Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Making the private sector care for public healthop-ed of the day


From UPSC perspective, the following things are important :

Mains level : Paper 2- Government should consider taking control of the private healthcare sector to deal with the Covid-19 outbreak.


As India enters the second week of a national lockdown imposed in response to COVID-19, it is still unclear how well prepared the healthcare system is in dealing with the pandemic.

Need for roping in the private healthcare

  • No indication of an increase in expenditure on health: A preparedness plan has to address all levels of care in terms of infrastructure, equipment, testing facilities and human resources in both the public and private sectors.
  • However, so far, the Central and State governments have given little indication of bringing an increase in public expenditure on health.
  • So, an already overburdened public health system will be unable to meet the increase in moderate and severe cases of COVID-19 that would require hospitalisation.
  • Need for the comprehensive national policy: While some individual private sector companies have come forward with offers of creating capacity and making it available to COVID-19 patients, there is a need for a comprehensive national policy to ensure that private healthcare capacity is made available to the public.
  • Some states like Chhattisgarh, Rajasthan, Madhya Pradesh and Andhra Pradesh have already roped in the private sector to provide free treatment.

What the government should do?       

  • Provide universal health service: The governments at the Centre and in States have to take responsibility for providing universal health services free of charge and accessible to all.
  • Tap into private sector capacity: This will require governments to not just expand the capacity within the public sector, but also to tap into the available capacity in the private sector.
  • Faced with a serious health emergency, the silence of the government on the expected role of the private sector is intriguing.
  • Include COVID-19 testing in PM-JAY: The National Health Authority has recommended that the testing and treatment of COVID-19 be included in the PM-Jan Arogya Yojana (PM-JAY) but this proposal is still awaiting clearance.
  • Form the central command: The governance of the health service system is clearly fragmented and has created anxiety among the public.
  • There is a lack of a visible central command, which should be created under the supervision of the Union Health Minister, aided by a team of experts.
  • They should be tasked to make policies as and when required and communicate them to State governments, taking into account an evolving situation.
  • Ensure that there is no cost to the patient: There have been some tentative measures taken by States to allow individuals seeking testing for COVID-19 to access private laboratories at subsidised rates.
  • At present, the government has put a cap on the cost at ₹4,500 per test, which is a burden for even a middle-class patient.
  • The poor will clearly have no access to this and the government itself does not have adequate facilities to meet the increasing demand. It is here that the government needs to ensure that there is no cost to the patient.
  • Create adequate testing facilities: At this point, and certainly, before the lockdown is lifted, it is absolutely essential that adequate testing and quarantine facilities are created.
  • The Central government has already taken over some private hotels to accommodate persons quarantined for COVID-19.
  • One way of expanding such facilities would be for the government to ‘take over’ private corporate laboratories and hospitals for a limited period.
  • Standard treatment protocol: The political directive for such a move needs to come from the Central government while ensuring that the Ministry of Health provides standard treatment protocols for health personnel.

Learning lessons from Spanish and British experience

  • The Spanish government issued an order bringing hospitals in the large private corporate sector under public control for a limited period.
  • This tough decision was taken with the understanding that existing public healthcare facilities would not be able to cope with the sudden, if short-term, rise in COVID-19 cases.
  • British trade unions have demanded that the government make the 8,000 beds in 570 private hospitals in the country available.
  • They have argued that while beds in private hospitals are lying empty, there is a severe shortage of beds in public hospitals.
  • The unions have also been critical of the U.K. government decision to rent these beds at an exorbitant cost to the exchequer.

Way forward

  • Rope in the private healthcare sector: In India, private corporate hospitals have, in the past, received government subsidies in various forms and it is now time to seek repayment from them.
  • They are also well poised to provide specialised care and have the expertise and infrastructure to do so.
  • Bring in the universal public healthcare: Universal public healthcare is essential not only to curb outbreaks but also to ensure crisis preparedness and the realisation of the promise of the right to health.
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

A pandemic in an unequal Indiaop-ed snap


From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- How lockdown affects the poor disproportionately and what the state must do mitigate the impact.


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.


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?

Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

After the lockdownop-ed snap


From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- The lockdown hits the poor hardest and how it could have been avoided?


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.


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.

Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Let’s use follower’s advantageop-ed snap


From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Learning from the experience of South Korea in designing the policies to deal with coronavirus.


How this coronavirus pandemic threat will pan out no one knows but what we do know is that the intensity of the challenge and its impact on our well-being will depend greatly on how we reach out to ordinary people, and the policies we implement.

Historical perspective and comparison

  • Compared to the fatality numbers of some earlier pandemics, such as the Asian flu, 1957-58 (1.1 million dead) and Hong Kong Flu, 1968 (2 million dead), the fatality numbers of the current coronavirus pandemic are, as yet, nowhere near.
  • One of the most comprehensive studies on the pandemic, by the Imperial College of London, shows that the “case fatality rate”, or fatality among those who get coronavirus is 0.9 per cent — this means a 99.1 per cent survival rate among the people who get it.
  • What makes this pandemic special is that it is happening in the age of digital connectivity and greater scientific knowledge than we have ever had.
  • We can inform people quickly and take big steps to contain it.
  • But this also has a danger we have never faced.
  • Policy actions can have a mega backlash on the economy.
  • We are in uncharted territory — never before have we taken the kind of collective action against a pandemic as we are doing now.

Time to collectively confront our common humanitarian challenge

  • Using the experience of South Korea: There is some evidence from history, and from the country that has been the most successful in dealing with this pandemic —South Korea.
  • The country’s success has saved lives, protected the economy from undue damage, boosted the popularity of the Korean President Moon Jae-In across political divides and raised the global standing of South Korea.
  • France’s President Emmanuel Macron and Sweden’s Prime Minister Stefan Lofven have consulted Moon Jae-In for advice.
  • We have some evidence and estimates about the kind of damage this pandemic can do.
  • China’s industrial production in January-February 2020 declined by 5 per cent compared to a year ago.
  • Goldman Sachs has estimated that the US’s GDP growth could decline 24 per cent for the second quarter this year.
  • Data are coming in on recent US unemployment claims climbing by 30 per cent.
  • This is clearly time to put political differences aside, and collectively confront our common humanitarian challenge.

Designing policy to deal with the pandemic

  • Economic implications: In designing policy, it is important to realise that all interventions to contain the pandemic have economic implications.
  • Some people react to this by saying that our first priority is to save lives, not the economy. This is a mistake. The two are not separate matters.
  • A poorly-executed policy can damage the economy and this can end up taking more lives than the original problem.
  • Examples of policy doing damage to lives: We have examples of the damage policies can do from history. In 1958, Mao Zedong initiated the Great Leap Forward to boost China’s production. This unleashed the biggest famine in modern times, which resulted in 20 to 40 million deaths.
  • The Bengal Famine of 1943 occurred with no decline in food production but there were disruptions in supply chains from the farms to those who needed food.
  • The death toll was two to three million. Such evidence from the past warns us that policies not designed well can cause more deaths than the pandemic itself.

Three lessons from South Korea

  • We already have three lessons from Korea, which are being widely discussed in newspapers and the media around the world.
  • First, you need strong leadership.
  • Second, it is critically important to have trust between society and government. There is only that much you can do if people do not cooperate.
  • Third, the need is for nuanced policies, with the government having the courage to make course correction as it goes along.

Way forward

  • First, trust can be a casualty with the lockdown. There are reports of the police wielding the baton too quickly on ordinary vendors, small grocers and sellers. They need to explain to people so that they begin to actually cooperate, instead of complying only when under observation. That is the key difference between a trusting society and a trustless one.
  • The government cannot be a substitute for the private firms: To believe that small traders and private firms can be substituted by the government is the mistake Communist China made in the 1960s and 1970s, before the arrival of Deng Xiaoping.
  • An example of the importance of specialised knowledge — this applies to the US as well — pertains to the role of cash grants to the poor. Such grants work well in normal times but may need to be supplemented with the direct support of food and medical services.


Some say that the Korea analogy is of no use to us because it is a relatively small country. It is true that everything will not apply here. But on the other hand, Korea and Hubei province of China are very comparable. Korea’s population is 52 million, Hubei’s is 58 million. The number of people who died of the virus in Korea is 126. The figure for Hubei is 3,160. Korea, of course, had the follower’s advantage since the virus struck there later. But we too have that advantage.

Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Home and nationop-ed of the day


From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2-Role of administration in 21-day lock-down of country.


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.


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.

Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Get a step ahead of the virusop-ed snap


From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- What are the attitudinal problems in India's healthcare system and how India should deal with the outbreak of COVID-19?


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.


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.

Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Time for a powerful display of humanityop-ed snap


From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- India is unprepared for dealing with pandemics.


India is unprepared for dealing with the outbreak of coronavirus.

Is India really faring better than the other countries?

  • 45 days for first 100,000: Globally, it took roughly 45 days for the first 100,000 cases. It is likely to take nine days for the next 100,000.
  • Death count: The global death count is now doubling every nine days and stands at 8,248, with 207,518 confirmed cases.
  • That is how epidemics work — they gather steam as infected individuals go on to infect even more people. Confirmed cases in India, as of today stand at 169.
    • It is much lower than in small countries such as Iceland (around 250). Could this really be the case that we have fared better than everyone else?
  • Probably India is not performing better: Testing in India remains abysmally low. Only about 10 in a million people in India have been tested, compared to say nearly 120 in a million in Thailand or 40 per million in Vietnam.
  • Why testing in not being done in India? The stated explanation is that the limited number of test kits are being conserved for when they are truly needed but when is the need greater than right now?
    • There are probably shortages even in being able to procure adequate supplies given that many countries are seeking to buy the limited stocks.
  • Importance of testing: Testing is the most important thing we could be doing right now.
    • As the Director-General of the World Health Organization, said recently about the need for more testing, “You cannot fight a fire blindfolded.”

