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GS Paper: GS2

  • BCG vaccine

    According to a  US-based research, a combination of reduced morbidity and mortality could make the Bacillus Calmette-Guerin (BCG) vaccination a “game-changer” in the fight against novel coronavirus.

    What is BCG Vaccine?

    • Bacillus Calmette–GuĂ©rin (BCG) vaccine is a vaccine primarily used against tuberculosis (TB).
    • In countries where TB or leprosy is common, one dose is recommended in healthy babies as close to the time of birth as possible.
    • In areas where tuberculosis is not common, only children at high risk are typically immunized, while suspected cases of tuberculosis are individually tested for and treated.

    How can TB vaccine help fight COVID-19?

    • The BCG vaccine contains a live but weakened strain of tuberculosis bacteria that provokes the body to develop antibodies to attack TB bacteria.
    • This is called an adaptive immune response, because the body develops a defense against a specific disease-causing microorganism, or pathogen, after encountering it.
    • Most vaccines create an adaptive immune response to a single pathogen.
    • Unlike other vaccines, the BCG vaccine may also boost the innate immune system, first-line defenses that keep a variety of pathogens from entering the body or from establishing an infection.

  • Telemedicine/Telehealth as a tool to fight COVID-19

     

    The Medical Council of India and the NITI Aayog have developed new guidelines released on March 25, 2020 for registered medical practitioners to deliver consultations to patients via telemedicine.

    Telemedicine

    • Telemedicine involves the use of telecom and virtual technology to deliver health care outside of traditional health-care facilities.
    • It is the essential delivery of health care services where distance is a critical factor — comes in.
    • At least one doctor is needed for a population of 1,000, according to WHO guidelines.
    • Telemedicine, thus, holds significance for countries like India that have low doctor-to-patient ratios.

    About the guidelines

    • The guidelines aim to empower registered doctors to reach out to patients safely using technologies for the exchange of valid information.
    • This information can be used for diagnosis, treatment and prevention of disease and injuries, research and evaluation and for continuing the education of healthcare providers.
    • The guidelines have empowered medical practitioners. They have, however, also imposed many restrictions.
    • Registered medical practitioners, for instance, have to take the patient’s consent.
    • If the patient denies her consent, however, the practitioner cannot insist that the patient to go in for telemedicine.

    How telemedicine can help against COVID-19?

    • Telemedicine can help bridging the gap between people, physicians and health systems, enabling everyone, especially symptomatic patients, to stay at home and communicate with physicians through virtual channels.
    • It thus helps reducing the spread of the virus to mass populations and the medical staff on the frontlines.
    • It can help provide routine care for patients with chronic diseases who are at high risk if exposed to the virus.

    Limitations

    • The out-of-hospital management is has not been yet established in India. Perhaps a ‘crisis-based’ evolution of telemedicine can help find local testing centers and also manage the flow of patients seeking a test.
    • However, for a smaller subset of higher risk patients, the clinical course may not be consistent with conventional telemedicine.
    • These patients often present with a more serious condition require rapid hospitalization.
    • Telemedicine hasn’t traditionally been used in response to public health crises. Many health practitioners are not equipped to deliver care in this way.
    • Another issue is access to broadband – some hospitals struggle with running a quality connection within their facilities and now we are faced with taking this to potential new areas of care, such as an outside tent.

  • Price Monitoring and Resource Unit (PMRU)

    The National Pharmaceutical Pricing Authority (NPPA) has set up price monitoring and resource unit (PMRU) in the UT of Jammu and Kashmir. With this J&K has become the 12th State/UT where the PMRU has been set up.

    Price Monitoring and Research Unit (PMRU)

    • It is a registered society set up for drug price monitoring.
    • PMRUs have already been set up by the drug price regulator NPPA in 11 states such as Kerala, Odisha, Gujarat, Rajasthan, Punjab, Haryana, Nagaland, Tripura, Uttar Pradesh, Andhra Pradesh and Mizoram.

