Coronavirus – Health and Governance Issues

Coronavirus – Health and Governance Issues

CoAST India (Collaboration/Covid Action Support Group) PlatformPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : CoAST India

Mains level : Not Much


India Observatory has come up with a GIS-enabled dashboard called CoAST India to monitor migrants in India.

Here, UPSC may create an illusion on:

India Observatory – open-source database (misleading name): It may be asked in relation to some ISRO project.

CoAST India – COVID related info (again misleading): UPSC may ask it in context to Cyclone Warning Systems.

CoAST India

  • The platform is a map reflecting the movement of migrants in real-time on their long journeys, often on foot, along with facilities and relief organisations on their routes.
  • It is a collaboration with Anand-based Forest Ecological Security (FES) as its main nodal point.
  • It draws information from 55 organisations on the ground, mostly in villages, and aims to make such data available so that it would enable governments and small local civil society groups to be of assistance.
  • The map matches time and spatial data, on administrative facilities in the area, transportation and healthcare facilities of an area and summaries, on the fly, in real-time of people passing by.

Features of the portal

Four elements are sought to be brought together in this portal:

  • Location of migrants and vulnerable people, their specific needs,
  • Location of key infrastructure on the way which can double up as a rest-centre, or
  • Quarantine space and location of relief and
  • Rehabilitation providing NGOs and civil society organisations

About India Observatory

  • The Foundation for Ecological Security (FES), an NGO working on conserving natural resources at the grassroots, has brought together a unique ecosystem of tools – open data platform India Observatory – to help understand the status of local-level resources and facilitate the action plans for conserving them.
  • The data made available on India Observatory platform has been pooled from various sources and dates as far back as the 1960s.
  • India Observatory was set up in December 2019, with FES focused on ecological issues about forests, water bodies, conservation, etc. that needed “a bird’s eye view or a satellite’s vision”.
  • It is a research unit at the London School of Economics and Political Science (LSE).
Coronavirus – Health and Governance Issues

Examining role played by Civil Society and NGOs in fight against Covid-19op-ed of the day

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Role of NGO and Civil Society amid pandemic.


Social capital is what civil societies are known as. The article highlights the valuable role played by the civil society, and NGO in the pandemic. They constitute the backbone of the collective expression of citizen  interest in a democracy. So, read about the ways in which they can contribute in dealing with destruction due to pandemic.

Partnership with 3 key stakeholders: NGO, Private Sector, international development organisation

  • The nature and scale of the crisis which the COVID-19 pandemic has led to is unparalleled.
  • In such a scenario, solutions are unlikely to come from past experiences or best practices.
  • The biggest source of strength now is the partnerships we have built over the years.
  • The situation at hand calls for stakeholders to come together, work side by side and support each other.
  •  The fight against COVID-19 needed as many hands as were available.
  • The job was too big for the government to handle alone.
  • The strategy was to leverage vertical and horizontal partnerships: Vertical partnerships, which the stakeholders have built within their organisations and horizontal partnerships, which the government has institutionalised with stakeholders.
  • This is precisely what one of the Empowered Groups created by the government has been doing since it was formed.

 Role played by NGOs

Significance of NGOs

  • The NGOs, given their deep connect with spatial and sectoral issues, were a natural partner in this endeavour.
  • There is nobody better placed than the NGOs to understand the pulse at the grassroots and engage closely with communities.
  • Around 92,000 organisations were urged to partner with district administrations and contribute to the response efforts.

How the NGOs helped?

  • Chief Secretaries of all states were requested to engage NGOs in relief and response efforts and designate state and district nodal officers to coordinate with them.
  • The approach was to leverage the strength and reach of the local NGOs in identifying priority areas for action and avoid duplicity of efforts.
  • NGOs have been actively setting up community kitchens, creating awareness about prevention, and physical distancing, providing shelter to the homeless, the daily wage workers, supporting government efforts in setting up health camps and in deputing volunteers to deliver services to the elderly, persons with disabilities, children, and others.
  • An outstanding contribution of NGOs was in developing communication strategies in different vernaculars which went a long way in taking awareness measures to the community level.
  • Akshaya Patra, Rama Krishna Mission, Tata Trusts, Piramal Foundation, Bill and Melinda Gates Foundation, Action Aid, International Red Cross Society, Prayas, Help-age India, SEWA, Sulabh International, Charities Aid Foundation of India, Gaudia Math, Bachpan Bachao Andolan, the Salvation Army, and Catholic Bishops’ Conference of India are some partners who have embodied the whole-of-society approach in COVID-19 response management.

Important role played by startups

  • The crisis has brought out the best in the start-up space.
  • Many of them have risen to the occasion and accelerated the development of low cost, scalable, and quick solutions.
  • The results have been promising.
  • AgVa accelerated the development of ventilators which are low-cost, mobile, low on power consumption and require minimal training for operators.
  • Biodesign has developed a robotic product called ResperAid, which enables mechanised use of manual ventilators.
  • Kaaenaat has developed highly portable ventilators which can be used to serve two patients simultaneously and has a built-in battery, oxygen concentrator, and steriliser cabinet.
  • The products of a few non-ventilator start-ups too came to the aid of the COVID-19 fighting machinery.
  • The AI-enabled analysis of chest X-Rays developed by Qure.ai enables large-scale screening to identify potential cases.
  • GIS and geo-fencing technologies by Dronamaps enabled information cluster strategies for hotspots.
  • AI-powered online doctor consultation and telemedicine platform by Mfine connects diagnostics labs and pharmacies with doctors and patients.
  • The AI-enabled thermal imaging camera developed by Staqu facilitated large-scale screening at low cost.
  • These developments strengthen the argument that low-cost and scalable solutions designed and developed domestically must drive our country’s transformation.

How the stakeholders operated through partnership?

  • The manner in which stakeholders have responded to the pandemic reinforces the power of partnerships.
  • In fact, they have operated through partnerships.
  • The NGO leaderships created momentum throughout their networks and delivered the much needed response.
  • They also brought to the attention of the group the problems from the grassroots.
  • Multiple agencies of international development organisations designed and executed joint response initiatives, leveraging their presence across the country.
  • The coalitions which industry organisations such as CII, FICCI, and NASSCOM have built over the years brought people and resources together, identified problems at multiple levels, channelised ideas and solutions and facilitated innovations.
  • The role played by the government has been facilitative in nature.
  • This role was based on the institutional and informal partnerships built with the three groups of stakeholders over the years.

Adaptiveness of Indian Industry

  • Until three months ago, not a single N95 mask or personal protective equipment (PPE) was manufactured in India.
  • Today, we have 104 domestic firms making PPEs and four manufacturing N95 masks.
  • Over 2.6 lakh PPEs and two lakh N95 masks are being manufactured in India, daily.
  • Domestic manufacturing of ventilators has strengthened manifold — orders for more than 59,000 units have been placed with nine manufacturers.
  • While this shows the adaptiveness of Indian industry, the shift to domestic production must happen on a larger scale for a wider set of sectors in the long run, as envisioned by Make in India.

Consider the question-“As facilitators, mediators, and advocates of collective articulation of citizen interest in a democracy, Civil Society and NGOs have put people before everything else during this crisis. In light of this, examine the role played by them in unparalleled crisis brought in by Covid-19 pandemic.”

Conclusion

Civil society, and voluntary and non-government organisations constitute the backbone of the collective articulation of citizen interest in a democracy. Surely, they can prove to be an asset in our fight against corona pandemic.

Coronavirus – Health and Governance Issues

India to chair ‘WHO Executive Board’IOCR

Note4Students

From UPSC perspective, the following things are important :

Prelims level : WHO

Mains level : Losing credibility of WHO in COVID-19 times


India would now be playing a more prominent role at the World Health Organisation (WHO), with Union Health Minister taking charge as chairman of the WHO Executive Board at its 147th session.  Dr Harsh Vardhan would succeed Dr Hiroki Nakatani of Japan.

Practice question for Mains:

Q. The World Health Organisation (WHO) had “missed the call” on the COVID-19 pandemic. Critically comment with context to the ongoing spat between the US and China.

About WHO

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

The WHO Executive Board

  • The WHO is governed by two decision-making bodies — the World Health Assembly and the Executive Board.
  • The Board is composed of 34 members technically qualified in the field of health, with members being elected for three-year terms.
  • The Health Assembly is the WHO’s decision-making body and consists of 194 Member States.
  • The Board chairman’s post is held by rotation for one year by each of the WHO’s six regional groups: African Region, Region of the Americas, South-East Asia Region, European Region, Eastern Mediterranean Region, and Western Pacific Region.

Functions of the Board

  • The main functions of the Board are to give effect to the decisions and policies of the Health Assembly, to advise it and generally to facilitate its work.
  • The Board and the Assembly create a forum for debate on health issues and for addressing concerns raised by the Member States.
  • Both the Board and the Assembly produce three kinds of documents — Resolutions and Decisions passed by the two bodies, Official Records as published in WHO Official publications, and Documents that are presented “in session” of the two bodies.

Back2Basics: India at the WHO

  • India became a party to the WHO Constitution on 12 January 1948.
  • The first session of the South East Asia Regional Committee was held on October 4-5, 1948 in the office of the Indian Minister of Health, and was inaugurated by Jawaharlal Nehru, the first PM.
  • The first Regional Director for South-East Asia was an Indian, Dr Chandra Mani, who served between 1948-1968.
  • Currently, the post has again been occupied by an Indian appointee, Dr Poonam Khetrapal Singh, who has been in office since 2014.
  • Since 2019, Dr Soumya Swaminathan has been the WHO’s, Chief Scientist.

Also read:

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

Coronavirus – Health and Governance Issues

Unanimity at WHOop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : WHO

Mains level : Paper 2- Role of WHO under scanner for handling corona pandemic.


WHO has been in news recently for all the wrong reasons. This article focuses on wide-ranging support for the resolution calling for the inquiry into the origin of the novel coronavirus. With this resolution, WHO has a chance to redeem its credibility. Until recently China seemed to be in the control of the global narrative on the pandemic. And now we witness near-unanimous support to this resolution.

Inquiry of the origin of the virus

  • International attention is riveted on the question of an inquiry into the origin of the corona-virus.
  • The call for an international investigation was first voiced formally by the Australian prime minister, Scott Morrison.
  • Beijing reacted with open threats of trade sanctions. But Canberra pushed the investigation ahead.
  • It is working with the European Union to promote a resolution at this week’s World Health Assembly (WHA), which brings ministers from all the member states of the WHO.
  • The resolution also calls for an “impartial, independent and comprehensive” evaluation into the international response to the corona pandemic.
  • The WHA has 194 members.
  • So, the entire international community — has a voice in addressing the key issues raised by the corona crisis by debating the resolution.

Wide support to the resolution

  • According to media reports, the resolution is close to gaining support from two-thirds of the WHA’s 194 members.
  • Australia and the EU hope to have the resolution approved unanimously.
  • Since the resolution does not mention China by name, Canberra and Brussels hope Beijing will not oppose the resolution.
  • They also hope to persuade Washington, which wanted tougher language including references to China, to endorse the resolution.
  • Whatever the fate of the resolution, the wide-ranging support it has got amidst the vocal Chinese opposition is impressive.

So, how effective is the resolution?

  • To be sure, the resolution was watered down to get the maximum possible backing at the WHO.
  • But it is said to have enough teeth to dig deep into the issues raised by the corona crisis.

How China controlled the corona narrative until now?

  • A few weeks ago, it seemed China and the Director-General of WHO, had full control over the corona narrative on the issues involved.
  • The Trump administration’s aggressive questioning of China’s role and WHO DG’s role had not gone down well.
  • Nor did the US threat to cut off funding for the WHO.
  • Within the US itself, opposition Democrats and the foreign policy establishment has attacked Trump for trying to “divert attention”.
  • China’s success in quickly getting things under control at home and its expansive mask diplomacy seemed to give Beijing an upper hand at the WHO.
  • China’s growing clout in the developing world and bilateral economic levers against major developed countries, including in Europe, appeared to insure against any serious international questioning of its handling of the virus.
  • What factors played the role in the passing of the resolution?
  • 1) The public pressure from the US concentrated minds at the WHO.
  • 2) Some quiet diplomacy by middle powers, including India, appears to have created the political basis for learning the right lessons from the pandemic and preventing similar eruptions in the future.

Is it a setback for China?

  • Some observers see a unanimous approval of the resolution as a diplomatic setback for Beijing.
  • Since limiting the demands for an external inquiry has been a major political priority for Beijing.
  • There are similar demands at home for an investigation into a crisis that led to an enormous loss of life in China and punishing those responsible.
  • The leadership in Beijing is not comfortable with these demands.

Issues with the WHO that India must pay attention to

1. International norms for early detection

  • There is the need to develop new international norms that will increase the obligations of states and the powers of the WHO in facilitating early detection and notification of pandemics.
  • This will involve finding ways to bridge the contested notions of state sovereignty and collective security.

