India’s Central Government and state governments are empowered to regulate health-related matters. The Epidemic Diseases Act is the main legislative framework at the central level for the prevention and spread of dangerous epidemic diseases. The Act empowers the central government to take necessary measures to deal with dangerous epidemic disease at ports of entry and exit. The Act also empowers the states to take special measures or promulgate regulations to deal with epidemics within their state jurisdictions. In such emergencies the states delegate some of these powers to the deputy commissioners in the districts, typically through state health acts or municipal corporation acts. Thus, responsibility for directly addressing the crisis rests with the deputy commissioner at the district level.
I. Structure of Public Health Crisis Management System
India is a union of twenty-eight states and seven territories, with a constitutional division of legislative responsibilities between the central government and the states. Both the central government (also known as the Union government) of India and the state governments are constitutionally empowered to legislate on matters of public health. The Union law may deal with port quarantine, including in connection with seamen’s and marine hospitals. The law may also deal with interstate migration and quarantine. State law may provide for matters relating to public health and sanitation, hospitals, and dispensaries. The central government and state laws may also provide for the prevention of the transmission from one state to another of infectious or contagious diseases or pests affecting humans, animals, or plants. There are several central laws managing the prevention of contagious diseases.
A. Union Laws
1. Epidemic Diseases Act
The preamble to the 1897 Epidemic Diseases Act states that its objective is to provide for better prevention of the spread of dangerous epidemic diseases. The Epidemic Diseases Act empowers the state governments and the central government to take measures as may be warranted or necessary to control the further spread of disease. Thus, any state government, when satisfied that any part of its territory is threatened with an outbreak of a dangerous disease, may adopt or authorize all measures, including quarantine, to prevent the outbreak of the disease. Similarly, the central government, when satisfied that there is an imminent threat of an outbreak of an epidemic disease and that the provisions of the law at that time are insufficient to prevent such an outbreak, may take measures and prescribe regulations allowing for the inspection of any ship or vessel leaving or arriving at any port and for the detention of any person arriving or intending to sail.
Any person who disobeys any regulation or order made under the 1897 Act may be charged with an offense under section 188 of the Indian Penal Code. The person in violation of the provision is liable, upon conviction, to a sentence of simple imprisonment for one month, a fine, or both. Notwithstanding anything contained in the Code of Criminal Procedure, such offense, at the discretion of the trial magistrate, may be tried summarily. No suit or legal proceeding lies against any person or authority for anything done, or in good faith intended to be done, under this Act.
Some critics have observed that the Epidemic Diseases Act of 1897 “is a century-old blunt act” that needs a “substantial overhaul to counter the rising burden of infectious diseases both new and old.” Some of the issues that require revisiting, they argue, are the “definition of epidemic disease, territorial boundaries, ethics and human rights principles, empowerment of officials, [and] punishment.” It appears that India’s National Centre for Disease Control (NCDC) is developing a “Public Health Emergencies Act,” which is “expected to take care of public health emergency situations in the country arising as a result of disasters and bio-terrorism incidents besides dangerous epidemic diseases including newly emerging infectious diseases.” In recent years, the Epidemic Disease Act 1897 was invoked by a number of states in India to deal with the pandemic H1N1 (“swine flu”) influenza and other communicable diseases.
2. Quarantine of Visitors
For people entering India from abroad, a health officer appointed by the central government is posted at the port of entry. Upon being satisfied that a ship or aircraft is in compliance with the health regulations, the health officer grants pratique to the vessel or aircraft for landing. The health officer may demand to see the aircraft journey log book, which shows the places the aircraft visited. He may also inspect the aircraft, its passengers, and its crew, and subject them to medical examinations after their arrival. The officer must follow specific precautions with regard to communicable diseases that require a period of quarantine (such as yellow fever, plague, cholera, smallpox, typhus, and relapsing fever) and other infectious diseases that do not require a period of quarantine.
Except in the case of an emergency constituting a grave danger to public health, an aircraft should not, on account of an infectious disease that does not require a period of quarantine, be prevented by the health officer of an airport from discharging or loading cargo, fuel, or water. However, where any person is required under the rules to be disembarked and isolated for any period, the officer may cause him to be removed to a hospital or another approved place and detain him in quarantine. If necessary, the officer may require the person to report to him at specified intervals during the period of surveillance. The health officer may also remove, cause to be removed, or order the removal of any person, other than someone proceeding on an international voyage, who, in the opinion of the officer, is likely to spread any quarantinable or infectious disease.
