6 min readSep 3, 2026 03:39 PM IST First published on: Sep 3, 2026 at 03:39 PM ISTPandemics are cruel, unforgiving, and the worst time to learn how to deal with them. Lessons are best learnt in the interpandemic period, like the current influenza surge. Different parts of India have reported 2-10 times higher numbers of influenza cases this year than last year. We should treat these surges like an end-semester test before the coming board exam.While the newspaper headlines scream about the number of reported influenza cases, experts and government officials keep reassuring the populace not to panic, as this is the same influenza strain as before. It asks patients with cough and fever to use masks and take steps to avoid spreading it further. Government advisories also ask the public to remain informed and vigilant but not to get alarmed. That’s a confused message.AdvertisementThe three pillars of managing any outbreak are surveillance, prevention and control. Surveillance means the ability to pick up the outbreak at the earliest and initiate appropriate action. With influenza, this also includes genomic surveillance to identify the strain/variant responsible for this uptick to gauge its virulence and the susceptibility of the population. A well-established virus, like the current one, should not be of serious concern. Prevention of infection means advisories, especially to high-risk individuals like the elderly, pregnant women, and people with comorbidities, to avoid crowded places and promote the use of personal protection like masks. In addition, this could include vaccination of high-risk individuals and health workers. Control means ensuring those who are infected get treated well – providing for increased availability of beds, laboratory testing, and early use of antivirals (most effective within two days of onset).Post-Covid, India has an excellent viral disease surveillance system across the country where testing of a fixed number of samples of patients with influenza-like illnesses and Severe Acute Respiratory Infections (SARI) occurs throughout the year and is supported by genomic testing. If the influenza positivity rate among these cases crosses a certain threshold, it should be seen as a warning signal to initiate steps for prevention and control. Our study among selected hospitals found that the positivity rate among those admitted with SARI was 16 per cent this year, compared to 12 per cent last year. To the best of my knowledge, we do not yet have alert thresholds. It would also be useful to have a publicly available dashboard so that people can stay informed, as we do with air quality levels.Also Read | I am from Nepal. This disaster has made preparedness personalOne can be certain that the actual number of cases of influenza would be considerably more than reported. This is because not everyone with an infection comes to the health system, not everyone who comes to the health system gets tested, and finally, not everyone who tests positive gets reported to the government portals.AdvertisementThe second issue is the weak link between surveillance and action. This often falls between the cracks of the ICMR (which runs laboratory surveillance), NCDC (which coordinates the response), and the state health systems (which implement the response). The way out is to have an integrated command structure (as in defence). Such an agency can lead the response promptly and have the authority to get appropriate actions implemented during such upsurges as well as during pandemics. We have failed to learn this lesson from the Covid pandemic.Given the current level of the surge, our primary interest is best served by preventing avoidable deaths, especially in the high-risk groups. The government’s advisory should ask such people to avoid crowded places, use masks, etc. Governments may fear that such advisories will lead to panic. There is a thin line between an appropriate response and an overblown one. Governments across the world struggle to walk that thin line. The WHO, as well as governments, have often been accused of overreacting. If our primary concern is to save lives, overreaction is a better response than the opposite. The current response appears to be too cautious and bureaucratic. Such situations demand professional communication strategies and experts. We also need to train the media to report these matters with nuance rather than screaming headlines.The use of the influenza vaccine even among the high-risk groups is very low, likely below 5 per cent. Such low coverage despite existing government guidelines as well as professional body recommendations has multiple reasons, including a perceived threat, non-affordability, doubtful effectiveness, need for annual injections, etc. While one can debate the need for influenza immunisation in routine times, if we do not consider immunising high-risk cases at times of major seasonal surges, we run the risk of being less than fully prepared for the next pandemic. Health workers are our frontline force for epidemic/pandemic management, and their vaccination should also be a priority.you may likeThe use of antivirals for influenza management is also quite low. Our experience is that less than 10 per cent get antivirals at the time of admission. Such low use of antivirals, even in peak influenza season, needs further probing and a relook at the guidelines for influenza management. The private sector and professional bodies need to be on board for this.Outbreaks, epidemics of different magnitude and pandemics are a part of a continuum and need a calibrated response. This response needs to be local rather than national. We need to have a strategy that clearly defines when the response needs to be escalated. “Mini pandemic” situations provide us with an opportunity to refine our response and communication strategies. That is perhaps the most important lesson that we can learn. The next pandemic is not far away. Failure is not an option.The writer is a professor of community medicine at the All-India Institute of Medical Sciences, New Delhi. Views are personal