Avoiding undercounting

  • Timely identification is essential to prevent secondary infection: We need to identify coronavirus-infected patients in a timely manner in order to increase our chances of preventing secondary infections.
    • There is no shame in saying that we have far more cases than what we have detected so far.
  • K.’s admitted undercounting: Even the United Kingdom, which has a far better health system than India, has admitted that it is probably undercounting its true infections by a factor of 12, and is likely have about 10,000 cases.
    • Is it possible that India with 20 times their population has only 169 cases?
  • Preparedness to deal with a higher number of cases: If widespread testing were to commence in India, the number of confirmed cases would likely climb to the thousands very quickly. This is something we have to be prepared for without panic or fear-mongering.
  • Positive action: This is how epidemics move and the real numbers should spur us into positive action.
  • Strict measures by the government: At some stage, it is possible that the government may have to put in place very strict measures on quarantining and closures, much like what China had to do to control the epidemic in Wuhan.

How prepared is India?

  • There is not an easy answer to how worst things could go.
  • Mutation or sensitivity of virus: If we escape the worst, either because this virus mutates to a less virulent form or because there is something about its temperature or geographical sensitivity that we know nothing about, then we should count our blessings.
    • Viruses do mutate and generally to be less lethal.
  • Projection from Europe: If the projections from Europe are applicable in India, our ‘namastes’ and clean hands notwithstanding, the prevalence in India would be upwards of 20%.
  • In other words, we should expect to see about 200-300 million cases of COVID-19 infections and about four and eight million severe cases of the kind that are flooding hospitals in Italy and Spain at the moment.
  • More importantly, these cases are projected to appear in just a two to the four-month window.
    • In the current scenario, we are not ready.
  • India has somewhere between 70,000 and 100,000 intensive care unit beds and probably a smaller number of ventilators.
    • That is simply inadequate.
  • What should be done? The next two weeks should be spent on planning for large, temporary hospitals that can accommodate such numbers. If we are lucky, we will not need them.

Unprepared for pandemics

  • Catastrophic event with highest probability-Pandemic: This all sounds doomsday-like. But we have known for decades now that of all catastrophic events to befall humanity, between an asteroid hit and a nuclear war, a disease pandemic has always been the highest on our list of impact and probability.
  • Not enough changes in preparedness: There were some changes after the Severe Acute Respiratory Syndrome (SARS) but not nearly enough.
    • Pandemic preparedness always took a backseat to the crisis of the moment.
    • And in fairness, there is truly no amount of preparation that can fully mitigate such an occurrence.


Things are about to get a lot worse. Let us hope that this brings out the best in us, and not the worst. Whether we know this or not, these events are just a dress rehearsal for the more challenging events such as climate change that are likely to be with us this century. And if we take care of each other, we will survive both these challenges with our humanity intact.


Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Explained: Social DistancingExplained

The last two days, a number of states in India have enforced measures aimed at reducing public gatherings. This is called “social distancing”.

How does social distancing work?

  • To stem the speed of the coronavirus spread so that healthcare systems can handle the influx, experts are advising people to avoid mass gatherings.
  • Offices, schools, concerts, conferences, sports events, weddings, and the like have been shut or cancelled around the world, including in a number of Indian states.
  • An advisory by the US Centers for Disease Control recommends social distancing measures such as: reducing the frequency of large gatherings and limiting the number of attendees; limiting inter-school interactions; and considering distance or e-learning in some settings.

What is the objective of such restrictions?

  • Compared to deadlier diseases such as bird flu, or H5N1, coronavirus is not as fatal —which ironically also makes it more difficult to contain.
  • With milder symptoms, the infected are more likely to be active and still spreading the virus.
  • For example, more than half the cases aboard a cruise ship that has docked in California did not exhibit any symptoms.
  • In a briefing on March 11, WHO officials said, “Action must be taken to prevent transmission at the community level to reduce the epidemic to manageable clusters.”
  • The main question for governments is to reduce the impact of the virus by flattening the trajectory of cases from a sharp bell curve to an elongated speed-bump-like curve.
  • This is being called “flattening the curve”. How does ‘flattening the curve’ help?
  • Limiting community transmission is the best way to flatten the curve.

What was the curve like in China?

  • The numbers show that the virus spread within Hubei exponentially but plateaued in other provinces.
  • Some say it’s because many of these countries learnt from the 2003 SARS epidemic.
  • Just as Chinese provinces outside of Hubei effectively stemmed the spread in February, three other countries —South Korea, Italy, and Iran — were not able to flatten the curve.


Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Positive responseop-ed of the day


From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- India's handling of coronavirus pandemic.


Cooperation between the Centre and the States in dealing with the threat of the virus is commendable.

Hope in dealing with the pandemic and India’s response to the pandemic

  • What is the best response?  World Health Organisation declared it a pandemic, Secretary-General offered hope: “If countries detect, test, treat, isolate, trace, and mobilise their people in the response, those with a handful of cases can prevent those cases becoming clusters, and those clusters becoming community transmission.”
  • The advantage with India: India, with 70-odd cases, has the advantage, and commendably, the central and state governments have reacted rapidly to the developing pandemic
  • Equally importantly, they have set aside the acrimony over the CAA-NRC question and pulled together, without the need for external urging.
    • Because everyone realises that COVID-19 is everyone’s problem.
  • Steps taken by the government: No visas are being issued, screening is in progress, health education messaging is visible, public gatherings are sharply reduced and there is no sign of the wearying political blame game which generally besets such challenges.

No room for complacency

  • Display of political will: The secretary-general has also cautioned that while many nations can avoid the pandemic, the operative verb is not “can” but “will”. The Indian response has displayed political will, but there is no room for complacency.
  • Fear of the unknown: This is the first coronavirus to reach pandemic levels. For at least 18 months, no vaccine can be market-ready. At least until the summer, there will be insufficient information about the behaviour of the organism in the wild. Wisely, Homo sapiens fears the unknown.
  • Caution is the best prescription: Until we learn more about the nature of the beast, abundant caution is the only credible prescription.
    • Isolation at the focus of the response: At present, the focus of the response is isolation (including self-isolation) and the maintenance of sanitation barriers. Schools have been closing down, some workplaces are screening staff, and people are discouraged from leaving home without a compelling reason.
    • However, outside the controlled conditions in homes and hospitals, maintaining the patency of the sanitation barrier requires extraordinary vigilance and self-control.

Status of healthcare infrastructure

  • The readiness of healthcare facilities: In the case of breaches — a few oversights or accidents are inevitable — the readiness of healthcare facilities would become a serious factor in controlling mortality.
  • Variation in states’ preparedness: The quality of the states’ level of preparedness and the quality of health services varies. While Kerala efficiently controlled the Nipa virus, Uttar Pradesh, the most populous state, has failed to contain annual outbreaks of Acute Encephalitis Syndrome for over a decade.
    • And the capital’s initial failure in the face of seasonal waves of lethal mosquito-borne diseases cannot be forgotten.
  • Rural cluster-most vulnerable: How much less protected would a rural cluster be, serviced by a poorly equipped primary health centre?


If community transmission becomes commonplace, it would become a difficult battle. Hence, the sanitation barrier remains the most reliable epidemiological response. If the government has to resurrect primordial provisions from the era of bubonic plagues to keep it patent, so be it.

Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

One country, two virusesop-ed snap


From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- What India can learn from China's dealing with the coronavirus outbreak?


China’s handling of coronavirus, in contrast to SARS, has been effective, should be a template for others.

Why lockdown of Wuhan is a big deal?

  • A move without precedent: China’s lockdown of roughly 60 million people in Wuhan and other cities in Hubei province for more than a month now is without precedent in the history of public health.
  • Best way to stop the virus from spreading: The best way to stop a virus from spreading from person to person, is to give it no place to spread to.
    • This is achieved by isolating those who are infected and quarantining those who might be infected.
  • Cordon sanitaire: In China, though, the control has moved beyond traditional quarantine to a cordon sanitaire-an exclusion zone people cannot travel into or get out of.
    • In most countries, this simply would not work for a period this long and a population that large.
  • Inconceivable move in other places: Wuhan is a city of 11 million people, slightly larger than Chennai or Bengaluru. It would be inconceivable to think of cutting off transportation in and out of these cities or asking people to stay at home for even a day, let alone a month.
    • No political control nor administrative mechanism: Like India, most countries in the world have neither the political control to impose their will on people this way nor the administrative mechanism to enforce this degree of control.

Human cost and ethic of the lockdown

  • The human cost: The human cost of such a strategy is immense.
    • Feeling of being unable to escape: The fear induced by being unable to escape from a place where a new virus is circulating is immense.
    • The worries and stresses of everyday life multiply one hundred-fold when everything from shopping for food to occupying children stuck at home becomes a challenge.
    • The slightest cough, cold or fever can trigger panic.
  • Ethics involved in the move: The ethics of the cordon sanitaire in Wuhan, as well as the quarantining by Japanese authorities of the cruise ship Diamond Princess, will be debated for years after this particular outbreak is over.
  • Slowing the spread: But whatever its human and financial cost, China’s actions in the first month of the outbreak helped to slow the spread of the virus within the country as well as internationally.

How China’s response this time is different from the SARS

  • On December 31, the Chinese government informed the WHO, and the world, of the existence of a form of pneumonia of unknown cause
    • It also told the people of Wuhan to wear masks if they had symptoms and seek medical attention.
  • Virus identification: For the world, the big breakthrough from China came on January 7, when researchers in Wuhan identified the virus as a new coronavirus.
  • Sharing of the genetic sequence of the virus: Two days later, China shared its genetic sequence with the world.
    • How genetic sequence helped? The sharing of the genetic sequence allowed labs all over the world to develop testing kits to detect the disease.
    • It also put countries on the alert for travellers with the disease, without which the new coronavirus would have spread much quicker and farther than it has so far.
  • China’s response to SARS: The Chinese response to SARS in 2003, in contrast to this, was a cover-up.
    • The disease circulated for nearly three months, enabled by government secrecy and censorship.
    • Spread of disease without warning: When travellers from China brought the disease first to Hong Kong and from there to other cities across the globe, there was no warning.
    • It was only after the disease spread in Hong Kong, that scientists and public health experts began to decipher this new virus.
    • Lessons learned: China, fortunately, learned the lessons for SARS and put together systems to identify and respond to this new disease quickly.