    Its composition

    • The State Health Secretary would be the Chairman of the society and the Drugs Controller would be its member secretary.
    • Its members include a State government representative, representatives of private pharmaceutical companies, and those from consumer rights protection fora.
    • The society would also have an executive committee headed by the Drugs Controller.

    Terms of reference

    PMRU offers technical help to the State Drug Controllers and the NPPA to:

    • Monitor notified prices of medicines
    • Detect violation of the provisions of the DPCO
    • Look at price compliance
    • Collect test samples of medicines, and
    • Collect and compile market-based data of scheduled as well as non-scheduled formulations.

    Why need PMRU?

    • Pharma companies have been accused of overcharging prices of drugs in the scheduled category fixed by the DPCO and those outside its ambit too.
    • The suggestion to set up PMRUs was made against the backdrop of the lack of a field-level link between the NPPA and the State Drugs Controllers and State Drug Inspectors to monitor drug prices.

    Expected outcomes

    • The NPPA had fixed the prices of around 1,000 drugs and the unit would track if buyers were being overcharged.
    • It would also check if pharma companies were hiking the prices of non-scheduled drugs by more than 10% a year.
    • It will check if there is any shortage of essential medicines.

  • [pib] ArogyaSetu App

     

    The Government of India has launched a mobile app ArogyaSetu developed in a public-private partnership to bring the people of India together in a resolute fight against COVID-19.

    AarogyaSetu App

    • The App enables people to assess themselves the risk of their catching the Corona Virus infection.
    • It will calculate this based on their interaction with others, using cutting edge Bluetooth technology, algorithms and artificial intelligence.
    • Once installed in a smartphone through an easy and user-friendly process, the app detects other devices with AarogyaSetu installed that come in the proximity of that phone.
    • The app can then calculate the risk of infection based on sophisticated parameters if any of these contacts has tested positive.
    • The personal data collected by the App is encrypted using state-of-the-art technology and stays secure on the phone till it is needed for facilitating medical intervention.

  • Supreme Court upholds “Right to discuss COVID-19”

    The Supreme Court has upheld the right to free discussion about COVID-19, even as it directed the media to refer to and publish the official version of the developments in order to avoid inaccuracies and large-scale panic.

    Right to Discuss

    • The Right to Discuss falls under the purview of the right to freedom of speech and expression.
    • Article 19(1)(a) of the Constitution of India states that all citizens shall have the right to freedom of speech and expression.
    • It ensures all citizens the liberty of thought and expression.
    • The exercise of this right is, however, subject to “reasonable restrictions” for certain purposes being imposed under Article 19(2) of the Constitution of India.
    • These restrictions are imposed in the interests of the sovereignty and integrity of India, the security of the State, friendly relations with foreign States, public order, decency or morality or in relation to contempt of court, defamation or incitement to an offence.

    Why such a move?

    • The court was responding to a request from the Central government that media outlets, in the “larger interest of justice”, should only publish or telecast anything on COVID-19 after ascertaining the factual position from the government.
    • Any deliberate or inaccurate reporting by the media, particularly web portals, had the serious and inevitable potential of causing panic in a larger section of the society.
    • Any panic reaction in the midst of an unprecedented situation based on such reporting would harm the entire nation.
    • Creating panic is also a criminal offence under the Disaster Management Act, 2005.

  • A pandemic in an unequal India

    Context

    The official strategies to deal with the virus place the responsibility on citizens, a majority without privilege, to fight the virus.

    The poor disproportionately affected

    • If the COVID-19 pandemic lashes India with severity, it will not be just the middle class who will be affected.
    • India’s impoverished millions are likely to overwhelmingly bear the brunt of the suffering which will ensue.
    • Inequality and impact of a pandemic: The privileged Indian has been comfortable for too long with some of the most unconscionable inequalities in the planet.
    • But with the pandemic, each of these fractures can decimate the survival probabilities and fragile livelihoods of the poor.

