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GS Paper: GS2

  • Global recovery after the Covid-19

    This article discusses the various factors with geopolitical significance. These factors would shape the post-pandemic recovery on a global scale. Though these factors have been touched upon in the previous op-eds, they are dealt with in detail here.

    Post-pandemic strategic environment for the recovery

    • It’s the post-pandemic strategic environment that will dictate how soon the world recovers from this unexpected shock.
    • It must start with the international geopolitical angle, with many assumptions.
    • With some clarity in this domain, we can prepare ourselves better for the recovery phase of a near post-war situation.
    • Shortly, even as the world continues to reel under the pandemic threat, there will be more endeavours on enhancing human security through better strategic management of the world.
    • So, what will all that be about? It could be a major conference.
    • Major conference with agenda for revival: The situation is similar to the elusive efforts towards the creation of new world order after the end of the Cold War in 1989.
    • Will the world consider a major conference with the agenda being a revival after the coronavirus?
    • The 2015 Paris Summit of the United Nations, which was convened to save the world from the rapid impact of climate change, could not muster a consensus.
    • Will a potential 2020 “pandemic conference” succeed in getting big powers to jettison their geopolitical ambition?

    China’s role has significance for India. The UPSC asks questions touching the economic or security aspect of China for India. So, the role played by China in the post-pandemic world is important from Mains perspective. Take note of the issues discussed below.

    The US-China rivalry

    • The US-China rivalry will remain the core issue, with several other regions and nations aligning with the one who can bring them short to medium-term advantages.
    • Contingent upon how badly the US is finally affected, its current confused leadership is unlikely to inspire and its efforts at internal stabilisation may compromise US power.
    • A major turn in political fortunes in the US and its bumbling on pandemic management could throw open opportunities for others to exploit.
    • The US will perceive itself far more insecure than it was even after 9/11.

    Accusations over China’s role in the pandemic

    • There is likely to be a huge effort to slander China — accusing it of being the originator of the scourge — and isolate it economically and politically.
    • The allegations on the use of biological warfare are the ones which will cause turbulence in relationships.
    • Ironically, China is also in a unique position to help the world bounce back.
    • Against the backdrop of these accusations regarding culpability, we need to be ready for changes in the norms of international cooperation and behaviour.
    • Cold war situation: A cold war of sorts could well be on the cards for some time, hampering a full recovery.
    • It will be brutal in the cyber world — fake news on social media will prevent international cooperation in crucial fields such as scientific research, patents.
    • And this could perhaps even slow down the ability to prevent the next pandemic.

    The crucial role of the US

    • Subject to the US’s economic capability after the pandemic, the ability to find a consensus to put on hold defence spending for the sake of human security will be the key.
    • But the trust deficit between nations will probably hamper this to a great extent.
    • The key anchor of globalisation — the US-China trade relationship — will change even more.
    • China cannot be replaced by the US as a major industrial producer (even for the US market).
    • Other countries or blocs — ASEAN, Bangladesh and India — will all chip in but that will still not be enough.
    • Nor can any country buy as much grain from the US as China does.
    • So, an economic relationship will continue but will be politically fractured as both parties search for alternatives, which don’t exist on a scale that both of them need.

    The growing influence of China

    • China’s recovery is likely to be the fastest.
    • Its ambitious Belt and Road Initiative (BRI) may now go uncontested by the US-led efforts to create alternatives.
    • The Chinese ability to influence politics among smaller nations in Asia and Africa could bring it strategic advantages.
    • But this influence is unlikely to be enough to replace America unless the recession-hit US remains defensively oriented.
    • Potential for conflict: Knowing the US propensity to bounce back, China’s efforts will have to remain energetic and that is where the potential for conflict is likely to rise.
    • Of course, it is not as if the US would abandon its interests for an era of only-inward economic healing.
    • Its eye on the future will remain firmly in place.

    The decline in the credibility of the UN

    • Role of WHO: The UN has lost credibility with the World Health Organisation taking the worst hit any UN agency has suffered in years.
    • Its future is contingent upon how it manages the geopolitical fallout of the pandemic.
    • The sooner it can get the world leaders on board, the better.

    Instability in Iran and Afghanistan

    • The collapse of the economy: Iran has been hit badly and with the US unrelenting on sanctions, its economy could collapse with frightening results as far the Middle East is concerned.
    • The threat for peace in the region: A big nation in instability mode with internal turbulence and leadership challenges could spread greater threats of an undefined kind.
    • The US may abandon Afghanistan with less commitment towards keeping its economy sustainable.
    • Possibility of IS revival: It could be a sure recipe for internal instability, which could see the Islamic State emerge a major player.
    • Russian advantage: Everything in the Middle East points towards Russian advantage and domination.

    Opportunities for India

    • India without recession: Economically hit but probably one of the few nations without a recession, India’s strong central leadership could be a big advantage.
    • International cooperation: Prime Minister Narendra Modi would need to use all his influence to cobble together international cooperation to pull the world from the abyss it could sink into.
    • His credibility is already higher than most international leaders and could spell a leadership role for India not in conflict with China but in cooperation with it.
    • It is India’s established multilateral foreign policy that could eventually come to the assistance of the world.

