KPHA 2023 should explicitly include state accountability: Response to Fernandez et al.

The commentary "Public health ethics and the Kerala Public Health Act, 2023" published on January 27, 2024 in the Indian Journal of Medical Ethics (IJME) has received a response from members of the State Health Systems Resource Centre and Government Medical College, Malappuram, Kerala. They explain that the Kerala Public Health Act (KPHA) is a legal document and not required to explicitly include accountability mechanisms and social obligations of the state. Given the very real danger of state over-reach as was evident during the Covid pandemic, these checks and balances should, in fact, be non-negotiable. The position of KPHA on healthcare of migrant workers and patients with tuberculosis goes against existing public healthcare principles. There is therefore a need to revisit the Act to explicitly include state accountability.