    Inadequate capacity of the health system  

    • Low investment in public health: India’s investments in public health are among the lowest in the world, and most cities lack any kind of public primary health services.
    • A Jan Swasthya Abhiyan estimate is that a district hospital serving a population of two million may have to serve 20,000 patients, but they are bereft of the beds, personnel and resources to do this. Few have a single ventilator.
    • The poor left with meagre services: India’s rich and middle-classes have opted out of public health completely, leaving the poor with unconscionably meagre services.
    • The irony is that a pandemic has been brought into India by people who can afford plane tickets, but while they will buy private health services, the virus will devastate the poor who they infect and who have little access to health care.

    No planning and preparation by the state

    • Official strategies placing responsibility on citizens: Most of the official strategies place the responsibility on the citizen, rather than the state, to fight the pandemic.
    • No preparation by the states: The state did too little in the months it got before the pandemic reached India for expanding greatly its health infrastructure for testing and treatment.
    • This includes planning operations for food and work; security for the poor; for safe transportation of the poor to their homes; and for special protection for the aged, the disabled, children without care and the destitute.

    What must be done?

    • 25 day’s minimum wage: For two months, every household in the informal economy, rural and urban, should be given the equivalent of 25 days’ minimum wages a month until the lockdown continues, and for two months beyond this.
    • Pensions must be doubled and home-delivered in cash.
    • There should be free water tankers supplying water in slum shanties throughout the working days.
    • Double the PDS entitlement: Governments must double PDS entitlements, which includes protein-rich pulses, and distribute these free at doorsteps.
    • Provide cooked and packed food: In addition, for homeless children and adults, and single migrants, it is urgent to supply cooked food to all who seek it, and to deliver packed food to the aged and the disabled in their homes using the services of community youth volunteers.
    • Ensure prisons are safe: To ensure jails are safer, all prison undertrial prisoners, except those charged with the gravest crimes, should be released.
    • Likewise, all those convicted for petty crimes. All residents of beggars’ homes, women’s rescue centres and detention centres should be freed forthwith.

    Way forward

    • Commit 3% of GDP on health: India must immediately commit 3% of its GDP for public spending on health services, with the focus on free and universal primary and secondary health care.
    • Nationalise private healthcare: Since the need is immediate, authorities should follow the example of Spain and New Zealand and nationalise private health care.
    • An ordinance should be passed immediately that no patient should be turned away or charged in any private hospital for diagnosis or treatment of symptoms which could be of COVID-19.

    Conclusion

    While one part of the population enjoys work and nutritional security, health insurance and housing of globally acceptable standards, others survive at the edge of unprotected and uncertain work, abysmal housing without clean water and sanitation, and no assured public health care. Can we resolve to correct this in post-COVID India? Can we at least now make the country more kind, just and equal?

  • J&K Reorganization (Adaptation of State Laws) Order, 2020

    • The Ministry of Home Affairs has promulgated the Jammu and Kashmir Reorganization (Adaptation of State Laws) Order, 2020, which comes into force with immediate effect.
    • Earlier this month order for an adaptation of Central Laws was also promulgated. It ordered application of 37 central laws envisaged in the Concurrent List to the newly formed UT.

    About the Order

    • Issued by the Department of J&K and Ladakh Affairs, the Order stems from Section 96 of the J&K Reorganization Act, 2019.
    • The Act was a consequence of the abrogation of Article 370 of the Constitution of India and it reorganized the State into two UTs.
    • The Order notifies changes in the J&K Civil Services (Decentralization and Recruitment) Act (hereafter, “Civil Services Act”), which defines “domicile” for employment in the region
    • Domicile Criteria
      Under the newly inserted Section 3A of the Civil Services Act which is regarding domicile for purposes of appointment to any service in UT of J&K.A person will have to fulfill the following conditions to be deemed to be a domicile of the UT of J&K:
    • She/he has to have resided for period of 15 years in the UT of J&K or has studied for a period of 7 years and appeared in Class 10th/12th examination in an educational institution located in the UT of J&K; or
      She/he is registered as a migrant by the Relief and Rehabilitation Commissioner (Migrants) in the UT of J&K.
    • Scope of Section 3A
    • Children of those fulfilling the aforementioned conditions are also deemed to be included.
    • Section 3A also goes on to include children of those Central Government Officials, All India Services Officers, Officials of PSUs and Autonomous body of Central Government, PSBs, etc. who have served in J&K for a total period of ten years.
    • Additionally, it includes those children of such residents of UT of J&K who reside outside the UT of J&K in connection with their employment or business or other professional and vocational reasons, but the parents fulfill the conditions provided under Section 3A(1).

