|Year : 2013 | Volume
| Issue : 2 | Page : 109-111
Epidemic diseases act 1897, India: Whether sufficient to address the current challenges?
Binod K Patro1, Jaya Prasad Tripathy2, Rashmi Kashyap2
1 Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
2 Department of Community Medicine, Post Graduate Institute of Medical Education and Research School of Public Health, Chandigarh, India
|Date of Web Publication||6-Sep-2013|
Binod K Patro
Associate Professor, Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar - 751 019, Odisha
Source of Support: None, Conflict of Interest: None
In this age of noncommunicable diseases, communicable diseases still contribute 30% of disease burden in India. Hundreds of epidemics occur each year and we fail to respond and contain most of them. Apart from various biological and behavioral public health interventions, we need to closely look at the structural intervention, that is, the legal framework to review health system preparedness. Although India has a number of legal mechanisms to support public health measures in an epidemic situation, they are not being addressed under a single legislation. The Epidemic Act 1897 is a century old blunt act which needs a substantial overhaul to counter the rising burden of infectious diseases both new and old. Issues like definition of epidemic disease, territorial boundaries, ethics and human rights principles, empowerment of officials, punishment, etc., need more deliberations and warrant a relook.
Keywords: Epidemic diseases act, outbreak control, public health interventions
|How to cite this article:|
Patro BK, Tripathy JP, Kashyap R. Epidemic diseases act 1897, India: Whether sufficient to address the current challenges?. J Mahatma Gandhi Inst Med Sci 2013;18:109-11
|How to cite this URL:|
Patro BK, Tripathy JP, Kashyap R. Epidemic diseases act 1897, India: Whether sufficient to address the current challenges?. J Mahatma Gandhi Inst Med Sci [serial online] 2013 [cited 2020 Jul 11];18:109-11. Available from: http://www.jmgims.co.in/text.asp?2013/18/2/109/117796
| Introduction|| |
India is witnessing epidemiological transition. In the 21 st century, the country is facing dual burden of diseases. While struggling to combat the burden of communicable diseases, our health system is challenged to address chronic noncommunicable diseases. The burden and spectrum of infectious diseases are enormous in India. They still contribute about 30% of disease burden in India.  Epidemics of communicable diseases impose a heavy economic burden on individuals, families, communities, and nation at large. We still are clueless while handling influenza pandemics and struggle to contain them.
A total of 1,584 disease outbreaks were reported and responded during the year of 2012 in India.  This is just the tip of the iceberg as many outbreaks go unnoticed and unreported. The rise in the number, geographic extent, severity of outbreaks, threat of bioterrorism, emergence of emerging and reemerging infections, volume of air travel, globalization, and the complex lifestyle behaviors of the people has stressed the need for devising new public health interventions to respond to the epidemics effectively and swiftly.
Public health interventions can be broadly divided into four categories: Biological, behavioral, political, and structural. The biological interventions are most commonly used for containing communicable diseases. They are the ones based on classical biomedical model of health. Behavioral interventions rely upon bringing upon a change in the behavior of an individual or the community which is based upon social determinants model of health promotion. Political interventions are in the form of prescribing policies related to health. The last category of public health interventions is structural which is the end result of political process, that is, passage of laws and regulations. 
Two pronged strategy is employed by Government of India to control infectious diseases. First, we have selective vertical diseases control program which focuses on one disease at a time. This approach is suitable for endemic diseases. Cost and nonintegration with general health services of this approach makes it nonreplicable and inefficient in the containment of infectious diseases. The second approach is based on investigation and control of outbreaks and epidemics. This approach is suitable for short-term containment of epidemics, but inappropriate for endemic diseases. Both approaches operate with within a legal and administrative framework and require community participation to be effective. A recent review on challenge of infectious diseases in India have concluded the inadequacy of our health system in tackling the infectious diseases and recommended overhauling of our health system.  Review of health systems preparedness will not be complete without reviewing the legal frameworks available. Regulatory options available in India are namely Epidemic Act 1897 and Internal Health Regulations. International Health Regulations is an instrument designed and implemented by World Health Organization for diseases of national, regional, and global health security. Epidemic Act 1897 is the only act which provides legal interventions in case of a subnational epidemic.
| Epidemic Diseases Act 1897|| |
The Epidemic Diseases Act came into force on February 4, 1897 as a response to the plague epidemic in Bombay. This act confined plague to Bombay by a series of tough measures which prevented crowds from gathering.  This Act has four sections, the first section describes the title and the extent, the second section empowers state and central government to take special measures and prescribe regulations that are to be observed by public to contain the spread of disease. The third section defines penalty for violating the regulations, whereas the fourth section gives legal protection to persons acting under the act.
Section 1 says that the act may be called as Epidemic Diseases Act, 1897 and it extends to the whole of India except the territories which immediately before the 1 st November, 1956 were comprised in Part B states.