    Conclusion

    Successful and swift recovery of the world hinges on international cooperation among the nation. This provides India with an opportunity to stitch together international cooperation in dealing with the aftermath of the crisis.

  • Beijing’s response to Covid underlines that the world needs more democracy, not less

    The article deals with the fundamental differences between democratic states and one-party state against the backdrop of response to Covid-19. The second part of the article focuses on post-Covid-19 scenarios like changes in the supply chains and the state of the China’s economy.

    Two aspects of Chine’s propaganda campaign

    • China, with the lack of transparency inherent in its one-party authoritarian system, contributed to the spread of Covid-19.
    • There is a desperate effort on the part of China to erase its culpability in unleashing COVID-19 across the world.
    • It has sought to overcome the damaging global public opinion which it has suffered by a subsequent sustained propaganda campaign.
    • This has two aspects.
    • 1. Highlighting the success: One highlights the success China claims to have achieved in arresting the pandemic within the country through drastic measures on a massive scale.
    • Thereby demonstrating the superiority of its authoritarian system.
    • This authoritarian system is contrasted with the delayed and often less-than-effective measures taken in democratic European countries and the US in particular.
    • 2. Publicity of assistance provided to other countries: The other seeks blanket publicity of much-needed medical equipment and medical teams to assist affected countries.
    • The main target is Europe, though assistance to other countries is also given prominence.
    • Chinese diplomats are using Twitter, Facebook and other social media platforms to create an image of a benign China providing public goods to a grateful community of beleaguered nations.
    • In reporting on India, Chinese media has often highlighted the plight of migrant workers and the frequent violations of social distancing regulations.
    • It is true that India has sought and received much-needed medical supplies from China.

    What China would like us to believe?

    • China wants us to believe that COVID-19 virus did erupt in Wuhan, but it may not have originated in China.
    • That there may have been a delay in acknowledging the seriousness of the crisis, but this was due to missteps by the local leadership in Wuhan city and Hubei province.
    • Once the gravity of the situation was recognised, Chinese leaders promptly informed the WHO and shared the DNA sequence of the virus with it and other countries.
    • The unprecedented measures adopted by Chinese authorities bought valuable time for the rest of the world to get prepared to deal with the pandemic.
    • Having achieved notable success in arresting the spread of the virus, valuable assistance is now being provided to affected countries in the spirit of solidarity.
    • China’s economy is beginning to recover and this will contribute to the recovery of the global economy.

    China has been highlighting its success in dealing with Covid-19 as an achievement of its single-party system. So, it is important to understand why it is not entirely true. And UPSC can frame a question like “To what extent has democratic system helped India in dealing with the corona crisis? “. Following points highlight the advantages of democracy in this regard.

    Democracy Vs. One-party system

    • Has China demonstrated the superiority of China’s one-party system as compared to democracies? No!
    • There is no escaping the fact that COVID-19 may not have become a pandemic if China were a democracy.
    • With a free flow of information through an independent media and accountable political leadership, the rest of the world would have been alerted in time.
    • There are democracies which have done as well if not better than China without resorting to its sledgehammer tactics.
    • Notably, there is Taiwan, which is constantly bullied by China.
    • There is South Korea, which has even held parliamentary elections after having brought the pandemic under control.
    • Even in India, the government is providing daily updates on the spread of the virus.
    • Conclusion: The bottom line is that as a result of being a democracy, we have a better chance of knowing the true dimensions of the crisis.
    • With the democracy we have a better chance of being able to obtain constant feedback on people’s reactions and access the best advice from multiple sources.

    China’s assistance and resentment against it

    • One must acknowledge China’s assistance to affected countries despite reports of defective and low-quality materials.
    • But recipients have often been “persuaded” to express fulsome praise for China.
    • This accompanying publicity overdrive has caused resentment rather than gratitude
    • Then there have been reports from Guangzhou on racial discrimination against stranded African students.
    • This has led to a sharp reaction from African countries.
    • This will be difficult to live down.

    The revival of China’s economy

    • There is no doubt that economic activity in China is beginning to revive after a steep drop of 6.8 per cent (year on year) in GDP during the first quarter of 2020.
    • Latest estimates are that the Chinese economy is now functioning at about 80 per cent of the level last year, which is impressive.
    • Less dependence on export: China’s economy is not as export-dependent as it has been in the past.
    • Exports were 5 per cent of GDP in 2018 against 32.6 per cent in 2008.
    • But the external economic environment is critical for China’s globalised economy.
    • It is a significant node in the most important regional and global supply chains.

