Agreement on the Application of Sanitaryand Phyto-sanitary Measures

This Agreement, commonly known as SPSAgreement of WTO of which India is asignatory member, concerns the applicationof food safety, animal and plant health



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regulations. It recognises the government’srights to take sanitary and phyto-sanitarymeasures but stipulates that they must bebased on science, should be applied onlyto the extent necessary to protect human,animal and plant life or health and shouldnot arbitrarily or unjustifiably discriminatebetween members where identical or similarconditions prevail. The Agreement aims toovercome health-related impediments ofplants and animals to market access byencouraging the ‘establishment, recognitionand application of common sanitary andphyto-sanitary measures by differentMembers’.

SPS measures are defined as any measureapplied to protect animal or plant life orhealth from risks arising from the entry,establishment or spread of pests anddiseases; to protect human or animal lifeor health from risks arising from additives,contaminants, toxins or disease causingorganisms in food, beverages or foodstuffs;and to protect human life or health fromrisks arising from diseases carried byanimals. There are three standard-settinginternational organisations whose activitiesare considered to be particularly relevantto its objectives: FAO/WHO, CAC, OIE, andthe international and regional organisationsoperating within the framework of theInternational Plant Protection Convention(IPPC).

ii) Global Developments in the wake of SPSAgreement of WTO

Recently, the Department of Agriculture,Fisheries and Forestry of theCommonwealth of Australia establishedBiosecurity Australia for conducting importrisk analyses as per the AustralianQuarantine Inspection Service’s Import RiskAnalysis Process. Biosecurity Australia isresponsible for the development of phyto-

sanitary standards and it has set up animport conditions database. Further,Biosecurity Australia is actively involved innegotiations with trading partners andinternational fora to maintain, gain orimprove access to export markets for liveanimals and their genetic material, plants,and plant products.

Similarly, New Zealand’s Ministry ofAgriculture and Forestry has establishedPlants Biosecurity, which has implementedan integrated biosecurity system forimported agricultural/horticultural products.The New Zealand Ministry of Agriculture andForestry Biosecurity Authority is responsiblefor the development and implementation ofplant import health standards and itsofficials have been closely associated withthe development of international standardson phyto-sanitary measures.

Canada also has established anindependent self-sustaining Canadian FoodInspection Agency, an umbrella organisationfor implementation of SPS measures relatedto animal and plant products. Uruguay andChile have established self-sustainingagricultural quarantine inspection servicesfor enforcing SPS measures totally in linewith the WTO-SPS Agreement and forgedstrong economic integration amongArgentina, Brazil, Bolivia and Paraguay.

The European Union has forged strongeconomic integration and adopted commonplant health directives to protect theinterests of the member countries. TheAnimal and Plant Health Inspection Service(APHIS) is an independent serviceestablished under the United StatesDepartment of Agriculture (USDA) which isresponsible for implementing SPSmeasures. A list of national standards onphyto-sanitary measures is provided inAnnexure-I.

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iii) Major challenges under the WTO-SPSAgreement for developing countries

In the wake of implementation of the WTO-SPS Agreement, developing countries haveto face the following challenges:

a. Review and updating of phyto-sanitarylegislation and regulations to giveeffect to the international agreementand establish a nodal point forenquiries and information exchange,including a notification procedure.

b. Establishment of national standards onSPS measures in line with internationalstandards to undertake pest riskanalysis and identify pest-free areasand scientifically justify the high levelof protection in the absence of pestrisk assessment.

c. Recognition of the equivalence ofspecific measures through bilateral ormultilateral agreements.

d. Strengthening of backup research inquarantine for diagnosis and treatment.

e. Capacity building in terms ofinfrastructure and expertise.

iv) Biological and Toxin Weapons Convention

Refer to Chapter 4 of this document.

v) Convention on Biological Diversity (CBD)

In 1992, the largest ever meeting of worldleaders took place at the UN Conferenceon Environment and Development in Rio deJaneiro, Brazil. A historic set of agreementswere signed at this ‘Earth Summit’, includingCBD, the first global agreement on theconservation and sustainable use ofbiological diversity. The biodiversity treatygained rapid and widespread acceptance.Over 150 governments signed thedocument at the Rio conference, and sincethen more than 175 countries have ratifiedthe Agreement.

The Convention had three main goals, viz.,conservation of biodiversity, sustainable useof the components of biodiversity, andsharing the benefits arising from thecommercial and other utilisation of geneticresources in a fair and equitable way. TheConvention was comprehensive in its goalsand dealt with an issue so vital to humanity’sfuture that it stands as a landmark ininternational law. It recognises for the firsttime that the conservation of biologicaldiversity was ‘a common concern ofhumankind’ and is an integral part of thedevelopment process. The Agreementcovers all ecosystems, species and geneticresources. It links traditional conservationefforts to the economic goal of usingbiological resources sustainably. It setsprinciples for fair and equitable sharing ofthe benefits arising from the use of geneticresources, especially those destined forcommercial use. It also covers the rapidlyexpanding field of biotechnology,addressing technology development andtransfer, benefit-sharing and biosafety. TheConvention is legally binding and thesignatory member countries are obliged toimplement its provisions.

Article 8 (h) of CBD, 1992 emphasises onpreventing the introduction and eradicationor control of those invasive alien specieswhich threaten other species, habitats orecosystems. These alien species arerecognised as the second largest threat tobiological diversity and natural resources,after habitat destruction. Article 8 (g) of theConvention directs the members to establishor maintain means to regulate, manage orcontrol the risks associated with the useand release of LMOs which are likely tohave adverse environmental impacts on theconservation and sustainable use ofbiological diversity, also taking into accountthe risks to human health and, specifically,



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focusing on transboundary movements.Recognising the potential risk arising fromLMOs, Article 19.3 of CBD provides for thesafe transfer, handling and use of LMOs.....After several meetings the parties adoptedthe International Protocol on Biosafety inJanuary 2000.

7.4.2 National Organisation

Indian Council of Agricultural Research

ICAR is an autonomous apex body responsiblefor the organisation and management of researchand education in the fields of agriculture, animalsciences and fisheries. To fulfil its mission, ICARaims to achieve the following mandate:

i) To plan, undertake, aid, promote andcoordinate research and education,extension in agriculture, horticulture,plantation crops, animal sciences, fisheries,agroforestry, home science and alliedsciences.

ii) To act as a clearing house for research andgeneral information relating to agriculture,animal husbandry, fisheries, agroforestry,home science and allied sciences throughits publications and information system, andinstituting and promoting transfer oftechnology programmes.

iii) To look into the problems relating to broaderareas of rural development concerningagriculture, including post-harvesttechnology, by developing cooperativeprogrammes with other organisations suchas the Indian Council of Social ScienceResearch, CSIR, Bhabha Atomic ResearchCentre, Agricultural and Processed FoodProducts Export Development Authority, theMinistry of Food Processing Industries,MHA, state agricultural universities andcentral research institutes.

ICAR has established several research centresin order to meet the agricultural research andeducation needs of the country. It is activelypursuing HRD in the field of agricultural sciencesby setting up numerous agricultural universitiesacross the country. The Technology InterventionProgrammes form an integral part of ICAR’s agenda,making KVKs responsible for training, research anddemonstration of improved technologies. ICAR,through its various institutes, carries out researchwork on the detection and management of bothindigenous and exotic pests and diseases oflivestock, plants, animals and fisheries, andundertakes quarantine processing of plantgermplasm and research material, including thatof transgenics, at NBPGR. HSADL, Bhopal, hasthe facilities to work with exotic disease-causingmicrobes under high containment conditions.

7.4.3 International Organisations

(A) World Trade Organization

WTO, established on 1 January 1995, is thelegal and institutional foundation of the multilateraltrading system. It is the platform on which traderegulations among countries evolve throughcollective debate and negotiation and which in turnhave a broad scope in terms of commercial activityand trade policies for all the member countries.The WTO Agreement contains more than 60agreements in 29 individual legal texts coveringeverything from services to governmentprocurement, rules of origin and intellectualproperty (http://www.wto.org). Of these, theAgreement on the Application of Sanitary andPhyto-sanitary (SPS) measures is in fact the onewhich is going to have major implications onbiosecurity in trade. It covers measures to beadopted by countries to protect human health fromdiseases; human or animal life from food-bornerisks; and animals and plants from pests anddiseases. The specific aims of SPS measures are

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to ensure food safety and to prevent the spread ofdiseases among animals and plants.

In order to achieve these targets, internationalstandards need to be developed for which WTOhas assigned the responsibilities as follows:

i) For food safety: CAC, Vienna, a subsidiaryorgan of FAO, and WHO has beenauthorised for all matters related to foodsafety evaluation and harmonisation.

ii) For animal health and zoonosis: OIE, Paris,develops the standards, guidelines andrecommendations.

iii) For plant health: IPPC at FAO, Rome, is thesource for International Standards for thePhyto-sanitary Measures affecting trade.

These three organisations are often referred toas the ‘Three Sisters’ who are observers andcontributors to the SPS committee meetings. Theyalso serve as experts who advise WTO disputesettlement panels.

The main purpose of WTO is to promote freetrade flow, serve as a forum for trade negotiationsand serve as a dispute settlement body, basedupon the principles of non-discrimination, equaltreatment and predictability. Agriculture wasbrought under the purview of multilateral tradenegotiations and this has led to apprehensionsamong the people that implementation of theprovisions of the agreement will have an adverseeffect on domestic agricultural production, exportsand imports.

(B) Food and Agricultural Organization

FAO is an organ of the UN which has a numberof programmes on plant and animal biosecurity.IPPC, as mentioned earlier, has its secretariat inFAO and takes care of plant biosecurity issues.IPPC develops international standards on phyto-sanitary measures through a Commission on Phyto-

sanitary Measures and networks with all regionalplant protection organisations at the global level.FAO has a biosecurity portal which is a storehouseof knowledge and information on all aspects ofanimal and plant diseases and gives informationon the various Technical Cooperation Projectsundertaken in the developing world. It alsopromotes or sponsors various trainingprogrammes on issues related to pest risk analysis,EWS, etc.

7.4.4 Prevention and Preparedness: NationalContext

DPPQS under the Department of Agricultureand Cooperation of MoA has a network of 29 PQstations at various international airports, seaportsand land frontiers to check bulk imports of grains,seeds and other planting materials for the presenceof diseases and pests that may be associated withthese materials. Though a few of these stationsare well equipped, in general they lack trainedmanpower and infrastructure to handle importedmaterials effectively and quickly. As far asquarantine of imported research material(germplasm, transgenic planting material) isconcerned, it is undertaken by ICAR at NBPGR,which has both the expertise and the laboratoryand post-entry quarantine facilities (including acontainment facility of CL-4 level) to do the jobeffectively.

(A) Legislation

The new PQ (Regulation of Import into India)Order, 2003 is an attempt to comply with the variousprovisions of the SPS Agreement of WTO of whichIndia is a signatory. The new PQ Order has howeverevoked many queries from the EuropeanCommission, US Department of Agriculture (USDA),Canada, and other developed countries. The PQorder is being looked into for suitable amendmentsto promote trade and not to use quarantinemeasures as a technical barrier to trade.



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(B) Recent Developments in Strengthening PlantQuarantine Facilities

Keeping in view the significant role played byphyto-sanitary services in the safe conduct of globaltrade in agriculture, MoA has established modernpest diagnostic laboratory facilities with high-techscientific equipment at five regional centres atAmritsar, Chennai, Kolkata, Mumbai and New Delhiunder the FAO-United Nations DevelopmentProgramme (UNDP) Project. The Project wasaimed at developing and strengthening plantquarantine facilities at major ports through capacitybuilding and HRD. Further, under this project,various expert consultations were organised indrafting PQ legislation; training programmes/workshops in pest risk analysis and surveillance;preparation of operational manuals; setting up oflaboratory diagnostic facilities; designing of glasshouse facilities; quality systems and auditing; etc.

Besides, a PQ website, www. plant quarantineindia.org was designed and hosted under theabove-mentioned project. The PQ website providesinformation about contact points, plant quarantinesetup, PQ Act and regulations, New Seed Policyguidelines, quarantine procedures for issuance ofpermit, import clearance, post-entry quarantineinspection and export inspection and certificationof agriculture commodities. But it needs to beupgraded in a dynamic mode. Also, a suitablesoftware package was developed for creating adatabase on endemic pests of prioritisedcommodities. Quality Systems-InternationalStandards Organisation (ISO) 9002 certification hasbeen implemented for quarantine screening andlaboratory testing of import/export plants and plantmaterial at the Regional PQ Station, Chennai. Thisinvolved preparation of quality policy manual/quality procedures manual for documentation ofthe procedures being practiced and periodicalreview and auditing to ensure these proceduresare being followed through corrective andpreventive actions.

(C) Recent Attention given to Technical Issues

i) Steps are now being taken to conduct PRAon priority commodities of export/import,though still in an ad hoc manner.

ii) The database on endemic pests is beingdeveloped at Regional PQ Station,Chennai, and the database on pests ofquarantine significance to India are beingdeveloped at NBPGR, New Delhi. Thesewill be complimentary and serve as abackbone of information for developingPRA.

iii) Amendments to the revised PQ Order, 2003are being brought about, keeping in viewthe global demands for facilitating trade.

iv) A task force on phyto-sanitary capacitybuilding has been recently set up to lookinto the immediate and long-term trainingneeds at different levels.

v) Steps are also being taken to establish aPQ authority which would make the systemmore dynamic from the operational andfinancial aspects.

7.5 Guidelines for Biological DisasterManagement—Agroterrorism

7.5.1 Legislative and Regulatory Framework

Quarantine legislations are in place and havebeen revised. Specific regulatory measures will bedeveloped to deal with agroterrorism. It shouldinclude strong legislative and administrativepolicies for import/export processes related toapplication of SPS measures; to implement surveyand control, including emergency actions againstpests; to search, seize, inspect, treat or destroyinfected/infested material; to enact or enforce SPSregulations; to negotiate, establish and comply withbilateral agreements; and to allow and performauditing and monitoring of SPS activities.

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7.5.2 Risk and Vulnerability Assessment

Mechanisms to assess the risk of attack onagricultural crops/storage godowns will be definedand developed based on threat analysis.

As far as imports are concerned, steps arebeing taken to gear up pest risk analysis forimported commodities, but it is still in process. Anorganised system dedicated to carry out pest riskanalysis against identified quarantine pests will beestablished. This requires an independent unit forrisk analysis with trained manpower and computerand internet facilities.

