Maya Valecha examines the recently passed Kerala Public Health Act and uncovers worrying evidence of the capture of the Indian State of Kerala’s health-care system by the WHO’s authoritarian infectious disease control mandate.
The governor of Kerala, India has signed the Kerala Public Health Act which essentially reverses the people’s campaign in healthcare services in Kerala by decentralisation and relinquishing of state powers in 1996 that resulted in improvement of all health parameters in Kerala. In its place, enforcement of the law through the exercise of powers, fines, etc, and the implementation of protocols during a pandemic are of prime emphasis in various ways throughout the bill.
This has obviously been passed to implement WHO directives more stringently. The WHO Treaty that is to come in effect by May 2024 is going to be legally binding and countries are to amend their laws accordingly. The Kerala government, always ready to be first in implementing harsh measures, wants to be prepared with their own legislation to implement WHO dictates.
The first sentence in the Bill’s preamble emphasises “one-health for public healthcare”, the catchphrase floated by the WHO. But neither the WHO nor this Act include nutrition, and socioeconomic conditions including the proper housing of people as primary ingredients contributing to the health of the people. The climate, Viruses, and human-animal contact, on the other hand, are given extraordinary importance in line with the WHO IHR and coming Pandemic Preparedness Treaty.
The initial draft had renamed Public Health Officers as a Public Health Authority. After much criticism the term ‘Public Health Officers’ is used in the Final draft/Act. But the authoritarian powers conferred to these officers remains the same. So, these Public Health Officers will have an all-compassing power to issue instructions to all other Government departments including the Police; any refusal or non-cooperation will be considered breach of conduct and indiscipline.
It is mentioned in the Act that the elected bodies are to provide all support to the Public Health officers but there is no mention of feedback or suggestions to be collected from them or the communities they will serve.
The State Health Authority and the District Health Authority will advise the State Government/District Magistrate to declare an emergency. But in the chapter of Definitions in the Act, it is the WHO definition of an emergency that is used. That is: a sudden and rapid increase in number of a disease cases is mentioned and not the severity or hospitalisation burden. Thus, as we saw during Covid-19, even asymptomatic people with a non-diagnostic test such as rt-PCR can now be forcefully quarantined.
In the event of an outbreak, The District Collector, with or without the application of the Public Health Authority can prohibit assembly of persons, number as specified, in any place, public or private. We previously saw this with some western governments, during the Covid State of Emergency, specifying how many friends or relatives can gather in a private dwelling. These are all irrational, unscientific measures, justification for which weakly conceals the underlying motive of establishing control over people. In India, different number of people were allowed to assemble in different circumstances, as if the virus knew whether or not to attack when the assembly is for marriage or for last rites for example.
The bill states:“The State Public Health Authority shall publish Standard Medical Treatment Protocols that are to be followed by public and private healthcare providers and healthcare establishments in respect of the National Health Programmes and the diseases notified under this Act.”
We find not only diagnosed patients but also patients with disease symptoms are impelled to follow protocols. “Where the State Public Health Authority has notified an epidemic disease and prescribed the mode of management to be followed exclusively in the management of the disease, including collection of specimens, diagnostic and therapeutic procedures, such mode of management and procedures shall be followed by all the medical practitioners and healthcare establishments, who treat the patients with the symptoms of such disease.”
Due to the protests by AYUSH (Ayurveda, Yoga, Unani, Siddha, Homeopathy) doctors, they are included in some advisory committees, but most AYUSH doctors fear that their presence will be ornamental. Kerala is the Hub of other medical knowledge systems and one of the reports appreciates that as a contributing factor for the superior health of people in Kerala. Not only does excluding these knowledge systems during an emergency seem ill-advised, what about individual freedom to choose from any legal medical treatment? On the other hand, medical ethics violations by doctors of all systems have no mention or remedy in the Act. Where is the room for professional judgement of the doctor who is handling these cases if a strict protocol is to be followed? As with all other provisions, noncompliance will be dealt with through fines.
The bill also states that any building can be entered at any time without notice and giving just 2 hours’ notice for houses. Premises may be vacated to carry out activities as are necessary for that area to prevent the spread of infection, as may be prescribed at that time. Where will patients go in such cases? What about their health after displacement? Remembering the images of China showing government evacuation of residents from their apartments, is this public health management or active mismanagement?