    Changes in supply chains in the future and opportunity for India

    • China’s position as a significant node will be impacted by countries re-shoring production or opting for shorter and closer-to-home supply chains.
    • Japan will spend $2.2 billion to assist Japanese companies to shift units from China back to Japan or relocate to South East Asia.
    • In 2012, when China-Japan tensions were at a peak, there was a similar move and India was seen as an alternative.
    • But that opportunity was lost. Perhaps India has a second chance.
    • Decoupling from the US economy: China will suffer from accelerated “decoupling” from the US economy with COVID-19 sharpening the already fraught bilateral relations.
    • In a sense, China was already decoupled from the US by denying entry to US tech giants, Google, Facebook, Microsoft and Amazon.
    • This even while its own tech multinationals like Huawei and Alibaba have built markets in the West.
    • This cannot be sustained.
    • The winners in the more digital world which will emerge post-COVID-19 will be the American tech giants, even though the US is politically dysfunctional.
    • Democracies sometimes win even if their politics is frustrating.

    Conclusion

    Rather than express envy of Chinese authoritarianism, Indians should be thankful that we are a democracy. We need more democracy, not less, to overcome the COVID-19 challenge. India should also be ready to grab the opportunities in the post-Covid-19 era in the economic realms.

  • A virus, social democracy, and dividends for Kerala

    This article is an analysis of Kerala’s success in dealing with the Covid-19. Factors that emerge are-strong emphasis on the social democracy, the participation of civil society and strong social compact between the government and citizenry. We have also covered the same subject in a previous article but focus there was more on the administrative level.

    Kerala’s success story

    • Kerala was the first State with a recorded case of coronavirus and once led the country in active cases.
    • It now ranks 10th of all States and the total number of active cases (in a State that has done the most aggressive testing in India) has been declining for over a week and is now below the number of recovered cases.
    • Given Kerala’s population density, deep connections to the global economy and the high international mobility of its citizens, it was primed to be a hotspot.
    • Yet not only has the State flattened the curve but it also rolled out a comprehensive ₹20,000 crore economic package before the Centre even declared the lockdown.

    Why does Kerala stand out in India and internationally?

    • Kerala’s much-heralded success in social development has invited endless theories of its cultural, historical or geographical exceptionalism.
    • But taming a pandemic and rapidly building out a massive and tailored safety net is fundamentally about the relation of the state to its citizens.
    • From its first Assembly election in 1957, through alternating coalitions of Communist and Congress-led governments, iterated cycles of social mobilisation and state responses have forged what is in effect a robust social democracy.
    • The current crisis underscores the comparative advantages of social democracy.

    Kerala’s success is built on social democracy in the state. Following are the factors that constitute the social democracy in the state which is helping it fight against the Covid-19 pandemic with considerable success. These factors are also important from the Mains point of view if the question is framed on Kerala’s success story.

    How social democracy is practised in Kerala?

    • Social democracies are built on an encompassing social pact with a political commitment to providing basic welfare and broad-based opportunity to all citizens.
    • In Kerala, the social pact itself emerged from recurrent episodes of popular mobilisation.
    • Popular mobilisations include the temple entry movement of the 1930s to the most recent various gender and environmental movements.
    • These movements nurtured a strong sense of social citizenship.
    • These movements also drove reforms that have incrementally strengthened the legal and institutional capacity for public action.
    • Second, the emphasis on rights-based welfare has been driven by and in turn has reinforced a vibrant, organised civil society.
    • This civil society demands continuous accountability from front-line state actors.
    • Third, this constant demand-side pressure of a highly mobilised civil society and a competitive party system has pressured all governments in Kerala.
    • The pressure made governments to deliver public services and to constantly expand the social safety net, in particular a public health system that is the best in India.
    • Fourth, that pressure has also fuelled Kerala’s push over the last two decades to empower local government.
    • Nowhere in India are local governments as resourced and as capable as in Kerala.
    • Finally, all of this ties into the greatest asset of any deep democracy, that is the generalised trust that comes from a State that has a wide and deep institutional surface area.
    • That on balance treats people not as subjects or clients, but as rights-bearing citizens.

    How the built-in social democracy is helping in dealing with the pandemic?

    • A government’s capacity to respond to a cascading crisis such as the COVID-19 pandemic relies on a very fragile chain of –(1)mobilising financial and societal resources, (2)getting state actors to fulfil directives, (3)coordinating across multiple authorities and jurisdictions and maybe, most importantly, (4)getting citizens to comply.
    • First, an effective response begins with programmatic decision-making.
    • From the moment of the first reported case in Kerala, Chief Minister convened a State response team that coordinated 18 different functional teams.
    • The CM held daily press conferences and communicated constantly with the public.
    • Kerala’s social compact demanded no less.
    • Second, the government was able to leverage a broad and dense health-care system.
    • The health-care system, despite the recent growth of private health services, has maintained a robust public presence.
    • Kerala’s public health-care workers are also of course highly unionised and organised, and from the outset the government lay emphasis on protecting the health of first responders.
    • Third, the government activated an already highly mobilised civil society.
    • As the cases multiplied, the government called on two lakh volunteers to go door to door, identifying those at risk and those in need.
    • A State embedded in civil society — the women’s empowerment Kudumbasree movement being a case in point.
    • Kudumbasree movement was in a good position to co-produce effective interventions, from organising contact tracing to delivering three lakh meals a day through Kudumbasree community kitchens.
    • Fourth, you can get the politics right and you can have a great public health-care system, but its effectiveness in a crisis like this will only be as good as the infamous last kilometre.
    • And this is where two decades of empowering local governments have clearly paid off.

