The identification of old and new diseases, and the mapping of their spread requires a robust disease surveillance and expansive public healthcare facilities. Unfortunately, as discussed in this chapter, there are systemic problems with existing disease surveillance. It is largely piecemeal disease surveillance that exists. In India, this is partly a consequence of inadequate funding for the Integrated Disease Surveillance Program (IDSP), as well as the low allocation of state funds for educational programs that can produce the required number of epidemiologists and other specialists for expansive and effective disease monitoring.
Such a scenario nurtures pervasive opacity about the origins of disease outbreaks, as well as conflicting assessments about such outbreaks and about the disease burden of the Indian population. A comparison between well-documented disease outbreaks of the twentieth century and that of the COVID-19 moment is used to explore the underlying politics informing mainstream epidemiology, scientific research funded by big pharmaceutical companies, and the interventions and health policy framework of the state. Breaking with the mainstream biomedical approach to disease, this comparative historical overview showcases the relevance of the syndemics approach, developed by medical anthropologists when analyzing disease outbreaks and disease management. The syndemics approach recognizes that the Indian population is a perpetual prey to the sinister synergy between co-existing diseases and the vulnerability fostered by the overall functioning of our socio-economic system. The disease surveillance system and scientific establishment fails to capture the actual disease burden of populations. Hence, there is need for greater interface between social epistemology and epidemiology.