    Job reservations

    • Section 5A provides for the domicile reservation for the purpose of appointment of any post carrying a pay scale of not more than Level-04 under the UT of J&K or under local or any other (other than cantonment board) within the UT of J&K.
    • Therefore, lowest level of non-gazetted rank jobs would be reserved exclusively for the Jammu and Kashmir domiciles.

  • Lock, don’t shut

    Context

    Economy is a living machine — cannot be simply turned off and on. Even in lockdown, it needs to be kept alive.

    Movement of goods exempted

    • Essential and non-essential distinction removed: It is, welcome that the Centre has now exempted transportation of all goods from the lockdown’s provisions, without distinction of “essential” and “non-essential”.
    • When goods aren’t the culprit — it didn’t make sense, in any case, to allow bureaucrats and local authorities to decide what is essential and hold up trucks carrying material deemed non-essential.
    • One cannot expect officials or state border police to have intimate knowledge of production processes and inputs that go into every good, essential or otherwise.
    • The purpose of a lockdown is to minimise physical human interaction and maintain social distancing even if people have to meet.
    • Blocking movement of goods, far from achieving that objective, only results in overcrowding and snarls at check posts.

    How allowing Industrial establishment to operate matters?

    • Allowing industrial establishment to operate: There’s no reason why even industrial establishments cannot be permitted to run during the lockdown.
    • Again, it shouldn’t matter whether these units are producing essential or non-essential goods. What matters is only social distancing.
    • Right step by the Punjab government: The Punjab government has taken the right step of permitting all factories in the state to resume operations, subject to their being able to provide in-house lodging, food and medical facilities to workers and ensure no overcrowding at the plant.
    • Mass exodus could have been avoided: Most factories today, whether in Punjab, Haryana and Delhi or Maharashtra, Gujarat and Tamil Nadu, are manned by migrant labourers from Bihar, Uttar Pradesh and other eastern states.
    • Had measures to retain this workforce within or close to the premises of factories been in place — instead of a blanket order to shut down — the current situation of a mass exodus of labourers and the attendant risk of COVID-19 transmission may have been avoided.
    • Difficulty in getting the labour back: It isn’t going to be easy for the closed units to get this labour back even when the lockdown ends.

    Conclusion

    • The economy needs to be kept alive: An economy is ultimately a living machine — one that cannot simply be turned off and on. Even in lockdown, it needs to be kept alive and whirring.
    • Difficulty in resumption: The danger from mechanically ordered closure of activities is that resumption becomes difficult. Rebuilding broken supply chains is easier when things are allowed to run even if at low key so that the system can respond when demand returns.
    • Lockdown is not an end in itself: Combating COVID-19 should obviously be the government’s top priority now. Lockdown is a necessary part of that strategy, but cannot be an end in itself. It is necessary primarily for social distancing, which can also be achieved without bringing the wheels of commerce to a complete halt.

  • The art of China’s legalpolitic

    Context

    A resolution has been moved in the US Senate calling on the international community to inquire into the origins of the virus in China’s Wuhan province. Delhi could learn a trick or two from Beijing on how to make international law the keystone of India’s diplomacy, especially in the multilateral domain.

    Fixing responsibility for the outbreak on China

    • Compensation demand: Lawyers and activists have begun to sue China in US courts demanding compensation. Politicians are not far behind.
    • The U.S. Senate resolution: A resolution has been moved in the US Senate calling on the international community to inquire into the origins of the virus in China’s Wuhan province, quantify the damage inflicted on the rest of the world, and design a mechanism of reparations from Beijing.
    • Basis of the demand for compensation: The case for China’s culpability is based on the principles of state responsibility and Beijing’s alleged failure to respect the obligation, under the 2005 International Health Regulations (IHR), to notify the world on the outbreak of the epidemic.
    • Is the basis valid? Many international jurists dismiss these claims by citing the principles of sovereign state immunity, the lack of precedent in holding states to account for the spread of infectious disease beyond their borders and the absence of provisions for reparations under the IHR.