(A) Integrated Pest Surveillance System

i) An effective integrated pest surveillancesystem and organisation devoted toperforming field inspection and pest surveyactivities for the detection, delimitation ormonitoring of established pests, as well asa system and organisation devoted to thedetection of new pests will be introduced.

ii) Specific systems will be required foridentification, establishment andmaintenance of pest-free areas accordingto international standards.

(B) Intelligence Gathering and SecuredDissemination of Information

The agriculture departments of the district/stateagricultural machinery will work out the modalitiesat the local/regional levels for intelligence gatheringand secured dissemination of information. Suchprocesses will be developed knowing the fact thatthe stakeholders are generally farmers, a majorityof whom have small land holdings and need to beprotected from any unforeseen calamity to avoidchaos at all levels.

7.5.3 Prevention and Early Detection

i) The first step to ward off ultimate harm froman agroterrorist attack in the field is to have

a mechanism for early detection of thedisease. This again highlights theimportance of integrated pest surveillancewith the component of early detection asone of its mandates.

ii) At the field level, this would involve propereducation and awareness programmes forthe villages to ward off intentional attacksby suspected agroterrorists on their crops/animals/livestock and also to equip themwith the emergency curative measures tobe taken in such a situation.

iii) DDMAs will ensure that there is enoughstock of disinfectants and vaccines foranimals; and chemicals, biopesticides andbiocontrol agents to save crops from anysuspected attack.

iv) For imports, the quarantine network will bestrengthened especially at land frontiers ofthe country through which agroterrorists caneasily bring in exotic pests in a clandestinemanner.

7.5.4 Preparedness

(A) Emergency Control and Treatment

i) An EOC will be established as a nationalhub for incident operations support,communications, and informationdissemination pertaining to themanagement of animal and plant incidentsand all similar hazards. The EOC willintegrate and provide overall monitoringand operations support and serve as theprimary point of coordination duringagricultural health emergencies.

ii) The EOC has to be used in both routineand emergency situations. When anemergency situation is not underway, theCentre’s facilities will be used to monitorand report on international and domesticsurveillance of pest pathogens and diseaseconditions of concern and to conductadvanced training.



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iii) The EOC will have advanced securityfeatures such as a secured room withinfrared motion sensors and cameras, soundmasking and a secure phone line. Thecommunication capabilities will includevideo teleconferencing, advancedcomputer interfaces, GIS mapping and astrong multimedia component.

iv) A system and organisation for performanceof quarantine treatments, includingemergency pest control activities for newpest introductions, will be defined.

(B) Development of National Standards on Phyto-sanitary Measures

The establishment of national standards onphyto-sanitary measures in line with internationalstandards is of critical concern to meet the stiffchallenges under international agreements.Currently, there are 27 such international standards.Therefore, it is necessary to review the 21 nationalstandards (Annexure-I).

Also, certain new standards will be developedon priority a for the following:

i) Guidelines for aluminum phosphidefumigation.

ii) Guidelines for surveillance, consignmentsin transit, pest reporting, sampling anddiagnostic protocols.

iii) SOPs and manuals will be developed foroperational purposes.


i) The quarantine stations at sea ports, airportsand land frontiers will be upgraded in termsof facilities and expertise for detection andidentification of exotic pests and salvagingof the infected/infested material bydeveloping suitable disinfestation protocols.

ii) Post-entry quarantine facilities for materialsknown to carry latent infections of pests willalso be developed and maintained.

iii) An antisera bank of exotic viruses, adatabase on sequences of virus specificprimers and also a repository of seeds ofindicator hosts will be developed forspecialised detection and identification ofviruses of exotic origin.

iv) Professionals will be trained to identify newpests or strains unknown to a particular region.

7.5.6 Documentation

i) SDMAs and DDMAs will ensure thedevelopment of a proper documentation ofpest surveillance data of the state, andmethods for early detection of diseases andpests, including exotic diseases not knownto occur in the region. They will undertakemanagement of options and emergencyoperations, including contact points, etc.,in case of any agroterrorist activity.

ii) The documentation must be available in theregional/local language also as thestakeholders generally do not have a highliteracy profile.


(A) Academic and Scientific Research Institutions

The designated institutions will be directed bythe respective authorities/departments/ministries toundertake the following activities:

i) Generation of comprehensiveepidemiological data on important pests/diseases to determine their tolerance limits.This would also help in developing pest riskanalysis.

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ii) Development of sensitive detection andsalvaging techniques to detect low levelsof infections as the quarantine samplesneed to be subjected to various techniquesfor detection of a variety of pests. This ismore challenging in the case of smallsamples of germplasm as besides beingsensitive, the technique also needs to benon-destructive.

iii) Development of suitable alternatives tomethyl bromide, a widely used quarantinefumigant which is being phased outbecause of to its adverse environmentalimpacts. This is now designated as anozone-depleting substance and a potentialhealth hazard to various organisms in theMontreal Protocol (1987). India has ratifiedthe Montreal Protocol and is legallycommitted to phase out the use of methylbromide except for pre-shipment andquarantine purposes, by 2015.

iv) Development of molecular techniques forthe detection of races/biotypes/strains willalso be intensified as they are alsoconsidered pests under the IPPC definitionof pests. These detection techniques shouldbe sensitive enough to detect even lowlevels/concentrations of pests.

v) Studies on factors affecting the likelihoodof survival of pests under different conditionsof transport, mode of dispersal, distributionof hosts/alternate hosts at the destination,potential for establishment, reproductivestrategy and method of pest survival,potential vectors and natural enemies of thepest in the area, etc., will be urgentlyundertaken to authentically prepare a PRAduring exchange.

(B) Accreditation of Laboratories

An auditing system to monitor theimplementation and evaluation of the effectiveness

of SPS measures to ensure their consistentapplication or justification in maintaining suchmeasure or modification to the changed situationwill be put in place by the departments ofagriculture, both central and state.

(C) Linkages with National Programmes

At present, the staff of DPPQS works in isolationand is not really getting the benefits of the variousresearch organisations of ICAR and stateagricultural universities for the detection andidentification of pests and for control strategies.An active linkage will be developed between theAll India Coordinated Research Projects andactivities of DPPQS in order to have comprehensivesurvey and surveillance programmes. After theNational Agricultural Technology Project ended,ICAR started the National Agricultural InnovationProject in 2007 with assistance from the WorldBank. In this research, projects in the fields ofagronomy, soil science, horticulture, plantbreeding, extension, etc., are submitted by stateagriculture universities and national institutes, andapproved by the Project Implementation Unit inKrishi Anusandhan Bhavan II in Pusa, New Delhi.


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Implementation ofthe Guidelines8

The National Guidelines on BDM have beenformulated as part of an integrated national 'allhazard' approach for the management of disasters.The prime aim is to reduce the occurrence andmitigate to the lowest level possible the effects ofbiological disasters affecting mankind, livestockand crops, and the associated risks posed tohealth, life and environment. It is ensured that allaspects of preparedness required are covered forprevention, mitigation and quick and efficientresponse, including measures pertaining to relief,recovery and rehabilitation. The BDM approachaims to institutionalise the implementation ofinitiatives and activities covering the entirecontinuum of the disaster management cycle. Theobjective is to develop a national community thatis informed, resilient and prepared to face disasterswith minimal loss of life while ensuring adequatecare for the survivors. Therefore, it will be theendeavour of the central and state governmentsand local authorities to ensure its implementationin an efficient, coordinated and focused manner.This can be accomplished by forging reciprocalrelationships as envisaged by the institutionalmechanism set up through the DM Act, 2005, viz.,the NDMA, SDMAs and DDMAs.

The primary responsibility of preparedness andresponse shall continue to remain with the stateand district authorities. Further capacityenhancement and reinforcement of the system,whenever required, will be provided by the centraland state governments. Initiatives like PPP will beencouraged for further revamping the system. Inorder to optimise the use of resources whileensuring effectiveness and promptness, theresponse to biological disasters will be highly

structured and coordinated. The following factorsare considered critical for ensuring a seamless andharmonious functioning of all concernedstakeholders during the management of biologicaldisasters:

i) Institutionalisation of programmes andactivities at the ministerial/department level.

ii) Identification of the various stakeholders/agencies/institutions with precise roles,responsibilities, a clear chain of commandand work relationships.

iii) Rationalisation and augmentation of theexisting regulatory framework andinfrastructure.

iv) Matching infrastructure, capacitydevelopment and response mechanisms foroverall preparedness.

v) Improved inter-ministerial and inter-agencycommunication, coordination andnetworking at all levels.

MoH&FW, as the nodal ministry, will foreseethe implementation of the guidelines at the nationallevel. The other stakeholders in biologicalemergency management are MoD, MoR, MoL&E,MoA, DADF at the central level; ministries/departments of health of the states/UTs; scientificand technical institutions, academic institutions inagriculture, life sciences, zoological sciences,animal husbandry, medical, biomedical andparamedical field; and professional bodies,corporate sector, NGOs and the general community.

Implementation of the Guidelines will beginwith the formulation of a biological disaster

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preparedness plan as part of an ‘all hazard’ DMplan in all districts, states/UTs and centralministries. The enabling phase will be used to buildnecessary capacity, taking into consideration theexisting elements such as techno-legal regimes,stakeholder initiatives, emergency plans, gaps,priorities based on vulnerabilities and riskassessment. The existing DM plans at variouslevels will be further revamped/strengthened toaddress biological disaster preparedness. Thecentral ministries/departments, states/UTs anddistricts will prepare and implement DM plans atall levels that address the strategic, operationaland administrative aspects through an institutional,legal and operational framework.

These Guidelines have set modest goals andobjectives of biological disaster preparedness tobe achieved by mustering all stakeholders throughan inclusive and participative approach. Allconcerned ministries of GoI, the state governments,UT administrations and district authorities willallocate appropriate financial and other resources,including dedicated manpower and targetedcapacity development, for successfulimplementation of the Guidelines. A list of importantwebsites is given in Annexure-J.

8.1 Implementation of the Guidelines

8.1.1 Preparation of the Action Plan

Implementation of the Guidelines at thenational level will begin with the preparation of adetailed action plan (involving programmes andactivities) by MoH&FW that will promote coherenceamong different BDM practices and strengthenmass casualty management capacities at variouslevels. Line ministries such as MoD, MoR, MoL&E,MHA, and MoA, etc., will also prepare theirrespective preparedness plans as part of ‘allhazard’ DM plans and action plan. In view of theexpected role of these important line ministries inmanagement of mass casualties in the event of

national calamities, they should also cater fordeveloping additional capacities besides meetingtheir own requirements, in their preparedness plan.

The plan will be simple, realistic, functional,flexible, concise, holistic and comprehensive,encompassing networking of medical, laboratoryand public health components. The plan wouldlay special emphasis on the most vulnerablegroups/communities to enable and empower themto respond and recover from the effects of biologicaldisasters.

The National Plan needs to include:

i) Measures to be taken for minimisation/reduction of biological disasters (leadingto zero tolerance), or mitigation of theireffects (leading to avoidable morbidity andmortality).

ii) Measures to be taken for integration ofmitigation procedures in the developmentplans.

iii) Measures to be taken for preparedness andcapacity development to effectivelyrespond to any threatening mass casualtysituation.

iv) Roles and responsibilities of the nodalministry, different ministries or departmentsof the GoI, institutions, community andNGOs in respect of the measures specifiedin clauses i), ii), and iii) above.

The action plan will spell out detailed workareas, activities and agencies responsible, andindicate targets and time frames for implementationand be continually reviewed and updated. Theidentified tasks, to the extent possible, will bestandardised to have SOPs and resource inventory,etc. The action plan should have an inbuiltmechanism to coordinate with other ministries andNEC. The plan will also specify indicators ofprogress to enable their monitoring and reviewwithin the ministry and by the National Authority.

IMPLEMENTATION OF THE GUIDELINES


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The plan would be sent to NDMA through NEC forapproval.

The ministries/agencies concerned, in turn, will:

i) Issue guidance on the implementation ofthe plans to all stakeholders.

ii) Obtain periodic reports from thestakeholders on the progress ofimplementation of the DM plans.

iii) Evaluate the progress of implementation ofthe plans against the time frames and takecorrective action, wherever needed.

iv) Disseminate the status of progress andissue further guidance on implementationof the plans to stakeholders.

v) Report the progress of implementation ofthe plans to the nodal ministry.

MoH&FW will keep the National Authorityapprised of the progress on a regular basis.Similarly, concerned state authorities/departmentswill develop their state-level DM plans and dovetailit with the national plan and keep the NationalAuthority and SDMA informed. The statedepartments/authorities concerned will implementand review the execution of the DM plans at thedistrict and local levels along the above lines.

8.1.2 Implementation and Coordination at theNational Level

Planning, execution, monitoring and evaluationare four facets of the comprehensiveimplementation of the Guidelines. If desired, thenodal ministry can co-opt an expert nominated bythe National Authority during the planning stageso that the desired results are achieved throughthe action plan. The consultative approachincreases ownership of the stakeholders in thesolution process by bringing clarity to the rolesand responsibilities with regard to variouspreparedness activities. Detailed documentation

of the monitoring mechanism to be employed forundertaking a transparent, objective andindependent review of the National DisasterManagement Guidelines—Management ofBiological Disasters will be worked out. A separategroup of experts may be earmarked for evaluationto get an objective, third-party feedback on theeffectiveness of the activities based upon theGuidelines.

The important issues while preparing the actionplan include:

i) Adopting a single window approach forconducting and documenting the activitiesoutlined in the guidelines in each of thestakeholder ministries, departments,state governments, agencies andorganisations.

ii) Laying down the roles and responsibilitiesof all stakeholders at the state and districtlevels for managing biological disasters andto assist them in terms of the requiredresources.

iii) Developing detailed documents on how toensure implementation of each of theactivities envisaged in the Guidelines soas to attain a synergy among variousactivities and ensure coordination.

iv) Ascertaining medical preparednessmeasures, including capacity developmentto effectively respond to intentional and non-intentional incidences of biologicaldisasters.

v) Incorporating measures for the preventionof biological disasters, or the mitigation oftheir effects by integration of mitigationmeasures in the development plans.

vi) Coordinating with line ministries such asMoD, MoR, civil aviation and ESIC networksfor maintaining their resources and ensuringthese are available during biologicalemergencies.