When it is brought to the attention of the health officer, he may prohibit the embarkation on any aircraft of any person showing symptoms of any quarantinable disease and any person whom the health officer considers likely to transmit infection because of his close contact with a person showing symptoms of a quarantinable disease. When a case of typhus or relapsing fever occurs at the airport, the person on an international voyage who is considered liable by the officer to spread such a disease must be disinfected. Upon request, the health officer must issue to the commander of an aircraft a certificate specifying the health measures taken with respect to the aircraft, the parts of the aircraft treated, the methods employed, and the reasons why the measure have been applied.
Regulations require that airline staff report any suspected cases or passengers who in their opinion, from observations made in flight, may be suffering from symptoms of a quarantinable disease.
With respect to Ebola, in early August 2014, the Health Ministry announced that authorities would begin screening “travellers who originate from or transit through affected nations, and track them after their arrival in India.” Passengers are informed through in-flight announcements that “mandatory self-reporting is required at immigration.” The government also “set up facilities at airports and ports to manage travellers showing symptoms of the disease.” The surveillance system will track travelers for four weeks and persons who develop symptoms will be advised to self-report. On August 26, 2014, six Indian nationals were isolated after returning from Liberia but all tested negative for the virus.
B. State Laws
In order to prevent the outbreak of smallpox, states have enacted laws in their territories for the vaccination of children under thirteen years of age. For example, the Punjab Vaccination Act makes primary vaccination and revaccination of children compulsory throughout the state. Where the state’s Superintendent of Vaccination has reasons to believe that a child was not vaccinated, he may serve notice on the guardian of the child, requiring him to bring the child for vaccination. Upon failure to comply with the notice, a district magistrate may summon the guardian and demand an explanation for noncompliance with the Superintendent’s notice. If the explanation is not satisfactory, the district magistrate may require him to produce the child for vaccination and also produce a certification of such vaccination within the period specified.
II. Powers of Public Health Authorities
Every state in India is divided into districts, and the deputy commissioner of each district is not only head of the district administration but also acts as revenue collector and as district magistrate, responsible for the maintenance of law and order in his jurisdiction. He is the key official, and acts as a liaison between the people and the government.
In order to meet a health crisis, following the outbreak of an epidemic, the Epidemic Diseases Act gives wide ranging powers to the states. The states, in such emergencies, delegate some of these powers to the deputy commissioners in the districts typically through state health acts or municipal corporation acts. Thus, responsibility for addressing the crisis rests with the deputy commissioner.
A. State and Municipal Governments
If at any time a state government is satisfied that the state or any part of it is threatened with the outbreak of a dangerous disease and that ordinary provisions of the law in force at the time are insufficient for the purpose of addressing the outbreak, it may take, require, or empower any person to take such measures and, by public notice, prescribe such temporary regulations as may be necessary to be observed by the public or by any person or class of persons for the prevention of the outbreak or spread of such disease.
A state government may also take measures and prescribe regulations for the inspection, vaccination, and inoculation of persons traveling by road or rail, including their segregation in a hospital, temporary accommodation, or otherwise, if such persons are suspected by the inspecting officer of being infected with any such disease.
A state government, by general or special order, may also empower a deputy commissioner to exercise, in relation to his district, all the powers under section 2 of the 1897 Act that are exercisable by the state government in relation to the state, other than to determine the manner in which and by whom any expenses are to be defrayed. Many of these powers are prescribed in Municipal Corporation Acts governing “major municipal areas,” or Public Health Acts that also provide municipal-level commissioners or collectors with quarantine or other powers, including the following:
- Removal of a person to separate premises for medical treatment: “Persons suffering from such a disease may be removed to any hospital or place for medical treatment, based on an order from the Commissioner or the Collector.”
- Cleansing or disinfecting any building or part of any building or any articles: “The cleansing and disinfection of any building or part of it or of any articles in such building which are likely to retain infection, may be required to be cleansed and disinfected based on an order of the Commissioner or Collector to prevent or check the spread of any dangerous disease.”