2. Funding of the WHO

  • If you have a club that depends on donations rather than membership fees, donors will inevitably set the agenda.
  • Over the decades, the WHO has become ever more reliant on voluntary contributions from governments and corporations rather than assessed contributions from the member states.
  • This is going to leave the WHO rather vulnerable to pressures.

3. WHO’s focus should be on fewer objectives

  • India must also ask if the WHO is trying to do too many things.
  • The WHO’s initial successes came when it focused on a few objectives like combatting malaria and the elimination of smallpox.
  • A limited agenda might also make the WHO a more effective organisation.

Way forward for India

  • India knows it is one thing to pass to a resolution and entirely another to compel a great power like China to comply.
  • Any current effort to understand the origin and spread of the COVID-19 virus and a long-term strategy to deal with future pandemics must necessarily involve more than a measure of Chinese cooperation.
  • Sustained engagement with Beijing, then, is as important for Delhi as deeper cooperation with Washington and the “Quad plus” nations.
  • India should also focus on more intensive engagement with the non-aligned nations in promoting a new global regime on preventing and managing pandemics.

Consider the question “Corona pandemic and its handling by the WHO resulted in the loss of its credibility. But the collective efforts of the nations which resulted in the passage of the resolution for inquiry of the origin of the virus, could soften the blow the credibility of WHO had suffered. Comment.”

Conclusion

For India, the widespread support for the resolution is a vindication of its early call for transparency and accountability in the responses of China and the WHO to the pandemic. India should take initiative to ensure the reforms at WHO and the formation of global order for preventing and managing the global order.

Coronavirus – Health and Governance Issues

Controlled Human Infection Studies and its Ethical ConcernsPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Controlled human infection and ethical issues involved


At a time when the whole world is focused on protecting itself from the novel coronavirus SARS-CoV-2, more than 20,000 people from 102 countries have enrolled on a US website to voluntarily infect themselves with the virus.

Practice question:

Discuss various ethical and bioethical considerations involved in the development of a vaccine for any deadly virus with context to the ongoing  COVID-19 pandemic.

Controlled human infection

  • Controlled human infection studies (or ‘human challenge studies’) involve the deliberate infection of healthy volunteers.
  • Such studies can be particularly valuable for testing vaccines.
  • The World Health Organization (WHO) has given the go-ahead, subject to a set of preconditions being met.
  • They can be substantially faster to conduct than vaccine field trials because far fewer participants need to experiment in order to provide preliminary estimates of efficacy and safety.
  • Such studies can be used to compare the efficacy of multiple vaccine candidates and thus select the most promising vaccines for larger studies.

Why need such trials?

  • Currently, there are over 100 vaccine molecules under various stages of development across the world. At least two are already in Phase II clinical trials.
  • Human challenges expedite trials because a lot of time may be lost waiting for a trial subject to contract the disease naturally from the community.
  • Till such time that happens, whether the vaccine works or not cannot be tested.
  • Then again, if the infection does not happen normally, there is little way of finding out whether it is because of the vaccine or whether it is because the person was never exposed at all.

Previous occasions of such trial

  • Human challenge trials are routinely done for diseases such as malaria, dengue, influenza and cholera which extract a heavy public health toll but are not otherwise deadly.
  • Back in 1796 Edward Jenner, father of the smallpox vaccine infected his gardener’s son with the smallpox virus after having used his newly developed vaccine on the eight-year-old.
  • The child did not get smallpox. Later, Jenner used the deliberate infection strategy on 6,000 other people to test the efficacy of his vaccine that eventually became the principal reason why smallpox could be eradicated.
  • WHO says that in the last 50 years, challenge studies have been performed safely in tens of thousands of consenting adult volunteers under the oversight of research ethics committees.
  • These studies have recently helped to accelerate the development of vaccines against typhoid and cholera among others.

How necessary is this programme for deliberate infection?

  • There is currently no approved treatment against COVID. This means that there are only two ways of stopping the global march of SARS-CoV-2.
  • The first is herd immunity — when a critical mass of people in a given population gets infected by the virus, develop some immunity against it.
  • This involves a lot of death and suffering; there is also an element of uncertainty because nobody knows how long immunity in a person who has already had it.
  • The other way of stopping it is a vaccine. That is why there is so much work going on across the world on a COVID vaccine.
  • There are estimates that even a vaccine that clears all trials in a breeze could have a waiting period of 12-18 months before it is available at a global scale.

Is it ethical to infect people deliberately with a virus that has caused so much suffering?

  • There are no easy answers to this.
  • That is why it is important to choose volunteers with care, with full disclosure is given and informed consent sought from them, before going ahead with the actual act of infection.

The WHO says-

  • WHO, in its guidance document says that- challenge studies are nonetheless ethically sensitive and must be carefully designed and conducted in order to minimize harm to volunteers and preserve public trust in research.
  • In particular, investigators must adhere to standard research ethics requirements.
  • Furthermore, research should be conducted to especially high standards where

(a) Studies involve exposing healthy participants to relatively high risks

(b) Studies involve first-in-human interventions (including challenge) or high levels of uncertainty (for example, about infection, disease and sequelae, or

(c) Public trust in research is particularly crucial, such as during public health emergencies

Coronavirus – Health and Governance Issues

Cooperative Federalism in the Time of Covid-19op-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : National Plan under DMA 2005

Mains level : Paper 2- Cooperative federalism amid Covid-19.


Federalism is part of Basic Structure (Doctrine) of the Constitution. The article is about the lack of cooperative federalism in some of the Central Government’s actions in its fight against the corona crisis. What are those actions? Read to know…

Opinion of political thinkers on federalism in India

  • K.C. Wheare notes, federalism traditionally signifies the independence of the Union and State governments of a country, in their own spheres.
  • The members of India’s Constituent Assembly carefully studied the Constitutions of other great federations like the US, Canada, Australia and Switzerland.
  • However, they adopted a ‘pick and choose’ policy to formulate a system suited uniquely to the Republic’s need.
  • As a result, India’s Constituent Assembly became the first-ever constituent body in the world to embrace what H. Birch and others have referred to as ‘cooperative federalism’.
  • ‘Cooperative federalism’ is administrative cooperation between the Centre and the States, and a partial dependence of the States upon payments from the Centre.
  • Accordingly, Indian constitutional law expert Granville Austin remarks that despite a strong Centre, cooperative federalism doesn’t necessarily result in weaker States.
  • He also said that the progress of the Republic rests upon active cooperation between the two.

Lack of consultation with States under DMA 2005

  • The zone classifications into ‘red’ and ‘orange’ has evoked sharp criticisms from several States.
  • The States have demanded more autonomy in making such classifications.
  • The Disaster Management Act of 2005 under which binding COVID-19 guidelines are being issued by the Centre to the States mandates consultation with the States.
  • The Act envisages the creation of a ‘National Plan’ under Section 11, as well as issuance of binding guidelines by the Centre to States under Section 6(2), in furtherance of the ‘National Plan’.
  • The ‘National Plan’ then is a broader vision document while the binding guidelines are its enforcement mechanism.
  • Now, Section 11(2) of the Act mandates State consultations before formulating a ‘National Plan’.
  • And when such binding guidelines are ultimately issued under it, they are expected to represent the views of the States.
  • However, the Centre has not formulated the ‘National Plan’, and has chosen instead to respond to COVID-19 through ad hoc binding guidelines issued to States.
  • Such guidelines thereby circumvent the legislative mandate of State consultations.
  • This selective application of the Act serves to concentrate all decision-making powers with the Centre.

Lack of funds

  • The Centre has declared that corporations donating to PM-CARES can avail CSR exemptions, but those donating towards any Chief Minister’s Relief Fund cannot.
  • This directly disincentivises donations to any Chief Minister’s Relief Fund.
  • And diverts crores in potential State revenues to PM-CARES; and makes the States largely dependent upon the Centre.
  • Further, the revenue streams of several States have dried up because of the liquor sale ban; negligible sale of petrol/diesel; no land dealings and registration of agreements.
  • States’ GST collections have also been severely affected with their dues still not disbursed by the Centre.
  • All this has made it difficult for States to defray expenses of salaries, pensions and welfare schemes.
  • As it is the States which act as first responders to the pandemic, supplying them with adequate funds becomes a pre-requisite in effectively tackling the crisis.
  • This requires the Centre to view the States as equals, and strengthen their capabilities, instead of increasing their dependence upon itself.

Consider the question-“Cooperative federalism is the key in the country’s fight against the corona pandemic. Critically examine.”

Conclusion

Keeping the spirit of cooperative federalism alive whether in consultation with the States or taking care of their finances is essential as the country is fighting the pandemic. The Centre must realise that we have the best chance of winning the war against pandemic when we are united.

Coronavirus – Health and Governance Issues

Legal aspects of using Disaster Management Act to deal with pandemicop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : DMA 2005, Residuary power of the Union legislature.

Mains level : Paper 2- Issues arising out of the use of the DMA 2005 to deal with the pandemic.


This article analyses the legal basis of application of the Disaster Management Act to deal with the pandemic by the Central Government. The Disaster Management Act had been enacted using the residuary power of the Union legislature. So, its application to deal with the pandemic gives rise to certain legal issues. Read to know more about such issues.

Two examples of why centralised approach may be counter-productive?

  • One, the Central government has classified all districts in the country as red, orange or green zones.
  • This classification was done in a bid to lift lockdown restrictions in an area-specific manner.
  • Some States/Union Territories objected to the classification of certain areas/districts as red zones on the ground that these areas are very large.
  • They pointed out that there was no need to keep economic activity on hold in an entire district when cases had been reported only from a small portion of that district.
  • Two, Kerala, probably the best-performing State in terms of its response to COVID-19, was sent a missive by the Central government to refrain from relaxing restrictions in the State.
  • The Central government did not trust the wisdom and judgment of the State government in the matter.

The federal scheme and residuary power to legislate

  • Under the federal scheme, Parliament can legislate on matters under the Union List (List I).
  • Stage legislatures can legislate on matters under the State List (List II).
  • And both Parliament and State legislatures can legislate on matters under the Concurrent List (List III).
  • The residuary power to legislate on matters that are not mentioned in either List II or List III vests with Parliament under Article 248 of the Constitution read with Entry 97 of List I.
  • Furthermore, the rule of harmonious construction dictates that the entries in the legislative lists must be interpreted harmoniously.
  • And in the event of any overlap between two or more entries, the specific subject matter contained in a particular entry must be deemed to have been excluded from another entry which may deal with a more general subject matter.
  • Finally, as per Articles 73 and 162, the executive power of the Centre and the States is co-extensive with their respective legislative powers.
  • Coextensive legislative and executive power means that the Central and State governments can only take executive actions in matters where Parliament and State legislatures, respectively, have powers to legislate.

So, which list contains Disaster Management?

  • Disaster management as a field of legislation does not find mention in either List II or List III.
  • Nor does any particular entry in List I specifically deal with this.
  • Thus, the Disaster Management Act could only have been enacted by Parliament in the exercise of its residuary powers of legislation under Article 248 read with Entry 97 of List I.

Legal problems in using Disaster Management Act for pandemic

  • The Disaster Management Act allows the Centre to issue guidelines, directions or orders to the States for mitigating the effects of any disaster.
  • The definition of ‘disaster’ under the Act is quite broad and, literally speaking, would include a pandemic too.
  • Such a reading of the Act would vest the Central government with powers to issue directions and guidelines to State governments for dealing with the pandemic in their States.
  • However, ‘public health and sanitation’ is a specific field of legislation under Entry 6 of List II.
  • This would imply that States have the exclusive right to legislate and act on matters concerning public health.
  • Thus, the Centre’s guidelines and directions to the States for dealing with the pandemic trench upon a field of legislation and executive action that is exclusively assigned to the States — public health.
  • The Supreme Court has held time and again that federalism is a basic feature of the Constitution and the States are sovereign.
  • The Disaster Management Act cannot be applied to pandemics in view of the fact that the power to legislate on public health is vested specifically and exclusively with the States.
  • Also, under Entry 29 of List III, both Parliament and State legislatures are competent to legislate on matters involving inter-State spread of contagious or infectious diseases.
  • Therefore, theoretically speaking, Parliament would be competent to pass a law that allows the Central government to issue directions to the States to prevent inter-State spread of a disease like COVID-19.
  • That law is not the Disaster Management Act which is concerned with disasters in general, and not pandemics in particular.
  • ‘Prevention of inter-State spread of contagious and infectious diseases’ being a specific legislative head provided in List III, the same must be deemed to have been excluded from Parliament’s residuary legislative powers.
  • Therefore, the Disaster Management Act, which has been enacted under Parliament’s residuary legislative powers, cannot be applied to the prevention of the inter-State spread of contagious and infectious diseases.