Section 2 states that when the state government is satisfied that the state or any part thereof is visited by or threatened with an outbreak of any dangerous epidemic disease; and if it thinks that the ordinary provisions of the law are insufficient for the purpose then the state may take, or require or empower any person to take some measures and by public notice prescribe such temporary regulations to be observed by the public. The state government may prescribe regulations for inspection of persons travelling by railway or otherwise, and the segregation, in hospital, temporary accommodation or otherwise, of persons suspected by the inspecting officer of being infected with any such disease.
Section 2A empowers the central government for inspection of any ship or vessel leaving or arriving at any port and for detention thereof, or of any person intending to sail therein, or arriving thereby.
Section 3 prescribes penalty for disobeying any regulation or order made under the Act in accordance with section 188 of the Indian Penal Code. Under this provision, a punishment of 6 months imprisonment or 1,000 rupees fine or both shall be meted out to the person who disobeys any order under the Act.
Section 4 clearly mentions that no suit or other legal proceeding shall lie against any person for anything done or in good faith intended to be done under this Act. 
| Major Limitations of the Act|| |
Epidemic Act 1897 is an archaic framework, 113-year-old. The century old Act over the years has accumulated quite a number of flaws which can be attributed to the changing priorities in public health emergency management. Epidemic Act 1897 is silent on the definition of dangerous epidemic disease. Moreover, it being a century old act, the territorial boundaries of the act needs a relook. Apart from the isolation or quarantine measure the act is mum on the legal framework of availability and distribution of vaccine and drugs and implementation of response measures. There is no explicit reference pertaining to the ethical aspects or human rights principles during a response to an epidemic. The punishment for violation of regulations under section 188 of Indian Penal Code also warrants a revision. Can section 188 IPC guarantee justice to all those who suffered from the plague epidemic which cost the Indian economy over $600 million and took the toll of hundreds of lives is a big question, and we certainly have no answers to that. 
Although India has a number of legal mechanisms to support public health measures in an epidemic situation, they are not being addressed under a single legislation. There is an urgent need to assemble all the provisions in one over-arching public health legislation, so that the implementation of the responses to an epidemic can be effectively monitored. Without a comprehensive public health Act, we are dependent upon old blunt instruments like Epidemic Act 1897 which is nonfunctional in itself. Constant efforts are underway to strengthen public health legislation in India. In 1955 and again in 1987 the central government developed a Model Public Health Act, but could not advocate states to adopt them. The latest revision done by NICD in 2003 is still pending for approval by central authorities. The National Health Bill 2009 seeks to ensure broad legal framework for providing essential public health services and functions and powers to respond to public health emergencies through effective collaboration between center and the states. Some states like Gujarat and Karnataka have a gone a long way in drafting the Public Health Bill. 
Integrated Disease Surveillance Project (IDSP) was another initiative launched in 2004 which collects routine disease surveillance data to detect and respond to disease epidemics quickly. On an average, IDSP reports 30-40 outbreaks every week by the states.  But these provisions seem to be adequate to deal with small scale emergencies but do not appear to be sufficient for large scale health crisis during pandemics. With the advent of emerging and reemerging infectious diseases and widespread global movement, the legal frameworks need to be strengthened under a sound public health law infrastructure under areas like isolation or quarantine of infected or suspected patients, travel or movement restrictions, prohibition of mass gatherings, closure of educational and other institutions, compulsory vaccination, etc.
| Conclusion|| |
Thus it is far beyond doubt that this century old Act needs a complete overhaul to cater to the changing public health priorities. Undeniably, the role of public health specialists in this regard cannot be ruled out. The lawmakers can draw a leaf out of the National Disaster Management Act 2005  (deals with public emergency) as it clearly defines all the terms and has an explicit description of all the implementing measures and agencies to be instituted in the event of any emergency.
| References|| |
|1.||WHO. The global burden of disease: 2004 update. Geneva: World Health Organization, 2008. |
|2.||Integrated Disease Surveillance Project. Ministry of Health and Family Welfare, Government of India. Available from: http://www.idsp.nic.in/ [Last accessed on 2012 Jun 24]. |
|3.||Nutbeam D, Wise M. Structures and strategies for public health intervention. In: Detels R, McEwen J, Beaglehole R, Tanaka H, editors. Oxford Textbook of Public Health. 4 th ed. London: Oxford University Press; 2002. |
|4.||John TJ, Dandona L, Sharma VP, Kakkar M. Continuing challenge of infectious diseases in India. Lancet 2011;377:252-69. |
|5.||Epidemic Diseases Act 1897. Available from: www.mohfw.nic.in [Last accessed on 2012 Dec 24]. |
|6.||Dennis DT. Plague in India. BMJ 1994;309:89. |
|7.||Kakkar M, Hazarika S, Zodpey S, Reddy KS. Influenza pandemic preparedness and response: A review of legal frameworks in India. Indian J Public Health 2010;54:11-7. |
|8.||National Disaster Management Act 2005. Available from: http://www.ndmindia.nic.in/acts-rules/DisasterManagementAct2005.pdf [Last accessed on 2012 Dec 24]. |