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GS Paper: GS2-13.Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

  • Sections 269 & 270 IPC invoked against those accused of spreading COVID-19

    Sections 269 & 270 IPC invoked are being invoked against persons who malignantly do any act which is likely to spread the infection of any disease dangerous to life.

    Sections 269 and 270 of the IPC

    • Sections 269 (negligent act likely to spread infection of disease dangerous to life) and 270 (malignant act likely to spread infection of disease dangerous to life) come under Chapter XIV of the IPC.
    • The chapter is named ‘Of Offences Affecting The Public Health, Safety, Convenience, Decency and Morals’.
    • While Section 269 provides for a jail term of six months and/or fine, Section 270 provides for a jail term of two years and/or fine.
    • In Section 270, the word ‘malignantly’ indicates a deliberate intention on the part of the accused.
    • During the coronavirus outbreak, penal provisions, such as Sections 188, 269 and 270 of the IPC, are being invoked to enforce the lockdown orders in various states.

    Earlier instances of invocation

    • Both Sections have been used for over a century to punish those disobeying orders issued for containing epidemics.
    • The Sections were similarly enforced by colonial authorities during outbreaks of diseases such as smallpox and bubonic plague.

  • PM-CARES Fund

    Our PM has called for donations to the newly instituted PM-CARES Fund which has been formed on popular demand to help fight the novel coronavirus.

    PM-CARES Fund

    • The fund will be a public charitable trust under the name of ‘Prime Minister’s Citizen Assistance and Relief in Emergency Situations Fund’.
    • The PM is Chairman of this trust and members include the Defence Minister, Home Minister and Finance Minister.
    • Contributions to the fund will qualify as corporate social responsibility (CSR) spending that companies are mandated to make.
    • The Fund accepts micro-donations as well.

  • [pib] National Teleconsultation Centre (CoNTeC)

    The Union Ministry of Health & Family Welfare has launched the National Teleconsultation Centre (CoNTeC).

     About CoNTeC

    • The CoNTeC is a Telemedicine Hub established by AIIMS, New Delhi, wherein expert doctors from various clinical domains will be available 24×7 to answer the multifaceted questions from specialists from all over the country.
    • It is a multi-modal telecommunications hub through which 2 way audio-video and text communications can be undertaken from any part of the country as well as the world at large.
    • The modes of communication will include simple mobile telephony as well as two way video communications, using WhatsApp, Skype and Google Duo.
    • The CoNTeC is also fully integrated with the National Medical College Network (NMCN) to conduct a full fledged Video Conference (VC) between the 50 Medical Colleges.

    How to Contact the CoNTeC?

    • A single mobile number (+91 9115444155) can be dialled from anywhere in the coutnry/world by COVID-19 treating doctors to reach the CoNTeC which has six lines that can be used simultaneously at present.
    • This number of lines can be increased in future if needed.
    • The incoming calls will be picked up by the CoNTeC Managers, who will then handover the call to the appropriate expert doctors from the clinical domains as desired by the calling specialists managing the COVID-19 cases anywhere in the country.
    • The Managers will guide the callers in establishing a two way video call using the WhatsApp, Skype or Google Duo as preferred by the caller.
    • The callers from the NMCN network can connect anytime using the Telemedicine infrastructure at their end.

  • After the lockdown

    Context

    Lockdown announcement has not been matched by national strategy — on containing fallout for poor.

    Two arguments advanced against lockdown

    • India’s decision to lock down was necessary. Two arguments are being advanced against it.
    • The first argument: India is a poor economy, with millions at the margins of subsistence, who cannot bear the consequences of a lockdown. The density and living conditions in India make social distancing difficult in many cases.
    • The second argument: It is that the extent of community transmission does not justify such drastic measures.

    What are the justifications for the lockdown?