Role of Centre under Epidemic Diseases Act 1897

  • The Epidemic Diseases Act, 1897, has the objective of preventing “…the spread of dangerous epidemic diseases.”
  • However, under this Act, it is the State governments which have the prerogative to take appropriate measures for arresting the outbreak or spread of a contagious or infectious disease in their respective States.
  • The Central government’s powers are limited to taking measures for inspecting and detaining persons travelling out of or into the country.
  • Even if that Act were to be amended, it would not empower the Central government to issue directions to the States to contain the pandemic within the State.
  • It can only deal with the inter-State spread of the disease.

Consider the question, “Use of the Disaster Management Act to deal with the Covid-19 pandemic gave rise to certain legal issues. Examine them.”

Conclusion

Instead of resorting to the Epidemic Diseases Act which gives powers to the States, the Centre has applied the Disaster Management Act. The States are not legally bound to observe the directions/guidelines being issued by the Central government and would be well within their rights to challenge them before the apex court.


 

Coronavirus – Health and Governance Issues

What is Stringency Index?Priority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Stringency Index

Mains level : Effectiveness of the nationwide lockdown and its shortcomings


India enforced one of the strongest lockdowns at an early phase of case growth. Now, an index created by the University of Oxford quantifies that.

The Stringency Index provides a computable parameter to evaluate the effectiveness of the nationwide lockdown in India.

What is Stringency Index?

  • It is among the metrics being used by the Oxford COVID-19 Government Response Tracker.
  • The Tracker involves a team of 100 Oxford community members who have continuously updated a database of 17 indicators of government response.
  • These indicators examine containment policies such as school and workplace closings, public events, public transport, stay-at-home policies.
  • The Stringency Index is a number from 0 to 100 that reflects these indicators. A higher index score indicates a higher level of stringency.

What does the Stringency Index tell us?

  • It provides a picture of the stage at which any country enforced its strongest measures.
  • Oxford provides an overlay of countries’ death curve and their stringency score.
  • Some countries saw their deaths just begin to flatten as they reached their highest stringency, such as Italy, Spain, or France.
  • As China pulled stronger measures, its death curve plateaued.
  • In countries such as the UK, the US, and India, the Oxford graphs find that the death curve has not flattened after strictest measures were enforced.

How does India compare with others?

  • The Index has found that India indeed had one of the strongest lockdown measures in the world — at a 100 score since March 22.
  • When compared to other countries with the similar or higher caseload, India called its strict lockdown at a much earlier point on its case and death curves.
  • These 18 other countries had more than 500 cases when they called their strictest lockdown, while India had 320.
  • Again, India had only four deaths on March 22, when its score reached 100, while most countries had more deaths at that point (except Switzerland; no deaths).
  • Spain called for its strictest measures later in its case and death count than all others. Sweden has had the most liberal measures in this set, and Iran the second most liberal.
Coronavirus – Health and Governance Issues

Law to deal with pandemicsop-ed of the day

Note4Students

From UPSC perspective, the following things are important :

Prelims level : NDMA 2005, Epidemics Act 1897

Mains level : Paper 2- Laws invoked for dealing with pandemic.


India lacks specific legislation to deal with pandemics like COVID. While NDMA 2005 and Epidemic Diseases Act 1897 has been invoked to deal with the present situation, both acts lack specific provision in dealing with the pandemics. Here we can take lessons from UK’s Coronavirus Act and Singapore’s regulations to create a well-drafted Indian COVID 19 law.

Which acts were used for enforcing lockdown?

  • The home ministry issued directions to State governments and district authorities under the Disaster Management Act of 2005.
  • Under the Act, the National Disaster Management Authority (NDMA) was set up under the Prime Minister, and the National Executive Committee (NEC) was chaired by the Home Secretary.
  • The State governments and authorities exercised powers under the Epidemic Diseases Act of 1897 to issue further directions.
  • District authorities such as the Commissioner of Police have consequently issued orders to impose Section 144 of the Criminal Procedure Code in public places.

Issues with the laws used for lockdown

  • The invoking of the Disaster Management Act has allowed the Union government to communicate seamlessly with the States.
  • But serious questions remain whether the Act was originally intended to or is sufficiently capable of addressing the threat of a pandemic.
  • The use of the archaic Epidemic Diseases Act reveals the lack of requisite diligence and responsiveness of government authorities in providing novel and innovative policy solutions to address a 21st-century problem.
  • Another serious problem is that any violation of the orders passed would be prosecutable under Section 188 of the Indian Penal Code.
  • But section 188 of IPC is a very ineffective and broad provision dealing with disobedience of an order issued by a public servant.

The UK and Singapore’s laws to deal with the pandemic

  • U.K’s Coronavirus Act, 2020: It deals with issues including emergency registration of healthcare professionals, temporary closure of educational institutions, audio-visual facilities for criminal proceedings, powers to restrict gatherings, and financial assistance to industry.
  • Singapore’s Infectious Diseases Regulations, 2020: These regulations provides for the issuance of stay orders which can send ‘at-risk individuals’ to a government-specified accommodation facility.
  • Both U.K.’s and Singapore’s laws set out unambiguous conditions and legally binding obligations.
  • As such, under Singaporean law, the violators may be penalised up to $10,000 or face six months imprisonment or both.
  • In contrast, Section 188 of the Indian Penal Code has a fine amount of ₹200 to ₹1,000 or imprisonment of one to six months.
  • Even then, proceedings under Section 188 can only be initiated by private complaint and not through a First Information Report.
  • As such, offences arising out of these guidelines and orders have a weak basis in terms of criminal jurisdiction thereby weakening the objectives of the lockdown.

Problems in the government’s approach

  • The Union government showed no inclination towards drafting or enacting COVID-19-specific legislation that could address all the issues pre-emptively.
  • There has been little clarity on a road map to economic recovery.
  • A consolidated, pro-active policy approach is absent.
  • In fact, there has been ad hoc and reactive rule-making, as seen in the way migrant workers have been treated.
  • This has also exposed the lack of coordination between the Union and State governments.

Consider the question, “Unlike many countries which legislated specific acts to deal with Covid-19 pandemic, India was already equipped with acts which enabled it to deal with the pandemic. Describe the acts and their provisions used to deal with the pandemic. What were the issues  with these provisions?”

Conclusion

In past instances, the Union government has not shied away from promulgating ordinances. These circumstances call out for legislative leadership, to assist and empower States to overcome COVID-19 and to revive their economic, education and public health sectors.


Back2Basics: National Disaster Management Act 2005

  • On 23 December 2005, the Government of India enacted the Disaster Management Act.
  • The act envisaged the creation of the National Disaster Management Authority (NDMA), headed by the Prime Minister.
  • The act also provides for State Disaster Management Authorities (SDMAs) headed by respective Chief Ministers.
  • NDMA and SDMAs spearhead and implement a holistic and integrated approach to Disaster Management in India.
  • The NDMA was formally constituted on 27thSeptember 2006, in accordance with the Disaster Management Act, 2005 with Prime Minister as its Chairperson and nine other members, and one such member to be designated as Vice-Chairperson.
  • According to the Disaster Management Act, 2005 a disaster is defined as-
  • A catastrophe, mishap, calamity or grave occurrence in any area, arising from natural or manmade causes, or by accident or negligence which results in substantial loss of life or human suffering or damage to, and destruction of, property, or damage to, or degradation of, environment, and is of such a nature or magnitude as to be beyond the coping capacity of the community of the affected area.
  • The MHA has defined a disaster as an “extreme disruption of the functioning of a society that causes widespread human, material, or environmental losses that exceed the ability of the affected society to cope with its own resources.

Epidemic Diseases Act  1897

  • The Epidemic Diseases Act is routinely enforced across the country for dealing with outbreaks of diseases such as swine flu, dengue, and cholera.
  • The colonial government introduced the Act to tackle the epidemic of bubonic plague that had spread in the erstwhile Bombay Presidency in the 1890s.
  • Using powers conferred by the Act, colonies authorities would search suspected plague cases in homes and among passengers, with forcible segregations, evacuations, and demolitions of infected places.
  • Historians have criticised the Act for its potential for abuse.
  • In 1897, the year the law was enforced, Lokmanya Tilak was punished with 18 months’ rigorous imprisonment after his newspapers Kesari and Mahratta admonished imperial authorities for their handling of the plague epidemic.

Provisions of the 1897 Epidemic Diseases Act

  • The Act is one of the shortest Acts in India, comprising just four sections. It aims to provide for the better prevention of the spread of Dangerous Epidemic Diseases.
  • The then Governor-General of colonial India had conferred special powers upon the local authorities to implement the measures necessary for the control of epidemics.
  • Although, the act does define or give a description of a “dangerous epidemic disease”.

Its various sections can be summarized as under

  • The first section describes all the title and extent, the second part explains all the special powers given to the state government and centre to take special measures and regulations to contain the spread of disease.
  • The second section has a special subsection 2A empowers the central government to take steps to prevent the spread of an epidemic, especially allowing the government to inspect any ship arriving or leaving any post and the power to detain any person intending to sail or arriving in the country.
  • The third section describes the penalties for violating the regulations in accordance with Section 188 of the IPC. Section 3 states, “Six months’ imprisonment or 1,000 rupees fine or both could be charged out to the person who disobeys this Act.”
  • The fourth and the last section deals with legal protection to implementing officers acting under the Act.
Coronavirus – Health and Governance Issues

Vande Bharat and Samudra Setu Missions to repatriate Indian nationalsPrelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Vande Bharat and Samudra Setu Missions

Mains level : Indian migrants and associated issues


India is all geared to operate flights and naval vessels to repatriate Indian nationals stranded abroad.

The name Samudra Setu typically sound like a combatant naval exercise whereas Vande Bharat reminds us of Train-18. Both ideas have opposite context and meaning. One must keep this in mind.

What is the ‘Vande Bharat Mission’ mission about?

  • ‘Vande Bharat Mission’ will see the operation of 64 flights from May 7 to May 13 to bring back around 15,000 Indian nationals stranded abroad.
  • Once completed, it may turn out to be the largest evacuation operation ever since the 1990 airlift of 1.7 lakh people from Kuwait.
  • Approximately, 2,000 people from abroad will fly back to India daily.

What is Indian Navy’s ‘Operation Samudra Setu’?

  • The Indian Navy launched ‘Operation Samudra Setu’ (Sea Bridge) as a part of national effort to repatriate Indian citizens from overseas.
  • Indian Naval Ships Jalashwa and Magar are presently enroute to the port of Malè, Republic of Maldives to commence evacuation operations from 08 May 2020 as part of Phase-1.
  • INS Jalashwa is the largest amphibious platform in the Navy and is based at the Eastern Naval Command headquarters in Visakhapatnam.
  • It can normally accommodate 1,000 people but will take about 800.
Coronavirus – Health and Governance Issues

Strategy for calibrated opening of economyop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Opportunity cost.

Mains level : Paper 2- Easing the lockdown, strategy that could be adopted.


The article discusses the performance of India so far and the strategy for reopening of the economy. Dividing the districts based on the number of cases and adopting a suitable approach for opening the economy there while keeping the spread of the virus in control is suggested in the article.

India performing better

  • While the OECD countries are reeling under the COVID-19 impact, India is clearly ahead of the curve.
  • This is not merely in terms of the confirmed cases in the country but is also strongly reflected in very low mortality numbers (8.5 deaths per lakh population) compared to other nations (4,040 in the UK and 1,930 in the US).
  • While the first cases were reported in most hotspot countries and India around the same time (last week of January), today, the outbreak is far more manageable in India than in most other countries.
  • It was pragmatic for a resource-poor country to be pre-emptive and declare a national lockdown when the total number of cases were still low at 500.
  • The subsequent growth of the pandemic clearly shows a perceptible decline in the number of cases due to the lockdown.
  • Though stringent, this was much-needed and a timely policy intervention by the government.
  • It is important, however, to appreciate the high and growing opportunity costs that are involved during a lockdown.
  • We must brace ourselves for long-term pandemic management (18 to 24 months) with significant economic impact on our lives.

Policy interventions by government and two major concerns

  • The immediate costs of the lockdown are borne by the most economically vulnerable people in society.
  • This perhaps was the rationale behind the first round of economic policy interventions announced by the finance minister within a few days of the lockdown.
  • They targeted front-loading of cash transfers through PM-Kisan, support to construction workers, self-help groups, food distribution through the public distribution system, among others.
  • Two major concerns: Beyond welfare concerns, there are significant growth concerns that are mounting with every day of economic inactivity in the country.
  • Companies are struggling to honour payroll and maintain their workforce against cancelling orders and declining demand for their goods and services.
  • These in turn will lead to greater delays and defaults in loan repayments, thereby further weakening the fragile banking sector and struggling credit markets.

