India looks to overhaul disease outbreak response with a regional push

The plan entails a makeover of NCDC by setting up five new regional offices, 20 new metropolitan surveillance units, and 27 new state regional centres of India's apex public health institute.

The proposals under the upcoming new iteration of the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) aim to ensure a decentralized response to disease outbreaks. Under the plan, 10 new biosafety level-3 (BSL-3) laboratories will be set up to enable advanced diagnostics at the field-level to counter pandemics.

The plan entails setting up special units to handle health security in crowded cities by focusing on sanitation and overcrowding. It gives NCDC full responsibility for frontline service delivery and collecting evidence, conducting field surveillance, while the Indian Council of Medical Research (ICMR) would focus on medical research.

BSL-3 laboratories are high-containment facilities to prevent the escape of airborne pathogens are an intrinsic part of a nation's strategy for detection and surveillance of emerging diseases and viruses. India has 35 BSL-3 laboratories run by NCDC, ICMR, Council for Scientific and Industrial Research (CSIR), Indian Council of Agricultural Research (ICAR) and Department of Biotechnology (DBT) and the Anusadhan National Research Foundation (ANRF). India has only one biosafety level 4 (BSL-4) laboratory at National Institute of Virology Pune; the highest safety level one, run by ICMR, to handle the deadliest pathogens including the ebola, marburg and lassa viruses.

The development assumes significance given that India is facing an increasing number of infectious diseases outbreaks including zoonotic ones such as nipah virus, zika virus, avian influenza (H5N1), Crimean-Congo hemorrhagic fever (CCHF), Kyasanur forest disease or monkey fever, leptospirosis, Japanese encephalitis, and scrub typhus, which have accounted for large number of fatalities over the last five years. Also, chikungunya, influenza A (H3N2), hhuman metapneumovirus (HMPV), and Guillain-Barré syndrome (GBS) outbreaks are increasing.

The ₹64,180 crore-PM-ABHIM scheme will come to end in the current fiscal (FY26). From FY27, the scheme will have fresh budgetary allocations to ensure disease surveillance and lab maintenance. Mint could not ascertain the new budgetary allocation. The government takes a final call on allocations closer to the budget announcement, slated for 1 February, keeping in mind the fiscal scenario, specific funding needs and the macroeconomic prospects.

The New Delhi-headquartered NCDC is the management of Indian SARS-CoV-2 genomics consortium (INSACOG) for genomic surveillance of covid-19 variants. NCDC currently has eight outstation branches located at Jaipur (Rajasthan), Bengaluru (Karnataka), Kozhikode (Kerala), Chennai (Tamil Nadu), Raipur (Chhattisgarh), Patna (Bihar), Mangalgiri (Andhra Pradesh) and Varanasi (Uttar Pradesh).

“By upgrading these facilities, the government intends to bridge critical gaps in the public health network, allowing for faster identification and containment of infections," said the second government official cited above. “This strategic step aims at creating a pandemic-resilient healthcare system."

India had 237 bio-safety labs as of March 2025, and the number is seen hugely inadequate to cater to the country’s population with increased zoonotic threats necessitating a much larger network to ensure samples do not have to travel hundreds of kilometers for high-containment testing.

The Department of Health Research (DHR) also runs 165 labs, including 11 BSL-3 and 154 BSL-2 facilities. While ICMR operates 21 labs, including the country’ sole BSL-4 facility, 26 labs are under the DBT, 11 under the CSIR, and 9 under the ICAR. Also, the Anusandhan National Research Foundation (ANRF) runs five specialized BSL and Animal Biosafety Level (ABSL)-3 laboratories. India also has a network of 165 Virus Research and Diagnostic Laboratory (VRDL) set up by the Department of Health Research (DHR) and ICMR.

Queries emailed to the spokespersons of the ministries of finance and health and family welfare on 20 January remained unanswered until press time.

Reflecting on the critical gaps exposed by recent outbreaks, Dr Sujeet Singh, a former NCDC director, said, “India should move beyond the complacent phase' that typically follows a pandemic. Our laboratory detection capacity has been quite limited. During the 2018 nipah outbreak, we faced diagnostic delays that contributed to fatalities because samples had to travel 600 km for testing. Similarly, in the H1N1, nipah and covid-19 outbreaks, the existing laboratories including NCDC and NIV (National Institute of Virology) Pune were overburdened with the samples in the pandemic. To address these vulnerabilities, the country needs a robust network of at least 15 BSL-3 laboratories and a dedicated BSL-4 facility for human samples."

“The establishment of five high-capacity regional centres is needed to decentralize the burden on Delhi, and these must be ‘technical hubs’ rather than mere administrative branches," Dr Singh added. "Our east, west, north and south health problems are different. NCDC should raise their level to BSL-4 like CDC Atlanta... We should become a regional centre for the Southeast Asia region."

Raman Gangakhedkar, former chief scientist of epidemiology and communicable diseases at ICMR, said that the revamp plan is “a crucial element for our future survival"—whether it is about detecting new organisms or investigating outbreaks. "While ICMR will remain supportive, its primary mandate is generating evidence and identifying disease burdens, rather than service delivery," he added.

India surpassed China to become the world's most populous country in the world in 2023. Its six mega cities—Delhi, Mumbai, Kolkata, Bangalore, Chennai and Hyderabad—have a population of over 10 million each, and then there are 53 urban centres with a population of over 1 million each.

“The necessity of specialized metropolitan surveillance units are vital to managing urban health security. Large populations reside in our metros, and unless you have a clear metropolitan surveillance unit, you won't be able to tackle outbreaks and do robust disease surveillance. It has to have a totally different structure focused on urban problems such as overcrowding and sanitation," Dr Singh said.