Any person or medical establishment who knows of any incident/death or outbreak of any notifiable or communicable disease must report it to Public Health Authority, and failure to report is punishable with a fine of up to five thousand rupees! So, citizens are thusly made vigilantes. The private and public health establishments will have to provide Data in the format prescribed by the Authority. The Data safety is to be ensured by the Public Health Officer who is already given so many other duties.
It might give an air of legitimacy when forceful isolation of infected persons is prescribed under law, but our experience in India during Covid-19 involved incidences such as a 3 years old children (who should not have been tested in the first place) being isolated for a full month, just because the child was exposed to the asymptomatic positive father and tested positive herself. Imagine the life time trauma a child like this will carry. Previously, even asymptomatic adults were quarantined and some of them committed suicide.
To remove all doubts the preamble clearly defines “Communicable Disease” as disease caused to human or animals due to infection with or without symptoms and communicable from human to human or from animals to animals or to human, and which can be detected with the assistance of diagnostic measures. Thus, with the use of an EUA test, (not even diagnostic by itself) people can be quarantined and all measures like lockdowns and masks, that were previously found ineffective, can be imposed.
In the words of AK Shiburaj, “The provisions of this bill have been prepared without considering the socio-economic and political conditions that render due importance to the social determinants of health. The new bill provisions are limited to a regulatory approach without exploring possibilities like service approach and health education. Instead, enforcement of the law through the exercise of powers, fines, etc., and the implementation of protocol during the pandemic are of prime emphasis in various ways throughout the bill.”
A particularly concerning aspect is that, ‘71. Bar of jurisdiction of civil courts. No civil court shall have the jurisdiction to entertain any suit, application or petition against any proceedings or decision done or purported to be done or taken or purported to be taken by the Public Health Officer or by any other officer authorised by her or the Public Health Committee by exercising any powers as per this Act or rules made thereunder.’ And ‘72. Protection of actions done in good faith. No suit, prosecution or other legal proceedings shall lie against the Public Health Officer or any officer acted as authorised by her or the Public Health Committee or the Members or Secretary of the Committee for anything done or intended to be done in good faith in respect of any matter as per the provisions of this Act or the rules made thereunder.” Good faith is one thing and irresponsible decisions that can harm people is a different matter. In the name of public health all manner of unscientific decisions resulting in grave harms were seen during Covid-19. It is especially concerning then that there is no room for public involvement in the Act.
Even after the reports of deaths of children living in tribal rural areas in 2020 due to malnutrition, “. . .the recent reports about the tribal deaths due to malnutrition and lack of medical care facilities point fingers to the things to be improved in Kerala’s health system”, there is no mention of nutrition monitoring and management in any section of the Bill. Neither in the Maternal, Neonatal and Adolescent health section nor in the Preventive, Promotive guidelines. The promotion of healthy diets is mentioned but measures to ensure this are not.
This is particularly objectionable for Kerala where “In 1996, recognizing the eroding trust in the public system, Kerala underwent a major overhaul when the state government implemented the People’s Campaign for Decentralized Planning movement. Through this reform, the state government decentralized and relinquished a significant amount of power.” Moreover: “Communities were brought together to determine which health topics were important and needed attention, with selected topics ranging from strengthening PHC facilities to improving water and sanitation safety.” The results were clear for all to see, even with comparatively low per capita income, Kerala improved its health parameters above the national average. Now, under the effects of Market Forces, budget cuts because of decreased funding from centre and blind faith in “science” that comes from the West or the WHO, all the gains in public health will be reversed and a medical tyranny will replace it.
The central Government has consented to the WHO Pandemic Preparedness Treaty without informing the public. In the past, central government tried to bring such a draconian Health Bill and failed because under federal structure in India, Health is under the jurisdiction of individual states, and States previously opposed this move. The strategy now appears to be to progressively introduce such Bills in the states, one after the other. Not only the people of Kerala but people all over India should protest this Act and ask for its repeal, on the basis that it allows for Human Rights violation in the name of Public Health, and thus violates all foundational principles of Public Health.