The RBI’s intervention and increasing damage to the economy

  • The Reserve Bank of India stepped in for some timely monetary interventions.
  • However, the longstanding climate of risk aversion within the banking sector will mean that transmission of these monetary interventions is unlikely to be timely or adequate.
  • All eyes are set expectantly in one direction.
  • Historically, when economies are faced with major calamities, governments step in to stabilise the environment and boost confidence within the business community.
  • We have seen this response from all major economies disrupted by COVID-19 over the last several weeks.
  • India will not be an exception to this as the government fine-tunes its strategy to support and kickstart our immobilised economy.
  • The opportunity cost of time, however, is ballooning with each passing day.
  • Just like the spread of the virus, we are up against the full force and power of compounding.
  • Mindful policy interventions, when timed well, can cut growing losses and the misfortune of many.

How the states are performing against Covid-19?

  • While we have succeeded in slowing the growth of the virus at the national level, the true gains and pains are at the state and local level.
  • As the data reveals, currently we have three states that have made remarkable gains and “flattened the curve” of COVID cases.
  • These are Kerala, Haryana and Tamil Nadu where recoveries are growing and active cases are rapidly declining.
  • States like Karnataka and Telangana are improving their recovery rates consistently, despite fluctuations.
  • Every state and local administration has to keep eternal vigil and double down on containment and testing.
  • They have to aggressively improve their contact tracing efforts with the help of their police who are trained in debriefing, call record mapping and have more manpower than public health departments of local administrations.

The article contains the policy and governance aspects which are important from Mains Paper-2, and economic issues such as the size of the package and opportunity cost of time involved are important from the Mains Paper-3 perspective. Take note of these issues.

What should be the strategy?

  • Given the scale and variation in infection control across the country, our national strategy needs to be informed and calibrated.
  • Currently, there are more than 300 districts in the country which have reported zero COVID-19 cases.
  • This can be confirmed quickly with some random testing and the lockdown can be lifted effective immediately.
  • Then there are about 225 districts which have reported less than 10 cases each.
  • With adequate ring-fencing at the level of the block where these cases are reported, these districts too can afford to lift their lockdowns.
  • There are, however, approximately 30 districts across the country which have reported large numbers of confirmed cases and are identified as “hotspots”.
  • The lockdown in these places needs to continue with some relaxations for basic trade and essential services.
  • Not surprisingly, these “hotspots” are also important economic centres of the country.
  • The capacity of the local administration to develop and enforce appropriate strategies of containment, contact tracing and testing, should determine their decisions to ring-fence and isolate blocks while allowing other parts of the district/city to resume economic activity.

Way forward

  • Given the uncertainty of the virus, we seem prepared for large hospitalisation and care if the need arises.
  • The efforts now must be to further contain the growth of the infection.
  • Acting against the power of compounding: If the current rate persists, we will reach over lakh cases within three weeks. That is the power of compounding we are against.
  • Public health support team: Beyond knowledge sharing across states and adopting successful containment strategies from each other, there is a role for the central government in providing “NSG-like” public health support teams to states that need them.
  • Economic package: On the economy front similarly, the central government’s timely economic package should flatten the curve of exponentially rising opportunity costs across the sectors.

Conclusion

Given the relative scale and virulence of the COVID-19 virus in India, the odds seem stacked in favour of a calibrated opening of the economy.

 

Coronavirus – Health and Governance Issues

[pib] Year of Awareness on Science & Health (YASH) ProgramPIB

Note4Students

From UPSC perspective, the following things are important :

Prelims level : YASH Program

Mains level : NA


National Council for Science & Technology Communication (NCSTC) has launched a programme on health and risk communication ‘Year of Awareness on Science & Health (YASH)’ with focus on COVID-19.

There are various initiatives named with Hindi acronyms. YASH is newer among them. It is very unlikely to frame a prelim question on it. Still, we should know it for the sake of general awareness.

YASH Program

  • YASH is a comprehensive and effective science and health communication effort for promoting grass-root level appreciation and response to health.
  • The current pandemic scenario has posed concerns and challenges all around, where scientific awareness and health preparedness play a significant role to help combat the situation.
  • This requires translation and usage of authentic scientific information to convey the risks involved and facilitates communities to overcome the situation.
  • The programme will encompass the development of science, health, and risk communication software, publications, audio-visual, digital platforms, folk performances, trained communicators, especially in regional languages to cater to various cross-sections of the society in the country.
  • It would help to save and shaping the lives of people at large, as well as build confidence, inculcate a scientific temper and promote health consciousness among them.

Activities under YASH

  • The programme is aimed at minimizing risks at all levels with the help of public communication and outreach activities.
  • It would promote public understanding of common minimum science for community care and health safety measures like personal sanitation and hygiene, physical distancing, maintaining desired collective behaviour and so on.
  • It also includes information dissemination mechanisms to reduce the fear of risks and build confidence with necessary understanding for adopting sustainable healthy lifestyles and nurturing scientific culture among masses and societies.
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Coronavirus – Health and Governance Issues

Spanish Plan for Phased Easing of LockdownPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Easing of the nationwide lockdown and major considerations


  • Spain’s Prime Minister has presented a four-phase lockdown exit strategy for the country.
  • It’s imperative for India to learn from global examples for easing lockdown without doing away with health concerns.

With the nearing end of nationwide lockdown, various exit strategies are being discussed for a smooth restart.

Spain’s exit strategy

  • The opening up of the lockdown will begin with phase 0 throughout Spain, except for a few islands that will already be in phase 1 by then.
  • A week later, provinces will enter phase 1, which will last for two weeks and the remaining phases will also last for two weeks each.
  • In total, the de-escalation will take at least six weeks to be complete.

Phase 0: The preparation phase

  • De-escalations in this phase include opening up of takeaway facilities at restaurants and opening up of some other establishments such as hair salons.
  • From May 2, individuals will be able to go out for a walk or to exercise alone or with people they stay with. In this phase, professional athletes will be able to access individual training sessions.
  • Children aged 14 years or younger have been allowed to go out for walks from April 26.

Phase 1: The initial phase

  • Begins on May 11. Small businesses will be allowed to open under strict security measures.
  • For instance, gyms can open for people who want to train individually and by appointment.
  • Further, hotels and tourist accommodations will be allowed to open, excluding the common areas and with certain restrictions in place.
  • Places of worship will also be allowed to open, limiting their capacity to one-third. Owners of terrace bars can open their establishments but with 30 per cent capacity.
  • In this phase, some degree of social contact with a limited number of people may also be allowed, subject to what the conditions are then.

Phase 2: The intermediate phase

  • Begins on May 25.Will include the resumption of hunting and sport fishing, and the opening of cinemas and auditorium theatres at one-third of their capacity.
  • Visits to monuments and cultural facilities, such as exhibition halls and conference rooms, will resume with one-third occupancy.
  • Cultural shows will be allowed with less than 50 people in closed spaces. In the outdoors, shows and events can be held with less than 400 people provided they are seated.
  • All places of worship will have to limit their capacity to 50 per cent.

Phase 3: The advanced phase

  • Begins on June 8 and provided the situation is under control, general mobility will be made more flexible.
  • Wearing masks will be recommended when people venture outside, especially on public transport. In commercial settings, capacities will be restricted to 50 per cent.
  • Beaches may also open in this phase. The movement of people into other provinces or islands is restricted until the de-escalation process is complete.
Coronavirus – Health and Governance Issues

New global order in post-Covid-19 worldop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Changes in the post-Covid-19 world in geopolitics and the geoeconomics.


The article discusses the changes that the world will experience in the global order in the aftermath of Covid-19. The major changes will be on the economic and geopolitical front. Various changes are discussed in the article. We have read some article on the same topic and the basic theme is the same. Role of China and the US, failure of the international institutions are some of the common themes.

Failure of international institutions

  • The existing international institutions such as the United Nations, the United Nations Security Council and the World Health Organization (WHO) are seen to have failed to measure up to the grave challenge posed by the pandemic.
  • The UN Security Council is under attack for being slow in dealing with a situation that appears, at least on the surface, far graver than any military threat in recent decades.
  • The WHO has been tarred with the charge of bias and of grossly underestimating the nature of the epidemic.
  • That prestigious global institution should have been singled out for attack at this time speaks volumes about the mood prevailing across the world.

Economic shock

  • There are many other aspects of the COVID-19 crisis that will drastically impact the globe.
  • Negative growth: On the economic front, the World Bank has already predicted negative growth for most nations. India’s growth forecast for the current fiscal year has been put at 5% to 2.8%.
  • Contraction of the economy and the loss of millions of jobs across all segments will further complicate this situation.

One of the most important factors that we realised in the corona crisis in the role of the state. Take note of this factor. A question can be asked on the role of the state, for ex. “The COVID-19 pandemic has brought into focus the important role of the state in our lives. comment.”

The important role of the state in focus

  • What is likely to change even more dramatically are certain other aspects relating to political management and security. Both terms are set to gain new meanings.
  • The role of the state as an enforcer of public goodwill almost certainly become greatly enhanced.
  • The dominant imperative would be to not put limits on the role of the state even where the situation may not be as grave as the present one.
  • Many pieces of legislation of yesteryears that had been relegated to the archives — they were perceived to be anachronistic in a modern democratic set-up — may get a new lease of life.
  • Some pieces of legislation such as the Disaster Management Act already reflect this reality today.
  • Other pieces of legislation could follow in its wake.
  • This trend is already becoming evident to some extent across the world. Europe has shown a willingness to sacrifice personal liberties in favour of greater state control.
  • Post COVID-19, the world may have to pay a heavy price in terms of loss of liberty. An omnipotent state could well become a reality.

Following are the changes in geo-economics and geo-politics that post-covid world would see.

Role of China under scrutiny

  • Far-reaching changes can also be anticipated in the realm of geo-economics and geopolitics. The world needs to prepare for a sea change.
  • One nation, viz. China, is presently seeking to take advantage of and benefit from the problems faced by the rest of the world in the wake of the epidemic.
  • Negligence on the part of China: China remains totally unfazed by the stigma that the current world pandemic owes a great deal to its negligence.
  • More importantly, it is seeking to convert its ‘failure’ into a significant opportunity.
  • This is Sino-centrism at its best, or possibly its worst.
  • China now seeks to benefit from the fact of its ‘early recovery’.
  • It wants to take advantage of the travails of the rest of the world, by using its manufacturing capability to its geo-economic advantage.
  • Seeking geopolitical advantage: Simultaneously, it seeks to shift from being a Black Swan (responsible for the pandemic), to masquerade as a White one, by offering medical aid and other palliatives to several Asian and African countries to meet their current pandemic threat.
  • In turn, it seeks to gain a geopolitical advantage by this action.

Hostile takeover bids by China

  • There are enough reports of China’s intentions to acquire financial assets and stakes in banks and companies across the world amid crisis.
  • Shares in HDFC: India seems to have woken up only recently to this threat after the Peoples’ Bank of China acquired a 1% stake in India’s HDFC.
  • Across the world, meanwhile, the clamour against China’s hostile takeover bids is becoming stronger.
  • Several countries apart from India, such as Australia and Germany, have begun to restrict Chinese foreign direct investment in companies and financial institutions in their countries.
  • These countries recognised the inherent danger of a possible Chinese hostile takeover of their critical assets.

China taking advantage of RCEP and Belt and Road initiative

  • Restricting hostile takeovers may not be adequate to checkmate China.
  • It is poised to dominate the Regional Comprehensive Economic Partnership (RCEP).
  • Which will enable China to exploit market access across the Association of Southeast Asian Nations, East Asian nations, Australia and New Zealand.
  • Together with its Belt and Road Initiative, China is ostensibly preparing the way for a China-centric multilateral globalisation framework.

The diminishing role of the US’s and Europe

  • The geopolitical fallout of this pandemic could be still more serious.
  • One distinct possibility is that COVID-19 would effectively put paid to the existing global order that has existed since the late 1940s.
  • The United States which is already being touted in some circles as a ‘failing’ state, will be compelled to cede ground.
  • Weakened economically and politically after COVID-19 has ravaged the nation, the U.S.’s capacity to play a critical role in world affairs is certain to diminish.
  • The main beneficiary of this geopolitical turnaround is likely to be China, a country that does not quite believe in playing by the rules of international conduct.
  • Weakened Europe: Europe, in the short and medium-term, will prove incapable of defining and defending its common interests, let alone having any influence in world affairs.
  • Role of Germany: Germany, which may still retain some of its present strength, is already turning insular.
  • Both France and the post-Brexit United Kingdom will be out of the reckoning as of now.

Problems in West Asia and the possible role of Israel

  • In West Asia, both Saudi Arabia and Iran are set to face difficult times.
  • The oil price meltdown will aggravate an already difficult situation across the region.
  • There may be no victors, but Israel may be one country that is in a position to exploit this situation to its advantage.