    Conclusion

    At a time when India is dealing with this unprecedented crisis, it is important to be reminded that Kerala has managed the crisis with the most resolve, the most compassion and the best results of any large State in India. And that it has done so precisely by building on legacies of egalitarianism, social rights and public trust. Other states and the Central government must learn from Kerala’s experience.

  • Institutional fixes and the need for ethical politics

    The article discusses the recent event in Madhya Pradesh where a group of legislature resigned bringing down the government. A most important issue arising out such incidents is circumventing of the laws made to avoid such things from happening. Several such issues along with their solutions are described here.

    New method to bypass the anti-defection law

    • The political activities in Madhya Pradesh represent a new method of bypassing the anti-defection law and toppling elected governments.
    • The government in Karnataka was brought down in July last year in a similar manner with 17 MLAs of the ruling coalition resigning and joining the BJP.
    • What method was used? Under this novel method, a set of legislators of the party in power is made to resign from the Assembly to reduce the total strength of the House enough for the opposition party to cross the halfway mark to form the government.
    • In the ensuing by-elections, the members who resigned were then fielded as ruling party candidates (most of whom have been re-elected in the case of Karnataka).
    • The same practice is likely to be repeated in Madhya Pradesh soon.

    A question based on anti-defection law and its implication for healthy debate in the parliament was asked in 2013. And that issues still persist. So, take note of these issues.

    Exploiting the loophole in the Tenth Schedule

    • This method of mass defection circumvents the provisions of the Tenth Schedule of the Constitution (better known as the anti-defection law)
    • What is the Tenth Schedule? The tenth schedule prescribes the grounds for disqualification of legislators: voluntarily giving up party membership and voting or abstaining to vote against party directions.
    • Resignation is not mentioned as a ground for disqualification.
    • However, the Speaker in Karnataka disqualified them for the rest of the Assembly’s term, thereby barring them from contesting the by-polls.
    • While the Supreme Court upheld the disqualification.
    • It stuck down the bar from contesting by-polls.
    • In Madhya Pradesh, since the Speaker has accepted the resignation of the MLAs, the defectors can in any case contest the by-polls.

    Damaging the underpinnings of democracy

    • The recurrence of this model of defection signals the exploitation of the inherent weaknesses of the anti-defection law.
    • While solo legislators jumping ship might have reduced now, “horse-trading” seems to have gone from retail to wholesale.
    • This threatens the underpinnings of India’s electoral democracy since such surreptitious capture of power essentially betrays the people’s mandate in a general election.

    Kihoto case is an important case in relation to the anti-defection law.

    Time to reframe the anti-defection law

    • In this context, it is important to examine whether the anti-defection law fulfils any purpose.
    • This law raises fundamental concerns regarding the role of a legislator in a parliamentary democracy.
    • Issues with the law: It denies the legislator the right to take a principled position on a policy matter and reduces her to an involuntary supporter of the whims of party bosses.
    • Challenge to the constitutionality: The constitutionality of the Tenth Schedule was challenged for violating the Basic Structure of Constitution with regard to parliamentary democracy and free speech.
    • Judicial review of the Speaker’s decision: The Supreme Court in Kihoto Hollohan v. Zachillhu (1992) in a 3-2 verdict upheld the law while reserving the right of judicial review of the Speaker’s decision.

    What are the shortcomings in the anti-defection law?

    • Restriction on the freedom of legislator: The anti-defection law, on the one hand, severely restricts the freedom of a legislator and makes her a slave of party whips.
    • Failure in preventing the horse-trading: On the other hand, it has not been able to meet its primary objective of preventing horse-trading and continues to be circumvented to bring down elected governments.
    • This calls for reforms that address concerns at both ends of the spectrum.

    Following two are the solutions offered here. They are important from Mains point of view. As solutions are often asked for the pressing issues.

    Dinesh Goswami Committee and other suggestion

    • Restrict the scope of the binding whip: For addressing the first issue, as the Dinesh Goswami Committee also suggested, the scope of the binding whip should be restricted to a vote of confidence.
    • For addressing the second issue, it is best to institutionalise the Karnataka Speaker’s decision to bar the defected members from contesting in the ensuing by-poll, if not for a longer period.
    • This will disincentivise MLAs from jumping ship.
    • These reforms would require a constitutional amendment to the Tenth Schedule, an uphill task under the current circumstances.