What India can learn from China

  • Infrastructure with speed: Public health officials all over the world, including in India, should study the speed with which China put together an infrastructure to deal with this new disease.
    • Modern, well-equipped hospitals dedicated to coronavirus patients were constructed in weeks.
  • Centralised information and logistic system: Centralised information and logistics systems and systems to ensure coordination between multiple levels of government -from the central government to provincial and municipal governments, were put into place.
    • All the systems seem to have worked reasonably smoothly, given the chaotic and complex atmosphere of a disease outbreak.
  • Unique approach: The way China has tackled this disease has been an “all of government, all of the society approach”, in the words of Bruce Aylward, the leader of the WHO team that recently spent two weeks in the country.
    • It was, as he described it, “a very old-fashioned approach”, but one that had “prevented at least tens of thousands, but probably hundreds of thousands of cases.”


  • In all probability, it is only a matter of time before India sees new cases. The Indian health system, as in China, is multi-layered. Some states like Kerala have strong public health infrastructure and a strong response capability. Many other states like Uttar Pradesh and Bihar do not have strong public health systems. They will find it difficult to respond and will learn that diseases, like the revolution, can be brutal.
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Battling the bugop-ed snap


From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- India's preparedness to deal with epidemics.


With multiple cities in China under a public health lockdown, global supply chains of various essential products and consumer goods are likely to be affected. This should be particularly worrisome for India, which has a roughly $93 billion total trade and about $57 billion trade imbalance with China.

Cause of worry turned into a reality

  • Public health experts have worried most about an animal virus-
    • That gets into humans.
    • Causes human-to-human transmission.
    • Has high infectivity and a range of clinical severity.
    • With no human immunity, no diagnostic tests, drugs or vaccines.
  • An emerging virus, called the 2019 novel coronavirus (2019-nCoV), appears to be just that.
  • With the World Health Organisation declaring it a Public Health Emergency of International Concern (PHEIC), this outbreak is now a pandemic.

What is coronavirus

  • Group of animal virus: Coronaviruses are a group of animal viruses identified by their crown-like (corona) appearance under a microscope.
  • SAARS connection: The 2019-nCoV belongs to this group of viruses, six of which, including the 2003 Severe Acute Respiratory Syndrome (SARS) and the 2012 Middle East Respiratory Syndrome (MERS) viruses, were earlier known to cause disease in humans.
    • Genetic similarity with other viruses: Genetic sequencing of the virus from five patients showed it to be 5 per cent identical to the SARS virus.
  • Bats as hosts: Since the SARS outbreak in 2003, scientists have discovered a large number of SARS-related coronaviruses from their natural hosts-bats.
    • Previous studies have shown some of these bat coronaviruses to have the potential to infect humans.
    • Genetic sequencing showed it to human coronavirus to be over 96 per cent identical to a bat coronavirus.
    • Thus, 2019-nCoV clearly originated from bats, jumped into humans either directly or through an intermediate host, and adapted itself to human-to-human transmission.
    • Bats are a particularly rich reservoir for viruses with the potential to infect humans.
    • Examples of these include viruses such as Hanta, Rabies, Nipah, Ebola and Marburg viruses, and others that have caused high levels of mortality and morbidity in humans.
    • India has 117 species and 100 sub-species of bats, but we know little about the viruses they harbour and their disease potential.

India’s response

  • India’s response includes-
    • Surveillance of arriving passengers at airports.
    • Awareness drives in the border states.
    • Designation of hospitals with isolation wards and the availability of protective gear (e.g. masks) to health workers.
    • SOP: There are clear operating procedures for sample collection and its transport to the National Institute of Virology, Pune, which is the nodal testing centre.
    • A self-declaration mechanism is in place and a 24×7 telephone helpline has been set up.
  • Two areas of concern
    • 1. Promotion of untested medicines: There is mixed messaging promoting AYUSH products that are untested and of questionable efficacy.
    • 2. India- a hot zone of zoonotic pathogens: India has been a “hot zone” for the emergence of new zoonotic (animal-derived) pathogens for over a decade.
    • But we continue to lack the capacity to quickly identify, isolate and characterise a novel pathogen.
    • Example of China: China is a good example of how investments in research and public health will allow it to take a lead on developing diagnostic tests, vaccines and drugs for this new virus. We must do the same and prepare for the future.
  • Disruption in global supply chains and concerns for India
    • With multiple cities in China under a public health lockdown, global supply chains of various essential products and consumer goods are likely to be affected.
    • This should be particularly worrisome for India, which has a roughly $93 billion total trade and about $57 billion trade imbalance with China.
    • Disruption in medicine supply: The Indian pharmaceuticals industry imports about 85 per cent of its active pharmaceutical ingredients from China.
    • Any disruption in this supply chain would adversely affect the availability of medicines in India, which would be required in an outbreak situation.
    • Need to support local pharma. industry: India must, therefore, take steps to correct this imbalance and support the local pharmaceuticals industry in reducing its dependence on China

Possible scenarios

  • Public health experts estimate that the epidemic will peak in three months.
  • From here on, there are a few possible scenarios, but which of these would play out is hard to guess.
  • 1st possibility: There could be very large numbers of cases and global spread of the virus with a low CFR of 0.1-0.5 per cent, like the bad flu. Or the same with increased CFR, which would lead to significant mortality.
  • 2nd possibility: It is also possible that the outbreak spiralled in China due to a combination of factors not present elsewhere, such as population density, food habits and the Chinese New Year, which sees large population movements.
    • It is also possible that the pandemic may not sustain outside China and die out like the 2003 SARS outbreak.
  • Whatever be the case, surveillance and sensible public health measures will be needed over the next few months.


India escaped the 2003 SARS and 2012 MERS outbreaks largely unscathed. This may still be the case with 2019-nCoV, but the laws of probability are likely to catch up soon. It would help to invest, build capacity and be ready.





Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

[op-ed snap] Our expectations could mutate in response to the coronavirusop-ed snap


From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- India's preparedness for the public health response to outbreak of epidemic.


In some ways, China is setting the standard for a public health response that may become a way of life in the 21st century.

Origin of the outbreak and deadly it could turn out?

  • Outbreak of unknown virus: In December 2019, an outbreak of viral pneumonia of unknown etiology emerged in Wuhan, a city in the central Chinese province of Hubei.
  • Discovery of novel coronavirus:  A few weeks later, the World Health Organization (WHO) and Chinese health authorities announced the discovery of a novel coronavirus, known now as 2019-nCoV, as being responsible for the pneumonia.
  • Important questions: The two most important questions asked in a fast-evolving pandemic of this nature are:
    • 1) How deadly is the disease, and;
    • 2) Can it be contained?
    • The latest available figures suggest that the death toll in China is 304 and 14,411 have been infected. The current fatality rate estimate of 2% is unstable and is likely to fall as more cases are detected.

Containment attempts by China and spread to the other countries

  • Unprecedented attempt by China: The attempt at containment started late, but has never been attempted in the fashion that China has gone about it.
    • Wuhan lockdown: Belatedly, on 23 January, China locked down Wuhan and 12 other cities, quarantining 52 million people in one sweeping action.
    • This is the first known case in modern history of any country locking down an entire large city.
  • Reports of confirmed cases from other countries: Confirmed cases have since been reported from Hong Kong, Macau, Taiwan, Thailand, South Korea, Japan, Singapore, Australia and the US.
    • India reported its first case from Kerala of a medical student from Wuhan University, followed by two more.
    • Singapore and the US have now banned foreign nationals who have recently been in China from entering the country.
    • Russia, Canada, the UK and India have begun evacuating citizens from Hubei province.

Research on coronavirus so far

  • Coronaviruses (CoVs) are characterized by club-like spikes that project from their surface, an unusually large RNA genome and a unique replication strategy.
    • CoVs cause a variety of diseases in mammals and birds, ranging from enteritis in hoofed animals to potentially lethal human respiratory infections.
    • Genome sequence: The 2019-nCov genome was sequenced in China in early January and reported in The Lancet last week.
    • It suggests that the original host of this coronavirus was a bat reservoir, though it is unclear whether there was an intermediate host.
  • A recent entry to the human host: The uniformity of the sequenced genome suggests that the virus has entered human hosts very recently.
  • Recent emergence from the animal reservoir: Several other countries, including the US and France, have sequenced the RNA of the 2019-nCoV as well. These sequences and their similarity to the initial samples from China suggest a single, recent emergence from an animal reservoir.

Tests and vaccine development

  • How is the virus tested? Testing for 2019-nCoV requires a reverse transcription polymerase chain reaction test (RT-PCR) which converts RNA into DNA, making study and comparison easier.
  • No vaccine yet: There are no vaccines yet for this virus, but promising paths have been identified, borrowed from the SARS related vaccines.
    • Development of an effective vaccine may only come after the 2019-nCoV is contained, but it may still be useful if there were to be a subsequent outbreak.
    • The frequency of future outbreaks is only likely to increase because of climate change, global travel and fast mutating viruses.

What lessons can India learn?

  • Develop framework and capacity: For India, this global health emergency should serve as an eye-opener.
    • If lockdown turns out to be a useful tool to prevent the spread of a deadly virus, India will need to develop the framework and capacity to implement such a drastic measure.
    • Under-equipped municipalities: Our municipalities are hopelessly under-equipped to implement strict isolation and containment strategies.
    • We will need to develop the capacity to build large facilities for housing patients in isolation wards.
    • Use of pre-cast: This will require India to accelerate the use of construction methods like pre-cast technology.
  • Protocol and instructions: The National Centre for Disease Control (NCDC) has been proactive in updating its protocol related to the 2019-nCov and has clear instructions for reporting and assay preparation.
  • Develop capacity in geographically diverse regions: Samples in India need to be sent to the National Institute of Virology in Pune.
    • While the public health and epidemic escalation framework appears capable of handling a small number of cases well, it is not clear how it will stand up to a large number of cases in a specific geographic region.