India: Economic and geopolitical challenges

  • In the meantime, the economic downturn greatly reduces India’s room for manoeuvre.
  • In South Asia, India faces the prospect of being isolated, with the Chinese juggernaut winning Beijing new friends and contacts across a region deeply impacted by the economic consequences of the COVID-19 pandemic.
  • Likewise, India’s leverage in West Asia — already greatly diminished — will suffer further.
  • With oil prices going down and the Indian expatriate community (who are among the hardest hit by this downturn) out on a limb.
  • Reduction in remittances: Many of the latter may seek repatriation back to the host country, substantially reducing the inflow of foreign funds to India from the region.

A question based on the changes in the global order in the post-pandemic world could be asked by the UPSC, for ex- “In the post-Covid-19 world, we are experiencing several changes. What are the changes in the geo-politics that are likely to affect India’s interests?”

Conclusion

In the post-Covid-19 world, we are about to see many changes on the economic and geopolitical front. India should prepare itself for the emerging challenges on various fronts.

Coronavirus – Health and Governance Issues

Public policy dilemma of choosing between lives and livelihoodop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Policy making and balancing the conflicts between various stakeholders.


This article deals with how the different sections of a society assign different weightage to the various factors they are faced with in life. In the case of Covid-19, one section of society which is well-off might care more about the possible loss of life while other section might end up attaching more weightage to the loss of livelihood than to the possible loss of life due to infection. The article discusses this issue in detail.

Difference between risk and uncertainty

  • Since the days of Frank Knight, economists have differentiated between the two.
  • Risk has a known probability distribution.
  • For uncertainty, the probability distribution is unknwon.
  • COVID-19 makes us confront uncertainty, not risk.
  • For uncertainty, there is a subjective probability distribution, which can, and does, vary from individual to individual.

So, how the subjective probability distribution is devised by a person?

  • Through information and experience, one already possesses.
  • There are various rationality assumptions used by economists. They are often violated.
  • Otherwise, behavioural economics wouldn’t have come into existence.
  • Typically, given a situation, when your decision doesn’t agree with someone else, you say they are being irrational.
  • However, with uncertainty, the problem may not be with rationality assumptions, but with differences in subjective probability distributions.

Lack of data for various factors

  • Because of COVID-19, there is a certain risk of getting infected. Let’s call this the infection ratetotal infections divided by the total population.
  • We don’t know this infection rate for India or for any other country for that matter.
  • No country has done universal testing.
  • No testing for random sample: No country has done universal testing for a proper random sample either.
  • The ICMR has told us more than 75 per cent of Indian patients will be asymptomatic.
  • Who do we test? Those who show symptoms, those who have been in contact with confirmed patients and those who suffer from severe respiratory diseases.
  • Most countries do something similar.
  • Sampling bias: In other words, when we work out an infection rate based on those tested, there is a sampling bias.
  • This isn’t a proper infection rate.
  • The only country where we have had something like a random sample is Iceland.
  • There, the infection rate was 0.8 per cent.
  • Data for death rate: There are similar caveats about the death rate.
  • If we mechanically divide the number of deaths by the number of confirmed cases for India, we will get a death rate just over 3 per cent.
  • The global figure is a little less than 7 per cent.
  • But neither of these is a death rate for the total population since only those with severe symptoms are included in infection numbers.
  • Three per cent or seven per cent are over-estimates.
  • In a controlled environment like Diamond Princess, death rate as a ratio of total passengers, and not those infected, was less than 0.4 per cent.
  • The true infection rate and true death rate are not alarming numbers.

How the lack of data is reflected in subjective probability distribution?

  • There are slices in India’s population pyramid with rural/urban and other spatial differences too.
  • Consider two extreme types-type A and type B.
  • Type A, who are globalised in information access and morbidity.
  • Life expectancy is 80 plus and there are lifestyle diseases like diabetes and high blood pressure.
  • This co-morbidity increases possible death rates and thanks to globalised access to information, certainly increases perceptions about death rates, making them out to be higher than they are.
  • Some of them have fixed incomes, regardless of what happens to lockdown.
  • The high probability assigned to loss of life: In terms of maximising expected payoffs with a subjective distribution, high probability is attached to loss of life and low probability to loss of livelihood.
  • How type B forms a subjective probability?
  • Type B, someone whose life expectancy is 60, without a fixed income stream and whose health concerns are tuberculosis and water-borne diseases, not COVID-19.
  • Nor is access to information that globalised.
  • The high probability assigned to loss of livelihood: High subjective probability will be attached to loss of livelihood and low probability to death from COVID.
  • Both types reflect subjective probabilities. Neither is “irrational”.
  • The tension between the two: Type A would like the lockdown to continue indefinitely, until the long tail of the infection curve tapers off, perhaps beyond September.
  • Type B would like lockdown to be eased soon, with necessary restrictions in hotspots.
  • There is indeed tension between lives and livelihood.
  • Even if health outcomes and information access are like Type A, but income is contingent on growth, preferences might mirror Type B.

The issues highlighted here can be broadly used in the various scenario where there is uncertainty involved and various stakeholders perceive the probable outcomes in entirely different ways. Various points here can be used to answer the question based on policy making.

Balancing the differential individual preferences in public policy

  • One set of individuals imposes its choice on the rest.
  • Type A disproportionately influences policy.
  • This determination of aggregate preferences is a dynamic process.
  • Therefore, sooner or later, Type B contests this and as the lockdown is prolonged and livelihood costs mount, discontent surfaces, as it has across a range of countries.
  • There were also welfare economics notions that pre-dated social choice theory, such as compensation principles of Kaldor, Hicks and Scitovsky.
  • The point can be made using the two stereotypes. Specifically, Type A need to compensate Type B for their losses.
  • To state it starkly, livelihood losses suffered by Type B need to be compensated by the government through redistributive measures and this has to be financed by higher taxes imposed on Type-A.
  • The right question for the Type A is not whether they want the lockdown to continue, but whether they are willing to pay a COVID-tax to support lockdown extension.

A question based on policy formation issues explained here can be framed, for ex. “Risk has a known probability distribution. For uncertainty, the probability distribution is unknown. COVID-19 makes us confront uncertainty, not risk. In this context, there is a debate between saving lives and saving livelihoods. In such a scenario, what can be the most probable solutions that public policy must delve into, in order to maintain the balance between this uncertainty and risk.”

Conclusion

Extending or ending the lockdown decision represent the public policy dilemma. Without a revival in growth, the tax-paying capacity of Type B is limited and with job losses, some Type As become Type Bs. The choice is starker.

Coronavirus – Health and Governance Issues

Stress test of leadership in pandemicop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Do you agree with the view that coordination at global level was lacking in fight against Covid-19?


The article discusses the three stages involved in successfully dealing with the pandemic. In the next part, it goes on to explain the factors that determine the success or failure of the governments. In the last week, we read about the success story of Kerala and underlying reasons. This article is also written on similar lines.

Stages in the pandemic response

  • Disease outbreaks, even global pandemics, are scarcely new. The playbook for dealing with them, therefore, is well understood and has been honed by practices and lessons gleaned from hard-fought battles.
  • A first stage is an early clear-eyed recognition of the incoming threat, and, in the case of COVID-19 at least, requires the unpalatable decision to lock down society.
  • Ideally, this is done with full consideration of how to support the most vulnerable members of society, especially in a country such as India, where so many survive hand-to-mouth.
  • This is a phase aimed at buying time, of flattening the epidemic curve, so that public health facilities are not overwhelmed.
  • And, for using this time, paid for by collective sacrifice, to secure the personal protective equipment (PPE) and medical supplies necessary to save lives.
  • The second phase of the pandemic response is slowly to ease the burden on the economy by permitting a measured return of business activity so that livelihoods and supply chains can be restored.
  • This stage can only be safely executed if accompanied by a war-footing expansion of testing capacity so that new infections can be identified and isolated at once, allowing contact tracing to be implemented by masses trained to do this crucial and painstaking work in communities across the country.
  • The final stage, which for COVID-19 seems a lifetime away, is a mass vaccination programme and then the full rebuilding of economic and social life.
  • None of this is easy, but, like an examination in a dreaded subject, one’s only hope is early and persistent preparation and, at crunch time, remembering the lessons learned.

The above-mentioned stages are sort of a template that seems to have gained acceptance for dealing with the pandemic. A question based on it, like “What are the various stages involved in government’s response to deal with a pandemic?”

Following three factors make the difference between successful and failed response

1. Leadership problems in global politics

  • The defensive finger-pointing, opportunistic politicking and xenophobic posturing are shown by some leaders amid pandemic.
  • This is not a crisis that can be tackled without robust and multidimensional international cooperation between nations.
  • We are watching in real-time the benefits of intellectual collaboration that does not stop at national borders.
  • From the epidemiologists to the medical community identifying more effective treatments, to the research scientists racing to find a vaccine, we are benefiting from collaboration.
  • But the nationalistic turn in global politics over the past two decades has reduced investment in and undermined the legitimacy of the very institutions that facilitate international partnership at the very time they are needed most.
  • Prime Minister Narendra Modi did well to convene the leaders of the South Asian Association for Regional Cooperation (SAARC) nations in mid-March to discuss the possibility of a regional response.
  • But that video-conference call also highlighted that there have been no summit-level meetings of SAARC since 2014.
  • Similarly, United States President Donald Trump demanded that the U.S. end funding of the World Health Organization (WHO).
  • This not only endangers American lives by cutting off his own administration’s access to vital international data.
  • But also directly affects India which receives significant funding and expertise from WHO with ~10% of its overall WHO financing in 2019 coming directly from the U.S.

2. The whole-of-the-government strategy

  • Pandemic response requires a whole-of-government strategy, for which political will and legitimate leadership are vital to convene and maintain.
  • Germany and Kerala provide two powerful though different examples of this in action.
  • In Germany, in spite of a high level of federalism that gives its States (Länder) a lot of power, Chancellor Angela Merkel’s ability to mobilise the entire system has allowed Germany to emerge as a success story in Europe.
  • In Kerala, State Chief Minister Pinarayi Vijayan convened a State response team at the earliest possible moment and has provided the full weight of his office in support of a coordinated public health strategy that has been accepted by the State’s citizens who have learned to trust the government in such situations.
  • Yet these two examples stand out in part for how rare they are.
  • Consider again the cautionary tale of the U.S. where some State Governors have yet to issue stay-at-home orders.

3. The robust public health system

  • We are seeing first hand the consequences of starving public health systems of necessary funds and resources.
  • The comparative advantage of the private sector is efficiency; the need of the hour in pandemic response is redundancy, or, more precisely, excess capacity.
  • Most hospitals do not need invasive ventilators normally, just as they do not need vast stocks of PPE and extra intensive care units beds, but these are essential goods right now as we brace ourselves for a flood of sick patients into hospitals.
  • Watching the advanced health-care system of northern Italy buckle under the unimaginable pressures to which it was exposed over the past six weeks should be a cautionary tale for all countries that thought turning health care over to private actors was responsible governance. It is not.
  • Again, consider Kerala, which has consistently ranked at the top of State rankings for health expenditures.
  • Kerala has, a well-functioning local public health system capable of implementing the test-isolate-trace protocols critical for fighting COVID-19.

Conclusion

With the central role of leadership and governance underlined in the successful dealing with the pandemic, leadership across the world need to come together to coordinate at all levels in dealing with the problems that are not bound by any border.

Coronavirus – Health and Governance Issues

[pib] ‘COVID India Seva’ platform for citizen engagement on COVID-19PIB

Note4Students

From UPSC perspective, the following things are important :

Prelims level : COVID India Seva

Mains level : Coronovirus outbreak and its mitigation


The Union Ministry of Health & Family Welfare has launched the COVID India Seva platform to establish a direct channel of communication with millions of Indians amid the pandemic.

We can take this initiative as an example while answering mains questions like – “India’s fight against Coronavirus pandemic is a public movement at large. Discuss.”

COVID India Seva

  • This initiative is aimed at enabling transparent e-governance delivery in real-time and answering citizen queries swiftly, at scale, especially in crisis situations like the ongoing COVID-19 pandemic.
  • Through this, people can pose queries @CovidIndiaSeva and get them responded to in almost real time.
  • @CovidIndiaSeva works off a dashboard at the backend that helps process large volumes of tweets, converts them into resolvable tickets, and assigns them to the relevant authority for real-time resolution.
  • The dedicated account will be accessible to people be it local or national in their scope.
  • The Ministry will respond to broader queries and public health information. This does not require the public to share personal contact details or health record details.
Coronavirus – Health and Governance Issues

The occasion to revisit the state’s roleop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Need to revisit the state's role in political, social and economic aspect of the society.