    Conclusion

    We are facing a deeper challenge of the corrosion of India’s parliamentary system, for even in jurisdictions without such anti-defection laws, we do not see “horse-trading” and “resort politics”. Hence, beyond institutional fixes, we also need a popular articulation of an ethical politics that causes the public to shun such political manoeuvres.

    Back2Basic: What is the Tenth Schedule?

    • The Tenth Schedule was inserted in the Constitution in 1985.
    • It lays down the process by which legislators may be disqualified on grounds of defection by the Presiding Officer of a legislature based on a petition by any other member of the House.
    • A legislator is deemed to have defected if he either voluntarily gives up the membership of his party or disobeys the directives of the party leadership on a vote.
    • This implies that a legislator defying (abstaining or voting against) the party whip on any issue can lose his membership of the House.
    • The law applies to both Parliament and state assemblies.
    • Exceptions under the law: Legislators may change their party without the risk of disqualification in certain circumstances.
    • The law allows a party to merge with or into another party provided that at least two-thirds of its legislators are in favour of the merger.
    • In such a scenario, neither the members who decide to merge nor the ones who stay with the original party will face disqualification.
    • Is there any time limit to decide on the matter? The law does not specify a time period for the Presiding Officer to decide on a disqualification plea.
    • Given that courts can intervene only after the Presiding Officer has decided on the matter, the petitioner seeking disqualification has no option but to wait for this decision to be made.

  • What nation can learn from Kerala in the fight against Covid-19?

    With figures emerging of Kerala’s success in dealing with the Covid-19, the rest of the nation has lessons to learn from it. This article describes the approach adopted by Kerala, and how various factors like robust health infrastructure, past experience etc. are helping it.

    Kerala stands out in India: some figures and facts

    • The COVID curve in Kerala is flattening.
    • Every day, for a week now, the number of recoveries has exceeded the number of new infections.
    • The recovery rate in Kerala is nearly 50 per cent while the all-India average is around 11.
    • While the mortality rate among the infected is 5 per cent in Kerala, the all-India average is 3.4 per cent.
    • The transmission rate of a primary carrier is 6 while in Kerala it is only 0.4.

    With Covid-19, we are in unknown territory in many ways. If Kerala emerges as the success model, the question can be framed from that perspective. So, note down the factors described below that are helping the state in tackling Covid-19 successfully.

    Preparing for the next challenge

    • Kerala is preparing for the next challenge, the outcome of which will determine the result of the war against COVID.
    • Lifting of the lockdown is going to result in an influx of returning migrants from foreign countries and other states.
    • Hundreds of thousands would have to be quarantined, tested and, if positive, treated, ensuring there is no secondary spread.
    • State authorities have already identified accommodation and other facilities for more than two lakh persons.
    • Use of big data analytics: The state is also exploring the possibility of big data analytics to plan a strategy and, if necessary, for reverse quarantining.
    • Authorities have access to WHO data covering nearly two-thirds of the state`s population.
    • Integrating this data with the information currently being generated, we will be able to map vulnerable sections of the population, simulate scenarios and plan ahead.
    • Exit strategy: An exit strategy from the lockdown is being prepared to protect livelihoods and stimulate the economy.

    Strength of the public health system of Kerala

    • The single most important factor that enabled Kerala to be prepared for the COVID is the strength of the public health system.
    • Kerala’s health system is a proud legacy of our past.
    • It has had a big push in infrastructure and equipment investment of around Rs 4,000 crore from the Kerala Infrastructure Investment Fund Board.
    • Five thousand seven hundred and seventy-five new posts have also been created.
    • The Aardram Health Mission was launched with a focus to transform the PHCs into family health centres.
    • Distinctive feature: There is also the distinctive flavour of Kerala — mass participation in preventive and palliative healthcare.
    • Training to health workers: The morale of health personnel has been exceptionally high.
    • Special training, protective gear, scientific duty rotation and, most importantly, societal empathy and solidarity, have all contributed.

    Learning from the past experience

    • Nipah outbreak experience: The recent experiences of successful containment of the Nipah outbreak and management of the two post-flood health situations have provided a kind of herd immunity to the health workers to crisis situations.
    • Covid-19 preparedness: Once news of the Wuhan pandemic came, the Kerala health system scrambled to readiness — the control room was set up, mock drills were organised and the first influx was contained.
    • Once migrants from the Gulf and Europe began to return, things began to get out of hand.
    • But now this battle has been successfully concluded.

    Testing and tracing in Kerala

    • A route map of each COVID positive case is prepared and given publicity, alerting everybody who might have been in contact.
    • The protocol of cycles of intense test, trace, isolate and treatment has been the norm.
    • Kerala has the highest test rate in the country.
    • Break the Chain Campaign to promote social distancing has been successful.
    • Lockdown by itself is not going to contain the COVID spread. It would continue to multiply within households and dormitories.
    • Testing has been woefully insufficient in the national response so far.