“Nothing happens quite by chance. It is a question of accretion of information and experience,” said Jonas Salk, the virologist who developed the polio vaccine, in some ways, China is setting the standard for a public health response that may become a necessary way of life in the 21st century. India must use this as a guidepost to greater preparedness.

Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

[op-ed snap] Taking a holistic approach to dengueop-ed snap


From UPSC perspective, the following things are important :

Prelims level : Dengue vaccine

Mains level : Paper 2-Dealing with Dengue, stategies, suggestion, and holistic approach.


The advent of a new tetravalent vaccine against the dengue virus has thrown new light into the evidence-based management of dengue.

Why the holistic approach is needed

  • Apart from promoting the use of the vaccine, gaining control over dengue will also require a holistic approach that has to include within its ambit vector control and proper case management.
  • Tetravalent vaccine: The vaccine is tetravalent i.e. it provides protection against all the four types of dengue viruses.
    • The vaccine confers about 80% protection to children vaccinated between 4 and 16 years of age without any major side effects.
  • Climatic factors: It is essentially a tropical disease that occurs in the countries around the Equator; hot weather and intermittent rainfall favour the sustenance of Aedes aegypti.
    • Aedes eggs can remain dormant for more than a year and will hatch once they come in contact with water.
  • Risk factors: Urbanisation, poor town planning, and improper sanitation are the major risk factors for the multiplication of such mosquitoes.
    • Aedes eggs can remain dormant for more than a year and will hatch once they come in contact with water.
    • Aedes mosquitoes cannot fly beyond a hundred meters. Hence, keeping the ambiance clean can help prevent their breeding.
    • Further, these mosquitoes bite during the daytime, so keeping the windows shut in the day hours is also useful.

What needs to be done?

  • Source reduction activities: Activities like preventing water stagnation and using chemical larvicides and adulticides.
    • These chemicals need to be applied in periodic cycles to kill the larvae that remain even after the first spray.
  • Dealing with the manpower shortage: The number of skilled workers available for such measures is low; many posts in government departments remain vacant despite there being a dire public health need.
    • Due to this deficiency of manpower, active surveillance is not being done in India, says the National Vector Borne Disease Control Program.
  • Ending the Under-reporting: Dengue cases are often under-reported due to political reasons and also to avoid spreading panic among the common people. Under-reporting needs to be dealt with.
  • Increasing coordination: There is a lack of coordination between the local bodies and health departments in the delivery of public health measures.
    • A comprehensive mechanism is required to address these issues.
  • Need for epidemiological measures: Any communicable disease needs the epidemiological approach. Singapore uses one successful model of mapping and analysing data on dengue, using Geographical Information System (GIS).
    • The use of GIS involves mapping the streets with dengue cases for vector densities.
  • Emphasis on the WHO guidelines: Fluid management in the body is the cornerstone in the management of severe diseases like dengue hemorrhagic fever and dengue shock syndrome.
    • According to the guidelines, coagulation abnormalities are not due to a reduction in the number of platelets alone.
    • This is why the WHO recommends fresh whole blood or packed cell transfusion in the event of bleeding.
  • Caution in using alternative medicine drugs: Modern medicine is not against any complementary medicine; when such a medicine is approved after rigorous testing.
    • However, in the absence of evidence, the efficacy of such medicines remains in the realm of belief instead of science.
    • So, medicines like Nilavembu kudineer and papaya leaf extract are only belief based.


The communicable nature of Dengue and its asymptomatic nature requires the holistic approach to successfully tackle the disease.


Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

[op-ed snap] Ahead on malaria: on reduction in cases in Indiaop-ed snap


Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From the UPSC perspective, the following things are important:

Prelims level: World Malaria Report, WHO

Mains level: Efforts needed to eliminate Malaria from South Asia


Malaria incidence reduced in India

  1. The World Malaria Report 2018 of the World Health Organisation notes that India’s record offers great promise in the quest to cut the number of new cases and deaths globally by at least 40% by 2020 and to end the epidemic by 2030
  2. The declining trend of the scourge shows that sustained public health action can achieve good results

Factors for optimism: Odisha shows the way

  1. A lot of that optimism has to do with the progress made by Odisha, one of the most endemic States
  2. Investments made there in recruiting accredited social health workers and large-scale distribution of insecticide-treated bednets, together with strategies to encourage health-seeking behaviour, seem to have paid off
  3. The WHO report highlights a sharp drop in the number of cases in the State
  4. The reduction in cases by half in 2017 compared to the same study period in 2016 appears to reinforce research findings
  5. Malaria cases in Odisha have been coming down steadily since 2003, with a marked reduction since 2008, attributed to greater political and administrative commitment
  6. This positive trend should encourage authorities not just in Odisha, but in the northeastern States and elsewhere too to cut the transmission of the disease further

Further efforts required

  1. This positive trend should encourage authorities not just in Odisha, but in the northeastern States and elsewhere too to cut the transmission of the disease further
  2. Importantly, the reduction in the number of cases should not produce complacency and lead to a reduction in the deployment of health workers and funding cuts to programme components
  3. Where allocations have been reduced, they should be reversed
  4. One issue that requires monitoring in India is resistance to combination therapy using artemisinin
  5. Recent reports indicate that some patients in West Bengal became resistant to the treatment protocol used for the falciparum parasite, which causes debilitating cerebral malaria and leads to a high number of deaths
  6. Eliminating malaria requires an integrated approach, and this should involve Chhattisgarh, Jharkhand and West Bengal, which have a higher burden of the disease

Way forward

  1. India has suffered from a major burden of malaria for decades, with high levels of morbidity and death
  2. Odisha’s experience with using public health education as a tool and reaching out to remote populations with advice needs to be replicated
  3. Given that emerging resistance to treatment has been reported in Myanmar, among other countries in this belt, there is a need for a coordinated approach to rid southern Asia of malaria
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

[op-ed snap] A Matter of Dignityop-ed snap


Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From the UPSC perspective, the following things are important:

Prelims level: Dementia, Global Action Plan on the Public Health Response to Dementia 2017-2025

Mains level: Along with demographic dividend, the number of ageing people is also rising in India and hence an increase in diseases related to older age. How can India tackle this problem in line with global actions.


Increase in cases of dementia

  1. The rapid increase in ageing population across countries requires national strategies to deal with age-related diseases and thus dementia care is becoming a significant issue
  2. According to the WHO, it affects 50 million people worldwide; a number that is projected to increase to 82 million by 2030 and 152 million by 2050
  3. According to some estimates, one person gets affected by dementia every three seconds

About dementia

  1. Dementia is a form of cognitive impairment that affects memory and other cognitive abilities and significantly interferes with a person’s ability to perform daily activities
  2. Data from many parts of the world reveals age as a risk factor for dementia — though the debilitating condition is not an inevitable consequence of ageing

Social stigma related to dementia

  1. Studies have revealed how the stigma attached to the disease leads to the social isolation of patients, their families and careers
  2. Research has thrown light on the deterioration in the quality of their lives
  3. Studies that draw on interactions with people affected by dementia, their families and caregivers indicate that several of the needs of such people — social, economic or those related to health — remain unfulfilled
  4. For instance, leave concessions at work, adaptable housing environments, adequate diagnostic facilities, treatment options, care provisions and risk reduction measures for people with dementia are not in place
  5. Many require psychological support, biomedical facilities, appropriate medications, counselling services and end of life care. But these are not available

WHO action plan on dementia

  1. The complexity of needs cutting across health, economic and social sector requires attention and policy responses
  2. 2018 WHO dementia plan focuses on the urgent need for a multi-phased approach and a multi-sectoral policy response to address the needs of people with dementia, their carers and families
  3. Over a year ago, the World Health Assembly in Geneva adopted the Global Action Plan on the Public Health Response to Dementia 2017-2025
  4. India endorsed the plan, confirming its commitment to improving the lives of people with dementia, their carers and families

Policy action that needs to be taken in India

  1. The country’s commitment to Sustainable Development Goals — especially with respect to Goal 3 that deals with good health and well being — and the UN Convention on the Rights of Persons with Disabilities should push it into formulating a strategy to deal with this debilitating condition
  2. Such a plan should incorporate public awareness campaigns and research

Way forward

  1. As the percentage of aged people in the country increases, improving the lives of people with dementia and their families and careers must become a national priority
  2. These programmes could be aligned with existing policies and care models
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

[op-ed snap] The health transitionop-ed snap


Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: Non-Communicable Diseases

Mains level: Lifestyle changes leading to more NCDs and how its rise can be stalled


UN award for India & rising NCDs

  1. In the last week of September, India’s health ministry received the prestigious UN Inter-Agency Task Force Award for “outstanding contribution to the achievement of NCD (Non-Communicable Diseases) related SDG targets”
  2. NCDs are the leading cause of mortality, globally and in India, and are dominated by cardiovascular diseases, cancers, diabetes and chronic respiratory diseases

Targets for reduction

  1. A Lancet paper by the monitoring group, NCD Countdown 2030 has contended that India will fall short of the NCD targets pertaining to SDGs
  2. The target set for all countries is to achieve the one-third reduction in NCD related mortality between the ages of 30 and 70 by 2030, relative to 2015
  3. The Lancet study reports that high-income countries and several upper middle-income countries are on course to achieve this target
  4. Lower middle income countries, like India, will need to accelerate the rate of decline to reach the target

Method of measuring NCD mortality

The Lancet paper examines global trends in NCD mortality, using three rates:

Mortality between 30-70 years, mortality under 70 years and mortality under 80 years.