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vii) Ensuring professional expertise for thedissemination, monitoring and successfuland sustainable implementation of thevarious plans at all levels.

viii) Ensuring that the skills and expertise ofprofessionals are periodically updatedcorresponding to global best practicesaccording to the spirit of the emergencymedical management framework for BDM.

The national plans would lay emphasis onidentified critical gaps in managing biologicaldisasters and would strengthen the governmenthospitals and assist the states in putting uprequisite infrastructure, including specialisedcapabilities, for managing mass casualties arisingout of biological disasters. This may include self-contained mobile hospitals that can be airlifted ortransported by road, rail or waterways to thedisaster affected area, especially if the healthfacilities at local levels themselves are affected. Acoordinated and synergistic partnership with theprivate sector, NGOs and Red Cross will help inproviding critical resources during responseoperations and assist in restoring essential services.

8.1.3 Institutional Mechanisms andCoordination at the State and DistrictLevel

The state/UT governments may adopt in theirplan the measures indicated in para 8.1.2 above,as applicable. The respective state/UT/districtauthorities will develop the biological disasterpreparedness plans based upon the BDMGuidelines as a part of ‘all hazard’ DM plans. Themeasures indicated at the national level may beadopted to ensure effective implementation byregular monitoring at the state level by theconcerned authorities. The state will also allocateresources and provide necessary finances forefficient implementation of the plans. Since mostactivities under the Guidelines are community-centric and require the association of professional

experts for planning, implementation andmonitoring, the state DDMAs will formulate suitablemechanisms for their active involvement at variouslevels.

The India Disaster Resource Network databasewill be strengthened by the states by continualupdating, enhancement and integration with therespective DM plans. The activities are to be takenup in project mode with a specifically earmarkedbudget (both plan and non-plan) for each activity.The approach followed will emphasisepreparedness and disaster-specific risk reductionmeasures, including technical and non-technicalmitigation measures that are environment andtechnology friendly and sensitive to the specialrequirements of the vulnerable groups andcommunities.

8.1.4 District Level to Community LevelPreparedness Plan and AppropriateLinkages with State Support Systems

A number of weaknesses have been identifiedwith regard to awareness generation, response timeand actions like evacuation, medical assistanceand other timely actions for detection, earlywarning, vaccination, quarantine, evacuation,medical management activities and public healthissues. This is specially observed in the districtDM plans and has been found to be a weak link inemergency management. The central and stategovernments will evolve mechanisms through mockexercises, awareness programmes, trainingprogrammes, etc., with a view to sensitise andprepare the officers concerned for initiating promptand effective response during such emergencies.

The CMO of the district will be in charge ofthe overall medical management of bothgovernment and private set-ups during disasterevents. Prior arrangements will be worked out withthe private sector to ensure that all these resourcescan be adopted in disaster situations. He will be



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responsible for preparing the district BDM plan aspart of the district DM plans based on the BDMGuidelines.

Disaster resilience is the ability of thecommunity to anticipate disasters and react quicklyand effectively when they strike. The process ofbuilding resilience will be made through awarenessgeneration, organising health and sanitation fairs,involving them in mock exercises to give directionto their actions, PPP and development of localcapacities by education and training programmes.

8.2 Financial Arrangements forImplementation

After any disaster, central and stategovernments provide funds for immediate relief andrehabilitation to address the immediate needs ofthe affected population in terms of food, water,shelter and medicine. Different disasters in the pasthave revealed that expenditure on response, relief,recovery and rehabilitation far exceeds theexpenditure on prevention, mitigation andpreparedness. With the paradigm shift in thegovernment’s focus on activities during the pre-disaster phase, adequate funds will be allocatedfor prevention/mitigation, preparedness andcapacity development rather than concentratingonly on management at the time of a disaster. Thebasic principle of ‘return on investment’ may notbe applicable in the immediate context but thelong-term impact will be highly beneficial. Thus,financial strategies will be worked out such thatnecessary finances are in place and flow of fundsare organised on a priority basis by identificationof necessary functions in all the phases ofpreparedness, prevention/mitigation, response,relief, recovery and rehabilitation. Importantactivities in this respect include:

i) Central ministries/departments and the stategovernments will mainstream DM efforts intheir development plans.

ii) Specific allocations will be made forcarrying out disaster preparedness andmitigation efforts in the annual as well asdevelopment plans.

iii) On the basis of the multi-hazard vulnerabilitystatus of the particular area, the ‘all hazard’DM plan will have requisite inbuilt mitigationmechanisms, including earthquake-resistant structures for hospital buildingsand other health care managementinstitutions in the government and privatesectors.

iv) The developmental plans will have suitabletechno-financial measures for establishingan effective health care system for thehospitals to ensure preparedness andoverall management.

v) The concerned ministries/departments willinitiate mitigation projects for upgradationof existing infrastructure to meet theenhanced requirement of risk reduction andrisk management.

vi) Private stakeholder will allocate sufficientfunds for the purpose of disaster-specificprevention/mitigation and medicalpreparedness measures for BDM.

vii) Wherever necessary and feasible, thecentral ministries and departments andurban local bodies in the states may initiatediscussions with corporate sectorundertakings to support disaster-specificrisk reduction practices and establishmentof medical set-up to deal with all disastersas part of PPP and corporate socialresponsibility.

Central and state governments will facilitatethe development and design of appropriate risk-avoidance, risk-sharing and risk-transfermechanisms in consultation with financialinstitutions, insurance companies and reinsuranceagencies. The insurance sector will be encouraged

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to promote medical insurance mechanismscovering BDM aspects in the future. A nationalstrategy for risk transfer through insurance, usingthe experiences of micro-level initiatives in somestates and global best practices will be developedto reduce the financial burden of the government.Detailed mechanisms for insurance are requiredto be evolved during the response, relief andrehabilitation phases.

8.3 Implementation Model

The institutional and operational framework,including hospital infrastructure available with thestate and district health authorities in thegovernment sector, needs further revamping andstrengthening. The private sector health careinstitutions should also form an important medicalresource for the management of mass casualtiesduring biological disasters. As on date, none ofthe major hospitals in the government/private sectorare fully equipped and geared for managing masscasualties, particularly victims of natural outbreaks,epidemics and BT activities. The implementationplan has to be drawn up at each level setting atarget in terms of time line, and reviewed eachyear and at every level to evaluate the degree ofachievement, reasons for shortfall, and correctiveaction for timely implementation. The experiencegained in the initial phase of the implementationis of immense value, to be utilised not only to makemid-term corrections but also to frame long-termpolicies and guidelines after comprehensive reviewof the effectiveness of DM plans undertaken in theshort term.

8.3.1 Suggested Broad Time Frame for theImplementation of National Guidelines

The time lines proposed for the implementationof various activities in the Guidelines are consideredboth important and desirable, especially in caseof those non-structural measures for which noclearances are required from central or other

agencies. Precise schedules for structuralmeasures will, however, be evolved in the BDMmanagement action plan that will follow at thecentral ministries/state level duly taking into accountthe availability of financial, technical andmanagerial resources. In case of compellingcircumstances warranting a change, consultationwith NDMA will be undertaken, well in advance,for adjustment on a case-to-case basis. Allidentified activities under the action plan forpreparedness in BDM management will beprepared as part of the ‘all hazard’ managementplan, listed below, for implementation.

(A) Short-term Plan (0–3 Years)

i) Regulatory framework.

a. Dovetailing of existing Acts, Rules andRegulations with the DM Act, 2005.

b. Enactment/amendment of any Act,Rule and Regulation, if necessary, forbetter implementation of all healthprogrammes across the country fordisaster management.

c. Implementation of IHR, CBD and WHOguidelines through internationalcooperation.

ii) Prevention.

a. Strengthening of integratedsurveillance systems based onepidemiological surveys, detectionand investigations of diseaseoutbreaks.

b. Establishment of EWS.

c. Coordination between public health,medical care and intelligenceagencies to prevent BT.

d. Rapid health assessment andprovision of laboratory support.

e. Institution of public health measuresto deal with emergencies as anoutcome of biological disasters.



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f. Immunisation of first responders andadequate stockpiling of necessaryvaccines.

iii) Preparedness.

a. Identifying infrastructure needs forformulating mitigation plans.

b. Equipping MFRs/QRMTs with allmaterial logistics and backup support.

c. Upgrading of earmarked hospitals forCBRN management.

d. Communication and networkingsystem with appropriate intra-hospitaland inter-linkages with stateambulance/transport services, statepolice departments and otheremergency services.

e. Mobile tele-health services.

f. Laying down minimum standards forwater, food, shelter, sanitation andhygiene.

g. Organising community awarenessprogrammes for first aid, general triageand Dos and Don’ts to mitigate theeffects of biological emergencies anddefine their role as a part of thecommunity DM plan.

h. Sensitise and define the role of public,private and corporate sectors for theiractive participation.

i. Capacity development.

1) Knowledge management.

- Sensitising and defining therole of public, private andcorporate sectors for theiractive participation.

2) Human resource development.

- Strengthening of NDRF, MFRs,medical professionals,paramedics and otheremergency responders.

- Development of humanresources for monitoring andmanagement of delayed healtheffects, mental health andpsycho-social care.

3) Education and training.

- Inclusion of knowledge of BDMin the educational curricula ofstakeholders.

- Knowledge management.

- Proper education and trainingof personnel using informationnetworking systems by holdingcontinuing medical educationprogrammes and workshops.

j. Community preparedness.

1) Community awarenessprogrammes for first aid.

2) Dos and Don’ts to mitigate theeffects of medical emergenciesdue to the effect of biologicalagents.

3) Define roles as a part of thecommunity DM plan.

k. Hospital preparedness.

1) Hospital DM plans.

2) Developing tools to augmentsurge capacities to respond to anymass casualty event following abiological disaster.

3) Identifying, stockpiling, supplychain and inventory managementof drugs, equipment andconsumables, including vaccinesand other agents for protection,detection and medicalmanagement.

l. Specialised health care and laboratoryfacilities.

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1) Upgradation of existing andestablishment of new biosafetylaboratories and high containmentfacilities.

m. Scientific and technical institutions forapplied research and training.

1) Post-disaster medicaldocumentation procedures andepidemiological surveys.

2) Regular updation on certain issuesby adopting activities in R&Dmodes initially by pilot studies.

(B) Medium-term Plan (0–5 Years)

i) Prevention.

a. Strengthening of IDSP and EWS atregional levels.

b. Incorporation of disaster-specific riskreduction measures.

ii) Preparedness.

a. Institutionalisation of advanced EMRsystem (networking ambulanceservices with hospitals).

iii) Capacity development.

a. Strengthening of scientific andtechnical institutions for knowledgemanagement and applied researchand training in CBRN management.

b. Continuation and updation of HRDactivities.

c. Developing community resilience.

d. Hospital preparedness.

1) Testing of various elements of theemergency plan through table topexercises and mock drills.

2) Specialised health care andlaboratory facilities.

3) Ensuring stockpile of medicalcountermeasures and medical

supplies such as vaccines,antibiotics, etc.

(C) Long-term Plan (0–8 Years)

The long-term action plan will address the followingimportant issues:

i) Knowledge of BDM as a part of ‘all hazard’training programmes should be addressed inthe present curriculum of science and medicalundergraduate and postgraduate courses.

ii) Establishing of national stockpile of vaccines,antibiotics and other medical logistics.

iii) Initiating relevant postgraduate courses.

iv) Training programmes in the areas ofemergency medicine and BDM as a part of‘all hazard’ training programmes will beconducted for hospital administrators,specialists, medical officers, nurses andother health care workers.

v) Public health emergencies with the potentialof causing mass casualties due to covertattacks of biological agents would also beaddressed in the plan by setting upintegrated surveillance systems, rapidhealth assessment, investigation ofoutbreak, providing laboratory support andinstituting public health measures.

vi) Provision for quality medical care.

vii) Strengthening of the existing institutionalframework and its integration with theactivities of NDMA, state authority/SDMA,district administration/DDMA and otherstakeholders for effective implementation.

viii) Implementing a financial strategy forallocation of funds for different national/state/district-level mitigation projects.

ix) Establishing an information networkingsystem with appropriate linkages with stateambulance/transport services, state policedepartments and other emergency services.The states will ensure proper education and



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training of the personnel using thisinformation networking system.

x) Training of NDRF, MFRs, paramedics andother emergency responders. Identificationand recognition of training institutions fortraining of medical officers, paramedics andMFRs for emergency medicine and DM.

xi) Development of post-disaster medicaldocumentation procedures andepidemiological surveys.

To conclude, the present system ofpreparedness and arrangements for masscasualty management in a biological disaster arerequired to function in a more coordinated andproactive manner. MoH&FW, state governments/district administration, will enhance theircapacities with the help of the private sector. Theexisting DM plans at various levels will be furtherrevamped/strengthened to address themanagement of mass casualties due to biologicaldisasters.

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Summary ofAction Points9

The present chapter provides a summary ofall the guidelines mentioned in Chapters 4–7 forthe management of biological emergencies. Theimportant action points are discussed in thefollowing pages.

1. Legislative framework

Legislative framework includes theestablishment of a legal, institutional andoperational framework which clearly defines thepolicy, programmes, plans, SOPs, and institutionaland operational framework. Its role will be toimplement IHR (2005) and other legal mechanisms,mechanisms to manage BT activities, cross-borderissues, provisions to quarantine the areas affectedby epidemics or pandemics and various aspectsof transportation of biological samples, biosafetyand biosecurity aspects and upgradation of existinginfrastructure supported by various technicalexperts.

Policies and guidelines issued by NDMA willbe the basis for developing DM plans by variousstakeholders and service providers both in thegovernment (nodal and line ministries, stategovernment and district administration) and privateset-up at each level. The response to variousbiological disasters will be coordinated by NDMA/NEC/NCMC, SDMAs and DDMAs.

(para 4.1)

2. Capacity development for theprevention of biological disasters

The activities related to vulnerability and riskanalysis of various epidemics in the aftermath of

natural disasters or biological threats associatedwith a particular region will be undertaken by theDM authority at each level. Based on this, the IDSPwill be upgraded and strengthened. Facilities andamenities will be developed to cover all issues ofenvironmental management like water supply,personal hygiene, vector control, burial/disposalof the dead and the risk of occurrence of zoonoticdisorders.