- Taking special measures in case of the outbreak of dangerous or epidemic diseases: “In case of an outbreak, the Commissioner or Collector may take special measures and by public notice, give directions to be observed by the public or by any class or section of the public, as he thinks necessary to prevent the spread of the disease.”
B. Political and Civil Rights
By its very nature, the ambit of section 2 of the Epidemic Diseases Act is wide enough to allow a state or a lower functionary in the administration, in dealing with an emergency caused by the outbreak of a dangerous disease, to seek or require the cooperation of the public or corporate bodies in the public or private sectors. If the desired cooperation is not forthcoming, a regulation may be imposed. Failure to obey or comply with restrictions imposed by such a regulation constitutes a punishable violation.
Powers of segregation or quarantine that the central government and state governments enjoy may impinge on the political and civil rights of the public. Fundamental rights, as guaranteed by the Constitution of India, are justiciable. The judiciary does not shy away from enforcing these rights or voiding orders that constitute violations of such rights. Quarantine is a measure that adversely affects the fundamental right “to move freely throughout the territory of India.” However, this right is to be enjoyed subject to reasonable restrictions that the state may impose in the interest, among others, of the general public. As noted above, section 4 of the Epidemic Diseases Act includes a protection clause that gives state immunity such that “[n]o suit or other legal proceeding” can be brought against “any person for anything done or in good faith intended to be done under this Act.”
The right to privacy, as such, is not a fundamental right in India. The Supreme Court of India has found that the right of privacy is an essential component of the right to life, but that it is not absolute and may be restricted to prevent crime or disorder, or to protect health, morals, or the rights and freedom of others.
During the SARS epidemic in 2003, there was concern over the severity of quarantine enforcement measures, the discrimination that patients faced, and the lack of privacy and confidentiality. There were also reports of shaming of colleagues and neighbors who had been placed in quarantine.
III. Transparency of Public Health Crisis Management System
Within the democratic system, the judiciary in India ensures transparency in government actions and executive orders. The public frequently seeks judicial review of executive orders and regulations. The Parliament of India has also enacted a Freedom of Information Act, requiring transparency in government actions. The Act entitles the public, by filing a written or electronic application, to obtain information from any public authority.
IV. Cooperation with the World Health Organization (WHO)
In 1997 the WHO set up the National Polio Surveillance Project to help provide technical support for the government with surveillance of polio, mass vaccination campaigns, and routine immunizations.
In 2008, WHO, in collaboration with the NCDC, started a pilot project to prevent humans from contracting rabies in five Indian cities. The project “includes training of health professionals in animal-bite management and raising public awareness about the need to seek post-exposure treatment, notably through posting messages on buses and in other public places.”
Besides those projects, the WHO is available to provide assistance in all emergencies—for example, earthquakes, epidemics, or disasters resulting from terrorism of any sort that may create a health emergency in the country. The WHO’s Regional Office annually conducts ten-day, intercountry training courses on epidemic preparedness and response to develop regional capacity in early detection and response to disease outbreaks. Specifically, the WHO is assisting the National Centre for Disease Control (NCDC) (formerly the National Institute of Communicable Diseases) in the preparation, printing, and distribution of CD Alert, a monthly newsletter published by NCDC. The WHO has also been assisting the NCDC in cooperating more closely with neighboring health systems in south and southeast Asian countries through workshops and other meetings.
Prepared by Tariq Ahmad
Legal Research Analyst*
* This report updates a report originally prepared in 2003 by former Senior Foreign Law Specialist Krishan S. Nehra, which was previously updated in 2009.
 India Const. 7th Sched., List I, Entries 28 & 81.
 Id. List II, Entry 6.
 Id. List III, Entry 29.
 Epidemic Diseases Act, No. 3 of 1897, pmbl.
 Id. § 2.
 Id. § 2A.
 Indian Penal Code, No. 45 of 1860.
 Binod K. Patro, Jaya Prasad Tripathy & Rashmi Kashyap, Epidemic Diseases Act 1897, India: Whether Sufficient to Address the Current Challenges?, 18(2) J. Mahatma Gandhi Inst. Med. Sci. 109, 111 (2013), http://www.jm gims.co.in/article.asp?issn=0971-9903;year=2013;volume=18;issue=2;spage=109;epage=111;aulast=Patro#ref4.