    • The only hope: Precisely because millions in India are vulnerable and will not later have the possibilities of quarantining or medical care, the only hope we have of securing their lives is to slow down the spread of the virus as much as possible.
    • And the only shot you have at it is when community transmission is possibly still at manageable levels.
    • There is, therefore, a bit of bad faith in using the poor as the basis for expressing scepticism at the need for a lockdown. That is the most insidious form of privilege.
    • The risks of any catastrophic spread will be even more incalculable for the poor.

    Underscoring the importance of federalism and decentralisation

    • States responding in innovative ways: One of the more encouraging things has been the way in which several state governments like Punjab, Odisha, Kerala, Delhi and others have come into their own, innovating under difficult circumstances.
    • Role of panchayat and local officials: The much-neglected panchayat and local officials are key nodes in keeping track of possible cases and the creation of quarantining infrastructure.
    • Role of frontline workers: It would also be churlish not to acknowledge the ways in which most of the frontline workers of the state are responding, learning and innovating in this situation.
    • Federalism and decentralisation: If anything, this crisis is bringing home the importance of both federalism and decentralisation as central to a resilient governance architecture.

    The preparation and follow-up of the lockdown

    • But the national preparation and follow-up to take full advantage of the lockdown do not inspire full confidence.
    • Lack of strategy: The announcement of the lockdown has not been matched by a commensurate national strategy.
    • This is manifest, in the early signals on the following two important aspects:
    • Containing the economic fallout for the poor.
    • Building up the health infrastructure.
    • It is, admittedly, early days; but the signs are not good.

    Economic fallout for the poor

    • Focus is not on the poor: In the entire framing of the problem, the poor have been at best an afterthought, at worst expendable damage.
    • Steps taken not adequate: Steps like health insurance cover for frontline workers, increased food rations, are welcome steps. But a crisis of this magnitude required assurance to the most vulnerable that no stops will be pulled to secure their futures.
    • Instead, what you got was incrementalism of the worst kind, masquerading as a big commitment.
    • Low cash transfer: The cash transfers, in particular, through different schemes, are shockingly low.
    • Need for the unprecedented social security support: This crisis is one of the rare instances where economists and even bankers, from across the political spectrum, have rallied around the intellectual argument for unprecedented levels of social security support.
    • So the government’s “support by stealth” strategy is even more mystifying.
    • Impact of lockdown on migrant labour: The magnitude of the crisis unleashed for migrant labour could have been avoided with a little forethought.
    • What could have been done? Early announcement of cash transfers, shelter and food availability, would have obviated the need for migration.

    Opacity on the health infrastructure side

    • Issue of testing: Opacity is often a consequence of scarcity. And nowhere is this more manifest than in our discussion of testing.
    • Underutilisation of capacity: Everyone understands that India has the scarce testing capacity, though it seems it is also under-utilising what it has.
    • No clear testing strategy: The government is procuring more testing kits. But what is worrying is that there seems to be no publicly articulated statement of what exactly our testing strategy is, given the scarce resources.
    • But there is still no sense of how we plan to put a testing strategy in place (not just numbers of tests, but where can they be optimally deployed), that will minimise the need for future lockdowns.
    • What objectives is it trying to meet? There is more than a whiff of suspicion that there is a view that more testing might spread more panic.
    • Or it might put more pressure on the health care system than it can handle.
    • India has never understood that health expenditure is not an expenditure; it is an investment.
    • Building up of health infrastructure: The success of the lockdown strategy is premised on an unprecedentedly vigorous building up of health infrastructure to fight the pandemic.
    • There is a commitment by the Centre to infuse an extra Rs 15,000 crore in this sector. Some steps are being taken in building up capabilities, including ramping up production of ventilators and masks.
    • Need for warlike mobilisation: This is an area where India needs almost a warlike mobilisation, to make sure we have enough testing, tracking, frontline workers, logistics and equipment in place to make sure that the duration of a lockdown is minimised or a repeat is not necessary.
    • The creation of this kind of infrastructure will pay huge dividends even in non-pandemic times.

    Conclusion

    The prime minister is constantly asking the citizens to mobilise, and most of them respond. But it about time the state mobilises: On an economic stimulus that is truly meaningful and health infrastructure push that inspires confidence.