The existing IDSP programme will beexpanded and state/district IDSP units will beequipped with trained personnel for data collection,standard case definition, and its integration withthe information received from GOARN, WHO. Thesepersonnel will also be trained for dissemination ofappropriate information to the public healthauthorities, epidemiological analysis andconfirmation of the microorganism involved usingthe integrated laboratory network followed bydeployment of RRTs. Pre-exposure (preventive)immunisation of first responders against anthraxand smallpox must be practiced.....

The nodal health ministry (i.e., MoH&FW) andother line ministries and departments of health,state/district administrations will undertakenecessary preventive measures in DM anddevelopmental plans.

(para 4.2.1–4.2.4)

3. Pharmaceutical and non-pharmaceutical interventions andbiosafety/biosecurity measures

Tools will be developed to monitor the statusof available pharmaceutical interventions including


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antibiotics, chemotherapeutics and anti-virals, andlisting of essential drugs that may be required tomanage biological emergencies. On-sitecontingency planning will be done to containbiotoxins within the laboratory premises. Variousimmunisation and vaccination programmes will beundertaken and the existing arrangements will bestrengthened.

Mechanisms to employ various non-pharmaceutical interventions like social distancingmeasures, and isolation and quarantine techniqueswill be adopted at various levels.

A database of the inventories of variouslaboratories handling hazardous microorganisms,will be developed to ensure the implementation ofvarious biosafety and biosecurity measures atthese institutions. Provisions of biosecurityapplicable to imported articles to prevent any masscasualty event of biological origin, will be undertaken.

The nodal ministry (i.e., MoH&FW) and lineministries will undertake various pharmaceuticaland non-pharmaceutical interventions in their DMand development plans. Similarly, state/districtauthorities will also develop capacities at theirrespective levels.

(para 4.2.5–4.2.8)

4. Preparedness: establishment ofcommand, control and coordinationfunctions

A well-orchestrated medical response tobiological disasters will only be possible by havinga command and control function at the district levelwith the district collector as commander. The CMOwill be the main coordinator for management ofbiological emergencies.

NDMA/NEC will coordinate at the central levelwhile SDMA/DDMAs will coordinate the variousfunctions at their respective levels.

(para 4.3.1)

5. Capacity development of humanresource, training and education,community, standardised documentationprocedures and R&D

The roles of various health and non-healthprofessionals at various levels in the managementof a biological crisis will be defined. Control roomsto support the field responders will be set up. Theseprofessionals will be trained through refreshercourses to fill the prevailing gaps.

The various training modules will bedeveloped/standardised and implemented at eachlevel by district/state authorities and nodal/lineministries.

Educational institutions will organise symposia,exhibition/demonstrations, medical preparednessweeks and will also provide education on disastermedicine in the concerned vernacular languages.Various aspects of the management of infectiousdiseases related to BT will also be disseminatedthrough educational programmes.

Various provisions will be made according tothe SOPs laid down by the ministries/departmentsconcerned.

Community awareness about the delivery ofservices in various civic amenities will bestrengthened so that appropriate knowledge isdeveloped and provided to the stakeholders insuch a manner that it does not spread panic. Thisis intended to enhance participation of thecommunity in all phases of the DM cycle and beresilient enough to tackle biological emergencies.All the practices and training schedules will becoupled with mock exercises followed bydocumentation and evaluation of lessons learnt toimprove the existing system.

The aspect of community preparedness willbe included in the DM plans developed at each

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level by respective authorities and ministriesconcerned using the PPP mode.

R&D will cater for biodefence and operationalresearch with models to develop checks on variouspublic health consequences, thereby evaluatingvarious mitigation strategies after testing them atnumerous stages. These will lay the foundation forlong-term research interventions to be undertakento mitigate the impact of such emergencies.

MoH&FW, MoD and MHA will develop variousresearch strategies in conjunction with ICMR, CSIR,DRDO and other research organisations withadequate funding for these projects. NDMA willact as a facilitator, and advisory and monitoringbody to ensure the implementation of identifiedtasks at the national level.

(para 4.3.2)

6. Development of criticalinfrastructure for management ofbiological emergencies

The development of a laboratory networkincluding national/state level referral laboratories, anddistrict level diagnostic laboratories with medicalcolleges to confirm diagnosis under a singleintegrated framework is a felt need of the day. Ona similar basis, a chain of public health laboratorieswill also be developed and networked with IDSP.

The critical infrastructure will also be supportedby biomonitoring techniques based on advancedmolecular and biochemical techniques. To capturethese capabilities at one place, the variousscientific and technical institutions will be identifiedand upgraded based on their needs analysis. Themain focus of these institutions will be to developvarious models based on the preventive strategy.

Upgradation of the existing emergencycommunication network, health network, includingIAN and mobile tele-health, print and electronic

media channels, networking of NGOs andinternational organisations will be undertaken inthe immediate phase. The overall development ofinfrastructure will also cater for PPP models in thevarious programmes and plans.

Nodal and line ministries at the central leveland departments of health, SDMAs/DDMAs at thestate/district level will identify the variousrequirements of critical infrastructure to bedeveloped with PPP models to mitigate the impactof biological disasters.

(para 4.3.3)

7. Medical preparedness formanagement of biological disasters

Various activities like hospital disastermanagement planning (para 4.4.1), upgradationof earmarked hospitals, development of mobilehospitals and mobile medical teams supported byadequate medical logistics including essentialmedicines, antibiotics, vaccines, PPEs, etc., willbe undertaken on priority basis at each level.

A disaster-resilient public health infrastructuremust include an effective inbuilt mechanism tokeep a check on the early warning signs of anoutbreak, make available safe food, water, personalhygiene facilities and also have the capacity toprovide psycho-social care. The roles of variousstakeholders/service providers like MoH&FW asnodal ministry, other line ministries having healthcare facilities and departments of health at thestate/district levels will provide an integratedframework to manage public health emergencies.

The various response protocols—includingemergency medical response by instituting the ICPunder the overall directions of the incidentcommander, transportation of patients andtreatment at the hospitals—will be developed andpracticed through regular mock drills in a simulatedenvironment.

SUMMARY OF ACTION POINTS


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State/district health departments will have thebasic responsibility and fulfil the structural and non-structural requirements in their respectivedevelopment and DM plans. In addition, the nodalministry will incorporate the cross-cutting issuesto be implemented throughout the country throughnational programmes identified in their DM plans.

(para 4.4.)

8. Institution of mechanism forpublic health response

The response mechanism will include outbreakinvestigation by RRTs, standard case definition,surveillance, follow up, collection of biologicalsamples and transportation to the nearestlaboratories for analysis. The variouspharmaceutical and non-pharmaceuticalinterventions so required will be institutedimmediately. Provision of risk communication andmodes to provide psycho-social care, mediamanagement, inter-sectoral coordination followedby continuous monitoring and evaluation of thestandard case, are some of the principle activitiesthat would be integrated in district DM plans formanaging biological disasters of multiple origin.

The district DM plan for BDM will be the basicfunctional unit which will be in coherence with state/national DM plans to ensure prompt and effectiveresponse in the aftermath of biological disasters.

(para 4.5)

9. Establishment of provisions formanagement of pandemics

Biological disasters are different from othertypes of emergencies and can cross borders,causing various concerns in terms of globalsurveillance, monitoring of human and logisticfunctioning across the borders, health intelligence,guidelines framed by WHO, optimal utilisation ofinformation available with GOARN and resourcesavailable with member states at the global level.Similar concerns are applicable at multiple district/

state levels within the country. These two levels offunctioning require to be in synergy with each other.

The management of pandemics is a cross-cutting issue and specific preparedness plans willbe developed to contain these disasters within thelowest possible limits of spread under the overallguidance of IHR (2005). A properly functioningepidemiological mechanism, will be used toprepare an action plan for the management of avianflu, and similar incidences to effectively combatthe inherent risks. Various international bestpractices will be tested and incorporated in theDM plans by the nodal and line ministries to preventthe spread of biological disasters acrossinternational boundaries.

(para 4.6)

10. Developing a mechanism forenhancing international cooperation

During the preparedness phase, variousinteractive forums will be developed to evaluatethe common problems and identify viable solutionsfor prompt and effective management of biologicalemergencies. The mechanism for internationalcooperation will include both resource sharing,stockpiling of medical logistics at the regional level,joint international mock exercises and knowledgemanagement systems.

Various mitigation strategies addressinginternational cooperation will be identified in theDM plans at each level by DDMAs, SDMAs andthe nodal/line ministries concerned.

(para 4.7)

11. Preparedness for biologicalcontainment of microbial agents

Provisions that ensure the containment ofinfectious microorganisms within the laboratory, willbe developed in the DM plans. Various aspects ofbiosafety and biosecurity will also be developedin the DM plans.

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SOPs for biosafety and biosecurity will bedeveloped by the respective laboratories inaccordance with the National Code of Practice forBiosecurity and Biosafety.

(para 5.1)

12. Classification of microorganismsand biologics

The scheme for risk-based classification ofmicroorganisms is intended to provide a methodfor defining the minimal safety conditions that arenecessary when using these agents. It designatesfive classes of hazardous agents such as RiskGroups I, II, III, IV, and V. Each country should drawup a classification for risk groups of the agentsencountered in that country.

The nodal ministry through its laboratories andsurveillance system will collect, classify and makeavailable the requisite data at a secure nationalportal.

(para 5.2–5.3)

13. Biosafety laboratories andmicroorganism handling instructions

Existing BSLs will be upgraded and new onesdeveloped at various levels based on the needand threat assessment. The differences betweenthe requirements of various levels will be animportant factor of consideration while doing needassessment analysis. SOPs of the functioning ofsuch laboratories will also be laid down and strictlymonitored. Instructions on the handling ofmicroorganisms will also be laid down.

The nodal ministry along with line ministriesand health departments of state governments willassess the existing situation and undertakedevelopment of such critical structures throughdevelopmental plans. Upgradation of existinglaboratories will be carried out, if needed.

(para 5.4–5.5)

14. Development of counter bioriskmeasures

The existing and newly emerging biorisks willbe addressed through the accountability criteriain relation to VBM, secured system of transportationof such materials, development of laboratorybiosecurity plans, training of human resources andprovision of all logistics/facilities and development/strict implementation of the National Code ofPractice for Biosecurity and Biosafety. These willbe incorporated into the respective BDM plans.

These aspects will be developed andintegrated as SOPs in the district/state DM plans.At the national level, global best practices will beincorporated in the DM plans, if needed.

(para 5.6)

15. Risk and vulnerabilityassessment of livestock

The various risks posed to livestock duringnatural disasters, i.e., spread of infectious diseases,fodder poisoning, TADs, various types of warsincluding conventional wars, BW or BT will beanalysed to develop a comprehensive mitigationstrategy.

Relevant studies will be undertaken at eachlevel by the respective authority/ministry/department concerned.

(para 6.6.1)

16. Capacity development:management of livestock

This includes the development of VATs,infrastructure for disposal of carcasses, containmentof epidemics; temporary shelters, organisedrehabilitation package for livestock livelihood,awareness programmes and preparedness foremergency field and laboratory veterinary services.SOPs will be laid down to enhance inter-

SUMMARY OF ACTION POINTS


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departmental support and strengthen the weaklinkages.

Capacity development will be undertaken atthe district/state/national levels by the ministries/departments concerned as a part of their respectiveDM plans.

(para 6.6.2–6.6.3)

17. Preparedness for livestockmanagement during disasters

Various mitigation activities, includingdevelopment of EWS, establishment of fodderbanks, availability of low cost feed ingredients,conservation of monsoon grasses, development ofexisting degraded grazing lands, free movementof animals for grazing, treatment and vaccinationof animals, and strategy for compensation onaccount of loss and disposal of dead animalsduring disasters will be planned/undertaken. Acomprehensive strategy for emergency manage-ment will be developed and steps for prevention,mitigation and preparedness for management oflivestock during disasters will be laid down. Thevarious R&D activities to mitigate the impact onlivestock during disasters will be undertaken.

(para 6.6.4–6.6.8)

18. Establishment of legislative andregulatory framework and earlydetection facilities based on riskmanagement practices

The existing quarantine legislations will berevisited and modified, if needed. Strictenforcement of SPS measures and the relatedactivities thereof at all levels, will be ensured. Riskassessment of plausible attacks on agriculturalfields and adequate measures for pest risk analysiswith trained manpower and equipment will bedeveloped. It includes the development of theintegrated pest surveillance system, intelligencegathering and secured dissemination of informationfor a comprehensive risk management framework.

Preventive measures for early detection ofagroterrorism activities will also be outlined. Variousprovisions will be developed at each level by therespective departments/ministries or authorities.

(para 7.5.1–7.5.3)

19. Preparedness for managementof agroterrorism activities

The preparedness measures include provisionsfor emergency control and treatment, developmentof national standards on phyto-sanitary measuresand other related activities.

It includes various capacity building measuresincluding SOPs for documentation. It is pertinentto evolve newer R&D activities to mitigate theimpact of such situations and strengthen supportmechanisms such as accreditation of laboratoriesand development of linkages of local level initiativeswith national/state programmes.

(para 7.5.4–7.5.7)

20. Development of an ‘all hazard’implementation strategy

The strategy outlines the requirements fordevelopment of a BDM action plan by the nodalministry, measures to implement and coordinatevarious activities at the national level, andinstitutional framework and coordination at thestate/district levels. Adequate strategy will beevolved to develop linkages and state supportsystems. Necessary financial arrangements will bemade for implementation of all the plans developedat the district/state/national levels. An implement-ation model with suggested broad time frames asshort- medium- and long-term plans for 0–3, 0–5 and0–8 years, respectively have been recommended.

(para 8.1–8.3)

It is the responsibility of the variousstakeholders/service providers to identify variousaspects of BDM activities under different plans atdifferent levels.

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AnnexuresAnnexure-A

Refers to Chapter 1, Page 03

Characteristics of Biological Warfare Agents


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Source: Medical Management of Biological Casualties handbook, Sixth edition, April 2005; USAMRIID,Fort Detrick Frederick, Maryland

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Annexure-BRefers to Chapter 4, Page 43

Vaccines, Prophylaxis, and Therapeutics for Biological Warfare AgentsANTHRAX

VACCINE/TOXOID DEVELOPMENT

Emergent BioThraxTM

Anthrax Vaccine (AVA)

Preexposure (A)

: licensed for adults 18-65yr old, 0.5 mL SC @ 0, 2, 4 wk, 6, 12, 18 mo then annual boosters

Postexposure: Under INDvise Contingency Use Protocol for volunteer

anthrax vaccination SC@ 0, 2, 4 wk in combination with approved and labeled antibiotics Pediatric Annex

IND for postexposure use.