  1. The first is the indicator linked to the SDGs.
  2. The second also measures NCD mortality below 30 years of age, which represents a considerable burden in regions like sub-Saharan Africa.
  3. The third regards most NCD deaths before 80 as preventable and premature

Scale needs to be changed

  1. The arbitrary selection of the 30-70 year age range limits consideration of, and action against, NCD deaths in the younger and older age groups outside that age band
  2. As the epidemics mature, the 70-80 age group will pose challenges in many parts of the world
  3. Therefore, the current response should not be a short-term staccato response but one which anticipates and mitigates preventable NCD mortality across the entire 0-80 age range even after 2030

UHC target

  1. Age limits should not become a barrier to the provision of NCD care under a Universal Health Coverage (UHC) programme — another major SDG target
  2. Countries keen on achieving the specified 30-70 age related mortality target may tend to focus their resources on preferential care for that group, especially in the provision of life saving clinical services, neglecting other age groups
  3. This militates against equity and undermines the principle of universality
  4. Reduction of under-80 mortality would be a better measure to judge the overall health impact of UHC

Tracking India’s progress

  1. Reduction in 0-70 mortality would be a reasonable indicator for tracking India’s progress on NCDs while progress in under-80 mortality would be a good indicator for assessing progress on UHC

Measures that need to be taken

  1. Actions to curb tobacco and alcohol consumption will help reduce future risk of NCD in the under-30 age group
  2. Actions related to reduction of blood pressure, control of diabetes and provision of competent primary care supplemented by cost-effective specialist clinical care for treatable NCDs will benefit all age groups, with the highest benefits in the 30-80 age group
  3. Energetic implementation of public health policies and NCD-inclusive health services under UHC are what the country needs

Way forward

  1. It is essential that the government, civil society, academia and media recognise the nuances of health transition which shape the sweep of NCD epidemics as they evolve
  2. This will help create a healthier society which will yield inter-generational benefits well beyond 2030
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

[op-ed snap] Protecting persons with HIV/ AIDSop-ed snap


Mains Paper 2: Governance | mechanisms, laws, institutions & Bodies constituted for the protection & betterment of these vulnerable sections

From UPSC perspective, the following things are important:

Prelims level: HIV Prevention Act 2017

Mains level: Discrmination meted out by society against persons suffering from HIV/AIDS and laws to prevent it


HIV Prevention Act 2017

  1. The Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act of 2017 safeguards the human rights of people living with HIV and AIDS
  2. The Ministry of Health and Family Welfare issued a notification to bring the Act into force from September 10

History of the law

  1. The Act was born out of an urgent need to prevent and control the virus and syndrome.
  2. It has highlighted the necessity for effective care, support and treatment for HIV and AIDS
  3. The Act spawns from the commitment to the global community under the Declaration of Commitment on Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (2001)
  4. The declaration calls for enhanced coordination and intensification of national, regional and international efforts to combat the virus and syndrome in a comprehensive manner

Provisions of the law

  1. The statute aims to provide equal rights to persons with HIV and bring them into the mainstream
  2. The Act gains importance as it makes it a legal obligation to protect the privacy of persons with HIV and AIDS
  3. The law addresses discrimination meted out to persons with HIV and AIDS. It fortifies the health and medical health-care system for them and introduces legal accountability along with formal mechanisms to inquire into complaints and redress grievances
  4. The Act lists various grounds on which discrimination against persons with HIV is prohibited
  5. The requirement for HIV testing as a pre-requisite for obtaining employment or accessing health care or education is also prohibited
  6. The Act provides that every HIV infected or affected person below the age of 18 years has the right to reside in a shared household
  7. Every person in the care and custody of the state shall have the right to HIV prevention, testing, treatment and counselling services

Protecting privacy

  1. The Act prohibits any individual from publishing information or advocating feelings of hatred against HIV positive persons and those living with them
  2. Section 37 makes such propagation of hatred punishable with a term of imprisonment which shall not be less than three months but which may extend to two years, with fine which may extend to ₹1 lakh
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

[op-ed snap] Every breath you takeop-ed snap


Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: Global Burden of Disease Study

Mains level: National Health Policy and its relevance for Ayushman Bharat


Global burden of diseases study

  1. The National Health Policy, drawn up last year acknowledged a public health challenge in the form of NCDs
  2. It underscored the need to focus on non-communicable diseases (NCDs) like heart ailments, diabetes and respiratory afflictions
  3. This led the Union Ministry of Health and Family Welfare to collaborate with the Indian Council of Medical Research, Public Health Foundation of India and the Institute for Health Metrics and Evaluation on a two-year long study that mapped NCDs across the country
  4. The results of the project are also a part of the Global Burden of Disease Study and throw light on the challenges at hand for the National Health Policy

Respiratory diseases on the rise

  1. India with 18 per cent of the world’s population bears more than 30 per cent of the global burden of respiratory diseases
  2. The study also draws attention to a little-understood disease, COPD (Chronic Obstructive Pulmonary Disease) which constitutes more than 75 per cent of the country’s burden of respiratory diseases
  3. Pollution has become the major reason for stressing the lungs of people in different parts of the country

Ayushman Bharat’s focus not on respiratory diseases

  1. The much-publicised insurance component of the programme has little relevance for people who suffer respiratory diseases
  2. Very few of them require extensive hospitalisation — the precondition for availing insurance under Ayushman Bharat
  3. There is a plan for opening more than 1,50,000 primary healthcare centres
  4. But several studies have also shown that respiratory diseases like COPD evade diagnosis because doctors do not follow the protocols for treatment and most often target the symptoms — cough, cold and fever

Way Forward

  1. The challenge for Ayushman Bharat would be to equip doctors at these healthcare centres with the diagnostic acumen to tackle respiratory diseases and to make sure that drugs are available at all public dispensaries
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

In a first, WHO recommends quadrivalent influenza vaccinePriority 1

Image result for influenza


Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

The following things are important from UPSC perspective:

Prelims Level: Influenza Strain Types,  H#N# Subtypes

Mains level: Read the attached story


Quadrivalent vaccine approved

  1. Sanofi Pasteur’s injectable influenza vaccine (FluQuadri) containing two A virus strains — H1N1 and H3N2 — and two B virus strains — Victoria and Yamagata — for active immunisation of adults of age 18 to 64 years was approved in May last year by the Drug Controller General of India (DCGI).
  2. The application for the paediatric indication is under review by the DCGI and final approval is expected by the end of this month.
  3. Sanofi’s quadrivalent influenza vaccine was licensed for use by the U.S. Food and Drug Administration (FDA) in 2013; it is licensed in 26 countries.

Why Quadrivalent vaccine?

  1. While a trivalent influenza vaccine contains both A subtype viruses, it has only one of the B subtype virus, the quadrivalent vaccine offers a greater breadth of protection as it includes both B subtype viruses.
  2. It is because of a greater breadth of protection that a few other companies too have shifted from a trivalent to a quadrivalent vaccine.
  3. Since the vast majority of influenza vaccines manufactured were trivalent till recently, the World Health Organisation (WHO) used to recommend two A subtypes and one B subtype, plus an optional fourth strain (the other B virus strain).

Benefits of Quadrivalent Vaccine

  1. The quadrivalent vaccine will contain four influenza virus strains (two A subtypes and two B subtypes — H1N1 and H3N2, and Victoria and Yamagata respectively).
  2. The viruses used in the vaccine are killed and this eliminates the possibility of the virus in the vaccine itself causing infection.
  3. In India, the vaccine will be available as a single dose pre-filled syringe
  4. Eventually, it will be available in a vial for public health use.

Incidences of different Strains

  1. In the case of H1N1, there are two strains — California and Michigan — that cause influenza. In India, the Michigan strain was earlier circulating and has been replaced by the California strain.
  2. For 2018, the WHO has recommended the Michigan strain for the southern hemisphere, including India.
  3. Each year, the vaccine changes to reflect the different strains in circulation.
  4. Year-round, scientists across the globe track, analyze and classify the viral strains causing illness.

 Indian context

  1. Despite the high number of infections and mortality each year, India does not have in place a national policy for influenza immunization.
  2. Pregnant mothers, children aged below five and young people with asthma, cardiovascular disease, diabetes and high blood pressure are at a greater risk of infection and death.
  3. The Ministry of Health issues only H1N1 vaccination guidelines for different vulnerable groups including healthcare workers.
  4. If we want to reduce the influenza burden in adults, then we must target children as they act as reservoirs.



Influenza is a virus that actually has hundreds of different strains. The virus mutates frequently, but the strains are classified into one of three main categories—A, B, or C.

Influenza A is the group that most commonly causes illness in humans.