  • Home and nation

    Context

    A 21-day lockdown is extraordinary. Government, people must come together to ensure that supply chains and social trust must not break.

    An unprecedented move

    • A 21-day nationwide lockdown: The way we conduct ourselves in these 21 days will be critical in our fight against the coronavirus.” With these words, Prime Minister announced a measure unprecedented in India’s 72-year-old history.
    • Never have the people of the country been asked to stay within the confines of their homes for this long a period, not even when the country has fought wars.
    • Yet extraordinary times demand extraordinary measures. As the PM underlined, “stringent social distancing and staying within the Lakshman Rekha of our homes is the only prevention against the coronavirus”, the only way to break its transmission cycle.

    Challenges and consequences

    • There will be social and economic consequences and the PM did not equivocate on the challenges. He spoke of the vulnerable sections, and, as in last week’s speech, emphasised the imperative to be compassionate.
    • He lauded the frontline workers, doctors, nurses and other healthcare workers, expressed gratitude to safai karamcharis and praised the private sector and civil society.
    • A reworked social compact — more compassionate — will be necessary to confront the challenges posed by the lockdown.
    • It is now up to civil society, government agencies, the healthcare and corporate sectors to take their cues from the PM’s speech and ensure that the burden of fighting the pandemic does not fall too heavily on those at the margins, the migrant and daily wage labourers, the rickshaw pullers and others for whom these 21 days could prove to be the toughest.
    • Centre and state to work together: The Centre and state governments will need to work together, setting aside their political differences, to ensure that there is no shortage of essential commodities and the supply chains are not broken.

    Measures to mitigate the impact

    • Earlier in the day, Finance Minister Nirmala Sitharaman had announced a slew of measures that could soften the blow of a 21-day lockdown.
    • The deadline for filing of income taxes for the financial year 2018-19 has been extended, as has the last date for filing GST returns.
    • Sitharaman also announced that the threshold for taking companies through the insolvency and bankruptcy proceedings has been increased from Rs 1 lakh to Rs 1 crore.
    • This will prevent creditors from taking small and medium-sized companies, who may be facing temporary cash flow management issues due to the lockdown, and hence are unable to meet their obligations, through the IBC process.
    • The Centre has also advised state governments to transfer funds to construction workers from the cess fund collected by the labour welfare boards.

    Conclusion

    As the PM said, “21 days is a long period”. It’s now up to the authorities and the people to own and implement his message — to ensure that not just supply chains, but also social trust, isn’t broken.

  • AYUSH Health-Wellness Centres

    What is the news: The Union Cabinet has approved the inclusion of AYUSH Health and Wellness Centre (AYUSH HWC) component of Ayushman Bharat in the National AYUSH Mission (NAM).

    • A total of 12,500 Ayush health and wellness centres throughout the country will be operationalised within a period of five years.
    • The implementation of the proposal will establish a holistic wellness model based on Ayush principles and practices focusing on preventive promotive, curative, rehabilitative and palliative healthcare by integration with the existing public health care system.

    Why such a move?

    • The move is aimed at establishing a holistic wellness model based on AYUSH principles and practices focusing on preventive, promotive, curative, rehabilitative and palliative healthcare by integration with the existing public health care system.
    • The National Health Policy 2017 has advocated mainstreaming the potential of AYUSH systems (Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sows-rigpa and Homoeopathy) within a pluralistic system of Integrative healthcare.
    • The vision of the proposal is to establish a holistic wellness model based on AYUSH principles and practices, to empower masses for ‘self care’ to reduce the disease burden and out of pocket expenditure and to provide informed choice of the needy public.

    What is National AYUSH Mission (NAM)?

    • Department of AYUSH, Ministry of Health and Family Welfare, Government of India has launched National AYUSH Mission (NAM) during 12th Plan for im­plementing through States/UTs.
    • The basic objective of NAM is to promote AYUSH medical systems through cost effective AYUSH services, strengthening of educational systems, facilitate the enforcement of quality control of ASU &H drugs and sustainable availability of ASU & H raw-materials.
    • It envisages flexibility of implementation of the programmes which will lead to substantial participation of the State Governments/UT.
    • The NAM contemplates establishment of a National Mission as well as corresponding Missions in the State level.