Recombinant protective antigen (rPA) vaccine

CHEMOPROPHYLAXIS DEVELOPMENT

Ciprofloxacin(A)

: 500 mg PO bid (adults), 15mg/kg (up to 500mg/dose) PO bid (peds)

(A), or

Doxycycline(A)

: 100 mg PO bid (adults), 2.2mg/kg (up to 100mg/dose) PO

bid (peds < 45kg) (A)

or (if strain susceptible): Penicillin G procaine: 1,200,000U q 12 hr (adults)

(A), 25,000U/kg

(maximum 1,200,000 unit) q 12 hr (peds)(A)

, or Penicillin V Potassium: 500 mg q 6 hr (adults), or Amoxicillin: 500mg PO q 8 hr (adults and children>40kg), 15mg/kg q 8 hr (children<40kg), Plus, AVA (postexposure)

(IND)

1. Fully immunized (completed 6 shot primary series and up-to-date on annual boosters, or 3 doses within past 6 mo): continue antibiotics for at least 30 days.

2 Unimmunized: 3 doses of AVA 0.5cc SQ at 0, 2, 4 weeks(IND).

. Continue antibiotics for at least 7-14 days after 3

rd dose.

3 No AVA used: continue antibiotics for at least 60 days

Anthrax Immune Globulin (AIG)

CHEMOTHERAPY Inhalational, Gastrointestinal, or SystemicCutaneous Disease: Ciprofloxacin : 400 mg IV 1 12 h initially then by mouth (adult)

(A)

15 mg/kg/dose (up to 400mg/dose) q 12 h (peds)(A)

, or

Doxycycline: 200 mg IV, then 100 mg IV q 12 h (adults) (A)

2.2mg/kg (100mg/dose max) q 12 h (peds < 45kg) (A)

, or (if strain susceptible),

Anthrax Immune Globulin (AIG)

Contd

ANNEXURES


126

Penicillin G Procaine: 4 million units IV q 4 h (adults) (A)

50,000U/kg (up to 4M U) IV q 6h (peds)

(A)

PLUS, One or two additional antibiotics with activity against anthrax. (e.g. clindamycin plus rifampin may be a good empiric choice, pending susceptibilities). Potential additional antibiotics include one or more of the following: clindamycin, rifampin, gentamicin, macrolides, vancomycin, imipenem, and chloramphenicol. Convert from IV to oral therapy when the patient is stable, to complete at least 60 days of antibiotics. Meningitis: Add Rifampin 20mg/kg IV qd or Vancomycin 1g IVq12h COMMENTS In 2002 the American Committee on immunization Practices (ACIP) recommended making anthrax vaccine available in a 3-dose regimen (0, 2, 4 weeks) in combination with antimicrobial postexposure prophylaxis under an IND application for unvaccinated persons at risk for inhalational anthrax. Penicillins should be used for anthrax treatment or prophylaxis only if the strain is demonstrated to be PCN-susceptible. According to CDC recommendations, amoxicillin prophylaxis is appropriate only after 14-21 days of fluoroquinolone or doxycycline and only for populations with contraindications to the other drugs (children, pregnancy) Oral dosing (versus the preferred IV) may be necessary for treatment of systemic disease in a mass casualty situation. Cutaneous Anthrax: Antibiotics for cutaneous disease (without systemic complaints) resulting from a BW attack involving BW aerosols are the same as for postexposure prophylaxis. Cutaneous anthrax acquired from natural exposure could be treated with 7-10 days of antibiotics.

AIG is serum from human AVA recipients with high anti-PA titers.

Brucellosis VACCINE/TOXOID None CHEMOPROPHYLAXIS Can try one of the treatment regimens for 3-6 weeks, for example: Doxycycline : 200mg po qd (adults)

(A), plus Rifampin: 600mg PO qd

CHEMOTHERAPY Inhalational, Gastrointestinal, or SystemicCutaneous Disease Significant infection: Doxycycline: 100mg PO bid for 4-6 wks (adults)

(A), 2.2 mg/kg PO bid (peds),

plus Streptomycin 1g IM qd for first 3 wks (adults)(A)

, or Doxycycline(A)

+ Gentamicin (if streptomycin not available) Less severe disease: Doxycycline 100mg PO bid for 4-6 wks (adults)

(A), plus

Rifampin 600-900 mg/day PO qd for 4-6 wks (adults)(A)

, 15-20mg/kg (up to 600-900mg) qd or divided bid (peds) Others used with success: TMP/SMX 8-12mg/kg/d divided qid, plus Rifampin (may be preferred therapy during pregnancy or in children <8yrs), Or Ofloxacin + Rifampin Long-term (up to 6 mo) therapy for meningoencephalitis, endocarditis: Rifampin + a tetracycline + an aminoglycoside (first 3 weeks) COMMENTS Ideal chemoprophylaxis is unknown. Chemoprophylaxis not recommended after natural exposure. Avoid monotherapy (high relapse). Relapse common for treatments less than 4-6 weeks. Contd

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Glanders & Meliodosis VACCINE/TOXOID None CHEMOPROPHYLAXIS Can try one of the treatment regimens for 3-6 weeks, for example: Doxycycline : 200mg po qd (adults)

(A), plus Rifampin: 600mg PO qd

CHEMOTHERAPY Severe Disease: ceftazidime (40mg/kg IV q 8hrs), or imipenem (15mg/kg IV q 6hr max 4 g/day), or meropenem (25mg/kg IV q 8hr, max 6g/day), plus, TMP/SMX (TMP 8 mg/kg/day IV in four divided doses) Continue IV therapy for at least 14 days and until patient clinically improved, then switch to oral maintenance therapy (see “mild disease” below) for 4-6 months. Melioidosis with septic shock: Consider addition of G-CSF 30ug/day IV for 10 days. Mild Disease: Historic: PO doxycycline and TMP/SMX for at least 20 weeks, plus PO chloramphenicol for the first 8 weeks. Alternative: doxycycline (100 mg po bid) plus TMP/SMX (4 mg/kg/day in two divided doses) for 20 weeks. COMMENTS Little is known about optimum therapy for glanders, as this disease has been rare in the modern antibiotic era. For this reason, most experts feel initial therapy of glanders should be based on proven therapy for the similar disease, melioidosis. One potential difference in the two organisms is that natural strains of B. mallei respond to aminoglycosides and macrolides, while B. pseudomallei does not; thus, these classes of antibiotics may be beneficial in treatment of glanders, but not melioidosis. Severe Disease: If ceftazidime or a carbapenem are not available, ampicillin/sulbactam or other intravenous beta-lactam/beta-lactamase inhibitor combinations may represent viable, albeit less-proven alternatives. Mild Disease: Amoxicillin/clavulanate may be an alternative to Doxycycline plus TMP/SMX, especially in pregnancy or for children <8yr old. Plague VACCINE/TOXOID DEVELOPMENT Recombinant F1-V

Antigen Vaccines, DoD & UK

CHEMOPROPHYLAXIS Ciprofloxacin: 500 mg PO bid x 7 d (adults), 20mg/kg (up to 500mg) PO bid (peds), or Doxycycline: 100 mg PO q 12 h x 7 d (adults), 2.2 mg/kg (up to 100mg) PO bid (peds), or Tetracycline: 500 mg PO qid x 7 d (adults)

CHEMOTHERAPY

Streptomycin: 1g q 12hr IM (adults) (A)

, 15mg/kg/d div q 12hr IM (up to 2

g/day)(peds) (A)

, or Gentamicin: 5 mg/kg IM or IV qd or 2 mg/kg loading dose followed by 1.7 mg/kg IM or IV (adults), 2.5 mg/kg IM or IV q8h (peds). Alternatives: Doxycycline: 200 mg IV once then 100 mg IV bid until clinically

improved, then 100 mg PO bid for total of 10-14 d (adults) (A)

, or Ciprofloxacin: 400mg IV q 12 h until clinically improved then 750 mg PO bid for total 10-14 d, or Chloramphenicol: 25 mg/kg IV, then 15 mg/kg qid x 14 d.

FDA-approved therapeutics

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128

A minimum of 10 days of therapy is recommended (treat for at least 3-4 days after clinical recovery). Oral dosing (versus the preferred IV) may be necessary in a mass casualty situation. Meningitis: add Chloramphenicol 25mg/kg IV, then 15mg/kg IV qid. COMMENTS Greer inactivated vaccine (FDA licensed) is no longer available. Streptomycin is not widely available in the US and therefore is of limited utility. Although not licensed for use in treating plague, gentamicin is the consensus choice for parenteral therapy by many authorities. Reduce dosage in renal failure. Chloramphenicol is contraindicated in children less than 2 yrs. While Chloramphenicol is potentially an alternative for post-exposure prophylaxis (25mg/kg PO qid), oral formulations are available only outside the US. Alternate therapy or prophylaxis for susceptible strains: trimethoprim-sulfamethoxazole Other fluoroquinolones or tetracyclines may represent viable alternatives to ciprofloxacin or doxycycline, respectively.

Q Fever

VACCINE/TOXOID Inactivated Whole Cell Vaccine

(Preexposure)(IND):

DoD Laboratory Use Protocol using Australian QvaxTM

vaccine in at-risk laboratory personnel. CHEMOPROPHYLAXIS Doxycycline: 100 mg PO bid x 5 d (adults), 2.2mg/kg PO bid (peds), or Tetracycline: 500 mg PO qid x 5d (adults) Start postexposure prophylaxis 8-12 d post-exposure. CHEMOTHERAPY

Acute Q-fever: Doxycycline: 100 mg IV or PO q 12 h x at least 14 d (adults)(A)

, 2.2 mg/kg PO q 12 h (peds), or Tetracycline: 500 mg PO q 6 hr x at least 14 d Alternatives: Quinolones (eg ciprofloxacin), or TMP-SMX, or Macrolides (eg clarithromycin or azithromycin) for 14-21 days. Patients with underlying cardiac valvular defects: Doxycycline plus Hydroxychloroquine 200mg PO tid for 12 months Chronic Q Fever: Doxycycline plus quinolones for 4 years, or Doxycycline plus hydroxychloroquine for 1.5-3 years. COMMENTS Q-Fever vaccine manufactured in 1970. Significant side effects if administered inappropriately; sterile abscesses if prior exposure/skin testing required prior to vaccination. Time to develop immunity – 5 weeks. Initiation of postexposure prophylaxis within 7 days of exposure merely delays incubation period of disease. Tetracyclines are preferred antibiotic for treatment of acute Q fever except in: 1. Meningoencephalitis: fluoroquinolones may penetrate CSF better than tetracyclines 2. Children < 8yrs (doxycycline relatively contraindicated): TMP/SMX or macrolides (especially clarithromycin or azithromycin). 3. Pregnancy: TMP/SMX 160mg/800mg PO bid for duration of pregnancy. If evidence of continued disease at parturition, use tetracycline or quinolone for 2-3 weeks. T l i Contd

129

Tularemia

VACCINE/TOXOID

Live attenuated vaccine (Preexposure) (IND)

DoD Laboratory Use Protocol for vaccine. Single 0.1ml dose via scarification in at-risk researchers. CHEMOPROPHYLAXIS Ciprofloxacin: 500 mg PO q 12 h for 14 d, 20mg/kg (up to 500mg) PO bid (peds), or Doxycycline: 100 mg PO bid x 14 d (adults), 2.2mg/kg (up to 100mg) PO bid (peds<45kg), or Tetracycline: 500 mg PO qid x 14 d (adults) CHEMOTHERAPY

Streptomycin: 1g IM q12 h days x at least 10 days (adults)(A)

, 15mg/kg (up to 2g/day) IM q12h (peds)(A)

, or Gentamicin: 5 mg/kg IM or IV qd, or 2 mg/kg loading dose followed by 1.7 mg/kg IM or IV q 8 h x at least

10 days (adults)(A)

, 2.5mg/kg IM or IV q 8 h (peds), or Alternatives: Ciprofloxacin 400 mg IV q 12 h for at least 10d (adults), 15mg/kg (up to 400mg) IV q 12 h (peds), or

Doxycycline: 200 mg IV, then 100 mg IV q 12 h x 14-21 d (adults)(A)

, 2.2mg/kg (up to 100mg) IV q 12 h (peds<45kg), or Chloramphenicol: 25mg/kg IV q 6 h x 14-21 d, or Tetracycline: 500 mg PO qid x 14-21 d (adults)

(A)

COMMENTS Vaccine manufactured in 1964. Streptomycin is not widely available in the US and therefore is of limited utility. Gentamicin, although not approved for treatment of tularemia likely represents a suitable alternative. Adjust gentamicin dose for renal failure Treatment with streptomycin, gentamicin, or ciprofloxacin should be continued for 10 days; doxycycline and chloramphenicol are associated with high relapse rates with course shorter than 14-21 days. IM or IV doxycycline, ciprofloxacin, or chloramphenicol can be switched to oral antibiotic to complete course when patient clinically improved. Chloramphenicol is contraindicated in children less than 2 yrs. While Chloramphenicol is potentially an alternative for post-exposure prophylaxis (25mg/kg PO qid), oral formulations are available only outside the US. Botulinum Toxins VACCINE/TOXOID DEVELOPMENT

Pentavalent Toxoid Vaccine (IND)

(Preexposure use only) HBIG, DoD pentavalent human botulism immune globulin, types A-

E (IND).

IND for pre-exposure prophylaxis for high risk individuals only.

DoD rBONT Heptavalent Vaccine

CHEMOPROPHYLAXIS

DoD equine antitoxins(IND)

In general, botulinum antitoxin is not used prophylactic ally. Under special circumstances, if the evidence of exposure is clear in a group of individuals, some of whom have well defined neurological findings consistent with botulism, treatment can be contemplated in those without neurological signs.

Contd

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130Contd

defined neurological findings consistent with botulism, treatment can be contemplated in those without neurological signs. CHEMOTHERAPY CDC trivalent equine antitoxin for serotypes A, B and E. A and B are licensed and E is a CDC IND Product.

BabyBigTM

, California Health Department, types A and B

Human lyophilized IgG(A)

HE-BAT, DoD heptavalent equine botulism antitoxin, types A-

G (IND)

HFabBAT, DoD de-speciated heptavalent equine botulism

antitoxin, types A-G (IND)

Monoclonal antibodies

COMMENTS Pentavalent Toxoid Vaccine failed potency testing for Serotypes D and E. FDA has concerns about all of the other Serotypes potency. Must initiate series 13 weeks before potential exposure for optimum protection. Skin test for hypersensitivity before equine antitoxin administration.

