Delhi: As India struggles with the COVID-19 crisis, state governments have only just begun to hire epidemiologists--the specialised health professionals trained in dealing with infectious diseases. More than a quarter of India’s 736 districts have no district-level epidemiologists and 11 states have no state-level epidemiologist either, according to a letter from India’s health ministry reviewed by IndiaSpend.

The letter says the Indian Prime Minister has asked all state chief ministers to immediately hire for these positions.

Epidemiologists are vital in India’s programme against COVID-19. “An epidemiologist is like a whistleblower,” said Deepak Saxena, professor at Indian Institute of Public Health. “They are the ones who study the distribution and determinants of a health event. They are trained to look at just the raw data and quickly identify how the disease is spreading and where, and figure out how to act fast.”

“The number of people we need to hire speaks to how much epidemiological intelligence is needed right now to contain this outbreak,” said Sujeet Kumar Singh, director of India’s Integrated Disease Surveillance Programme (IDSP).

The directive

India’s health secretary, Preeti Sudan, sent the letter about hiring epidemiologists on April 7, 2020. India had recorded 124 deaths from COVID-19 by this time.

An annexure to the letter lists out 216 of India’s 736 districts for currently having epidemiologists’ positions vacant. The 11 states without a state-level epidemiologist include Andhra Pradesh, Telangana, West Bengal, Haryana, Chhattisgarh and Assam.

Sudan’s letter noted that the hiring should be done on “war footing” because epidemiologists are a “critical element in the effective management of the pandemics like COVID-19”. A handwritten note from her on the letter says, “I had written to you in this regard earlier also. Request urgent action please!”

Why is IDSP important in managing COVID-19?

While officials from the Union health ministry and the Indian Council of Medical Research (ICMR) have been the public face of India’s COVID-19 management, one agency that has been absent in the public so far is the National Centre for Disease Control, which runs the IDSP.

IDSP’s network of epidemiologists work close to the ground and by design, are meant to pick up on spikes in disease in the areas of their work. “Lockdown, testing and treatment is all very important but if cases are not picked up by epidemiologists in surveillance in the first place, it will affect the entire process. So IDSP’s surveillance is an important link,” said Singh.

In the normal scheme of things, one of the IDSP’s roles is to detect through surveillance and record cases of severe acute respiratory illness (SARI) and influenza-like illness (ILI), which is also a respiratory illness. The virus that causes COVID-19 being a respiratory virus--it is called the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)--the testing criteria for COVID-19 have been widened to include SARI and ILI. The IDSP’s role in tackling COVID-19 has thereby expanded.

Many experts have welcomed this decision to widen testing. “Given that COVID-19 is an acute respiratory disease, patients having SARI and ILI could also be positive for COVID-19,” said T Sundararaman, former dean at the Tata Institute of Social Sciences’ department of health systems studies. “Since the symptoms look similar, it is essential that patients with respiratory illness are tested for COVID-19, whether or not they have had travel history to hot spots. IDSP’s flu tracking system will help find these cases.”

IDSP has stopped publishing influenza cases

However, the IDSP has stopped publishing weekly numbers for seasonal influenza (H1N1) in India since February 2, 2020, without an explanation. This is just three days after India reported its first case of COVID-19 on January 30, 2020.

IDSP has not published data for any disease since February 2. Both H1N1 data and COVID-19 data are vital right now to understand the spread of the viral disease and IDSP’s last report records India’s first three COVID-19 cases (all in Kerala) along with 18 deaths from H1N1 (IDSP’s public data on H1N1 extends to at least 2010).

“All the information is there... Maybe it has not been uploaded because everyone is very busy right now,” IDSP’s director Singh said.

State governments swing into action

After the letter from the central government on April 7, various state governments have begun to issue circulars calling for epidemiologists to apply for these jobs within a few days. IndiaSpend has reviewed some of these circulars.

One National Health Mission director whom IndiaSpend spoke to said that it would be a challenge to hire for these positions as out-station candidates would not be able to travel and states would need to find talent locally. Some health professionals have pointed out that the contracts are far from lucrative--they offer short-term employment at low salaries, have varying eligibility criteria, and allow just a few days to apply.

For example, though Telangana has had a challenging time dealing with COVID-19, a circular from its health department says the state needs to hire 24 epidemiologists immediately. The state has 33 districts, 30 sanctioned positions for district-level epidemiologists, of which only six are filled. The state is offering a remuneration of Rs 50,000 per month and will hire these people for four months only, on outsourcing basis.

“These jobs are offering very low remuneration but asking for people with postgraduate degrees in medicine to apply. Why would someone risk their life in this pandemic situation, for such short term jobs, with such low pay?” said Shrikant Kalaskar, who has worked with the central government to train state-level staff in disease surveillance and outbreak investigation.

States have not taken this issue seriously, Kalaskar said, and that is why 216 of India’s 736 districts need epidemiologists urgently: “States are rushing to hire only after the central government’s letter.”

The Assam government is willing to hire those with degrees in ayurveda and homoeopathy as well. Karnataka is hiring one state epidemiologist at a remuneration of Rs 33,600 per month, also on a temporary basis. For both Assam and Karnataka, the circulars say candidates have to apply online but there are no visible links on the government’s website to do this. Himachal Pradesh is hiring one epidemiologist at a remuneration of Rs 40,000 per month, on a one-year contract. Chhattisgarh is offering Rs 60,500 for state epidemiologists but only Rs 35,000 at the district level.

IndiaSpend has sent queries regarding the shortage of epidemiologists to the Union health ministry. This report will be updated when we receive a reply.

(Bhuyan is a special correspondent at IndiaSpend.)