    Welfare payment in Kerala more than the rest of the country

    • In Kerala, 55 lakh elderly and disadvantaged have received Rs 8,500 as welfare payments.
    • An equal number of workers have been paid Rs 1,000-3,000 each from the welfare funds.
    • Every family has been provided with a food kit.
    • Interest-free consumption loan of Rs 2,000 crore has been distributed.
    • Besides, nearly 4 lakh meals are distributed every day to the needy from community kitchens set up by local governments.
    • Local governments are also duty-bound to monitor the camps of migrant workers, set up new ones and ensure medicine and food to them.

    Decentralisation paying off in Kerala

    • All the above was not made possible by the state government alone.
    • It is the synergy generated by integrating state government plans and programmes with the local governments, the co-operatives, women neighbourhood groups (Kudumbashree) and civil society organisations that make Kerala distinct.
    • The floods and the pandemic have given testimony for the potential of democratic decentralisation.
    • It is a case of multi-level planning with technical committees and groups working at the state level coordinated by the chief minister.

    Conclusion

    Though it is too early to declare Kerala as a success story, still there are many lessons to be learned by the rest of the country in its fight against Covid-19.

  • What is Post-intensive Care Syndrome (PICS)?

    • Various news reports in recent weeks have pointed out that for some COVID-19 patients who needed intensive care, the journey to recovery is a long one.
    • After leaving the ICU, they may suffer from what is known as post-intensive care syndrome (PICS), which can happen to any person who has been in the ICU.

    Infectious disease outbreaks, like the current Coronavirus (COVID-19), can be scary and can affect our mental health. This pandemic is going to leave a bigger trauma for those who had lost their dear ones as well those who recovered.

    What is PICS?

    • PICS comprise impairment in cognition, psychological health and physical function of a person who has been in the ICU.
    • Further, such patients may experience neuromuscular weakness, which can manifest itself in the form of poor mobility and recurrent falls.
    • The psychological disability may arise in a person in the form of depression, anxiety and post-traumatic stress disorder (PTSD).

    Its symptoms

    • The most common PICS symptoms are generalized weakness, fatigue, decreased mobility, anxious or depressed mood, sexual dysfunction, sleep disturbances and cognitive issues.
    • These symptoms may last for a few months or many years after recovery, the authors of the aforementioned article note.
    • Patients who develop this may take at least a year to fully recover, until which time they may have difficulty in carrying out everyday tasks such as grooming, dressing, feeding, bathing and walking.

    What causes PICS?

    • A combination of factors can affect aspects of an ICU survivor’s life.
    • PICS may be induced if a person was on prolonged mechanical ventilation, experienced sepsis, multiple organ failure and a prolonged duration of “bed-restore deep sedation”.

    Treatment

    • It is recommended that to avoid PICS, patients’ use of deep sedation is limited and early mobility is encouraged, along with giving them “aggressive” physical and occupational therapy.
    • Further, patients should be given the lowest dose of pain medications when possible and should be put on lung or cardiovascular rehabilitation treatments along with treatments for depression, anxiety and PTSD.

  • China manipulates the WHO, India needs to be cautious

    The article elaborates on the role played by China in manipulating WHO to its advantage and to the detriment of the rest of the world. India must take cognisance of the growing Chinese influence at various global platforms and act accordingly.

    China’s role in electing Director-General of WHO

    • Tedros was Ethiopia’s Minister of Health (2005—2012) and Minister of Foreign Affairs (2012 to 2016).
    • In 2017, China catapulted him to lead the WHO as its Director General (DG).
    • India, the world’s largest democracy, played second fiddle.
    • We will never know who gamed India inside and abroad, but tough questions must be asked.

    Pandemic as a wake-up call for India

    • Public health is a rights-driven developmental track for any country, especially for India.
    • The ministries of foreign, trade, information and broadcasting, home, finance, women and child development, law, infrastructure and industry, among others, should be part of the country’s health equation and decision-making on a daily basis.
    • Should the WHO be sitting in on high-level health ministry discussions given what we now know about its allegiance to all things Chinese?
    • China, an economic and military behemoth, now seeks the same power in public health.
    • India, with its double burden of disease and an uncritical alignment with the WHO, is fertile ground for data and dollars.

    Dependence on China for API

    • For now, India, like most countries, is at China’s mercy because of years of short-sightedness and corruption in the health sector.
    • While it is hailed as the pharmacy of the world and has sent drugs as humanitarian assistance, India relies heavily on raw materials from China.
    • Quick thinking and swift action can reverse this.

    The above points highlight the implications of Chinese dominance for India. Questions related to China is a recurrent theme in the UPSC papers. Next thing to note here is India’s dependence on China for APIs.

    The US’s stand on WHO funding

    • Some are blaming US President Donald Trump for contemplating cutting off funding for the WHO and not Tedros, for taking orders from China about the pandemic.
    • The war is not between an American President and Tedros.
    • It is between Tedros, a global public health head, and his subservience to China.
    • That ship of trust, the cornerstone of public health work that the WHO should have been leading, has long set sail.
    • Protecting Tedros is important as the WHO needs money to help poor countries with weak health systems.