Ricin Toxin VACCINE/TOXOID DEVELOPMENT COMMENTS Inhalation: supportive therapy G-I: gastric lavage, superactivated charcoal, cathartics.

Availability of ricin vaccine contingent upon transition of candidate to advanced development and upon availability of funds.

Encephalitis Viruses VACCINE/TOXOID DEVELOPMENT

JE live attenuated vaccine (A)

VEE Live Attenuated Vaccine(IND)

(DoD Laboratory Use Protocol for Preexposure) TC-83 strain, for initial immunizations

VEE (V3526) Vaccine.

Staphylococcus Enterotoxins VACCINE/TOXOID DEVELOPMENT DoD recombinant SEB

Vaccine CHEMOPROPHYLAXIS CHEMOTHERAPY COMMENTS Supportive care including assisted ventilation for inhalation exposure. Currently insufficient

funding for JVAP development to IND product.

131

VEE Inactivated Vaccine(IND)

(DoD Laboratory Use Protocol for Preexposure) C-84 strain, for booster immunizations

EEE Inactivated Vaccine(IND)

(DoD Laboratory Use Protocol for Preexposure) WEE Inactivated Vaccine

(IND) (DoD Laboratory Use Protocol for

Preexposure) CHEMOPROPHYLAXIS None CHEMOTHERAPY No specific therapy. Supportive care only. COMMENTS VEE TC-83 vaccine manufactured in 1965. Live, attenuated vaccine, with significant side effects. 25%-35% or recipients require 2-3 days bed rest. Time to develop immunity – 8 weeks. VEE TC-83 reactogenic in 20%. No seroconversion in 20%. Only effective against subtypes 1A, 1B, and 1C. VEE C-84 vaccine used for non-responders to VEE TC-83. Must be given prior to EEE or WEE (if administered subsequent, antibody response decreases from 81% to 67%). EEE vaccine manufactured in 1989. Antibody response is poor, requires 3-dose primary (one month) and 1-2 boosters (one month apart). Primary series yields antibody response in 77%; 5%-10% of non-responders after boosts. Time to immunity – 3 months. WEE vaccine manufactured in 1991. Antibody response is poor, requires 3-dose primary (one month) and 3-4 boosters (one month apart). Primary series antibody response in 29%, 66% after four boosts. Time to develop immunity – six months. EEE and WEE inactivated vaccines are poorly immunogenic. Multiple immunizations are required.

Hemorrhagic Fever Viruses VACCINE/TOXOID DEVELOPMENT

Yellow Fever live attenuated 17D vaccine (A)

AHF vaccine (IND)

(x-protection for BHF)

RVF inactivated vaccine(IND)

(DoD IND for high-risk laboratory workers)

Adenovirus vectored Ebola Vaccine Ebola DNA vaccine

CHEMOPROPHYLAXIS Lassa fever and CCHF: Ribavirin 500mg PO q 6 hr for 7 days (Not FDA approved for this use)

CHEMOTHERAPY Ribavirin (CCHF/Lassa/KHF): 30 mg/kg (up to 2g) IV initial dose; then 16 mg/kg (up to 1g)

IV q 6 h x 4 d; then 8 mg/kg (up to 500mg) IV q 8 h x 6 d (adults)(IND)

Mass Casualty Situation (Arenavirus, Bunyavirus, or VHF of unknown etiology. Not FDA-approved or IND) Ribavirin: 2000mg PO; then 600mg PO bid (if > 75kg), or 400mg PO in am and 600mg PO in PM (if < 75kg) for 10 days (adults), 30mg/kg then 15mg/kg divided bid for 10 days (peds)

Passive antibody for AHF, BHF, Lassa fever, and CCHF.

COMMENTS Aggressive supportive care and management of hypotension and coagulopathy very important. Human antibody used with apparent beneficial effect in uncontrolled human trials of AHF.

Ebola DNA vaccine in human trials at NIH

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132

Human experience with postexposure ribaririn use for VHF exposure is limited to a few cases exposed to CCHF and Lassa. Any use for this purpose should be ideally under IND. Consensus statement in JAMA from 2002 suggests using Ribavirin to treat clinically apparent hemorrhagic fever virus infection of unknown etiology using doses from CCHF/Lassa/KHF IND.

DryvaxTM

- W yeth calf lymph vaccinia vaccine 100 dose v ials undiluted: 1 dose by scarification. Greater than 97% take after one dose w ithin 14 days of administration. Dryvax

TM is effective (either preventing or attenuating resulting disease) up

to at least 4 days post exposure. Dryvax

TM (1:1) FDA license approved 25 Oct 2002.

APSV is also known as the Salk Institute (TSI) vaccine, a frozen, liquid formulation using the NYCBOH vaccine strain via calf-lymph production also used in the Dryvax

TM

Pre and post exposure vaccination recommended if > 3 years s ince last vaccine. Recommendations for use of smallpox vaccine in response to bioterrorism are periodical ly undated b y the Centers for Disease Control and Prevention (CDC), and the most recent recommendations can be found at http:www.cdc.gov.

Smallpox VACCINE/TOXOID DEVELOPMENT

W yeth DryvaxTM

(1:1) (Preexposure)(A)

Aventis Pasteur Smallpox Vaccine (APSV) (Preexposure)(IND)

Cell Culture derived Vaccines (all NYCBOH strain): - Dynport Vaccine (Preexposure)

(IND)

- Acambis/Acambis-Baxter Vaccines (ACAM1000 and ACAM2000) (Preexposure)

(IND)

Attenuated Vaccinia Vaccines : Acambis Modified Vaccinia Ankara (MVA) VaxGen LC16m8 strain

CHEMOPROPHYLAXIS

W yeth DryvaxTM

(1:1) (Postexposure)(IND)

Use of Smallpox Vaccine in Response to Bioterrorism: W yeth Dryvax

TM (1:5 dilution)

(IND)

CDC IND. If DryvaxTM

(1:5) used up, not available, or need both vaccines, then use: APSV (1:5 dilution)

(IND)

DoD IND for APSV (1:5) Contingency Use

CHEMOTHERAPY

Cidofovir for treatment of smallpox(IND)

: - Probenecid 2g PO 3 h prior to cidofovir infusion. - infuse 1L NS 1 h prior to c idofovir infusion - Cidofovir 5mg/kg IV over 1 hr - repeat probenecid 1g PO 2 h and again 8 h after cidofovir infusion completed. For Select Vaccine Adverse reactions (Eczema vacc inatum, vaccinia necrosum, ocular vaccinia w/o keratitis, severe generalized vaccinia): 1. VIG IV (Vaccinia Immune Globulin – intravenous formulation). 100mg/kg IV infusion. 2. VIG-IM (Vaccinia Immune Globul in – intramuscular formulation). 0.6ml/kg IM. 3. C idofovir 5mg/kg IV infusion (as above).

Oral formulations of c idofovir derivatives Monoclonal Vaccinia Immune Globulins

COMMENTS

Source: Medical Management of Biological Casualties handbook, Sixth edition, April 2005; USAMRIIDFort Detrick Frederick, Maryland

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Annexure-CRefers to Chapter 4, Page 44

Patient Isolation Precautions

Standard Precautions

• Wash hands after patient contact.

• Wear gloves while touching blood, body fluids, secretions, excretions and contaminated items.

• Wear a mask and eye protection, or a face shield during procedures likely to generate splashesor sprays of blood, body fluids, secretions or excretions.

• Proper handling of patient-care equipment and linen in a manner that prevents the transfer ofmicroorganisms to people or equipment.

Use proper precautions while handling a mouthpiece or other ventilation device as an alternative tomouth-to-mouth resuscitation.

Standard precautions are employed in the care of all patients

Airborne Precautions

Standard Precautions plus:

• Place the patient in a private room that has monitored negative air pressure, a minimum of six airchanges/hour, and appropriate filtration of air before it is discharged from the room.

• Wear respiratory protection when entering the room.

• Limit movement and transport of the patient. Place a mask on the patient, if the patient needs tobe moved.

Conventional Diseases requiring Airborne Precautions: Measles, Varicella, Pulmonary TB.

Biothreat Diseases requiring Airborne Precautions: Smallpox.

Droplet Precautions

Standard Precaution plus:

• Place the patient in a private room or cohort them with someone with the same infection. If notfeasible, maintain at least three feet between patients.

• Wear a mask when working within three feet of the patient.

• Limit movement and transport of the patient. Place a mask on the patient, if the patient needs tobe moved.

Conventional Diseases requiring Droplet Precautions: Invasive Haemophilus influenzae and meningococcaldisease, drug-resistant pneumococcal disease, diphtheria, pertussis, mycoplasma, Group A Beta HemolyticStreptococcus, influenza, mumps, rubella, parvovirus.

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134

Biothreat Diseases Requiring Droplet Precautions: Pneumonic Plague

Contact Precautions

Standard Precautions plus:

• Place the patient in a private room or cohort them with someone with the same infection ifpossible.

• Wear gloves when entering the room. Change gloves after contact with infective material.

• Wear a gown when entering the room if contact with patient is anticipated or if the patient hasdiarrhea, a colostomy or wound drainage not covered by a dressing.

• Limit the movement or transport of the patient from the room.

• Ensure that patient-care items, bedside equipment, and frequently touched surfaces receivedaily cleaning.

• Dedicate use of noncritical patient-care equipment (such as stethoscopes) to a single patient, orcohort of patients with the same pathogen. If not feasible, adequate disinfection between patientsis necessary.

Conventional Diseases requiring Contact Precautions: Methicillin Resistant Staphylococcus aureus,Vancomycin Resistant Enterococcus, Clostridium difficile, Respiratory Syncytial Virus, parainfluenza,enteroviruses, enteric infections in the incontinent host, skin infections (Staphylococcal Scalded SkinSyndrome, Herpex Simplex Virus, impetigo, lice, scabies), hemorrhagic conjunctivitis.

Biothreat Diseases requiring Contact Precautions: VHFs.

For more information, see: Garner JS. Guidelines for Infection Control Practices in Hospitals. InfectControl Hosp Epidemiol 1996;17:53-80.

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Annexure-DRefers to Chapter 4, Page 59

Laboratory Identification of Biological Warfare Agents

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136

* Toxin gene detected — only works if cellular debris including genes present as contaminant. Purifiedtoxin does not contain detectable genes.

ELISA — enzyme-linked immunosorbent assays.

FA — indirect or direct immunofluorescence assays.

Std. Micro./serology — standard microbiological techniques available, including electron microscopy.Not all assays are available in field laboratories.

X — Advisable.

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Annexure-ERefers to Chapter 4, Page 59

Specimens for Laboratory Diagnosis

1Within 18–24 hours of exposure

2Fluorescent antibody test on infected lymph node smears. Gram stain has little value.

3Virus isolation from blood or throat swabs in appropriate containment.

4C. burnetii can persist for days in blood and resists desiccation. Ethylene Di-amine Tetra Acetic Acid anticoagulated blood

preferred. Culturing should not be done except in BSL-3 containment.

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Annexure-FRefers to Chapter 4, Page 59

Medical Sample Collection for Biological Threat Agents

This guide helps to determine which clinical samples to collect from individuals exposed to aerosolisedbiological threat agents or environmental samples from suspect sites. Proper collection of specimensfrom patients is dependent on the time frame following exposure. Sample collection is described for ‘Earlypost-exposure’, ‘Clinical’, and ‘Convalescent/Terminal/Postmortem’ time frames. These time frames arenot rigid and will vary according to the concentration of the agent used, the agent strain, and predisposinghealth factors of the patient.

• Early post-exposure: when it is known that an individual has been exposed to a bioagent aerosol,aggressively attempt to obtain samples as indicated.

• Clinical: samples from those individuals presenting with clinical symptoms.

• Convalescent/Terminal/Postmortem: samples taken during convalescence, the terminal stages ofinfection or toxicosis or postmortem during autopsy.

Shipping Samples: Most specimens sent rapidly (less than 24 h) to analytical labs require only blue or wetice or refrigeration at 2° to 8°C. However, if the time span increases beyond 24 h, contact the USAMRIID‘Hot-Line’ (1-888-USA-RIID) for other shipping requirements such as shipment on dry-ice or in liquidnitrogen.

Blood samples: Several choices are offered based on availability of the blood collection tubes. Do notsend blood in all the tubes listed, but merely choose one. Tiger-top tubes that have been centrifuged arepreferred over red-top clot tubes with serum removed from the clot, but the latter will suffice. Blood culturebottles are also preferred over citrated blood for bacterial cultures.

Pathology samples: Routinely include liver, lung, spleen, and regional or mesenteric lymph nodes. Additionalsamples requested are as follows: brain tissue for encephalomyelitis cases (mortality is rare) and theadrenal gland for Ebola (good to have but not absolutely required).

Anthrax Bacillus anthracis 0 – 24 h Nasal and throat swabs, induced respiratory secretions for culture, FA, and PCR

24 to 72 h Serum (TT, RT) for toxin assays Blood (E, C, H) for PCR. Blood (BC, C) for culture

3 to 10 days Serum (TT, RT) for toxin assays Blood (BC, C) for culture. Pathology samples

Plague Yersinia pestis 0 – 24 h Nasal swabs, sputum, induced respiratory secretions for culture, FA, and PCR

24 – 72 h Blood (BC, C) and bloody sputum for culture and FA (C), F-1 Antigen assays (TT, RT), PCR (E, C, H)

>6 days Serum (TT, RT) for IgM later for IgG. Pathology samples

Bacteria and RickettsiaConvalescent/Early post-exposure Clinical Terminal/Postmortem

139

Glanders Burkholderia mallei 0 – 24 h Nasal swabs, sputum, induced respiratory secretions for culture and PCR.

24 – 72 h Blood (BC, C) for culture Blood (E, C, H) for PCR Sputum & drainage from skin lesions for PCR & culture.

>6 days Blood (BC, C) and tissues for culture. Serum (TT, RT) for immunoassays. Pathology samples.

Brucellosis Brucella abortus, suis, & melitensis 0 – 24 h Nasal swabs, sputum, induced respiratory secretions for culture and PCR.

24 – 72 h Blood (BC, C) for culture. Blood (E, C, H) for PCR.