The role of the state has come in the focus in the corona crisis. This article describes how the dominant role once played by the state declined over time and what implications it has for society. In the next part of the article, need to revisit the political system of the country is emphasised.

Paradigm shift due to Covid-19

  • We are unlikely to return to pre-coronavirus homeostasis after the war against it is won.
  • No section or sector is going to remain untouched and unaltered by the devastation the novel coronavirus is now unleashing.
  • Its annihilation in the near future is not on the cards.
  • Vaccines are going to be slow in coming; therefore, its taming is not immediate.
  • The second wave of an outbreak is a realistic probability.
  • Unlike the other threats: Unlike other threats to humanity such as global warming and nuclear armageddon, this threat is now, not in the future.
  • It is here simultaneously for everyone, not for someone else and somewhere else; its casualties are around us, not in faraway battlefields or polar regions and coastal areas.
  • No country can rescue another; it is each one fending for itself.

Possibility of a deep recession in the world

  • If the lockdown continues, the world economy will contract by as much as 6% according to the International Monetary Fund.
  • If it is not extended, the loss of human lives could be of unacceptable proportions.
  • The global community will be fortunate if it does not spiral into depression.
  • Both demand and supply contractions are likely to be severe.
  • They are not going to be short-lived. Political systems, economic architectures and cultural mores are on trial.

Time to build a new paradigm

  • Work patterns, production and distribution practices are up for
  • Denial and wishing away unpleasant, yet probable, realities by governments, global organisations and public intellectuals will only compound economic, social, political and human costs.
  • Build a new paradigm: We must now be quick in seizing lessons from the present crisis and get ready to embark on measures to build a new paradigm of life, work and governance.

Role of state in focus once again

  • The enlarged economic role of the state in the aftermath of the Second World War came under major assault since the 1980s.
  • Leaders who asked ‘where is society?’ rode to power on the promise of cutting down the government’s role.
  • Systems that were alternatives to capitalism fell out of favour.
  • Entrepreneurs heading unicorns and ‘soonicorns’ have become the new demigods.
  • Minimum governance became the mantra.
  • India too without much consideration joined this creed.
  • Role of state in focus: But COVID-19 is beginning to challenge the political economy of this creed.
  • Very soon the full scores of the performance of state and non-state actors in the COVID-19 stress test will be available across the globe.
  • The Indian state will also have to give answers as far as its report card is concerned.

How the state’s role declined in India?

  • India embarked on the path of reducing the role of the state, initially, with such caveats as ‘safety net’ and ‘reform with a human face’.
  • Gradually, those caveats fell by the wayside.
  • The Indian state’s role in health care, education, creation and maintenance of infrastructure and delivery of welfare has shrunk or become nominal, half-hearted, inefficient, and dysfunctional.
  • Of course, it is true that it did not give a great account of itself in these sectors even before the 1991 departure.
  • Disappointment with the dismal performance in its economic and administrative functions in the backdrop of a changing global ideological ecosystem encouraged a sharp de facto downsizing of the Indian state’s role.
  • Acceptance among the upper section of society: Its retreat from vital functions and abdication of its social responsibility have gained acceptance and legitimacy among the articulate upwardly mobile.
  • While retreat and abdication found influential and forceful evangelists, the selective retreat had few advocates.
  • This departure, however, was not vigorously interrogated.
  • Supporters of the departure, on the other hand, had little engagement in giving shape to the new policy.
  • Nor did they worry about calibrating the architecture of the emerging role for the state.
  • As a result, ‘private sector’ became the new holy cow in place of the ‘state sector’.
  • What made matters worse is the culture of a simplistic and shallow discourse of public policy that took hold in civil society.
  • It mindlessly privileges the agenda of corporates. It transacts in the idiom of stock exchanges and international rating agencies.

Who is affected due to declined role of the state?

  • Today, those who bear the brunt of the consequences of shrunken and unresponsive state are the farmer and farm labour, the migrant worker, the unemployed, those in the unorganised sector, the rural poor, and the small entrepreneur.
  • They are paying the highest price for the necessary but unbearable lockdown.
  • They are either stranded far away from home or confined to their homes with no work and incomes, unsupported by the state.
  • Underfunded public health systems are unable to serve them.
  • But the dominant strand of public discourse is out of its depth. It has no time for these concerns.
  • Worse, this discourse can be gamed from time to time.
  • And the alternative discourse is too feeble to draw the attention of the government to the grave implications of COVID-19 for the weak in our society.

State’s responsibility towards the marginalised

  • The state’s first responsibility is marginalised.
  • The marginalised are also the crucial part of our economy. They lubricate its wheels and generate demand.
  • Demand-side needs to be revived: Announcing stimulus packages that address the supply side alone without beefing up the demand side will be self-defeating to corporates.
  • Prioritising the needs of corporate entities will lead to convulsions in our body politic in the wake of COVID-19.
  • The state is in danger of forfeiting legitimacy if it does not ensure the survival and revival of the marginalised sections.

From the Mains perspective,  following points are important to highlight the importance of the state’s role in ensuring the welfare of society and why there is a need to revisit the current system owing to certain problems in it.

Time to revisit the political economy of the Indian state and its role

  • The country should begin a vigorous discourse on redefining every aspect of its involvement in our collective political, economic and social life.
  • The relation between the state and economy, its role in allocating resources and addressing questions of inequality, its duty to provide basic human needs, the extent of the market’s role in providing services such as health, education, civic amenities needs to be revisited.
  • The responsibility of the state and private enterprise towards deprived sections need urgent attention.
  • Re-examining the political structure: We should re-examine the efficacy of our political structures too.
  • The equation between citizens and government and what its implications are for individual freedom, privacy and national security.
  • Also, the equation between the legislature and executive needs to be re-visited.
  • Financial powers: The balance of administrative and financial power between provinces and the union on the one hand and provinces and local bodies on the other should be reconsidered.
  • Election of the representatives: The way we elect our representatives to legislatures must also come under the lens.
  • The issue of weakened local authorities and enfeebled legislatures need attention.
  • For, they are at the coalface, delivering the state to the citizen.
  • The way legislatures are elected and governments are made and unmade must be scrutinised.
  • Our outrage at the power of big money in our electoral system has not arrested its growth.
  • The role of serving and retired members of higher judiciary ought to be a part of the debate.
  • We had an opportunity for intensive debate when the Justice Venkatachaliah Commission submitted its report in 2002 to review the working of the Constitution.

Conclusion

The opportunity that COVID-19 provides should not be squandered and must be utilised to have a fresh look at the various issues regarding our social, economic and political life. And states responsibility towards marginalised.

Coronavirus – Health and Governance Issues

Beijing’s response to Covid underlines that the world needs more democracy, not lessop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- How effective is the democratic system in dealing with the pandemics like Covid-19?


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

Two aspects of Chine’s propaganda campaign

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

What China would like us to believe?

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

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

Democracy Vs. One-party system

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

China’s assistance and resentment against it

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

The revival of China’s economy

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

Changes in supply chains in the future and opportunity for India

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

Conclusion

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

Coronavirus – Health and Governance Issues

A virus, social democracy, and dividends for Keralaop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Social democracy.

Mains level : Paper 2- What were the factors that helped Kerala deal most effectively with the Covid-19 pandemic?


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

Kerala’s success story

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

Why does Kerala stand out in India and internationally?

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

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

How social democracy is practised in Kerala?

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

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

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

Conclusion

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

Coronavirus – Health and Governance Issues

What nation can learn from Kerala in the fight against Covid-19?op-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- What are the factors that helped Kerala deal with Covid-19 successfully compared to the rest of the country?


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

Kerala stands out in India: some figures and facts

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

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

Preparing for the next challenge

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

Strength of the public health system of Kerala

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

Learning from the past experience

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

Testing and tracing in Kerala

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

Welfare payment in Kerala more than the rest of the country

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

Decentralisation paying off in Kerala

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

Conclusion

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

Coronavirus – Health and Governance Issues

China manipulates the WHO, India needs to be cautiousop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : WHO.

Mains level : Paper 2- How failure of WHO to alert the world in time of Covid-19 pandemic matters for India?


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

China’s role in electing Director-General of WHO

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

Pandemic as a wake-up call for India

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

Dependence on China for API

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

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

The US’s stand on WHO funding

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

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

Issue of funding and spending by the WHO

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

Conclusion

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

Coronavirus – Health and Governance Issues

Partnership with the private sector in a fight against Covid-19op-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- The dominance of private health sector in India makes partnership with it a must to deal effectively with any pandemic.


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

Significance of private healthcare in India

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

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

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

1 Testing

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

2 Converting private hospitals into Covid-19-only hospitals

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

3 Protecting healthcare workers

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

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

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

5 Collaborate to share knowledge on the epidemic

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

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

Conclusion

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

Coronavirus – Health and Governance Issues

The WHO balance sheetIOCR

Note4Students

From UPSC perspective, the following things are important :

Prelims level : WHO and its funding

Mains level : Fall of major global institutions amid COVID-19 outbreak


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

 

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

About WHO

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

Where does WHO get its funding from?

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

Its expenditure

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

How does WHO prioritise its spending?

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

WHO and India

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

Immediate reason for US withdrawal

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

Impact

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

Also read:

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

Coronavirus – Health and Governance Issues

Private: Success stories in handling COVID-19 crisisop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much.

Mains level : Successful models for covid-19 containment


 Context

  • The so-called sudden outbreak of a novel Coronavirus that began in the Chinese city of Wuhan has rocked the world. Now, infections have been confirmed in almost every country.
  • With crumbling health infrastructure due to overburden, India’s preparedness for handling this epidemic has become a major challenge.
  • The world along with India being no exception has responded with extraordinarily aggressive measures such as phased lockdowns, Bhilwara Model, Pathanamthitta Model, Taiwan model etc.
  • The success of these models is attributed to various best practices which are were implemented days before the thought of nationwide lockdown was incepted.

An old African proverb says, “An ant can kill an elephant.” This effectively seems true in the current COVID-19 context. While the contagion is ravaging economies, people and livelihoods globally, governments — rich and poor — are gasping for an effective coping strategy.

There are handfuls of success stories of “Coronavirus Slayers” who have been courageously fighting the pandemic and have emerged successful.

Various models for COVD-19 containment

(Indian Models)

1) The Bhilwara Model

  • Rajasthan’s Bhilwara could have become the corona epicentre for the country had it not followed a stringent strategy, courtesy to IAS officer Tina Dabi (AIR 1, 2015) and her pro-active team.
  • The “Bhilwara model” of tackling COVID-19 cases involves, simply, “ruthless containment”.

What is this ‘ruthless containment’ model about?

  • It refers to the steps taken by the administration in Rajasthan’s Bhilwara district to contain the disease, after it emerged as a hotspot for coronavirus positive cases. It can be summarized as-
  1. District isolation
  2. Aggressive screening in the city and rural parts
  3. Quarantine and isolation wards
  4. Rigorous monitoring

What were the earliest measures adopted?

  • The measures taken by the state govt. included imposing a curfew in the district which also barred essential services, extensive screening and house-to-house surveys to check for possible cases.
  • It went for detailed contact tracing of each positive case so as to create a dossier on everybody they met ever since they got infected.

What did the administration do as part of the containment strategy?

  • The administration backed up the surveys by imposing a total lockdown on the district, with the local police ensuring strict implementation of the curfew.
  • Intense contact tracing was carried out of those patients who tested positive, with the Health Department preparing detailed charts of all the people whom they had met since being infected.
  • The state took the help of technology, using an app to monitor the conditions of those under home quarantine on a daily basis along with keeping a tab on them through GIS.
  • The patients were treated with hydroxychloroquine (HCQ), Tamiflu and HIV drugs.

Groundwork

  • Within three days of the first positive case, the district health administration in Bhilwara constituted nearly 850 teams and conducted house-to-house surveys at 56k houses and of 280k people.
  • Thousands were identified to be suffering from influenza-like illness (ILI) symptoms and were kept in-home quarantine.

Success:

Bhilwara which was the first district in Rajasthan to report the most number of COVID cases has now reported only one positive case since March 30.

 

2) The Agra Model

  • Agra was the first identified cluster in India and continues to have one of the highest district-wise caseloads.
  • The “Agra model” followed a localised yet massive combing operation for contacts, carried out by the district administration and Integrated Disease Surveillance Programme personnel.
  • It worked on war front with devised electronic survey including smart city control centre, drones, CCTVs etc.

Various measures taken

  • The State, District administration and frontline workers coordinated their efforts by utilizing their existing Smart City Integrated with Command and Control Centre (ICCC) as War Rooms.
  • Under the cluster containment and outbreak containment plans, the district administration identified epicentres, the delineated impact of positive confirmed cases on the map and deployed a special task force as per the micro plan made by the district administration.
  • The hotspots were managed through an active survey and containment plan.
  • The area was identified within a radius of 3 Km from the epicentre while 5 Km buffer zone was identified as the containment zone.