    Last year, UPSC asked about UNESCO when the US and Israel withdrew from it. This year, WHO has been in focus for allegedly towing China’s line.

    Issue of funding and spending by the WHO

    • War chests are being mobilised to help the WHO help China disburse aid and assistance to dying people and gasping economies.
    • The recent announcement by the World Bank to fast track $1.9 billion for health systems to respond to Covid-19 also includes Ethiopia.
    • For the first time in its history, the WHO has opened its doors to private funding via a Solidarity fund and China is expected to keep an eye on this.
    • To keep track of how the money is spent is a problem.

    Conclusion

    India must decide if it wants to blindly follow the blind or lead by bringing the WHO back to its original promise. At stake is the country’s economic security of which public health is a key component. India can either be a part of history or pick up the pen even in these times of distress and rewrite it.

  • Partnership with the private sector in a fight against Covid-19

    The article delineates five areas in which partnership with the private sector is essential to deal effectively with the epidemic and ensure a whole-of-society response. Ensuring the participation of the private sector has been the recurring theme of many op-eds we have come across after the outbreak.

    Significance of private healthcare in India

    • According to the WHO, a critical lesson from the 2014-16 West African Ebola epidemic was that both the public and private sector need to work in tandem in responding to large-scale epidemics.
    • In the COVID-19 response in India, the private sector has to play an even more important role, as it is the dominant provider of health services in the country.
    • The private sector includes the for-profit and not-for-profit segments.
    • The dominance of the private sector in India: The NSSO 71st round data on social consumption of health show that private hospitals, clinics and nursing homes provide over 70 per cent of healthcare.
    • Data on the nearly 1 crore treatments received under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) corroborate this finding.
    • AB PM-JAY data shows that over half of all treatments are being availed of from private providers, accounting for over 60 per cent of total disbursements.

    UPSC asked about community-level healthcare intervention in 2018. So, pay attention to the significant role played by the private health sector in India.

    Following five are the areas in which cooperation with the private sector will be essential-

    1 Testing

    • Creating a large and accessible testing infrastructure is the first weapon in the armoury.
    • Countries like South Korea, Singapore, Germany and Japan have been successful at controlling the spread of COVDID-19 and reducing mortality through early detection and quick containment.
    • This has been possible only through widespread testing.
    • India has opened testing up to private labs.
    • Testing has been included under the AB PM-JAY as well.
    • We need to substantially expand testing capacity.
    • This cannot happen without the active participation of the private sector.

    2 Converting private hospitals into Covid-19-only hospitals

    • As the government deepens its containment efforts, the country will need to rapidly surge the numbers of quarantine units, isolation wards and ICU beds in COVID-19-only
    • It will also need to ensure increased and continued supply of essential medical products — from testing kits, masks and other PPEs to oxygen and ventilators.
    • According to a recent ICMR study, around five per cent of those infected will need intensive care and half of those in intensive care units will need mechanical ventilation.
    • These projections translate into large numbers that considerably exceed the capacity of the government health system.
    • Private hospitals with adequate infrastructure will need to convert in COVID-19-only hospitals.
    • There should be a clear policy framework of designated hospitals, reporting and referral systems and an appropriate payment system.
    • With many government facilities being converted into COVID-19-only hospitals, a large number of non-COVID-19 patients will need facilities and providers to take care of their other urgent, critical or continuing healthcare needs.
    • The AB PM-JAY has started a process to bring on board more hospitals to respond to such needs.

    3 Protecting healthcare workers

    • As more private providers join this fight, a major concern that will arise is keeping healthcare workers from becoming infected.
    • In addition to being at a high risk of contracting the virus, healthcare workers are also potential carriers.
    • Ensuring their protection is of paramount importance.
    • Increasing the production: Companies manufacturing essential medical products such as ventilators, masks will need to crank up their production.
    • Direct support from banks may be needed to keep production and supply chains going.

    4 The private sector has to support the ecosystem driving health system

    • The private sector will need to vigorously support the large ecosystem that drives the health system as the lockdown and ongoing epidemic restrict movement and normal economic activities.
    • Activities such as the production of essential drugs and medical products, logistics to maintain smooth supply need to not only continue but also accelerate.
    • Support for community activities such as night shelters and community kitchens will need to be strengthened.

    5 Collaborate to share knowledge on the epidemic

    • An adequate stage-wise response to the pandemic and its economic, social and political aftermath will require the rapid filling of the many knowledge gaps.
    • Government, private and not-for-profit research institutions need to collaborate to understand the nature of transmission of the virus.
    • They must understand the factors that slow its spread, the most at-risk communities, or the optimal quarantine period.

    In 2015, UPSC asked whether the private health sector could help bridge the gap in providing universal health coverage. A question can be asked based on the same theme but in reference to dealing with the pandemic.

    Conclusion

    The fight against COVID-19 is not a race to a hilltop. It involves the continuous management of an evolving public health crisis that threatens to spawn economic and social crises. These multiple dimensions will require a whole-of-society approach that goes beyond the government alone.

