India's disease outbreak response is set to undergo a significant transformation with a regional strategy. The Union government is rethinking its approach to disease detection, tracking, and containment, and the upcoming budget could be a pivotal moment. Two government officials revealed that the National Centre for Disease Control (NCDC) is being overhauled as part of a broader initiative to decentralize outbreak response and reduce diagnostic delays. This includes establishing five new regional offices, 20 metropolitan surveillance units, and 27 state regional centers, marking a shift towards a more comprehensive and localized response system.
The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) will introduce 10 new biosafety level-3 (BSL-3) laboratories to enhance field-level diagnostics for pandemic preparedness. These laboratories will enable advanced testing to combat emerging diseases. Additionally, special units will focus on health security in densely populated cities by addressing sanitation and overcrowding issues, with NCDC taking the lead in service delivery and evidence collection, while the Indian Council of Medical Research (ICMR) will concentrate on medical research.
BSL-3 laboratories, designed to prevent airborne pathogen escape, are integral to a nation's disease detection and surveillance strategy. India currently operates 35 BSL-3 labs managed by various institutions, including NCDC, ICMR, CSIR, ICAR, DBT, and ANRF. The country's sole BSL-4 laboratory, located in Pune, handles the most dangerous pathogens. However, India faces a growing number of infectious disease outbreaks, including zoonotic diseases like Nipah virus, Zika virus, and avian influenza, which have caused numerous fatalities.
The PM-ABHIM scheme, worth ₹64,180 crore, will conclude in the current fiscal year (FY26). From FY27 onwards, the scheme will receive fresh budgetary allocations for disease surveillance and lab maintenance. The government's final decision on allocations will be made closer to the budget announcement on February 1, considering the fiscal scenario, specific funding needs, and macroeconomic prospects.
NCDC, based in New Delhi, manages the Indian SARS-CoV-2 genomics consortium (INSACOG) for COVID-19 variant genomic surveillance. It has eight outstation branches across the country. Upgrading these facilities aims to address critical gaps in the public health network, enabling faster infection identification and containment. This strategic move aims to create a pandemic-resilient healthcare system.
India's current bio-safety lab count of 237 is deemed insufficient to handle the country's population and increased zoonotic threats. The Department of Health Research (DHR) operates 165 labs, including BSL-3 and BSL-2 facilities. ICMR, DBT, CSIR, ICAR, and ANRF also manage labs. Dr. Sujeet Singh, a former NCDC director, emphasizes the need to move beyond the post-pandemic complacency phase, highlighting limited laboratory detection capacity. During the 2018 Nipah outbreak, diagnostic delays contributed to fatalities due to sample transportation distances. Similarly, during H1N1, Nipah, and COVID-19 outbreaks, existing laboratories were overwhelmed with samples.
To address these vulnerabilities, Dr. Singh suggests a robust network of at least 15 BSL-3 laboratories and a dedicated BSL-4 facility for human samples. He also advocates for five high-capacity regional centers to decentralize the burden on Delhi, emphasizing the need for technical hubs rather than administrative branches. India's health challenges vary across regions, and NCDC should aim for BSL-4 standards, similar to the CDC in Atlanta, to become a regional center for Southeast Asia.
Raman Gangakhedkar, a former chief scientist at ICMR, views the revamp plan as crucial for future survival, whether detecting new organisms or investigating outbreaks. While ICMR will provide support, its primary focus will be on evidence generation and disease burden identification, not service delivery.
India's rapid population growth, surpassing China in 2023, with six mega-cities and 53 urban centers, underscores the importance of specialized metropolitan surveillance units for urban health security management.