  1. All influenza A viruses are further broken down into H and N subtypes. So, any influenza virus that is described as “H#N#” (such as H1N1) is an influenza A virus.
  2. There are 16 H subtypes and nine N subtypes, but only three combinations have actually caused highly contagious illness in humans.
  3. Other combinations have been found to infect other species (such as birds and pigs), but they have not caused widespread human infections.
  4. The three combinations that cause almost all outbreaks of the flu in humans are H1N1, H2N2 and H3N2.
  5. Even in these subtypes, the influenza virus can mutate and change each year. For this reason, influenza viruses are also named using:
  • The host of origin (swine, chicken, etc., or no host if it is of human origin)
  • The geographical location of origin (Hong Kong, Alberta, etc.)
  • Strain number
  • Year of discovery (or isolation)

Influenza B

  1. Influenza B is less common but still causes outbreaks of seasonal flu.
  2. One or two strains of influenza B are included in the seasonal flu vaccine every year to protect people from the strain(s) that researchers believe are most likely to cause illness during the upcoming flu season.
  3. The quadrivalent flu vaccine contains two strains of influenza B but the traditional trivalent flu vaccine only contains one.
  4. Influenza B is not broken down into subtypes like influenza A is, but it is broken down into individual strains.
  5. Typically, two strains of influenza A and one strain of influenza B are included in the seasonal flu vaccine. Quadrivalent flu vaccines contain two strains of influenza A and two strains of influenza B.
  6. Influenza B can cause outbreaks of seasonal flu but they occur less frequently than outbreaks of influenza A.
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

[op-ed snap] Preventing the next health crisisop-ed snap


Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: State of nutrition report, stunting, wasting, non-communicable diseases,

Mains level: Rising levels of obesity in India and associated health dangers


Annual state nutrition report

  1. In March, the government had announced that it would release an annual “state of nutrition” report
  2. It would be detailing India’s level of stunting, malnutrition and feature best practices for States to scale up nutrition interventions

Nutrition challenges

  1. 26 million children in India suffer from wasting (a low weight-for-height ratio)
  2. The country also has the second highest number of obese children in the world

Fighting obesity

  1. India must step up its efforts to fight overweight and obesity just as it has been doing with wasting and stunting
  2. Rising obesity is putting pressure on already fragile health systems in India by posing a high risk of chronic diseases such as cardiovascular diseases, diabetes and some cancers (clubbed together as non-communicable diseases, or NCDs)
  3. Research shows that Indians have higher levels of body fat and lower levels of lean muscle when compared to many other populations
  4. The potent combination of Indian children eating more junk food while becoming increasingly sedentary puts them at an even greater risk

Good opportunity to tackle obesity expansion

  1. This year is an ideal opportunity to tackle obesity
  2. Global health decision-makers are focussing on how to garner the political will to drive “best buys” such as sugar taxes and mass media campaigns on healthy diets
  3. A high-level commission and a UN General Assembly meeting on NCDs are giving new life to existing evidence-based yet largely unimplemented plans of action

Policy interventions that are required

  1. Policy responses should include
  • agricultural systems that promote crop diversity (to enable dietary diversity)
  • regulatory and fiscal measures (to decrease the availability, affordability and promotion of unhealthy foods, while making healthy foods more accessible)

2 India should ban the sale of junk food in and around schools

Obesity management, prevention and treatment should be provided as essential health services

India should link obesity and undernutrition and treat them as twinned challenges to be jointly addressed under the universal health coverage umbrella

Way forward

  1. Tackling obesity benefits the economy and the environment, as healthy and sustainable diets are good for productivity levels and the planet
  2. While tackling undernutrition through assurance of adequate nutrition (usually interpreted as dietary calories), we need to ensure that it is also about appropriate nutrition (the right balance of nutrients)
  3. Our policy response has to move from “food security” to “nutrition security”
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Accelerate efforts to end rabies: WHO to India, South East Asian countriesIOCR


Mains Paper 2: IR | Important International institutions, agencies & fora, their structure, mandate

From UPSC perspective, the following things are important:

Prelims level: World Health Organization, World Organisation for Animal Health (OIE), Food and Agriculture Organization (FAO), UNICEF, Zero by 30 plan, GAVI- the Vaccine Alliance

Mains level: Various non-communicable diseases and their elimination targets

Efforts needed to end Rabies

  1. The World Health Organization has asked India and other South East Asian countries to accelerate efforts to end rabies
  2. The WHO said that rabies causes 59,000 agonizing and painful deaths globally every year, translating to one person every nine minutes, mostly children and the poor

Causes and elimination

  1. Human rabies is caused mostly by dogs
  2. It can be eliminated by
  • increasing awareness about the disease
  • vaccinating dogs
  • making the already available life-saving rabies vaccines, medicines, tools, and technologies affordable and available to all

Fast-track elimination of dog-transmitted rabies by 2030

  1. The global rabies partners comprising the WHO, World Organisation for Animal Health (OIE), Food and Agriculture Organization (FAO) and UNICEF and rabies endemic countries from Asia-Pacific and Africa, shared and deliberated on measures to fast-track elimination of dog transmitted rabies by 2030
  2. The member countries shared initiatives being rolled out as part of the new ‘Zero by 30: The Strategic Plan’, to be launched by the WHO and its partners to end dog-transmitted rabies
  3. These studies were conducted with the WHO support to enable GAVI- the Vaccine Alliance take an informed decision to support rabies vaccines

About Zero by 30 plan

  1. The plan centers on ‘One Health’ approach and addresses the disease in a holistic and cross-sectoral manner
  2. It aims at preventing and responding to dog-transmitted rabies by improving awareness and education, reducing human rabies risk through expanded dog vaccinations, and improving access to healthcare, medicines, and vaccines for populations at risk
  3. The plan calls for generating and measuring impact by implementing proven effective guidelines for rabies control and encouraging the use of innovative surveillance technologies to monitor progress towards “Zero by 30”


GAVI- the Vaccine Alliance

  1. Global Alliance for Vaccines and Immunization is a public-private global health partnership committed to increasing access to immunization in poor countries
  2. It is a global Vaccine Alliance with the goal of creating equal access to new and underused vaccines for children living in the world’s poorest countries
  3. Gavi brings together developing countries and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry in both industrialized and developing countries, research and technical agencies, civil society, the Bill & Melinda Gates Foundation and other private philanthropists
  4. Gavi was launched in 2000
  5. It is based in Geneva, Switzerland
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Expand national programmes to eliminate malaria by 2030: WHO


Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: World Health Organization, World Malaria Day

Mains level: India’s target for Malaria elimination and issues related to it

Expanding the coverage of National Malaria Programmes

  1. The World Health Organization called on its member countries to expand the reach of their national malaria programmes among disadvantaged or neglected communities, including tribal, migrant or mobile populations, to achieve the disease elimination target by 2030
  2. On the eve of World Malaria Day (25th April) WHO urged member countries to ensure that national malaria programmes are provided sustainable funding along with strengthening surveillance

Targeting the Vulnerable

  1. WHO said that high-level commitment was crucial for elimination of malaria, and member countries should be focused on implementing a series of evidence-based interventions
  2. It means providing them access to long-lasting insecticidal nets (and ensuring they know how and why to use them)
  3. Other measures include- Carrying out the indoor residual spraying
  4. And providing pregnant women and children under-5 within these groups special attention, including increased access to antenatal services


National framework for Malaria Elimination (NFME)

  1. NFME outlines the strategies for eradication of the disease by 2030
  2. It classifies districts or states/UTs depending upon their Annual Parasite Incidence (API) or malaria
    endemicity into categories 0,1,2,3
  3. API number gives the number of cases affected by malaria per 1000 population per annum
  4. The milestones and targets are set for 2016, 2020, 2022, 2024, 2027 and 2030 by when the entire country has sustained zero indigenous cases and deaths due to malaria for 3 years and initiated the processes for certification of malaria elimination status to the country
  5. The objectives of the NFME are to:
  • Eliminate malaria from all low (Category 1) and moderate (Category 2) endemic states/UTs (26) by 2022
  • Reduce the incidence of malaria to less than 1 case per 1000 population in all States/UTs and the districts and malaria elimination in 31 states/UTs by 2024
  • Interrupt indigenous transmission of malaria in all States/ UTs (Category 3) by 2027;
  • Prevent re-establishment of local transmission of malaria in areas where it has been eliminated and to maintain the malaria-free status of the country by 2030
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Heavy metals in fertilizers raise risk of diabetes, heart diseases in farmers


Mains Paper 3: Environment | Conservation, environmental pollution and degradation, environmental impact assessment

From UPSC perspective, the following things are important:

Prelims level: Particulars of the disease mentioned in the newscard, heavy metals, etc.

Mains level: Effect on human health


Research done by the nanoscience and water research unit of the central government’s department of science and technology

  1. According to the research, synthetic fertilizers used in farming can trigger diabetes and cardiovascular diseases
  2. The scientists found a close link between toxic heavy metals used in fertilizers and the prevalence of diabetes and cardiovascular diseases among farmers

Particulars of the research

  1. The government funded research was carried out in a village in Tamil Nadu on around 900 people whose urine samples were tested
  2. Around 82.5% of the study population was involved in farming and high levels of toxic metals were detected in the synthetic fertilizers used in the study village
  3. The prevalence of pre-diabetes, diabetes and atherosclerosis was 43.4%, 16.2% and 10.3%, respectively
  4. Pre-diabetes is a condition in which blood sugar is high, but not high enough to be type 2 diabetes in which the body either doesn’t produce enough insulin, or it resists insulin
  5. Atherosclerosis is a cardiovascular disease in which there is narrowing of the arteries due to plaque buildup on the artery walls

Seriousness of the government

  1. The health ministry has been running screening programs in rural areas to get to the bottom of the rising incidence of non-communicable diseases in these areas

Prevalence of Non-Communicable disease

  1. The phase one results of the Indian Council of Medical Research (ICMR)-INDIAB (India diabetes) study have also shown that the prevalence of non communicable diseases is higher in both urban and rural areas of India compared to earlier studies
  2. A recent analysis of trends done by the All India Institute of Medical Sciences, New Delhi revealed an increase in diabetes prevalence among the rural population at a rate of 2.02 per 1,000 population per year


Heavy metals

  1. Heavy metals are generally defined as metals with relatively high densities, atomic weights, or atomic numbers. The criteria used, and whether metalloids are included, vary depending on the author and context
  2. In metallurgy, for example, a heavy metal may be defined on the basis of density, whereas in physics the distinguishing criterion might be atomic number, while a chemist would likely be more concerned with chemical behaviour
  3. More specific definitions have been published, but none of these have been widely accepted. The definitions surveyed in this article encompass up to 96 out of the 118 known chemical elements; only mercury, lead and bismuth meet all of them
  4. Despite this lack of agreement, the term (plural or singular) is widely used in science
  5. A density of more than 5 g/cm3 is sometimes quoted as a commonly used criterion and is used in the body of this article
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Health Ministry to roll out prog to combat hepatitis


Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Particular of the Hepatitis disease

Mains level: Targets set under the initiative.