  • The WHO balance sheet

    The US has announced to halt the funding it gives to the WHO accusing it of mismanagement of the COVID-19 spread.

     

    WHO is facing the biggest pandemic in human history. For all the responsibility vested in the WHO, it has little power.  Whatever the causes of this disaster are, it is clear that the WHO has failed in its duty to raise the alarm in time. This shortfall of WHO is failure indicative of a deeper malaise: the global institutional framework is a pawn in the hands of the great powers, cash-strapped.

    About WHO

    • The WHO is a specialized agency of the United Nations responsible for international public health.
    • It is part of the U.N. Sustainable Development Group.
    • The WHO Constitution, which establishes the agency’s governing structure and principles, states its main objective as ensuring “the attainment by all peoples of the highest possible level of health.”
    • It is headquartered in Geneva, Switzerland, with six semi-autonomous regional offices and 150 field offices worldwide.

    Where does WHO get its funding from?

    • It is funded by a large number of countries, philanthropic organisations, UN organisations etc.
    • Voluntary donations from member states (such as the US) contribute 35.41%, assessed contributions are 15.66%, philanthropic organisations account for 9.33%, UN organisations contribute about 8.1%; the rest comes from myriad sources.
    • India contributes 1% of member states’ donations.
    • Countries decide how much they pay and may also choose not to.

    Its expenditure

    • The WHO is involved in various programmes. For example, in 2018-19, 19.36% (about $1 bn) was spent on polio eradication, 8.77% on increasing access to essential health and nutrition services, 7% on vaccine preventable diseases and about 4.36% on prevention and control of outbreaks.
    • The Africa countries received $1.6 bn for WHO projects; and South East Asia (including India) received $375 mn.

    How does WHO prioritise its spending?

    • The annual programme of work is passed by the WHO’s decision-making body, the World Health Assembly.
    • It is attended by delegates from all member states and focuses on a specific health agenda prepared by the Executive Board.
    • The main functions of the Assembly, held annually in Geneva, are to determine WHO policies, appoint the Director-General, supervise financial policies, and review and approve the proposed programme budget.
    • The decision on which country gets how much depends on the situation in the countries.

    WHO and India

    • India became a party to the WHO Constitution on January 12, 1948.
    • The first session of the WHO Regional Committee for South-East Asia was held on October 4-5, 1948 in the office of India’s Health Minister, and inaugurated by Prime Minister Jawaharlal Nehru.
    • The WHO India Country Cooperation Strategy (CCS) 2019-2023 has been developed jointly by the Health Ministry and the WHO India country office.
    • The CCS aims to address complex challenges such as the prevention of NCDs, the control of antimicrobial resistance (AMR), the reduction of air pollution, and the prevention and treatment of mental illnesses.
    • On the ground, the WHO has been a key partner in the immunisation programme, tackling TB and neglected diseases such as leprosy and kala azar, and nutrition programmes across states.

    Immediate reason for US withdrawal

    • The US contributes almost 15% of the WHO’s total funding and almost 31% of the member states’ donations, the largest chunk in both cases.
    • It receives $62.2 mn for WHO projects.
    • That is where most of the WHO funding comes from and the least of it goes.

    Impact

    • For the WHO, the loss of about 15% of its total funding is bound to have an impact on the world over.
    • However, unless other countries do the same as the US, the move may not severely hamstring WHO operations.

    Also read:

    [Burning Issue] World Health Organization (WHO) And Coronavirus Handling

  • TRAI wants set top boxes to be made interoperable

    The Telecom Regulatory Authority of India (TRAI) has recommended that all set-top boxes (STBs) in the country must be interoperable, meaning that consumers should be able to use the same STB across different DTH or cable TV providers.

    The TRAI and Telecom Disputes Settlement and Appellate Tribunal are quite often seen in the news.  Most recent was the dispute risen due to AGR dues.

    TRAI has a wide range of jurisdiction over Telecoms. Keep a track on all such news.

    Why such a recommendation?

    • TRAI noted that while the STBs deployed in the cable TV networks are non-interoperable, those by DTH players complied with licence conditions to support common interface module based interoperability.
    • However, in practice, even in the DTH segment the STBs are not readily interoperable.
    • The lack of interoperability of set-top boxes between different service providers deprives the customer of the freedom to change her/his service provider.
    • It also creates a hindrance to technological innovation, improvement in service quality, and the overall sector growth.

    About TRAI

    • The TRAI is a statutory body set up under section 3 of the Telecom Regulatory Authority of India Act, 1997.
    • It is the regulator of the telecommunications and its tariffs in India.
    • The TRAI Act was amended by an ordinance, effective from 24 January 2000, establishing a Telecom Disputes Settlement and Appellate Tribunal (TDSAT) to take over the adjudicatory and disputes functions from TRAI.
    • TRAI regularly issues orders and directions on various subjects such as tariffs, interconnections, quality of service, DTH services and mobile number portability.