  • Need for re-orientation

    Context

    State universities will have to deliver more to the State where they are located

    Status of the state universities in India

    • Significance of state universities: Out of about a thousand higher education institutions (HEIs) that are authorised to award degrees in India, about 400 are state public universities.
      • These state universities produce over 90% of our graduates (including those from the colleges affiliated to them) and contribute to about one-third of the research publications from this country.
    • Poor quality: That their quality and performance is poor in most cases is accepted as a given today.
      • It is evidenced by their poor performance in institutional rankings,
      • the poor employment status of their students,
      • rather poor quality of their publications,
      • negligible presence in national-level policy/decision-making bodies,
      • poor track record in receiving national awards and recognition, poor share in research funding and so on.
    • Stated reasons for poor performance– Commonly stated reasons for these observations include government/political interference in the management of the university, lack of autonomy, poor governance structures, corruption, poor quality of teachers, outdated curricula, plagiarism, poor infrastructure and facilities, overcrowding, evils of the “affiliation” system and poor linkages with alumni and industry.
      • Symptoms of the problem: While many of these observations are no doubt valid, they appear to be only the symptoms and consequences of some deeper malaise and not the underlying cause.

    Core causative factors for the poor state of state universities

    • Lack of support: State universities are not supported the way Central universities are supported by the Central government as well as given patronage by the section of society.
      • It is as though State-level players do not have much stake in the stability and performance of the State university system.
      • What could be the reason for lack of support? One reason why State-level players do not feel compelled to back the State university system more strongly could be that the latter does not commit itself to anything that may be of particular interest and value to the State where the university is located.
    • What could be the solution? In order to receive much more funding and support from the State system then, State universities would have to commit to delivering lots more to the State and its people where they are located.
      • New vision and programmes: They must come up with a new vision and programmes specifically addressing the needs of the State, its industry, economy and society, and on the basis of it make the State-level players commit to providing full ownership and support to them.

    Conclusion

    The initiative to start a larger dialogue on the future of our State universities would have to be taken primarily by the academic community of these institutions.

  • Get a step ahead of the virus

    Context

    The COVID-19 pandemic has repercussions beyond the biomedical sector — it impinges on industry, transport, finance, banking and education sectors. All of them must act in unison.

    Virus different from its nearest relative

    • Comparison with SARS and MERS: The rapid spread of the zoonotic (transmitted from animal-to-human) coronavirus infection in Wuhan in China — several hundreds every day — in December 2019 and January 2020 was a clear signal that COVID-19 is drastically different from its nearest relative viz.-
      • the Severe Acute Respiratory Syndrome (SARS) coronavirus,
      • and its distant relative, the Middle-East Respiratory Syndrome (MERS) coronavirus.
      • The former spread slowly among humans in 2002-2003. It was checked globally within nine months by screening passengers and quarantining travellers from infected countries.
      • There have been no cases since July 2003. MERS coronavirus is, by and large, an inefficient spreader — it has been confined to the Middle-East.
    • How COVID-19 is different? COVID-19 has assumed a pandemic form.
      • In less than three months, it has reached more than 180 countries and claimed more than 10,000 lives.
      • The disease has claimed more people in Italy than in the country of its origin.
      • Travel bans, screening travellers and quarantines are necessary to slow the spread of COVID-19.
      • However, there is a limit to the utility of these measures.
    • Community transmission: When the infection becomes widespread, screening procedures will become inefficient — the virus will spread stealthily.
      • Indigenous transmission — the virus spreading within communities — has begun in many countries.
      • This is typical of viruses that spread from human to human through the respiratory system.

    How India’s health management systems deals with the disease burden?

