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The Epidemic Diseases Act, 1897: A critique

In 1897 the Epidemic Diseases Act was enacted to help deter the transmission of “dangerous epidemic diseases” (1). It emerged to combat the bubonic plague outbreak that at the time broke out in the then state of Bombay. The Governor-General of Colonial India imposed special powers on local authorities to enforce the requisite disease control measures.

The Epidemic Diseases Act is one of India’s shortest legislation, consisting of only four parts. The first section explains the title and scope, while the second grants the State and Central Governments the power to take special measures and devise laws that are to be enforced by the public to prevent disease spread. The third section, in compliance with section 188 of the Indian Penal Code, outlines punishments for breaking the regulations. The fourth includes procedural security for executing officers working under the Act (1).

The Epidemic Act was aggressively implemented to contain the plague outbreak that occurred in the 1890s (2, 3, 4). The powers it bestowed were used in searching for alleged plague cases in homes and among travellers. Infected people were physically isolated, disinfection, relocation, and infected areas were demolished. It also prohibited crowd gathering, banned public assemblies and festivals, and halted pilgrimages. Alleged harassment (including public stripping) of and abuse against women caused outrage among people, and protests in some places were registered. In certain areas, military forces were used to ensure the prevention steps were adequately enforced (2, 3, 4). Historian David Arnold called the Act as one of the most authoritarian pieces of health legislation ever introduced in colonial India (3), and Myron Echenberg claimed in his book that “there was enormous potential for abuse” (4). Since Independence, the enforcement of the Act remained dormant.

The Act was written some 118 years ago and thus has significant drawbacks in this period of changing public health emergency response strategies. The causes that contributed to the onset and dissemination of communicable diseases have evolved over the years. Some of the reasons that need to be discussed now are the growing globalization related travel.

patterns, increased use of air travel relative to sea transport, increased migration within states in order to earn a living, the transition from agrarian to industrial communities, increased urbanization, dramatically increased population density in some regions, Increasing level of interaction with animals and wildlife, man-made ecosystem shifts, shifting climatic environments, mass food processing methods, deterioration of public health policies and lapses in biosecurity. In the changing world, the Infectious Diseases Act needs modifications.

It is too ship-oriented, for example, and quiet on “air travel,” which was unusual at the time. Also, the epidemiological principles used for infectious disease prevention and management have evolved over time. The Epidemic Diseases Act does not conform to the contemporary scientific understanding of prevention and response to outbreaks, but only reflects the scientific and legal standards that prevailed at the time of framing it. The Act, for example, places too much emphasis on isolation or quarantine measures but is silent on other scientific methods of preventing and controlling outbreaks, such as vaccination, surveillance, and organized response to public health.

In India, the act Epidemic Diseases Act 1897 requires attention medical practitioners to notify anyone with a communicable disease to the public health authority and to disclose the person’s identity. Notification is essential for good monitoring and for getting an idea of the disease burden in the community, as this helps in the planning, implementation, and evaluation of disease control programmes. Various states have made numerous diseases notifiable under various acts of public health. Recently, the Government of India has made tuberculosis a notifiable disease, although the order does not mention that it is backed by an Act (5). The Goa Public Health Act requires the declaration of an individual’s HIV status to public authorities. Ethical concerns related to the compulsory notification process have been extensively debated (6).

After the introduction of the Integrated Disease Surveillance Program (IDSP), each district has a surveillance unit and a Rapid Response Team (RRT) to handle a disease outbreak in every part of the nation. A comprehensive network of epidemiologists, microbiologists, and entomologists has been made available in both district and state offices under the IDSP to improve monitoring efforts and response mechanisms. Connectivity of information technology has been developed for fast data sharing with all states, districts and medical colleges. The IDSP has sought to engage the private sector but with little success in the disease surveillance process (7). The obstacles to receiving notices include the absence of a perceived obligation to include the private sector in the public sector; the reluctance of public sector workers to deal with the private sector; and the lack of mutual trust and respect in both the sectors. In the other hand, the private sector tends to have reservations about confidentiality, the difficulty of reporting procedures, worries of losing patients, lack of government recognition and confusion about when and how to inform (8).

Judicial regulations should not be seen as loopholes to force the private sector to report cases; rather, they should resolve the real problems. There are existing examples of good surveillance systems collecting privatesector alerts without the use of intimidation (9, 10). Polio surveillance is a clear example of involvement by the private sector in the control of diseases. The North Arcot District Health Information method in Vellore and the district-based surveillance model Kerala are examples of successful involvement by the private sector in disease surveillance. Non-financial benefits, such as the inclusion of names in the network directory, participation in surveillance committees, high-quality training, effective communication channels, consistent guidance, motivation and handholding, have been described as core factors that have helped to promote private sector notifications.

The last choice should be to use coercion to get updates and gather information, which can be resorted to only after all the above-listed considerations have been examined and only if the profit obviously outweighs the risks.

The Epidemic Diseases Act is like a guideline text, rather than providing specific statutory instructions. It makes no note of any practical steps the government needs to take to curb or deter disease transmission. Today we have a more organized public health system, with specific persons in charge of providing primary care. Primary care is responsible for avoiding infectious disease outbreaks and their management. For early warning of outbreaks, the IDSP is in place. The District Chief Medical Officer oversees the team for monitoring and preventing diseases together with the state-level team and the primary health centre medical officer, field nurses, and other community health employees

When such a structure is in effect, it does not make sense to go along with the recommendation of the Act that “any” individual can be empowered. In the present sense, the term “any” cannot be acknowledged, and the Act should address “who” should do “what.

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Author

– Dr. Shiv Joshi
MD (Community Medicine)

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