>6 days Blood (BC, C) and tissues for culture. Serum (TT, RT) for immunoassays. Pathology samples

Q-Fever Coxiella burnetii 0 – 24 h Nasal swabs, sputum, induced respiratory secretions for culture and PCR.

2 to 5 days Blood (BC, C) for culture in eggs or mouse inoculation Blood (E, C, H) for PCR.

>6 days Blood (BC, C) for culture in eggs or mouse inoculation Pathology samples.

BC: Blood culture bottle C: Citrated blood (3-ml)

E: EDTA (3-ml) H: Heparin (3-ml)

TT: Tiger-top (5 - 10 ml) RT: Red top if no TT

Tularemia Francisella tularensis 0 – 24 h Nasal swabs, sputum, induced respiratory secretions for culture, FA and PCR

24 – 72 h Blood (BC, C) for culture Blood (E, C, H) for PCR Sputum for FA & PCR

>6 days Serum (TT, RT) for IgM and later IgG, agglutination titers. Pathology Samples



TT: Tiger-top (5 – 10 ml) RT: Red top if no TT

Bacteria and Rickettsia

Convalescent/Early post-exposure Clinical Terminal/Postmortem

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140

ToxinsConvalescent/Early post-exposure Clinical Terminal/Postmortem

Botulism Botulinum toxin from Clostridium botulinum 0 – 24 h Nasal swabs, induced respiratory secretions for PCR (contaminating bacterial DNA) and toxin assays. Serum (TT, RT) for toxin assays

24 to 72 h Nasal swabs, respiratory secretions for PCR (contaminating bacterial DNA) and toxin assays.

>6 days Usually no IgM or IgG Pathology samples (liver and spleen for toxin detection)

Ricin Intoxication Ricin toxin from Castor beans 0 – 24 h Nasal swabs, induced respiratory secretions for PCR (contaminating castor bean DNA) and toxin assays. Serum (TT) for toxin assays

36 to 48 h Serum (TT, RT) for toxin assay Tissues for immunohisto-logical stain in pathology samples.

>6 days Serum (TT, RT) for IgM and IgG in survivors

Staph enterotoxicosis Staphylococcus Enterotoxin B 0 – 3 h Nasal swabs, induced respiratory secretions for PCR (contaminating bacterial DNA) and toxin assays. Serum (TT, RT) for toxin assays

2 - 6 h Urine for immunoassays Nasal swabs, induced respiratory secretions for PCR (contaminating bacterial DNA) and toxin assays. Serum (TT, RT) for toxin assays

>6 days Serum for IgM and IgG Note: Only paired antibody samples will be of value for IgG assays…must adults have antibodies to staph enterotoxins.

T-2 toxicosis 0 – 24 h postexposure Nasal & throat swabs, induced respiratory secretions for immunoassays, HPLC/ mass spectrometry (HPLC/MS).

1 to 5 days Serum (TT, RT), tissue for toxin detection

>6 days postexposure Urine for detection of toxin metabolites




141

VirusesConvalescent/Early post-exposure Clinical Terminal/Postmortem

Equine Encephalomyelitis VEE, EEE and WEE viruses 0 – 24 h Nasal swabs & induced respiratory secretions for RT-PCR and viral culture

24 to 72 h Serum & Throat swabs for culture (TT, RT), RT-PCR (E, C, H, TT, RT) and Antigen ELISA (TT, RT), CSF, Throat swabs up to 5 days

>6 days Serum (TT, RT) for IgM Pathology samples plus brain

Ebola 0 – 24 h Nasal swabs & induced respiratory secretions for RT-PCR and viral culture

2 to 5 days Serum (TT, RT) for viral culture

>6 days Serum (TT, RT) for viral culture. Pathology samples plus adrenal gland.

Pox (Smallpox, monkeypox) Orthopoxvirus 0 – 24 h Nasal swabs & induced respiratory secretions for PCR and viral culture

2 to 5 days Serum (TT, RT) for viral culture

>6 days Serum (TT, RT) for viral culture. Drainage from skin lesions/ scrapings for microscopy, EM, viral culture, PCR. Pathology samples


E: EDTA (3-ml)H: Heparin (3-ml)


Environmental samples can be collected to determine the nature of a bioaerosol either during, shortlyafter, or well after an attack. The first two along with early post-exposure clinical samples can help identifythe agent in time to initiate prophylactic treatment. Samples taken well after an attack may allow identificationof the agent used. While the information will most likely be too late for useful prophylactic treatment, thisinformation along with other information may be used in the prosecution of war crimes or other criminalproceedings. This is not strictly a medical responsibility. However, the sample collection concerns are thesame as for during or shortly after a bioaerosol attack and medical personnel may be the only personnelwith the requisite training. If time and conditions permit, planning and risk assessments should be performed.

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Like in any hazmat situation a clean line and exit and entry strategy should be designed. Obviously, if oneis under attack and in the middle of the bioaerosol, there can be no clean line. Depending on thesituation, personnel protective equipment should be donned. The standard Gas Mask is effective againstbioaerosols. If it is possible to have a clean line then a three person team is recommended, with one cleanand two dirty. The former would help decontaminate the latter. Because the samples may be used in acriminal prosecution, what, where, when, how, etc., of the sample collection should be documented bothin writing and with pictures. Consider using waterproof disposable cameras and waterproof notepads,asthese items also need to be decontaminated. The types of samples taken can be extremely variable.Some of the possible samples are:

• Aerosol Collections in Buffer Solutions

• Soil

• Swabs

• Dry Powders

• Container of Unknown Substance

• Vegetation

• Food/Water

• Body Fluids or Tissues

What is collected will depend on the situation. Aerosol collection during an attack would be ideal, assumingyou have an aerosol collector. Otherwise anything that appears to be contaminated can either be sampledby swabbing the item with swabs if available, or absorbent paper or cloth. The item itself could becollected if not too large. In the case of well after the attack, collection samples of dead animals or peoplecan be taken in a manner similar to samples that are taken during an autopsy. All samples should ideallybe double bagged in ziploc bags (the inner bag decontaminated with dilute bleach before placing in thesecond bag) labelled with the time and place of collection along with any other pertinent data. If ziplocbags are not available, use whatever expedient packaging is available which appears to reduce thechance of sample contamination and infection of personnel handling the sample.

Note: This above chart has been downloaded from Medical Management of Biological Casualties handbook,Sixth edition, April 2005; USAMRIID, Fort Detrick Frederick, Maryland.

This may be suitably modified under the guidance of a microbiologist.

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Annexure-GRefers to Chapter 6, Page 77

OIE List of Infectious Terrestrial Animal Diseases

1. The following diseases are included within the category of multiple species diseases:

• Anthrax

• Aujeszky’s disease

• Bluetongue

• Brucellosis (Brucella abortus)

• Brucellosis (Brucella melitensis)

• Brucellosis (Brucella suis)

• Crimean Congo haemorrhagic fever

• Echinococcosis/hydatidosis

• Foot and mouth disease (FMD)

• Heartwater

• Japanese encephalitis

• Leptospirosis

• New world screwworm (Cochliomyia hominivorax)

• Old world screwworm (Chrysomya bezziana)

• Paratuberculosis

• Q fever

• Rabies

• Rift Valley fever

• Rinderpest

• Trichinellosis

• Tularemia

• Vesicular stomatitis

• West Nile fever

2. The following diseases are included within the category of cattle diseases:

• Bovine anaplasmosis

• Bovine babesiosis

• Bovine genital campylobacteriosis

• Bovine spongiform encephalopathy (BSE)

• Bovine TB

• Bovine viral diarrhoea

• Contagious Bovine Pleuro Pneumonia (CBPP)

• Enzootic bovine leukosis

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• Haemorrhagic septicaemia

• Infectious bovine rhinotracheitis/infectious pustular vulvovaginitis

• Lumpy skin disease

• Malignant catarrhal fever (Wildebeest only)

• Theileriosis

• Trichomonosis

• Trypanosomosis (tsetse transmitted)

3. The following diseases are included within the category of sheep and goat diseases:

• Caprine arthritis/encephalitis

• Contagious agalactia

• Contagious caprine pleuropneumonia

• Enzootic abortion of ewes (ovine chlamydiosis)

• Maedi-visna

• Nairobi sheep disease

• Ovine epididymitis (Brucella ovis)

• Peste des petits ruminants

• Salmonellosis (S. abortusovis)

• Scrapie

• Sheep pox and goat pox

4. The following diseases are included within the category of equine diseases:

• African horse sickness

• Contagious equine metritis

• Dourine

• Equine encephalomyelitis (Eastern)

• Equine encephalomyelitis (Western)

• Equine infectious anaemia

• Equine influenza

• Equine piroplasmosis

• Equine rhinopneumonitis

• Equine viral arteritis

• Glanders

• Surra (Trypanosoma evansi)

• Venezuelan equine encephalomyelitis

5. The following diseases are included within the category of swine diseases:

• African swine fever

• Classical swine fever

• Nipah virus encephalitis

145

• Porcine cysticercosis

• Porcine reproductive and respiratory syndrome

• Swine vesicular disease

• Transmissible gastroenteritis

6. The following diseases are included within the category of avian diseases:

• Avian chlamydiosis

• Avian infectious bronchitis

• Avian infectious laryngotracheitis

• Avian mycoplasmosis (Mycoplasma gallisepticum)

• Avian mycoplasmosis (Mycoplasma synoviae)

• Duck virus hepatitis

• Fowl cholera

• Fowl typhoid

• HPAI in birds and low pathogenicity notifiable avian influenza in poultry

• Infectious bursal disease (Gumboro disease)

• Marek’s disease

• Newcastle disease

• Pullorum disease

• Turkey rhinotracheitis

7. The following diseases are included within the category of lagomorph diseases:

• Myxomatosis

• Rabbit haemorrhagic disease

8. The following diseases are included within the category of bee diseases:

• Acarapisosis of honey bees

• American foulbrood of honey bees

• European foulbrood of honey bees

• Small hive beetle infestation (Aethina tumida)

• Tropilaelaps infestation of honey bees

• Varroosis of honey bees

9. The following diseases are included within the category of other diseases:

• Camelpox

• Leishmaniosis

ANNEXURES


146

Annexure-HRefers to Chapter 6, Page 91

Disposal of Animal Carcasses: A Prototype

1. If death was caused by a highly infectious disease

• Clean and disinfect the area after the carcass is removed.

• Wear protective clothing when handling deadstock and thoroughly disinfect or dispose of clothingbefore handling live animals.

• Properly dispose of contaminated bedding, milk, manure, or feed.

• Check with the State Veterinarian about disposal options. Burial may not be legal. Special methodsof incineration or burial may be used in cases of highly infectious diseases.

• Limit the access of the deadstock collector and his vehicle to areas well away from other animals,their feed and water supply, grazing areas, or walkways.

The standard site requirements for disposal of dead animals are:

• 6 feet above bedrock, 4 feet above seasonal high ground water.

• 2 feet of soil on top, final cover.

• Greater than 100 feet from property lines.

• Greater than 300 feet from water supplies.

2. Composting deadstock

If you compost your deadstock, follow the steps listed below:

A. Decide what method you will use. Burial methods include static piles, turned windrows, turned bins,and contained systems. Information on the first three methods is available on several websites listedunder ‘Resources on deadstock disposal.’

• Static piles with minimum dimensions of 4 feet long, by 4 feet wide, by 4 feet deep are by far thesimplest to use.

• Turned windrows may be an option for farmers already composting manure in windrows.

• Turned bin systems are more common for handling swine and poultry mortalities.

• The eco-pod is a contained system developed by Ag-Bag, which has been used to compostswine and poultry mortalities.

B. Select an appropriate site.

• Well-drained with all-season accessibility.

• At least 3 feet above seasonal high ground water levels.

• At least 100 (preferably 200) feet from surface waterways, sinkholes, seasonal seeps, or ponds.

• At least 150 feet from roads or property lines—think about which way the wind blows.

• Outside any Class I groundwater, wetland or buffer, or Source Protection Area contact—NRCSfor verification.

147

C. Select and use effective carbon sources.

• Use materials such as wood chips, wood shavings, coarse sawdust, chopped straw or dryheavily bedded horse or heifer manure as bulking materials. Co-compost materials for the baseand cover must allow air to enter the pile.

• If the bulking materials are not very absorbent, cover them with a 6-inch layer of sawdust toprevent fluids from leaching from the pile.

• Cover the carcass 2 feet deep with high-carbon materials such as old silage, dry bedding (otherthan paper), sawdust, or compost from an old pile.

• Plan on a 12’ x 12’ base for an adult dairy animal. The base should be at least 2 feet deep andshould allow 2 feet on all sides around the carcass.

• When composting smaller carcasses, place them in layers separated by 2 feet of material.

D. Prepare the carcass.

• After placing the carcass on the base, lance the rumen of adult cattle. Explosive release ofgasses may uncover the pile releasing odours and attracting scavengers.

E. Protect the site from scavengers.

• Adequate depth of materials on top of the carcass should minimise odours and the risk ofscavengers disturbing the pile.

• Scavengers may be deterred by the temperatures within the pile, but, if not, an inexpensive fenceof upside down hog wire may be adequate to avoid problems.

F. Monitor the process.

• Keep a log of temperature, carcass weight, and co-compost materials when each pile is started.Weather and starting materials will affect the process.

• Measure pile temperature with a compost thermometer 6 to 8 inches from the top of the pile anddeep within to check for proper heating. Check daily for the first week or two. Pile temperatureshould reach 65oC for 3 consecutive days to eliminate common pathogens.

• Record events or problems such as scavenging, odours, or liquid leaking from the pile. Wait. Most large carcasses will be fully degraded within 4-6 months. Smaller carcasses take less time.Turning the pile after 3 months can accelerate the process.

ANNEXURES


148

Annexure-IRefers to Chapter 7, Page 100 and 106

List of National Standards on Phyto-sanitary Measures

New standards/guidelines need to be developed on a priority basis for aluminum phosphide fumigation;surveillance; consignments in transit; pest reporting; and, sampling and diagnostic protocols. SOPs andmanuals for the above must also be developed for the operational aspects.