    • Medicine consists of three components —
      • universal healthcare,
      • public health, and
      • research to constantly contextualise solutions to local problems.
    • Reaction after falling ill: Many of us in India believe that disease is a matter of fate or karma and disease prevention is not always in human hands — we only react after falling ill.
    • No focus on prevention and control: Therapeutics and surgeries — healthcare interventions — are valued much, but not disease prevention and control.
    • Cultural beliefs matter: Attitudes and cultural beliefs do matter. If victims are somehow regarded as responsible for their maladies, universal healthcare is perceived as an optional service — not mandatory.

    Good reasons to change the attitude

    • There are good reasons for such thinking to change.
    • Every person who contracts a communicable disease stands the risk of spreading it to others.
    • Prevention of disease is states’ duty: At the same time, the state, too, is responsible for the spread of diseases by not mitigating the environmental and social risk factors or determinants. Prevention of disease is the state’s duty.
    • Investment in health and its implications: Healthy people create wealth. For example, every year, uncontrolled tuberculosis drains India’s economy of the equivalent of the GDP of roughly 2 million people.
      • Investment in health, therefore, can have implications for the country’s economy.
      • But Indians have never really demanded an effective public health system.
      • Healthcare has never become a political slogan. That’s one reason for the sorry state of India’s public health system.
    • Absence of effective public health system: The country does have international obligations to control TB, malaria and leprosy, and eliminate polio.
      • Ad hoc measures: In the absence of an effective public health system, the country has depended on fulfilling these obligations through ad hoc measures that are targeted towards one disease.
      • Need for robust health system: Robust public health systems are needed to prevent typhoid, cholera, dysentery, leptospirosis, brucellosis, water-born hepatitis and influenza.
    • Overburdened healthcare system with communicable disease: The absence of an effective preventive element means that healthcare services in the public sector are over-burdened with uncontrolled communicable diseases.
      • The entry of the private sector: This encourages private sector healthcare providers to step in, which brings in problems related to unregulated profits.
      • Questions are often raised over the quality of service.
      • COVID-19 could compound the systems problems: Moreover, uncontrolled communicable diseases vie with the non-communicable ones for the healthcare provider’s attention. The COVID-19 outbreak could compound the system’s problems.

    One step ahead of the virus

    • SARS and Nipah in Kerala: The SARS and Nipah virus outbreak in Kerala in 2018 were crises that required short bursts of professional activity. Our healthcare systems coped with them.
      • But endemic diseases, even influenza, that has a vaccine, require sustained interventions.
    • Test for the country’s healthcare system: Herein lies the test for the country’s healthcare system.
      • It has often been seen that the system is not able to sustain its initial momentum.
      • There is a possibility that COVID-19 could follow the path taken by the HINI influenza – after the epidemic died down, the disease became endemic.
      • The country’s healthcare system has to prepare for that. In other words, it has to be one step ahead of the virus.

    Way forward

    • Equipping district hospitals: Every district hospital must be equipped to diagnose infections caused by serious communicable diseases — these affect the lungs, brain, liver and kidneys.
      • The system should also ensure that healthcare personnel do not get infected.
    • Allocate 5% of GDP to health budget: The country needs to allocate 5 per cent of the GDP to the health budget to have a health management system that can take care of public health emergencies such as the COVID-19 outbreak — and its aftermath.
    • Unified control machinery: A unified command and control machinery, under the prime minister’s guidance, to control the spread of COVID-19 is overdue by at least six weeks in the country.
    • Define the tasks of various authorities: The tasks of the Directorate-General of Health Services, National Centre for Disease Control, Indian Council of Medical Research, National Health Mission and state health ministries must be clearly defined.
    • The mechanism for coordination: Most importantly, a mechanism for coordination between these agencies should be set up to deal with the COVID-19 threat.

    Conclusion

    The COVID-19 pandemic has repercussions beyond the biomedical sector — it impinges on industry, transport, finance, banking and education sectors. All of them must act in unison.

