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The Dissection of The Epidemic Diseases Act, 1897: Medical And Legal Negligence

With Great Power, Comes Great Responsibility
Although this expression is quite archaic, cliched and comical, much like the medical legislature, statues and Public Health Law of our country; it nonetheless seems quite true, apt and effective, unlike the Public Health Law of our country.

In these bleak trying times, when our country is simultaneously, battling with an economic slowdown on one hand and fighting to curb the swift spread of the corona virus (COVID-19) on the other, one wonders in the 73 years of Independence, how has my country prepared itself? Quite frankly, it seems laughable. India is as unprepared for this epidemic 2020 as it was for the Spanish Flu in 1918. What law has the Indian Legislature brought forth, to stop the spread of this pandemic? What about the welfare of the citizens (most notably, the daily wage workers), who have been directly affected due to the lockdown and the quasi quarantine nature of affairs, caused by the pandemic? The Indian Legislature does not provide any welfare schemes or financial aid to the daily wage workers.

A pandemic, which is communicable from other infected individuals; the symptoms of which may take 2 weeks to showcase, causes enough panic to lead to a quasi lockdown of work by all, applying the prevention is better than cure agenda, thereby directly attacking the daily source of income of these daily wage workers. A daily wage worker would include anybody from a; Rickshaw Puller to a mazdoor working on dihari.

These individuals do not have any savings, dont have a proper roof on their heads and zero access to good healthcare. A daily wage worker, by definition, works daily to earn daily to eat daily. No work on a day means no food that day. And when you add the present background score, to the movie, the living situation becomes ever so dire and difficult. We are only scratching the surface here; no income and no food would mean a reduction in the immunity levels of the individual making them more susceptible to the COVID-19 virus. No proper roof to live in, rest & recover and no monitoring mechanism would only be a catalyst for the pandemic to spread and infect more individuals leading to an increase in the number of patients and a rise in the death tolls.

I am a man of law and not a man of science. I prefer precedence over facts. The facts say that India has just 0.5 hospital beds for every 1,000 citizens; the World Health Organization (WHO) recommends at least five. Furthermore, India averages 0.8 doctors for every 1,000 citizens; whereas Italy, which has been badly hit by the corona virus (COVID-19) outbreak, has five times as many doctors per capita. India's spends about 3.66 percent of its GDP on public health, while smaller economies like; Nepal spends 6.29 percent. Advanced economies like the United States, spends about 17 percent of its GDP on health care; Germany spends 11.14 percent and the United Kingdom spends 9.76 percent on public Health care.

But, the precedence favours India. India managed to control the HIV AIDS Plague in the 1980-90s and even managed to stop the spread of the deadly Nipah virus as latest as in 2018. I suppose this is a valid excuse for not having a proper health care legislation in the country.

When we can manage without it, why have it? However, in wake up of the spread of the corona virus, the truth however is a stark reality and one yet to be faced by India. In the vast majority of Indias citizenry, especially the poor, remain abysmal. For the poor, there is no way for prevention. Prevention requires a basic infrastructure, which the legislature does not provide. The archaic laws of our country are not well equipped to handle the medical needs of the citizens, let alone the welfare of the people in such apolitical times.

The Central and State Governments have however shown vigour and must be commended on all their efforts to curb the spread of the corona virus albeit limited by the colonial Epidemic Diseases Act, 1897.

The states of Delhi and Uttar Pradesh deserve special praise as they have passed various administrative orders towards welfare of the Daily Wage Workers in times of such crisis. The Uttar Pradesh Government has announced; Rs. 1,000/- for the daily wage labourers, free rations and free medical treatment for the infected. The Delhi Government has also promised; free rations for the poor, extra pensions for the members and free meals for all (especially Homeless) at its Night Shelters.

Special praise and respect must also be bestowed on Honble Mr. Justice SM Subramaniam of the Madras High Court, who on 21.03.2020, announced that he would pay his one months salary of Rs. 2.25 Lakhs for welfare of the unorganised sector labourers.

Now after an overly exhaustive prologue, we square back to the main culprit; the archaic and inefficacious, Epidemic Diseases Act, 1897. The main legislative framework at the central level for the prevention and control of spread of dangerous epidemic diseases. Any person disobeying any regulation or order passed or made under the said act is punishable with simple imprisonment or fine or both, under Section 188 of the Indian Penal Code, 1860.

The Epidemic Diseases Act, 1897 is a historical act. It is historically small, containing only five sections and it is historically inadequate and insufficient to deal with the contemporary requirements faced by the country during an epidemic. There is not even a speck of reference regarding providing financial aid and assistance to the poor and needy in times of lockdowns and quarantines caused by an epidemic or pandemic.

This colonial act serves no purpose anymore and needs a substantial overhaul to counter the rising burden of infectious diseases and the various ancillary actions which follow. The act must not only specify the types and categories of epidemics but must also have an action plan for providing financial aid to the poor and needy.

As epidemics cause a nation wide panic, halt all work and disrupt the local markets, the legislation must have contingencies and a nation wide database of all daily wage workers along with their bank and contact information to not only provide them with some income but also with proper nutritious food, clothing and proper medical education to identify a patient and simultaneously inform the authorities and also self-isolate to curb the spread.

Due to the inefficiency of the Epidemic Diseases Act, 1897, various states have their own model Public Health and Safety Acts, although they are also not that efficient and lack a basic pragmatic approach. These state and local acts may be able to tackle the epidemic but are ill equipped to handle the ancillary aspects including financial aid for the daily wage workers.
Another argument is being made towards Right to Health being declared as a Fundamental Right.