Massive scale of monitoring

  • In the containment zone, Urban Primary Health Centres were roped in.
  • Health workers including ANMs/ASHA/AWW reached out to 9.3 lakh of people through household screening.
  • Additionally, effective and early tracking of first contact tracing was thoroughly mapped.

Success:

The Agra model is important because it has proved effective in areas of high case density, which are being referred to as “hotspots”. Agra was also the earliest reference to community transmission.

 

3) The Pathanamthitta or Kerala Model

  • Use of technology has been the hallmark of the Pathanamthitta model in Kerala.
  • The district saw its first cases in early March when a three-member Italy-returned family ended up infecting several relatives while socializing with them. The count would eventually go up to 16.

How it differs from Agra Model?

  • Border sealing and contact tracing happened here too.
  • But more than just screening contacts, every person who had entered the district was screened and a database created so that they could be easily reached at short notice.

Self-reporting by people

  • Graphics were created showing the travel route of the positive cases and publicized.
  • This helped in self-reporting. As people realized from the route map that they had indeed come in contact with a COVID-19 positive person, many walked up to be screened or treated.

Intensive use of technology

  • Those under quarantine were checked daily on phone thorough a call centre even as 14 teams of health workers monitored some 4,000 people who had entered the district before its sealing.
  • There was also an app — Corona RM — designed by a few engineering students.
  • Those under home quarantine were monitored through this app as their whereabouts could be tracked and if they broke quarantine that could be immediately detected through the use of GP.

Success:

The growth of new cases has slowed down in Kerala, with six of the last 10 days witnessing a single-digit rise. This success of Kerala is being attributed to its “prompt response” to its past “experience (of Nipah) and investment” in health emergency preparedness.


 

Global Successes

 

1) Taiwan Model of Total Healthcare Management

  • Located less than 150 kilometres from the original viral source – China – Taiwan has seen far fewer cases of the coronavirus in the past month, with a much lower infection rate.
  • It is also worth noting the practices utilized by Taiwan’s hospitals as they seek to curb the virus and protect patients and medics.

Following were the not so exceptional measures which helped Taiwan authorities contain coronavirus:

Smaller staff groups

  • One of the early steps taken was the reduction of the workgroup sizes within medical facilities.
  • This reduces the risk of a community spread within the hospital emerging from infected patients being treated.

Traffic control in hospitals

  • Hospitals were establishing separate entrances and exits for in- and out-patients to help prevent the spread of infection via regular hospital traffic.
  • In effect, hospital entry began to resemble airport customs, with visitors passing through a temperature checkpoint and showing IDs before admittance.

Maintaining a high bed-per-capita ratio

  • Many countries have found that they do not have nearly enough hospital beds to care for patients suffering from a highly infectious disease like COVID-19.
  • In response, Taiwan has nearly 1,000 negative pressure isolation rooms (an isolation technique used in hospitals to prevent cross-contamination from room to room) available, with the capacity to add significantly more through room reconfigurations.
  • This is a remarkably high number, given the relatively small population of the island, and speaks to the country’s preparedness and advanced medical infrastructure.

Best public health policy

  • Finally, Taiwan has benefited greatly from the close coordination between its hospitals and the central government.
  • Within the country’s nationalized healthcare system, every citizen and resident is assigned a health card, embedded with a computer chip reflecting their identity and medical history.

Success:

As the global total of infections has neared 700,000, with over 30,000 deaths, Taiwan’s count stood at 300, with only 5 deaths.

 

2) Prolonged, total lockdown: The Wuhan model

Wuhan, the capital of Hubei province, and the geographic origin of the coronavirus have had the longest and most comprehensive lockdown of any region in the world, for a staggering 76 days, starting on 23 January and ending on 8 April.

Actual strategy

  • In January, China effectively shut down Wuhan and placed its 11 million residents in effective quarantine — a move it then replicated in the rest of Hubei province, putting 50 million people in mass isolation.
  • Across the rest of the country, residents were strongly encouraged to stay at home.

Mass mobilization

  • At least 42,000 doctors and medical personnel were sent to Hubei province to shore up the province’s health services.

Masks and checks

  • In cities, it quickly became necessary to wear a mask as apartment blocks, businesses and even parks barred entry without one.
  • Widespread mask use may have helped slow the spread of the disease, “particularly when there are so many asymptomatic virus carriers

Success:

China had 22 consecutive days (till yesterday) of one new case or less per day, before the lockdown was lifted.

 

3) No lockdown, rapid testing: South Korea Model

  • As countries across the world used their state machinery to impose partial or complete lockdowns, South Korea decided to follow a different route.
  • A week since the coronavirus started spreading in their neighbouring country, China, the government responded quickly and ordered all the factories to start producing testing kits en masse.
  • Within two weeks, South Korea was producing more than 1,00,000 testing kits per day.
  • Furthermore, the government used all its resources to and had carried out over 2,50,000 tests.
  • This allowed the government to gather data, monitor the spread and treat/isolate the infected individuals.
  • South Korea also used surveillance footage, drone images, credit card activities, etc. to trace the contacts of the infected individuals and put them into isolation.

Success:

By acting quickly, South Korea tackled the COVID-19 crisis effectively while keeping its economy up and running. When a third of the world’s population is living under a lockdown, the relative normality of Seoul feels surreal.

 


All these models have something in common. Guess what?

  • Capacity to contain a virus outbreak depends on the ability to identify cases and contacts in the community on clinical criteria while ensuring smart surveillance on travellers; isolate and identify the causative virus; treat severe cases while counselling mild cases.
  • Dealing with pandemics required a multi-pronged approach which all models did rather than solely focussing on discovering a vaccine.
  • The WHO’s mantra to tackle COVID i.e. “test, trace, isolate, treat” is the key.
  • All these models have followed this strategy either way in their letter and spirit, with exemplary efficiency.

How is India responding?

  • Health Infrastructure has been described as the basic support for the delivery of public health activities.
  • However, current health infrastructure in India paints a dismal picture of the healthcare delivery system in the country.
  • Public health experts believe that India is ill-equipped to handle such emergencies. It is not prepared to tackle health epidemics, particularly given its urban congestion.
  • The healthcare administration in crowded cities like Agra, Pathanamthitta and Bhilwara have busted this myth.
  • The willingness and effectiveness with which doctors and medical officials in India are working is a testament to the country’s rational and humane approach to the pandemic.

Way Forward

  • The aerial spread of the pandemic can be contained with an efficient response which combines effective public health, microbiological, clinical and communication responses.
  • In general, hospital services have quickly geared up to treat severe cases in urban areas but rural healthcare needs a step up.
  • Effective risk communication to the general public needs to be circulated to prevent panic and provide advice on precautionary measures.
  • Central and state health agencies must act in tandem and so are the public and private healthcare facilities.
  • The media too must help in increasing awareness without triggering panic through community counselling.
Coronavirus – Health and Governance Issues

Is the Centre’s lockdown different from a state’s lockdown?Prelims Only

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Various provisions allowing lockdowns

Mains level : Coronovirus outbreak and its mitigation


The central government has extended the 21-day nationwide lockdown by two more weeks. Before this, some states had already ordered to extend the lockdown till the end of this month.

How do the two lockdowns differ?

Newspapers are flooded up with news on lockdowns. The two lockdowns are fundamentally different from each other. Such difference sparks a thought in the mind of question framers.

1) State lockdowns

  • As per the Constitution, subjects of law and order and public health lie with state governments.
  • Additionally, the Epidemic Diseases Act of 1897, which many states have invoked to order a lockdown, empowers them to prescribe temporary regulations to prevent the outbreak and spread of disease.

2) Centre’s lockdown

  • The lockdown ordered by the centre is implemented under the Disaster Management Act, 2005.
  • The Union home ministry, in compliance with the NDMAs order can issue orders for the lockdown under Section 10(2)(l) of the DMA.
Coronavirus – Health and Governance Issues

COVID-19 and the crumbling world orderop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- What factors led to the failure of global world order in dealing with Covid-19, what would be the impact of Covid19 on the globalisation?


Theme of this article is the failure of the world order in mounting a collective fight against the epidemic that has become the global problem. Role of WHO has also come under the scanner. Functioning and reluctance of UNSC to discuss the pandemic have raised questions over its relevance. The issue of China’s growing influence and implications for the rest of the world are being discussed. In the past week, some newspaper articles have covered the same issue for instance-“The deep void in global leadership” in the Hindu.

Failure of the world order and global institutions

  • The contemporary global order and institutions were a hegemonic exercise meant to deal with isolated political and military crises and not serve humanity at large.
  • COVID-19 has exposed this as well as the worst nativist tendencies of the global leadership in the face of a major crisis.
  • That the United Nations Security Council took so long to meet (that too inconclusively) to discuss the pandemic is a ringing testimony to the UN’s insignificance.

The above para. indicates that global order we are living in was made for entirely different purpose i.e. to maintain the peace and they are not capable to deal with the Covid-19  like challenges. So, from UPSC mains point of view you must take note of this.

Failure of regional groupings

  • Regional institutions haven’t fared any better.
  • Prime Minister Narendra Modi’s SAARC initiative, curiously resurrecting a practically dead institution, was short-lived.
  • The EU, the most progressive post-national regional arrangement, stood clueless when the virus spread like wildfire in Europe.
  • Its member states turned inward for solutions: self-help, not regional coordination, was their first instinct. Brussels is the loser.

What these failures indicate?

  • These failures are indicative of a deeper malaise: the global institutional framework is unrepresentative, a pawn in the hands of the great powers, cash-strapped, and its agenda is focused on high-table security issues.
  • The global institutional architecture of the 1940s cannot help humanity face the challenges of the 2020s.
  • What can be the solutions? Nothing less than a new social contract between states and the international system can save our future.

Here we come across  the reasons for the failure of the world order and institutions. UPSC has asked questions related to UNESCO in 2019, who knows next could be the WHO.

Factors that will help China come out stronger from the pandemic

  • Reports indicate that China has now managed the outbreak of COVID-19, and its industrial production is recovering even as that of every other country is taking a hit.
  • The oil price slump will make its recovery even faster.
  • When the greatest military power found itself in denial mode and the members of the EU were looking after their own interests, China appeared to use its manufacturing power to its geopolitical advantage.
  • Beijing has offered medical aid and expertise to those in need; it has increased cooperation with its arch-rival Japan.
  • This will aid Beijing’s claims to global leadership, push Huawei 5G trials as a side bargain, and showcase how the Belt and Road Initiative is the future of global connectivity.
  • COVID-19 will further push the international system into a world with Chinese characteristics.

As China comes to dominate the emerging world order, we must pay attention to things related to China. Here, we can note down the factors that could help China emerge out stronger from the corona crisis.

Implications for globalisation: the rise of protectionism and hypernationalism

  • Neoliberal economic globalisation will have taken a major beating in the wake of the pandemic.
  • Economists are warning of a global recession.
  • How the world reacted? The first instinct of every major economy was to close borders, look inwards and
  • The pre-existing structural weakness of the global order and the COVID-19 shock will further feed states’ protectionist tendencies fueled by hypernationalism.
  • A more inclusive global political and economic order is unlikely any time soon, if ever.
  • Instead, as former National Security Adviser Shivshankar Menon warns, “we are headed for a poorer, meaner, and smaller world.”
  • How this epidemic impact big corporations? The ability of big corporations to dictate the production, stocks, supply chains and backup plans will be limited by increased state intervention to avoid unpredictable supply sources, avoid geopolitically sensitive zones, and national demands for emergency reserves.
  • The profits of big corporations will reduce, and the demand for stability will increase.
  • Will the world after Covid-19 be more balance? State intervention in economic matters and protectionism are the easy way out, and that’s precisely what states will do once the crisis is over.
  • It would be a return of the ‘Licence Raj’ through the backdoor, not a push for inclusive and responsible globalisation with its associated political benefits.

It is clear now that post-Covid-19 world would be different from the world we know today. Globalisation would take a significant beating. And globalisation is important topic from mains point of view. So, pay close attention to the points mentioned here.

Will post-Covid-19 world lead to some positive controls?

  • Rise of state-led models: With the severe beating that globalisation has taken, state-led models of globalisation and economic development would be preferred over (big) corporates-led globalisation.
  • Will this enable some positive controls over the inherent deficiencies of globalisation? We will have to wait and see.
  • The relation between capitalists and the states: But the more important question is whether the state has any incentive to take on big capital.
  • Given the symbiotic relationship between the state and big capital, states have become used to protecting the interests of their corporations, often at the cost of the general public.
  • States preferred capital over health: Consider, for instance, that the first response of many Western states was to protect their capital markets than be concerned about public health.