  • Smart-locking India

    Context

    Currently, India has entered Stage 2 of the COVID 19 epidemic, but can we do something urgently to halt it before Stages 3 and 4, and prevent it from becoming another China or Italy? Let’s look at what COVID 19 is doing globally and what it has already done in India.

    Nature and characteristics of COVID-19

    • It belongs to a simple family of cold viruses: Coronavirus 19, which emerged from China but has now spread globally, belongs to a simple family of common cold viruses which look innocent and harmless, unlike the sinister flu.
    • Footprints of similar epidemics: It has footprints of two similar epidemics: SARS (2002) and MERS (2012) apart from Ebola, which were contained well globally in the last two decades.
    • They are the group of viruses: Coronaviruses are large groups of viruses seen in humans as well as animals like camels, bats, cats, and even cattle, which India should take note of.
      • The current COVID 19 appears to be a bat-originated beta variant of the coronavirus.
      • Who is the most vulnerable? The human COVID disease is fatal predominantly in elderly or vulnerable groups, such as people with a chronic disease like hypertension, diabetes, cancer or people with suppressed immune systems.
    • How it is spread? It is spread via airborne droplets (sneeze or cough) or contact with the surface. It is possible that a person can get COVID-19 by touching a surface or an object that has the virus on it and then touching their own nose, eyes or mouth.

    Susceptibility and the measures needed to contain the spread

    • Mode of spread: The way virus spreads creates vulnerability and susceptibility of the spread of the virus through airborne droplets and contact surfaces — which are now, therefore, targets of public hygiene for preventing the spread.
    • Why India is more vulnerable? We are vulnerable due to the large population constantly travelling and working: This needs immediate containment to halt the virus spread. We are a ticking time bomb now with less than 30 days to explode in Stage 3, which will be the virus getting deeper into communities, and which will then be impossible to contain.
    • Poor public hygiene in India: Public hygiene in India is poor despite the “Swachh Bharat (Clean India)” movements. We need to have legislation with a penalty to stop spitting in public as well as private spaces.
    • Past performance: India has done very well to contain both SARS and the novel Nipah viral spread very well.

    Should India shut down the cities?

    • From China to global spread: The COVID 19 virus possibly came from the Wuhan epicentre of central China. Subsequent it assumed a large enough proportion to be called a pandemic. It rapidly transitioned across different geographies of the world including Korea, Japan, Iran, Italy and others for the WHO to declare it as a pandemic.
    • Neighbouring countries shutting down the cities: neighbouring countries like Thailand and Singapore shut down their major cities and towns for a few weeks to stop it from moving onto the next stages.
    • Should India shut down the cities? The big question today is, should the Indian government and the state governments stop the virus spread from Stage 2 to 3 by totally shutting down cities and towns when the economy is already fragile and on the brink?
    • From cluster to community spread: India had its first case diagnosed on January 30, from a student who returned from China. Later, it had a very slow spread despite the global transit involved. Such individual cases will become small clusters.
      • These clusters will then spread to communities.
    • We must halt the community-wide spread: Currently, we have just moved from case to clusters, but we must halt the community-wide spread.
    • Biphasic or dual-phase infection: COVID 19 usually follows what is known as a biphasic or dual-phase infection, which means the virus persists and causes a different set of symptoms than observed in the initial bout.
      • Also, sometimes, the recovered person can relapse.
    • The possibility of “super spreader”: Currently, the cases and clusters in India are simple spreaders which means an infected person with normal infectivity.
      • What is it? But COVID 19 can also have a “super spreader”, which means an infected person with high infectivity who can infect hundreds in no time.
    • This was reportedly seen in Wuhan where a fringe group spread the virus via a place of worship in Korea, infecting almost 51 cases.
    • India saw a mini spurt of cases on March 4, and then again between March 10 and 13, when cases jumped from 23 to 35, yet no super spreader was present.
    • We need to halt transition from stage 2 to stage 3: Now we have almost crossed a hundred cases and we must be vigilant.
      • As we enter Stage 2, we will now see a geometric jump in the number of cases which will put us at risk of rapidly transitioning from Stage 2 to 3 like Italy, which we need to halt urgently.