149

Annexure-JRefers to Chapter 8, Page 109

Important Websites

Ministry/Institute/Agency Website

Ministry of Home Affairs http://mha.nic.in/

Ministry of Health and Family Welfare http://mohfw.nic.in/

Ministry of Agriculture http://agricoop.nic.in/

Ministry of Defence http://mod.nic.in/

National Disaster Management Authority www.ndma.gov.in

Council of Scientific and Industrial Research http://www.csir.res.in/

Defence Research Development Organisation http://www.drdo.org/

Department of Biotechnology www.dbtindia.nic.in

National Institute of Virology www.icmr.nic.in/pinstitute/niv.htm

National Institute of Communicable Diseases www.nicd.org

Indian Veterinary Research Institute www.ivri.nic.in

World Health Organization www.who.int

Indian Council of Agricultural Research www.icar.org.in

United Nations Children’s Fund www.unicef.org

National Institute of Cholera andEnteric Diseases www.niced.org

Public Health Foundation of India www.phfi.org

National Institute of Epidemiology www.icmr.nic.in/pinstitute/nie.htm

Vector Control Research Centre www.pon.nic.in/vcrc/

International Health Regulations www.who.int/csr/ihr/en/

Centers for Disease Control and Prevention www.cdc.gov

National Bureau of Plant Genetic Resources www.nbpgr.ernet.in

Disaster Management Institute www.dmibpl.org

Armed Forces Medical Services www.indianarmy.gov.in/dgafms/index.htm

The Australia Group www.australiagroup.net/en/biological_agents.html

ANNEXURES


150

Core Group for Managementof Biological Disasters

1 Lt Gen (Dr.) Janak Raj Bhardwaj, Member, NDMA Chairman

PVSM AVSM VSM PHS (Retd) New Delhi


2 Maj Gen J.K. Bansal, VSM CBRN Coordinator, Coordinator

NDMA, New Delhi

3 Lt Gen (Dr.) D. Raghunath Principal Executive, Member

PVSM, AVSM (Retd) Sir Dorabji Tata Center

for Research in Tropical

Diseases, Bangalore

4 Dr. P. Ravindran Director, Emergency Member

Medical Relief,

MoH&FW, New Delhi

5 Dr. Shashi Khare Head, Department of Member

Microbiology, NICD,

New Delhi

6 Dr. S.J. Gandhi Dy. Director (Epidemic), Member

Directorate of Health

Services, Ahmedabad

7 Dr. R.K. Khetarpal Head, Plant Quarantine Member

Division, NBPGR,

ICAR, MoA, New Delhi

8 Col A.K. Sahni Senior Advisor and Member

Head, Microbiology and

Virology Department,

Base Hospital, Delhi Cantt.

9 Mr. A.B. Mathur Joint Secretary, Member

Cabinet Secretariat

New Delhi

10 Dr. S.K. Bandopadhyay Commissioner, Member

Department of Animal

Husbandry, MoA,

New Delhi

11 Mr. Murali Kumar NDM II, MHA, New Delhi Member

12 Mr. Arun Sahdeo Consultant, NIDM, Member

New Delhi

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Steering Committee

1 Lt Gen Shankar Prasad, Vasant Vihar, New Delhi Member

PVSM, VSM (Retd)

2 Dr. A.N. Sinha (Retd) Ex-Director, Emergency Member

Medical Relief,

MoH&FW, New Delhi

3 Dr. Narender Kumar Director of Personnel, Member

DRDO Bhawan, MoD

New Delhi

4 Dr. R.L. Ichhpujani Additional Director and Member

National Project Officer,

NICD, New Delhi

5 Dr. B. Pattanaik Project Director, FMD, Member

IVRI, Nainital

6 Brig R.K. Gupta, 278, Vasant Enclave, Member

AMC (Retd) Munirka, New Delhi

7 Dr. A.K. Sinha Veterinary Officer, Member

Director General, SSB,

New Delhi

8 Mr. S.D. Singh, IPS Senior Superintendent Member

of Police, Jammu

Significant Contributors

Agarwal G.S. Dr., Scientist E, DRDE Gwalior

Aggarwal A.K. Dr., Dy. Medical Commissioner, ESIC Head Office, New Delhi

Aggarwal Rakesh. Supdt. of Police, Central Bureau of Investigation, CGO Complex, New Delhi

Ahmad Muzaffar Dr., Director, Dte. of Health Services, Old Secretariat, Srinagar, Kashmir

Akhtar Suhel Dr., Commissioner, Govt. of Manipur, Imphal

Alam S.L., Scientist D, DRDE, Gwalior

Amrohi Rajesh Kr. Dr., SMO, 6th Bn ITBP, P.O. Sec 26, Panchkula, Haryana

Arora Rajesh Dr., Sceintist D, Institute of Nuclear Medicine and Allied Sciences, Delhi

Baciu Adrian, Coordinator, Interpol’s Bioterrorism Prevention Programme, Lyon, France

ACKNOWLEDGEMENTS


152

Bakshi C.M., DIG, Central Reserve Police Force, Pune,Talegaon, Pune

Bakshi Sanchita Dr., Director of Health Services, Govt. of West Bengal, Kolkata

Bharti S. R., Dy Comdt, Central Industrial Security Force, Arakonam, Tamil Nadu

Bhaskar N. Lakshmi Dr., Sr. Resident Nizam Institute of Medical Sciences (NIMS) Hospital, Hyderabad

Bhati S. G. IPS, DIG (Intellegence), Police Bhawan, Gandhinagar, Gujarat

Bhatia S. S. Lt Col, Research Pool Officer, DGMS (ARMY), L-Block, New Delhi

Biswas N.R. Prof., Deptt. of Pharmocology, AIIMS, New Delhi

Chattopadhyay Joydeep Dr., CMO, 106, Bn NDRF: BSF, KOLKATA

Chawla Raman Dr., SRO, (Man-made Disasters and Medical Preparedness), NDMA, New Delhi

Chokeda Deepak Major, 4011 Fd Amb, C/O 56 Apo

Dash Dipak, Sr. Correspondent, Times of India, New Delhi

Desai Rajnanda Dr., Dy. Director, Medical Dte. of Health Services , Panaji, Goa

Dhar G. Theva Neethi, Additional Secretary (R&R), Pondicherry

Flora S.J. Scientist F, DRDE, Gwalior

Ganguly N. K. Prof., Ex-DG, ICMR, Delhi

Gupta Amit Dr., Asst. Professor, Surgery, AIIMS, New Delhi

Gupta Kavita Dr., ICAR, New Delhi

Hojai Dhruba Dr., Director of Health Services, Assam, Guwahati

Jangpangi P.S., Addl. Secy, Government of Uttarakhand, Dehradun

Kamboj D.V. Dr., Scientist D, DRDE, Gwalior

Kapur Rohit Lt Col, Dte. Gen. Medical Services (Army) Room No.111 L Block , New Delhi

Kapur Sanjeev, Chief Operating Officer, Jain Studios, New Delhi

Kashyap R. C. Air Com, Medical Dte, Air HQ, R K Puram, New Delhi

Kaul R. Technical Officer B, DRDE, Gwalior

Kaul S. K. Lt Gen, Commandant, Armed Forces Medical College, Pune

Kaushik.M.P. Dr., Associate Director, DRDE, Gwalior

Khadwal Raman, Commandant, Dte. Gen., ITBP, Lodi Road, New Delhi

Kumar Das Abhaya Major, AMC, 320 Field Ambulance, C/o 99 APO

Kumar Dheeraj Capt Dr., Medical Officer, Base Hospital, New Delhi

Kumar Manoj, Cameraman, Jagran, Noida

153

Kumar Om Dr., Scientist E., DRDE, Gwalior

Kumar Rahul Brig, Deputy Director General (NBC Warfare), Army HQ, New Delhi

Kumar S Dr., Prinicipal and Dean, MS Ramaiah Medical College, Bangalore

Kumar Sanjay Srivastav, Second In Command, 106 BN NDRF: BSF, Kolkata

Kumar Subodh Dr., Scientist D, DRDE, Gwalior

Laumas Sanjiv Brig, DACIDS, Min Of Def., South Block, New Delhi

Lidder S.B.S. Brig (Retd.), Ex-Commander, Faculty of NBC Protection, College of Military Engg.,

Pune

Mandki Nawal Singh, Commissioner, Bhoo Abhilekh, Raipur, Chattisgarh

Manja K.S. Dr., Ex-Director of Personnel, DRDO, New Delhi

Meshram G.P., Scientist F, DRDE, Gwalior

Mitrabasu Dr., INMAS, New Delhi

Modi Y.C., Jt. Dir., CBI, CGO Complex, New Delhi

Naidu G.S. Dr., Deputy Director (Public Health), Dte. of Health, New Saram, Pondicherry

Nimesh G. Desai Prof., Head, Dept. of Psychiatry and Medical Suptd., Institute of Human Behaviour

and Allied Sciences, Delhi

Oberoi M.M. Dr., DIG/AC-III, CBI CGO Complex, New Delhi

Padhl G.C. Dr., C.M.O. (SG), NDRF(A) CISF Surakshya comp., Dist. Vellore (TN)

Parashar B.D. Dr., Scientist F, DRDE, Gwalior

Pariat W.M.S., Relief Commissioner, Main Secretariat Building, Shillong, Meghalaya

Parida M.M. Dr., Scientist E, DRDE, Gwalior

Pipersenia V.K., Principal Secretary, Assam Secretariat, Dispur

Prakash S. Dr., Director, Stali Institute of Health & Family Welfare, Magadi Road, Bangalore

Prakash Sri Dr., Associate Director, DRDE, Gwalior

Prasad G.S.C.N.V., Dr., Dy. Medical Supritendent, Nizam Institute of Medical Sciences (NIMS),

Hyderabad

Puri S.K. Brig (Retd.), Dean, Institute of Health Management Research, Jaipur

Rai G.P. Dr., Scientist F, DRDE, Gwalior

Rajenderan C. Dr., M.D., Poision Center, GGH & MMC, Chennai

Rao P.V.L. Dr., Scientist F, DRDE, Gwalior

Rathore C.B.S., DIG, CRPF, Gandhinagar, Gujarat

ACKNOWLEDGEMENTS


154

Rawat D. S., CO O/o Director General, SSB, Force Hqr, East Block-V, R.K.Puram, New Delhi

Rawat K.S., Sr. Field Officer, Force Hqs., SSB, RK Puram, New Delhi

Sachdeva T.S. Col., Director, Perspective Planning (NBC Medicine), Army HQ, New Delhi

Saha S.S. Dr., Director, Health Services, Delhi Govt., F-17 Karkardooma, East Delhi

Salhan R.N. Dr., Addl. DG, MoH&FW, Nirman Bhavan, New Delhi

Salunke Subhash Dr., Regional Advisor EHA, WHO-SEARO, Indraprastha Estate, New Delhi

Santosh Kumar Prof., NIDM, Delhi

Satayanarayanan S., Senior Staff Correspondent, Dyal Singh Library, 1 D.D.U. Marg, New Delhi

Saxena Amit, Scientist B, DRDE, Gwalior

Sayana R.C.S. Dr., D.G. (Medical Health),107, Chandra Nagar, Dehradun

Sekar Vijaya S., Dy. Director, Tamil Nadu Fire Service, North Western Region, Vellore, Tamil Nadu

Sekhose V. Dr., Principal Director, Health & FW, Government of Nagaland, Kohima

Sellamuthu, M.K., IAS, Joint Commissioner (LR) Deptt of Revenue Admn., DM&M, O/o RC

Selvam D.T. Dr., Scientist D, DRDE, Gwalior

Selvaraj S. Alphonse Dr., Joint Director, Public Health, Chennai, Tamil Nadu

Shankar Ravi Dr., INMAS, New Delhi

Sharan Anand M., Additional Resident Commissioner, Harayana Bhawan, New Delhi

Sharma Anurag, IG & Director, National Industrial Security Academy, Hakimpet, Hyderabad

Sharma Deepak, PPS, NDMA, Centaur Hotel, New Delhi

Sharma K. Dr., C. Dy. Director, Himachal Pradesh, Shimla, Himachal Pradesh

Sharma Mudit Wg Cdr, Air Force Station, Arjangarh, New Delhi

Sharma N.K. Dr., DGHS, O/o DGHS

Sharma R.C., Chief Fire Officer, Delhi Fire Services, Delhi

Sharma R.K. Dr., Joint Director and Head, CBRN Defence, INMAS, DRDO, Delhi

Singh Asar Pal, Liaison Officer, Lakshadweep, Kasturbha Gandhi Marg, New Delhi

Singh J.N., Gen. Secy., Aware World, C-181, Pandav Nagar, New Delhi

Singh Kamlesh K.R., Correspondent, Jain Studios, New Delhi

Singh Lokendra Dr., Scientist F, DRDE, Gwalior

Singh P.K., Officer, Secretariat (Man-made Disasters and Medical Preparedness) NDMA, New Delhi

155

ACKNOWLEDGEMENTS

Sohal S.P.S. Dr., Jt. Director, Health Services, O/o Director, Health Services, Government of Punjab,

Chandigarh

Sood Rubaab, Disaster Mgmt. Cosultant, NDMA, Centaur Hotel, New Delhi

Srivastava Shishir, Media Special Correspondent, Jagran, Noida

Sudan Preeti, IAS, Commissioner, Disaster Management, Andhra Pradesh Secretariat, Hyderabad

Sundaram Arasu Dr., Programme Director, Disaster Mgmt. Cell, Anna Institute of Management,

Chennai

Swain N. Gp Capt, DMS (O&P), Air HQ, R.K.Puram, New Delhi

Tandon Sarvesh Dr., Asstt Prof., Vardhman Mahavir Medical College (VMMC) and Safdarjung

Hospital, New Delhi

Tripude R. Dr., Scientist D, DRDE, Gwalior

Tuteja Urmil Dr., Scientist F, DRDE, Gwalior

Veer V. Dr., Scientist F, DRDE, Gwalior

Vijayaraghavan R. Dr., DRDE, Gwalior

Wangdi C.C., Addl. Secretary, Land Revenue & Disaster Management Dept., Govt. of Sikkim, Gangtok

Yadav R.K., Station Officer, DFS Nehru Place Fire Stn., New Delhi

Yaden Michael, Addl. Director, Civil Defence, Nagaland

Yaduvanshi Raajiv, IAS, Commissioner & Secy. (Revenue), Government of Goa, Panaji


156

For more information on these Guidelines for Management of Biological Disasters

Please contact:

Lt Gen (Dr.) J.R. Bhardwaj

PVSM, AVSM, VSM, PHS (Retd)


Member,

National Disaster Management Authority

Centaur Hotel, (Near IGI Airport)

New Delhi-110 037

Tel: (011) 25655004

Fax: (011) 25655028

Email: [email protected]; [email protected]

Web: www.ndma.gov.in

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