    The interplay between legality, moralpolitik and geopolitics

    • Gulliver and Lilliputs of the world: On the face of it, China is too much of a Gulliver to be tied down by legal Lilliputs.
    • The Legalpolitik: Before we dismiss international law as not real law, “legalpolitik” can put some real pressure on big nations and contribute to the power play among them.
    • Role of public opinion: As public opinion began to intrude into diplomacy over the last two centuries, legality and moralpolitik have become an integral part of geopolitics.

    Difficulty in proving the case against China

    • The cost of a pandemic: Most world leaders know, whether they say it aloud or not, the international costs of the pandemic could have been far lesser if China had acknowledged the spread of the virus from Wuhan early on and informed other countries.
    • It is one thing to know but entirely another to prove it under the law.
    • The pursuit of claims is a waste of time: Most governments believe the pursuit of claims against Beijing is a waste of time.
    • Political heft of China: If Beijing can make the World Health Organisation toe its line and prevent the rest of the world, including US President Donald Trump, from describing COVID-19 as the “China Virus”, it is unlikely to be impressed by a few legal impresarios from the West.
    • Precedence of defying the law: After all, China had dismissed the unanimous verdict of the International Court of Justice in 2016 on Beijing’s territorial claims over the South China Sea.
    • Beijing did not even bother to appear in the case filed by the Philippines.
    • China had simply declared that the ICJ has no jurisdiction in the matter.

    The relation between power and law in international relations

    • Power prevails: That power tends to prevail over law is certainly truer in international relations than domestic politics.
    • Law in the domestic domain: In the domestic domain, the state as the highest authority compels citizens to abide by the law, with force if necessary.
    • Law in the international arena: In the international arena, no single actor has a monopoly over the instruments of force.
    • We have multiple sovereigns but no “world government” that can compel deviant states to conform to rules.

    Role of the UNSC

    • In theory, the members of the UN Security Council can authorise coercion — in the form of economic sanctions or military force.
    • This, in turn, involves building a consensus among major powers, including the five permanent members of the UNSC who wield a veto.
    • In reality, then, the UNSC can’t act against one of the five permanent members.
    • Beijing, which was so eager to get the UNSC to discuss the situation in Jammu and Kashmir since last August, has simply blocked all suggestions for a discussion on the corona crisis in recent days.

    Are laws meaningless in the global arena?

    • Legal narratives have the weight of their own: While outcomes in international conflicts tend to be defined by power, the international discourse on any conflict today is framed in legal terms.
    • Whether it is a conversation between a state and its citizen or among governments or in a country’s outreach to the global society, legal narratives have a weight all of their own.
    • Delhi, for example, has struggled in recent days to counter the global interpretation of its domestic actions.
    • Importance of legal argument: Winning the legal argument, China has learnt from the history of great power relations, is very much part of great power jousting.
    • The negative lessons are from the Soviet Union that dismissed the Western legal arguments during the Cold War as based on the logic of capital and empire.
    • That did not convert many beyond the choir.
    • The positive lessons are from Great Britain and the United States.
    • The enduring Anglo-Saxon hegemony is rooted not just in economic and military power. It has always been underwritten by a powerful legal tradition that shapes the global narrative on most issues.
    • China developing own narrative: As it mounts a massive propaganda offensive against the US on the corona crisis, China’s state lawyers have filed a case in the Wuhan Intermediate People’s Court last week accusing various US government agencies of covering up the origin of the coronavirus.
    • China’s own narrative: It is no longer about China defending against a powerful international narrative; it is developing one of its own.