Important decision taken by the Health Ministry

  1. The Health Ministry has decided to roll out an initiative for prevention and control of viral hepatitis
  2. Why: to address aspects such as surveillance, awareness generation, safe blood and injection safety to combat the disease

Particulars of the initiative: The ‘Integrated initiative for prevention & control of viral hepatitis’ 

  1. Under the initiative, the ministry has decided to establish a state coordination unit under the state NHM for efficient rollout of the programme in 26 large and four small states
  2. There is also a plan to set up 50 state laboratories for assisting in diagnosis and training of the district hospitals for screening of hepatitis
  3. The ministry intends to scale up to 100 treatment and 665 testing centres over a period of next three years

Budgetary provisions

  1. The National Health Mission (NHM) has decided to roll out ‘Integrated initiative for prevention & control of viral hepatitis’ with a budget of Rs 517.39 crore for three years



  1. Hepatitis is inflammation of the liver tissue
  2. Some people have no symptoms whereas others develop yellow discoloration of the skin and whites of the eyes, poor appetite, vomiting, tiredness, abdominal pain, or diarrhea
  3. Hepatitis may be temporary (acute) or long term (chronic) depending on whether it lasts for less than or more than six months
  4. Acute hepatitis can sometimes resolve on its own, progress to chronic hepatitis, or rarely result in acute liver failure
  5. Over time the chronic form may progress to scarring of the liver, liver failure, or liver cancer
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Free viral load testing for all PLHIV


Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: Viral load test, HIV-AIDS, ART

Mains level: Growing incidences of HIV in country and measures to prevent it

Viral load testing for all HIV patients

  1. The Health Ministry has launched ‘Viral load testing for all People Living with HIV/AIDS (PLHIV)’
  2. India is home to the world’s third largest HIV population, with 25 lakh patients
  3. Out of these, only 12 lakh of the diagnosed HIV patients are on treatment

Services provided from ART centers

  1. These patients are availing the benefit of free treatment from ART (Antiretroviral Therapy) centers


Viral load test

  1. Viral load tests measure the amount of HIV’s genetic material in a blood sample
  2. Viral load assays measure HIV genetic material called RNA from virus particles called virions in the blood plasma
  3. Results are reported as the number of copies of HIV RNA per milliliter of blood
  4. The three most commonly used assays for measuring viral load are: HIV-1 RNA polymerase chain reaction (PCR); Branched-chain DNA (bDNA); Nucleic acid sequence-based amplification (NASBA)
  5. Viral load kits are used to determine the severity of an infection before deciding on the treatment regimen that is appropriate for HIV patients

ART (Antiretroviral Therapy)

  1. ART are medications that treat HIV
  2. The drugs do not kill or cure the virus
  3. When taken in combination they can prevent the growth of the virus
  4. When the virus is slowed down, so is HIV disease
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

PM Modi to inaugurate first ever TB India summit next month


Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: India TB summit, WHO End TB Strategy, SDGs, UN

Mains level: Rising incidence of TB in India

India TB summit

  1. The government of India is all set to organize a mega India TB summit from March 13-16
  2. It is a first of its kind event which is aimed at generating sufficient momentum for vision of a TB free India by 2025
  3. This is five years ahead of the global TB elimination target of 2030

National Strategic Plan for TB Elimination 2017-25

  1. During the summit, PM is also expected to formally launch the National Strategic Plan for TB Elimination 2017-25 (NSP)
  2. It has been designed in line with World Health Organization’s (WHO) End TB Strategy, and the Sustainable Development Goals (SDGs) of the United Nations (UN)
  3. The key features of NSP are to
  • Effectively address patients seeking care in private sector, including provision for free medicines
  • Augmentation of availability of rapid molecular tests
  • A nutritional support to TB patients in DBT mode – Rs 500 per month and
  • An India TB Control Foundation


WHO End TB Strategy

  1. WHO’s post-2015 End TB Strategy, adopted by the World Health Assembly in 2014, aims to end the global TB epidemic as part of the newly adopted Sustainable Development Goals
  2. The resolution calls on governments to adapt and implement the strategy with high-level commitment and financing
  3. It focuses on serving populations highly vulnerable to infection and poor health care access, such as migrants
  4. The strategy and resolution both highlight the need to engage partners within the health sector and beyond, such as in the fields of social protection, labour, immigration and justice
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Eyes to the island: Car Nicobar’s victory over hyperendemic trachoma


Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: Mass Drug Administration, Trachoma, WHO SAFE guidelines, GET 2020 alliance, Ten Degree Channel, Tribes of Andaman

Mains level: Measures required to control various public health concerns

Public health project to eliminate hyperendemic trachoma

  1. Mass Drug Administration is the medical response to a public health concern that entails treating the entire population of a specified area with a prescribed dosage of pharmaceuticals
  2. Such a project was started in Car Nicobar following the discovery of a hyperendemic and active infection of trachoma on the island

About Trachoma

  1. Trachoma is a contagious and preventable cause of blindness
  2. Trachoma occurs upon repeated infections from the bacterium Chlamydia trachomatis
  3. It thrives in congested living conditions among populations that have limited access to water and healthcare
  4. It is transmitted by flies and aided by poor personal hygiene and fomites
  5. Co-habitation with animals like pigs, hens, goats, dogs, cats etc. could be a contributory risk factor
  6. Trachoma is hyperendemic in many of the poorest and most rural areas of 41 countries of Africa, Central and South America, Asia, Australia and the Middle East

WHO SAFE guidelines

  1. World Health Organisation’s (WHO) SAFE (Surgery for trichiasis, Antibiotics for infections, Facial cleanliness, and Environmental improvement) guidelines were developed to address surgical safety
  2. These guidelines have undergone review and testing at pilot sites around the world

GET 2020 alliance

  1. WHO has been pushing the GET 2020 (Global Elimination of Trachoma by 2020) alliance since 1996
  2. India is a partner in the alliance
  3. India has moved to apply for ‘trachoma-free’ status
  4. India expects to meet the 2020 target

Nicobar archipelago

  1. Nicobar is India’s southernmost district
  2. The Nicobar archipelago is separated from the Andaman cluster by the Ten Degree Channel
  3. The Nicobarese are the largest, most urbanised, and most influential among the six better-known tribes of the Andaman and Nicobar Islands
  4. Other tribes are Jarawas, Shompen, Great Andamanese, Onge and Sentinelese


National Programme for Control of Blindness (NPCB)

  1.  India was the first country to launch the National Programme for Control of Blindness (NPCB) in 1976
  2. The flagship Central government initiative emanated from the Trachoma Control Programme of 1963
  3. It had a goal to reduce the prevalence of blindness from 1.4% to 0.3%
  4. Main causes of blindness are as follows: Cataract (62.6%) Refractive Error (19.70%), Glaucoma (5.80%)
  5. The definition of Blindness under the National Programme for Control of Blindness (NPCB) is in line with WHO Definition: “Presenting distance visual acuity less than 3/60 (20/400) in the better eye and limitation of field of vision to be less than 10 degrees from centre of fixation”
  6. The nomenclature of the scheme has changed from ‘National Programme for Control of Blindness’ to ‘National Programme for Control of Blindness and Visual Impairment’
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

First India-designed vaccine passes WHO test


Mains Paper 3: Science & Technology | Achievements of Indians in science & technology

From UPSC perspective, the following things are important:

Prelims level: WHO, Rotavac and Rabishield vaccine, India’s national immunization programme

Mains level: India’s achievements in pharmaceutical research

Rotavac vaccine pre-qualified by WHO

  1. For the first time, a vaccine conceived and developed from scratch in India has been “pre-qualified” by the World Health Organisation
  2. The Rotavac vaccine, developed by the Hyderabad-based Bharat Biotech Limited last year, was included in India’s national immunization programme
  3. To be “pre-qualified” means that the vaccine can be sold internationally to several countries in Africa and South America

Uniqueness of the vaccine

  1. Several vaccines from India have been pre-qualified, this is the first that was entirely developed locally
  2. The Rotavac vaccine protects against childhood diarrhea caused by the rotavirus
  3. It was built on strain of the virus isolated at the All India Institute of Medical Sciences here over 30 years ago

Another similar vaccine

  1. Pune-based Serum International also has developed a rotavirus vaccine called Rabishield
  2. It has also been included in India’s immunization programme


India’s national immunization programme

  1. Universal Immunization Programme is a vaccination program launched by the Government of India in 1985
  2. It became a part of Child Survival and Safe Motherhood Programme in 1992 and is currently one of the key areas of National Rural Health Mission(NRHM) since 2005
  3. The program now consists of vaccination for 12 diseases- tuberculosis, diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, measles, Hepatitis B, Diarrhoea, Japanese Encephalitis, rubella, Pneumonia( Haemophilus Influenza Type B)and Pneumococcal diseases (Pneumococcal Pneumonia and Meningitis)
  4. The other additions in UIP through the way are inactivated polio vaccine (IPV), rotavirus vaccine (RVV), Measles-Rubella vaccine (MR) and Pneumococcal Conjugate Vaccine
  5. Vaccines against rotavirus, rubella and polio (injectable) will help the country meet its Millennium Development Goals 4 targets that include reducing child mortality by two-thirds by 2015, besides meeting meet global polio eradication targets
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

India misses Kala Azar elimination deadline


Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From UPSC perspective, the following things are important:

Prelims level: Kala-Azar, PKDL

Mains level: Elimination of various communicable and non-communicable diseases in India

2017 deadline for elimination of black fever missed

  1. India has missed the 2017 deadline that Finance Minister had announced for elimination of Kala-Azar (black fever) in his Budget speech last year
  2. Endemic blocks have increased from 61 to 68 in 17 districts of Bihar and Jharkhand
  3. KA is a slow progressing indigenous disease caused by a single-celled parasite of the Leishmania family

Elimination criteria

  1. Elimination is defined as reducing the annual incidence of Kala-Azar (KA) to less than 1 case per 10,000 people at the sub-district level

Why increase in cases?

  1. KA vector needs to be eliminated to eliminate Kala Azar
  2. As the endemic blocks have majority of houses made from wood, it is very difficult to eliminate the vector as it dwells in the wooden structure and escapes various measures to kill it
  3. Further, a little-known skin condition called Post Kala Azar Dermal Leishmaniasis (PKDL) — a red flag for transmission of KA — has been growing steadily over the past few years

What can be done to control its spread?

