Preparedness for Millions

Daniel Brencic

Imagine a gathering on the scale of the Hajj or the Olympics in Rio de Janeiro, but instead of descending upon a city, more than a million religious pilgrims gather along the edges of a Hindu temple pool, waiting their turn to take a dip in the holy waters behind the thousands of sadhus, or holy men, who lead the procession. Makeshift food stands abound, water and sanitation is limited at best, and the constant crush of people is inescapable. It’s loud, colorful, chaotic, and – if you’re one of the lucky devotees – a transcendent experience.

Now imagine all of this unfolding without any major public health incident. That is what happened at the Mahamaham religious festival and other recent public health responses in India’s Tamil Nadu state, thanks to a new initiative to strengthen public health emergency management.

Along with CDC staff Rajeev Sharma and Jenny Beaver, I have been working with the Tamil Nadu Directorate of Public Health and the National Institute of Epidemiology to develop an Emergency Operations Center (EOC). Its purpose is to coordinate and manage the public health aspects of mass gatherings, like the Mahamaham religious festival, or to respond to emergencies, like the historic floods that struck Tamil Nadu state in December 2015. We hope to connect this state-level EOC with the national-level EOC at the Indian National Centre for Disease Control in New Delhi that was developed through a previous CDC project.

The enormous influx of people during a mass gathering can pose many challenges for local health officials, who are often already working with limited resources and staff. Establishing an Emergency Operations Center facilitates a more efficient response and improves coordination between district, state, and national-level partners. Having a centralized location to coordinate partners, surveillance and laboratory data, communication messages, and the deployment of Rapid Response Teams to investigate sources of outbreaks may dramatically reduce response times, which can save lives, infrastructure, and money.

The same principles of emergency management can be applied to planned events like the Mahamaham festival or unplanned events like an infectious disease outbreak or natural disaster. The Global Health Security Agenda target is for public health EOCs to activate a coordinated response within two hours of identifying a public health emergency.

Partnership with Tamil Nadu state has been rewarding. Our partners in India are some of the hardest-working people I know, and it is great to see how they use creativity and innovation to achieve significant public health impact with limited resources. Tamil Nadu state partners are already preparing for the next festival mass gathering, while simultaneously conducting their routine disease surveillance program, which covers 67 million people. In India, being prepared for millions is not just part of a program, it’s part of a culture of preparedness.

This project is funded through the U.S. State Department’s Biosecurity Engagement Program.