    Conclusion

    The ICMR has rightly advised the government to go into partial shutdown but is it too little too late now? It’s time to halt COVID 19 by smartly locking the country at home so that we can have a better tomorrow. This needs a political will which we currently have.

  • A tale of two bugs

    Context

    India needs to take TB at the same level of seriousness at which it is dealing with the Covid-19.

    Contrast and between the response

    • Tuberculosis in India: Indians will still have to contend with other deadly respiratory tract infections which spread via airborne transmission. We will still have to contend with one particular bug which kills millions of us and which has been around for millennia. Tuberculosis.
      • But all comparisons between COVID-19 and TB end with the superficial observation that they are both deadly respiratory tract infections.
    • Speedy tackling of COVID-19: COVID-19 began its march through humankind barely half a year ago and, in record time, scientists have identified the virus and hundreds of millions of dollars have been allocated to controlling its spread, developing vaccines (at last count, more than a dozen candidates) and testing medication regimens for those infected.
    • Waning of the epidemic: While the virus has spread to over 100 countries, the epidemic already shows signs of waning in the Asian countries where it hit first and hardest.

    Response to the TB

    • How long has the TB infected us? On the other hand, TB is as old as humanity itself, infecting us for at least 5,000 years.
      • The infecting agent, a bacterium, was identified way back in 1882, by Robert Koch, signalling one of the landmark discoveries which laid the foundation of modern medicine.
    • How was the response to TB? The subsequent response to this disease, which was infamously called the White Plague and was a leading cause of death globally at the start of the 20th century, is similar to what we see today for COVID-19, but played out over decades rather than months.
      • Measures taken: TB was made a notifiable disease, campaigns were launched to prohibit spitting and containment policies, including sequestering infected persons, were implemented.
    • The first vaccine was produced over a hundred years ago, and the first curative treatments available by the 1950s.
    • Divide between rich and poor in TB infections: TB was largely beaten in the rich world, not only because of these medical miracles but also thanks to the dramatic reduction in poverty and improvement in living standards.
      • There is compelling evidence that addressing these social determinants was even more impactful than medical interventions in the war against TB.
    • The disease of squalor: TB has always been, and this is even more true now than ever before, a disease of poverty and squalor. And no country is more affected than India.
    • Every TB statistic is grim:
      • We are home to 1 in 4 of the world’s TB patients.
      • Over 2.5 million Indians are infected.
      • In 2018, over 4,00,000 Indians died of the disease.
      • To put this in stark perspective, more people died of TB in India last week than the entire global death toll of COVID-19 to date.
      • Contrast with the response to COVID-19: Given our urgent, energetic and multifaceted response to the latter Covid-19, one is left wondering why we have failed so miserably for another bug, particularly one which has been around for so long, which has been exquisitely studied and characterised, which is preventable and treatable, and which most of the world has conquered.

    Why TB has not been given such attention?

    • It is because those who suffer from TB are not likely to be boarding international flights or passing through swanky airports to attend conferences.
    • It is because TB infects people in slower tides, slow enough for industries to replace the sick with healthier recruits without endangering the bottom line.
    • It is because TB does not threaten the turbines that keep the global economy throbbing.
    • It is because TB no longer poses a threat to rich and powerful countries.
    • It is because those who have TB live on the margins and have little political influence.
    • It is because TB control requires society to address the squalid environments, which shroud the daily lives of hundreds of millions of Indians.
    • It is because TB is a medieval scourge that reminds us of our shameful failure to realise a just, humane and dignified life for all our people.

    Conclusion

    If there is one lesson from COVID-19, it is that India, and the global community, has the political will, technical capacity and financial resources to act in a committed and concerted way to control infectious diseases. It needs to marshal these assets to eradicate TB, the most pernicious and pervasive infection of all, both through addressing its social determinants and scaling up effective biomedical interventions. But, for this to happen, we will have to be as concerned about the health needs of those who travel by foot and bicycle as we do for those who board cruise ships and international flights.