  1. To stop the infection transmission, pucca houses need to be built
  2. Even after treatment of Kala-Azar patients, it is the PKDL cases which become a source for future KA cases


Kala-Azar (Black fever)

Image source
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Supreme Court notice to Centre on PIL on laws


Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: Leprosy, fundamental rights

Mains level: Discrepancies in various laws that allow social discrimination

Notice to Centre against leprosy discrimination

  1. The Supreme Court issued notice to the Centre and states on a Public Interest Litigation (PIL) seeking repeal of 119 statutes that allegedly discriminate against leprosy-affected persons
  2. The PIL requested that the said Acts be declared unconstitutional

Violating fundamental rights

  1. PIL said that the provisions in the said statutes violated the fundamental rights guaranteed under Articles 14, 19 and 21 of the Constitution



  1. Leprosy, also known as Hansen’s disease (HD), is a long-term infection by the bacterium Mycobacterium leprae or Mycobacterium lepromatosis
  2. Symptoms that develop include granulomas of the nerves, respiratory tract, skin, and eyes
  3. This may result in a lack of ability to feel pain, thus loss of parts of extremities due to repeated injuries or infection due to unnoticed wounds
  4. Weakness and poor eyesight may also be present
  5. Leprosy is spread between people. This is thought to occur through a cough or contact with fluid from the nose of an infected person
  6. Contrary to popular belief, it is not highly contagious
  7. Leprosy is curable with a treatment known as multidrug therapy
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

India unlikely to cut malaria by half in 2020: WHO


Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources.

From UPSC perspective, the following things are important:

Prelims level: WHO, Malaria

Mains level: Eradication of malaria and other diseases


India unlikely to reduce its malaria case burden

  1. India accounted for 6% of global malaria cases and 7% of deaths caused by it in 2016, according to a report released by the World Health Organisation (WHO)
  2. This is in the same ballpark as last year
  3. The WHO figures also suggest that India is unlikely to reduce its case burden beyond 40% by 2020

Performance vis-a-vis other countries

  1. Maldives, Sri Lanka and Kyrgyzstan achieved malaria-free status in 2015 and 2016 respectively
  2. Bhutan, Nepal, Thailand, Bangladesh, Myanmar and Indonesia, says the WHO, are among the countries poised to reduce malaria incidence by over 40% by 2020
  3. About 80% of the deaths from malaria across the globe were accounted for by 15 countries, namely, India and 14 countries in Sub-Saharan Africa

Key impediments in elimination

  1. A key impediment to eliminating malaria is a weak surveillance system
  2. India and Nigeria, two major contributors to the global burden of malaria, were able to detect only 8% and 16% of cases, respectively, via the system


  1. 51% of Plasmodium vivax cases — the milder cousin of the p. falciparum — were traced in India
  2. This could be partially explained by resistance to chloroquine, the first line treatment to p. vivax infections
  3. For a long time, p falciparum dominated India’s case burden



  1. Malaria is a mosquito-borne infectious disease affecting humans and other animals caused by parasitic protozoans (a group of single-celled microorganisms) belonging to the Plasmodium type
  2. The disease is most commonly transmitted by an infected female Anopheles mosquito
  3. Five species of Plasmodium can infect and be spread by humans
  4. Most deaths are caused by P. falciparum because P. vivax, P. ovale, and P. malariae generally cause a milder form of malaria
  5. The disease is widespread in the tropical and subtropical regions that exist in a broad band around the equator
  6. The Malaria Policy Advisory Committee (MPAC) of the World Health Organization (WHO) was formed in 2012 to provide strategic advice and technical input to WHO on all aspects of malaria control and elimination
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Lifestyle risks higher in developed states, malnutrition in others

Image source


Mains Paper 2 | Issues relating to development and management of Social Sector relating to Health

The following things are important from UPSC perspective:

Prelims level: EAG, DALY, Global Burden of Disease 2016 study

Mains level: This article highlights various finding of the recently released “Health of the Nation’’ state level disease burden study


The first-ever “Health of the nation” state-level disease burden study has turned on its head the perception that some states, placed higher on the development ladder, are better than others in terms of health

The report- ‘India: Health of the Nation’s States India State-level Disease Burden Initiative’

  1. The analysis aims to equip the government with evidence to identify specific state-level health challenges and priorities for intervention.
  2. The health study focused on key drivers of ill health, disability and premature death in all states and union territories, and included people from over 2,000 ethnic groups.
  3. It covered 333 diseases and injuries, and 84 risk factor trends, for each state between 1990 and 2016, as part of the Global Burden of Disease 2016 study
  4. The report is a part of All India State-level Disease Burden Initiative, which was launched by the Ministry of Health with the ICMR, PHFI, and the Institute for Health Metrics and Evaluation, in 2015
  5. This report has major policy implications for national and local governments

Key highlights from the study

  1. The study shows that UP, MP, Bihar, Rajasthan, Jharkhand, Chhattisgarh, Odisha and Uttarakhand, in the government’s Empowered Action Group (EAG), continue to battle child and maternal malnutrition.
  2. However, it also shows that states such as Tamil Nadu, Kerala, Punjab, and Goa have become hubs of non-communicable diseases (NCDs), including cancer and lifestyle-linked issues like heart ailments and diabetes.
  3. It also includes states like Tamil Nadu, Kerala and Punjab in the highest bracket for NCDs, for which prevention is a primary counter-strategy
  4. The states with better health systems, as seen in infant mortality and immunization rates, are failing on the prevention front
  5. That is, while states like Bihar and UP are still battling diarrhea deaths in children, those that have won that war, now have newer battles to fight
  6. According to it the individual states in India are in different phases of epidemiological transition, and this has resulted in wide inequalities in the magnitude and progress against various diseases and their causes

What are the reasons for NCD burden?

  1. According to the study, the NCD burden is high in the southern states and Punjab
  2. One prominent factor is the lifestyle
  3. Also,National Rural Health Mission, 2005 for years have focused on reproductive and child health because infant and maternal mortality rates were among the MDGs (Millennium Development Goals)
  4. So they have not been focussing on prevention or spreading awareness about dietary requirements
  5. Therefore, the National Health Policy talks about shifting towards tackling NCDs

What does Report says about Life expectancy at Birth?

  1. The report also found that life expectancy at birth had improved from 59.7 years in 1990 to 70.3 years in 2016 for females.
  2. For males, it has increased from 58.3 years to 66.9 years.
  3. There are continuing inequalities between states, with a range of varying life expectancy for males in UP and Kerala for females and it varies widely in Assam and Kerela for women.

The contribution of injuries to the disease burden

  1. Increased in most states since 1990, with young adults forming the highest proportion.
  2. Road injuries and self-harm, including suicides, were the leading contributors to the injury burden.

DALY (Disability Adjusted Life Years)

  1. It is an internationally recognized metric to rate a disease or health condition
  2. It is calculated as the sum of years of life lost due to premature mortality and the years lost due to disability in people living with a health condition or suffering its consequences
  3. A higher DALY metric indicates a severe disease burden
  4. The report assessed DALY for various diseases and its trend across states in India


Empowered Action Group (EAG)

  1. In India, the eight socioeconomically backward states of Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttaranchal and Uttar Pradesh are referred to as the Empowered Action Group (EAG) states
  2. They lag behind in the demographic transition and have the highest infant mortality rates in the country
  3. They receive special attention from the central government
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Insulin does not mean end-stage of diabetes: Take it earlier

  1. Fact: India is estimated to have about 69 million people with diabetes, the second largest in the world after China
  2. Context: Most of these people should take insulin at an early stage in their diagnosis period
  3. But social stigma and the fear that insulin marks the last stage of diabetes prevents them from doing so
  4. Diabetes is the theme of this year’s World Health Day
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Anti-Diabetic Drug ‘Ayush-82’ to be commercialised

  1. News: National Research Development Corporation(NRDC) of Min of S&T signed a License Agreement with Kudos Laboratories India for commercialization of Ayush-82
  2. About Ayush-82: An ayurvedic formulation for prevention and management of Diabetes
  3. Developed by: Central Council for Research in Ayurvedic Sciences (CCRAS), New Delhi
  4. CCRAS is an apex organization for research in Ayurveda under the Ministry of AYUSH
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Agreement for Commercialisation of Ayush-64 and Ayush-82

  1. Developed by: Central Council for Research in Ayurvedic Sciences (CCRAS), New Delhi, an Autonomous body of the Ministry of AYUSH
  2. Context: Ayush-64, an ayurvedic formulation for treatment of Malaria and Ayush-82, an ayurvedic Formulation for management of Diabetes
  3. About Ayush-64: effective for the treatment of Malaria which is one of the most prevalent; destructive widely spread disease
  4. About Ayush-82: Anti diabetic drug also developed by CCRAS is a combination of known and tested hypoglycemic drugs
  5. Significance: Use of these two drugs would help millions of people suffering from Malaria and Diabetes
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

Polished Rice? Hello Diabetes!

  1. Have you ever wondered why over 40% of the people in India are diabetic?
  2. The more polished white rice a person eats, regardless of their nationality, they are at great risk of contracting Type 2 diabetes.
  3. White polished rice (parboiled/ non-parboiled) raises blood sugar levels quickly.
  4. These are called high GI (Glycemic Index) foods. In comparison, brown rice has a lower GI.
Communicable and Non-communicable diseases – HIV, Malaria, Cancer, Mental Health, etc.

New smartphone app to help people cut diabetes risk

  1. Aims to tackle type 2 diabetes by allowing users to track their exercise and eating habits.
  2. The app, called Noom, developed by a New York City tech startup.
  3. Noom’s app is an alternative to the CDC’s traditional in-person classes, in which attendees typically keep pen-and-paper journals for their diet and exercise.

Living with diabetes?

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