    Conclusions

    • 1. Make international law keystone of diplomacy: India has been at the receiving end of China’s legalpolitik — most recently on the quest for the membership of the Nuclear Suppliers Group and the constitutional changes in Kashmir.
    • Delhi could learn a trick or two from Beijing on how to make international law the keystone of India’s diplomacy, especially in the multilateral domain.
    • 2. Reinvest in the geo-legal arts: If China could emulate US and Britain on leveraging legalpolitik for strategic ends, India should not find it too hard to reinvest in the geo-legal arts that Delhi inherited from the Anglo-Saxons but seems to have lost along the way.

  • Regulating the Private Health Sector to Eliminate COVID-19

    Context

    The current COVID-19 crisis that India is battling has brought into sharp focus the public health system’s inadequacy to cope with it.

    Contradictory scenario between public and private healthcare delivery

    • The contrast between public and private: Hospitals with state-of-the-art equipment rivalling five-star hotels in their facilities are mushrooming mostly in cities even as the overburdened public hospitals are valiantly fighting to cope. 
    • Dismal picture in rural areas: As far as the rural areas are concerned, the community health centres and primary health centres and sub-centres present an even more dismal picture in terms of availability of medicine stock, trained para-medical staff, and doctors and nurses.
    • However, it is not as if urban hospitals offer patients excellent care. A common and widely held general misperception is that the private healthcare system is better than the public one.
    • Why private is not always better? Complaints of non-transparent billing, demanding exorbitant sums in advance even in a medical emergency, and cutting corners in services are all too familiar, as are cases of the denial of services.
    • In semi-rural areas and towns, the private sector is not necessarily similar to hospitals in cities.
    • The private hospitals in these areas are small and have basic infrastructure and limited medical and non-medical staff. Unlike the cities, the power and water supply in these areas also constitute a problem to the functioning of these hospitals.

    Problems in the public healthcare system

    • Within the public sector health system, there are a number of trends again that add to the dismal picture.
    • A high number of patients: Doctors in the public hospitals deal with an overwhelming number of patients majorly from the poor and marginalised sections.
    • Issue of contractual staff: Health activists have also pointed out that the growing trend of contractual hiring of paramedical and allied staff leads to an insecurity among them, and thus affects overall caregiving to patients.
    • Consequently, the poor patients’ families, frustrated by the lack of infrastructure and services, turn their anger upon the doctors and nurses.
    • What are the implications? The constant vilification of the public hospital staff coupled with starving these hospitals of resources has led to the view that the private hospitals are “much better” despite their exorbitant rates.

    State-wise variation in healthcare

    • States subject: Health is a state subject, and it is well known that the health delivery systems are not uniform across states.
    • Kerala a role model: Kerala is often held up as a role model generally, and even now in the manner in which it has dealt with the COVID-19 crisis.
    • The dismal system in North India: As it is, certain states in North India have abysmal healthcare systems, and a couple does not have any testing facilities, the media has reported.

    Getting the private sector involved in COVID-19 testing

    • Undoubtedly, at present, the private sector must be involved in screening, tests and treatment for COVID-19.
    • The highly trained professionals in this sector can contribute enormously by helping scale up the testing efforts.
    • Importance of large-scale testing: In South Korea too, it was large-scale testing that was instrumental in reducing mortality rates.
    • The pricing issue: Services across sectors must not be priced differently at a time like this. The media has reported that there is a difference of opinion between the government and private sector on the price of COVID-19 tests flowing from the prices of test kits.
    • Need for the protocol: A clear and non-negotiable protocol for the private sector must be established regarding the present crisis and how the government is going to help financially and otherwise in dealing with it.

    Way forward

    • Regulate the testing, screening and treatment facilities: The experience with the government offering subsidies to hospitals, especially in urban areas in terms of land and other concessions, has not borne out desired objectives such as better care for the poor.
    • Taking a cue from this, the testing, screening, and treatment facilities must be regulated in terms of pricing and quality.
    • Focus on strengthening the public health system: The Supreme Court has held healthcare to be a fundamental right under Article 21. The biggest lesson of the current crisis is that political will must focus on strengthening the public health system.

    Conclusion

    The finance minister has announced a package of `1.7 lakh crore to deal with this catastrophic situation. This is welcome, but long-term resource allocation to invigorate the public health system must be a continual and parallel process.