 Centre for Epidemiology and Parasitic Diseases,National Centre for Disease Control, http://nicd.nic.in/ index2.asp?slid=496&sublinkid=143 (last visited Nov. 10, 2014).
 T. Dikid et al., Emerging & Re-emerging Infections in India: An Overview, 138(1) Indian J. Med. Res. 19–31 (July 2013), http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767269/.
 Aircraft Act, No. 22 of 1934; Indian Aircraft (Public Health) Rules, 1954, R. 2(8).
 Id. R. 6(2).
 Id. R. 8(1).
 Id. R. 9–29.
 Id. R. 30–32.
 Id. R. 56.
 Id. R. 58.
 Id. R. 61.
 Id. R. 36(1).
 Id. R. 39.
 Id. R. 54.
 Nita Bhalla, India Goes on Alert for Ebola, with Thousands of Nationals in West Africa, Reuters (Aug. 8, 2014), http://in.reuters.com/article/2014/08/08/ebola-india-virus-west-africa-idINKBN0G80OA20140808.
 Sneha Shankar, Ebola Alert: Six Indians Isolated at Delhi Airport Test Negative, More People Expected to Arrive and Be Tested,International Business Times (Aug. 26, 2014), http://www.ibtimes.com/ebola-alert-six-indians-isolated-delhi-airport-test-negative-more-people-expected-arrive-1669216.
 Indian Port Health Rules, 1955.
 Indian Ports Act, No. 15 of 1908, http://www.mumbaiport.gov.in/writereaddata/linkimages/6177609667.pdf.
 E.g., Punjab Vaccination Act, No. 49 of 1953.
 Id. §§ 13–14.
 Epidemic Diseases Act, No. 3 of 1897, § 2(1).
 Id. § 2(2).
 Id. § 2(3).
 See, e.g., Delhi Municipal Corporation Act, 1957, http://mcdonline.gov.in/tri/sdmc_mcdportal/publications/ DMC%20Act.v.11..pdf; and Chennai City Municipal Corporation Act, 1919 (Tamil Nadu Act IV of 1919), http://www.chennaicorporation.gov.in/images/chennai_city_municipal_corporation_act.pdf.
 Monica Dasgupta, Public Health in India: Dangerous Neglect, XL(49) Econ. & Pol. Weekly 11 (Dec. 3, 2005), available at http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1410508&#.
 See, e.g., Madras Public Health Act, No. 3 of 1939, available at http://www.sanchitha.ikm.in/sites/default/files/ MadrasPublicHealth_%20Act1939..pdf.
 “Municipal Acts of Delhi, Gujarat, West Bengal, Tamil Nadu and Manipur,” Table 1 :Existing Legal Frameworks, Indian J. Pub. Health, http://www.ijph.in/viewimage.asp?img=IndianJPublicHealth_ 2010_54_1_11_70539_t1.jpg (last visited Nov. 10, 2014).
 Epidemic Diseases Act § 3.
 India Const. art. 19(1)(d).
 Id. art. 19(2), (4).
 Epidemic Diseases Act § 4.
 ‘X’ v. Hospital ‘Z’, 1998 S.C.C. 296, para. 28.
 Sanjay Nagral, Editorial, SARS: Infectious Diseases, Public Health and Medical Ethics,11(3)Indian J. Med. Ethics (2003), http://ijme.in/index.php/ijme/article/view/861/2020.
 Freedom of Information Act, No. 5 of 2003.
 Id. § 6.
 Surveillance, at the Heart of India’s Polio Success Story, WHO Country Office for India, http://www.searo.who.int/india/topics/poliomyelitis/surveillance/en/. For more information on WHO-India cooperation, see WHO Country Office For India , Country Cooperation Strategy India 2012–2017 at 29 (2012), http://www.who.int/countryfocus/cooperation_strategy/ccs_ind_en.pdf?ua=1.
 Patralekha Chatterjee, India’s Ongoing War Against Rabies, 87(12) Bulletin of the World Health Organization 890–91 (Dec. 2009),http://www.who.int/bulletin/volumes/87/12/09-021209/en/.
 K.S. Jayaraman, India Upgrades Its Disease Surveillance Network,Nature (Aug. 17, 2009), http://www.nature. com/news/2009/090817/full/news.2009.825.html.
Last Updated: 06/09/2015