The Seventh Schedule under Article 246 of the Constitution of India, 1949 contains, Public Health as a state subject under the State List (List-II), thereby granting each state complete authority over all public health affairs. This leads to a difference in the level of medical infrastructure, medical technology, staff, medicines etc. for each state. A stark contrast in the medical development of a state like Kerala and Bihar is thus glaringly noticeable, which may further change with different political agendas. As opined by the Honble Supreme Court of India, right to health is an integral part of right to life under Article 21 of the Indian Constitution[1] and thus its priority and importance should not be meddled with every five years.

In fact in 2019, a High Level Group (HLG) on the Health Sector constituted by the (15th) Fifteenth Finance Commission had recommended that ‘Right to Health be declared as a Fundamental Right under the Indian Constitution on the (76th) Seventy Sixth Independence Day in 2022 and further recommended for the constitution to be amended to shift ‘Public Health from the State List (List-II) to the Concurrent List (List-III).

Such a move would definitely remove any and all financial limitations on any future medical legislatures of Public Health and Safety Acts and the economic capacity of the state would be immaterial. Such a move, would further bolster and improve the ancillary tangents which contribute towards a health and medical welfare of the citizens, especially the daily wage workers, whose daily lives are affected the most in cases of a medical crisis.

Now shifting from the generic to the specific, the financial difficulties faced by the daily wage workers today is not intangible. It is quite clear, right in front of us and has incepted due to the outbreak and swift spreading of the corona virus (COVID-19). The practical difficulties due to the spread of COVID-19 has led to a complete stoppage of movement by individuals. The threat being real and imminent has encouraged social distancing by all.

The term is fancy and not something the daily wage labourer would understand. But its impact is very real. By social distancing, individuals are not getting out, not going to their offices, avoiding public transport, working from home and avoiding all unnecessary outings. The result of which, has led to a loss of daily income of the Rickshaw Pullers, the roadside shopkeepers, the makeshift food stalls etc. Industries have shut down.

Labourers are being asked to stay at home and not report for their duties. Furthermore, homeowners are also avoiding any local repairs in their houses, all constructions are shut down under the fear of spread of COVID-19 from the labourers.

Not only has this impacted the income earning capacity of the daily wage labourer, it also exposes them to the virus even more. No income means no food and no food means a decline in the body immunity level making the labourers more susceptible of being infected by the corona virus. This domino effect by not having a proper financial aid for the poor, further encourages the spread of the virus than its suppression.

Eminent Scholar, Frank Grad observed that Public Health Law does not come in a neat legislative package but consists of may types of legislations which have little in common except for the benign purpose of advancing Public Health.

It is writ large that an amendment is of dire need and some judicial activism by our Hon'ble Courts to rid our nation of the archaic, colonial and impotent statute of the; Epidemic Diseases Act, 1897. In lieu of the same, we must have a more contemporary and time appropriate statute, granting strong executive and administrative powers to appointed authorities and must further grant financial aid and assistance to all in need, especially the poor. The act must be comprehensive covering medical, financial, infrastructure, administration etc. and must purely be Public Health Law consisting of may types of legislation advancing Public Health.

The primary goal must be to prevent disease and promote health in population. Prevention and Promotion are the backbones of public health practice. Furthermore, the precautionary principle states that action should be taken to prevent harm even if some cause-and-effect relationships have not been fully established scientifically[2].

How can this be practically achieved? Applying this principle in the present scenario of corona virus (COVID-19), with a country like India in the background, where a major chunk of the population is poor and the country lacks proper medical infrastructure, can only be achieved through proper financial assistance; which in turn will provide proper nutrition, shelter, will boost immunity, improve morale and medical awareness for all, thus curb the outbreak of the virus.

Pertinently, the legislative reform must provide any and all necessary relief to the daily wage workers and other poor citizens, who lose their jobs and daily source of income as a direct result of the epidemics and lockdowns. Such loss, in turn also effects their Right to Life.

Some suggestions for the financial aids could include:

  1. Specific allocated monthly amount to be given to the daily wage workers/ labourers as per size of supporting family.
  2. Providing free of cost, three (03) nutritious meals a day.
  3. Providing proper isolated shelter homes.
  4. Free of cost check-up and free medical assistance, including but not limited to free medical tests and free supply of medicines.
  5. 24 x 7 medical counselling; to make the daily wage workers/ labourers and their families aware of the risks of the epidemics, its spread and ways of prevention.

An amendment in the law or enactment of a fresh law on these grounds, support for the law, the cost of implementation of the law will require strong political commitment, requisite infrastructure, capacity, technical and professional competencies as well as ancillary support structures besides an overall conducive environment to obtain and achieve desired results.

There is further a need for judicial activism and suo moto action by the Honble Courts to enforce Social Security for the daily wage workers and other poor citizens to dissuade individuals from moving out of their home towns/ domiciles.

End-Notes:

  1. Consumer Education and Research Centre v. Union of India AIR 1995 SC 636. State of Punjab & Ors. v. Mohinder Singh AIR 1997 SC 1225.
  2. The Precautionary Principle: Protecting Public Health, the environment and the future of our children by Martuzzi M and Tickner JA @ WHO Regional Office of Europe (Conference at Budapest, Hungary 2004)

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