Policy failure before Covid-19 pandemic and options for the government in near future

In the context of Covid-19 pandemic, majority of the Indian states failed miserably in disease surveillance, primarily because of almost a complete policy void in health system and coordination failure in the preceding years. This chapter attempts to analyse the historical traits of health policy matrix of pandemic preparedness and post-epidemic policy interventions in different countries and then look into the sheer neglect of public health in general and epidemic preparedness in particular in India. While recognizing the fact that restrictive policies of quarantine, lockdown and isolation can at best postpone the disease spread, these policies actually could have reduced the burden of epidemic only if the health infrastructure and public health policy matrix were robust enough for inserting correct dose of disease surveillance and treatment. The surveillance mechanism had hit a floor as the public-funded test coverage was low and inadequate in most of the states. The private demand for prevention (in the form of behavioural change and going for detection) could not supplement the overall preventive services. State-wise data analysis identifies that the death rates were very high in some states primarily owing to demographic pattern and prevalence of non-communicable diseases. This indicates that what we need at this hour is not compartmentalized and segregated vertical programmes for specific diseases, but a holistic approach towards health system strengthening, with a renewed focus on public health comprising strict disease surveillances and preventive mechanism. © 2022 selection and editorial matter, Rajib Bhattacharyya, Ananya Ghosh Dastidar and Soumyen Sikdar;individual chapters, the contributors.