Rise of racism in post-Covid-19 world

  • Yet another undesirable outcome of the pandemic would be a spike in various forms of discrimination.
  • Globally, societies could become more self-seeking and inward-looking leading to further pushback against liberal policies regarding migration and refugees.
  • Implications for world trade: New questions are likely to be asked about the source of goods. More stringent imposition of phytosanitary measures by advanced states on products emanating from the less developed countries might become the new normal.
  • Lockdowns and travel restrictions could potentially legitimise the rhetoric around border walls in more conservative countries.
  • Tragically, therefore, while one answer to global pandemics is political globalisation, COVID-19 might further limit it.

Conclusion

The world order needs to wake up to new reality take measures to avoid the above listed undesired fallouts that could emerge in the post-Covid-19 world, and before that there is an urgent need for the global coalition to deal with the pandemic.

 

Coronavirus – Health and Governance Issues

Taiwan: a role model for pandemic managementPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Successful models for covid-19 containment


As many nations struggle to keep COVID-19 infection numbers down, the island of Taiwan presents an example of how to be prepared in the event of a pandemic. As the global total of infections has neared 700,000, with over 30,000 deaths, Taiwan’s count stood at 300, with only 5 deaths.

When you read through this article, try and map the best practices which could be incorporated in India. You might have to tweak a few. UPSC Mains may ask a question on “what could be done better etc.” and this is where you shine!

Taiwan Model of Healthcare Management

  • Located less than 150 kilometres from the original viral source – China – Taiwan has seen far fewer cases of the coronavirus in the past month, with a much lower infection rate.
  • It is also worth noting the practices utilized by Taiwan’s hospitals as they seek to curb the virus and protect patients and medics.

Following were the not so exceptional measures which helped Taiwan authorities contain coronavirus:

1) Smaller staff groups

  • One of the early steps taken was the reduction of the workgroup sizes within medical facilities.
  • This reduces the risk of a community spread within the hospital emerging from infected patients being treated.
  • Depending on the size of the staff handling an area of the hospital, and the number of patients being overseen there, one infection could jeopardize the safety of an entire ward.

2) Traffic control in hospitals

  • Hospitals were establishing separate entrances and exits for in- and out-patients to help prevent the spread of infection via regular hospital traffic.
  • In effect, hospital entry began to resemble airport customs, with visitors passing through a temperature checkpoint and showing IDs before admittance.

3) Maintaining a high bed-per-capita ratio

  • Many countries have found that they do not have nearly enough hospital beds to care for patients suffering from a highly infectious disease like COVID-19.
  • In response, Taiwan has nearly 1,000 negative pressure isolation rooms (an isolation technique used in hospitals to prevent cross-contamination from room to room) available, with the capacity to add significantly more through room reconfigurations.
  • This is a remarkably high number, given the relatively small population of the island, and speaks to the country’s preparedness and advanced medical infrastructure.

4) Best public health policy

  • Finally, Taiwan has benefited greatly from the close coordination between its hospitals and central government.
  • Within the country’s nationalized healthcare system, every citizen and resident is assigned a health card, embedded with a computer chip reflecting their identity and medical history.

Significance of the Taiwanese model

  • Taiwan’s biggest success can be attributed to how ready the country and its hospitals were from Day-1, while other states were still assessing whether the virus was a threat to them at all.
  • Many of these countermeasures can be easily duplicated by India.
  • However, the willingness and effectiveness with which doctors and medical officials have worked to cooperate with each other and the public is a testament to the country’s smart and rational approach to healthcare and disease prevention.
Coronavirus – Health and Governance Issues

[pib] YUKTI web-portalPIB

Note4Students

From UPSC perspective, the following things are important :

Prelims level : YUKTI portal

Mains level : Coronovirus outbreak and its mitigation


Union Ministry for HRD has launched a web-portal YUKTI (Young India Combating COVID with Knowledge, Technology and Innovation).

There are various web/portals/apps with peculiar names, ex. DISHA, SWAYAM. Note them down with their one line purpose. UPSC Prelims may quiz you on these.

YUKTI web-portal

  • YUKTI is a unique portal and dashboard to monitor and record the efforts and initiatives of MHRD.
  • The portal intends to cover the different dimensions of COVID-19 challenges in a very holistic and comprehensive way.
  • The primary aim of the portal is to keep academic community healthy, both physically & mentally and to enable a continuous high-quality learning environment for learners.

Utility of the portal

  • The portal allows various institutions to share their strategies for various challenges which are there because of the unprecedented situation of COVID-19 and other future initiatives.
  • It will give inputs for better planning and will enable MHRD to monitor effectively its activities for coming six months.
  • It will establish a two-way communication channel between the Ministry of HRD and the institutions so that the Ministry can provide the necessary support system to the institutions.
Coronavirus – Health and Governance Issues

Regulating the Private Health Sector to Eliminate COVID-19op-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Regulation of private sector to deal with the COVID-19.


Context

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

Contradictory scenario between public and private healthcare delivery

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

Problems in the public healthcare system

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

State-wise variation in healthcare

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

Getting the private sector involved in COVID-19 testing

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

Way forward

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

Conclusion

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

Coronavirus – Health and Governance Issues

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

Note4Students

From UPSC perspective, the following things are important :

Prelims level : IPC sections mentioned in the newscard

Mains level : COVID-19 and its mitigation


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

Sections 269 and 270 of the IPC

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

Earlier instances of invocation

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

[pib] National Teleconsultation Centre (CoNTeC)PIB

Note4Students

From UPSC perspective, the following things are important :

Prelims level : National Teleconsultation Centre (CoNTeC)

Mains level : Telemedicine and its effectiveness


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

 About CoNTeC

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

How to Contact the CoNTeC?

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

After the lockdownop-ed snap

Note4Students

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?


Context

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

Two arguments advanced against lockdown

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

What are the justifications for the lockdown?

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

Underscoring the importance of federalism and decentralisation

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

The preparation and follow-up of the lockdown

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

Economic fallout for the poor

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

Opacity on the health infrastructure side

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

Conclusion

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

Coronavirus – Health and Governance Issues

Legal Provisions Used By Law Enforcement Agencies To Control The Spread Of Coronavris

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not Much

Mains level : Significance of self-imposed curfew


To enforce a full lockdown to contain the spread of COVID-19, law enforcement agencies have taken the help of various legal provisions in CrPC and IPC.

  • The orders issued to curb the spread of the coronavirus have been framed under the Epidemic Diseases Act, 1897, which lays down punishment as per Section 188 of the Indian Penal Code, 1860.
  • Similarly, Sections 269 and 270 IPC are being invoked against persons who malignantly do any act which is likely to spread the infection of any disease dangerous to life.

    Sections 269 and 270 of the IPC

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

    Earlier instances of invocation

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

What is Section 188 of the Indian Penal Code?

  • Section 3 of the Epidemic Diseases Act, 1897, provides penalties for disobeying any regulation or order made under the Act.
  • These are according to Section 188 of the Indian Penal Code (disobedience to order duly promulgated by public servant).
  • It is not necessary that the offender should intend to produce harm, or contemplate his disobedience as likely to produce harm.
  • It is sufficient that he knows of the order which he disobeys, and that his disobedience produces, or is likely to produce, harm.

What happens if you violate the lockdown orders? 

Under Section 188, there two offences:

1) Disobedience to an order lawfully promulgated by a public servant, If such disobedience causes obstruction, annoyance or injury to persons lawfully employed

Punishment: Simple Imprisonment for 1 month or fine of Rs 200 or both

2) If such disobedience causes danger to human life, health or safety, etc.

Punishment: Simple Imprisonment for 6 months or fine of Rs 1000 or both

According to the First Schedule of the Criminal Procedure Code (CrPC), 1973, both offences are cognizable, bailable, and can be tried by any magistrate.

Triable By: Any Magis­trate

 

Coronavirus – Health and Governance Issues

Get a step ahead of the virusop-ed snap

Note4Students

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?


Context

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

Virus different from its nearest relative

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

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

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

Good reasons to change the attitude

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

One step ahead of the virus

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

Way forward

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

Conclusion

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

Coronavirus – Health and Governance Issues

Positive responseop-ed of the day

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

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


Context

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?

Conclusion

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.

Coronavirus – Health and Governance Issues

Explained: Epidemic Diseases Act, 1897Priority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Epidemic Diseases Act, 1897

Mains level : Epedimics and their mitiagtion strategies


Till today, at least 60 COVID-19 cases have been confirmed in India. So it was decided in a Cabinet Secretary meeting that States and UTs should invoke provisions of Section 2 of Epidemic Diseases Act, 1897, so that Health Ministry advisories are enforceable.

History of the 1897 Epidemic Diseases Act

  • The Epidemic Diseases Act is routinely enforced across the country for dealing with outbreaks of diseases such as swine flu, dengue, and cholera.
  • The colonial government introduced the Act to tackle the epidemic of bubonic plague that had spread in the erstwhile Bombay Presidency in the 1890s.
  • Using powers conferred by the Act, colonies authorities would search suspected plague cases in homes and among passengers, with forcible segregations, evacuations, and demolitions of infected places.
  • Historians have criticised the Act for its potential for abuse.
  • In 1897, the year the law was enforced, Lokmanya Tilak was punished with 18 months’ rigorous imprisonment after his newspapers Kesari and Mahratta admonished imperial authorities for their handling of the plague epidemic.

Provisions of the 1897 Epidemic Diseases Act

  • The Act is one of the shortest Acts in India, comprising just four sections. It aims to provide for the better prevention of the spread of Dangerous Epidemic Diseases.
  • The then Governor-General of colonial India had conferred special powers upon the local authorities to implement the measures necessary for the control of epidemics.
  • Although, the act does define or give a description of a “dangerous epidemic disease”.

Its various sections can be summarized as under:

  • The first section describes all the title and extent, the second part explains all the special powers given to the state government and centre to take special measures and regulations to contain the spread of disease.
  • The second section has a special subsection 2A empowers the central government to take steps to prevent the spread of an epidemic, especially allowing the government to inspect any ship arriving or leaving any post and the power to detain any person intending to sail or arriving in the country.
  • The third section describes the penalties for violating the regulations in accordance with Section 188 of the IPC. Section 3 states, “Six months’ imprisonment or 1,000 rupees fine or both could be charged out to the person who disobeys this Act.”
  • The fourth and the last section deals with legal protection to implementing officers acting under the Act.

Examples of implementation

The act has been invoked several times since independence. Few recent incidents include-

  • In 2018, the district collector of Gujarat’s Vadodara issued a notification under the Act declaring a town as cholera-affected.
  • In 2009, to tackle the swine flu outbreak in Pune, Section 2 powers were used to open screening centres in civic hospitals across the city, and swine flu was declared a notifiable disease.
Coronavirus – Health and Governance Issues

One country, two virusesop-ed snap

Note4Students

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?


Context

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.”

Conclusion

  • 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.
Coronavirus – Health and Governance Issues

Gearing up to fight the next big viral outbreakop-ed of the day

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

Mains level : Paper 2- Preparing healthcare system for viral outbreaks.


Context

India is ill-prepared to deal with the new strain of coronavirus (SARS-CoV-2) that is causing worldwide panic. Policymakers must take forceful action to prevent the spread of the new virus and heed the urgent warnings of global public health professionals about new pathogens.

No country is adequately prepared

  • Finding of the Global Health Security Index: The World Health Organization (WHO)’s Global Health Security Index finds that no country is adequately prepared.
  • It assesses 195 countries across six categories
    • Prevention
    • Early detection.
    • Rapid response.
    • Health system quality.
    • Standards.
    • Risk environment.
  • India’s dismal rank: India is ranked 57th.
    • That the country scores around the global average is no comfort, because the global average is a low 40.2 out of 100, and India’s score is 46.5. (For the record, the U.S. is ranked first and China 51st).

Four-point health agenda

  • The prospect of new outbreaks puts four items on the health agenda in the spotlight that require both immediate and longer-term action:
    • Early detection and prevention.
    • Better collaboration across health service providers.
    • More investment in health systems; outcomes, and education; and-
    • Better care of the environment and biodiversity, which directly affects people’s health safety.

Thailand’s outstanding example

  • Sixth rank on Health Security Index: That Thailand is ranked sixth in the Health Security Index- the highest ranking for an Asian country.
    • The rank says a great deal about the country’s track record in disease prevention, early detection, and rapid response linked to investments in its public health system.
    • When the deadly Middle East Respiratory Syndrome (MERS), also caused by a coronavirus, broke out in 2015, Thailand quickly notified the WHO of its first confirmed case and acted transparently to arrest the spread.
    • This is in stark contrast to delayed notification by China’s officials of the recent outbreak.

India’s record in past outbreaks

  • Underscoring inadequacies: The influenza A (H1N1) outbreaks since 2009 in Rajasthan, Maharashtra, Tamil Nadu and other States have acutely underscored the need for better detection, awareness of symptoms and quarantining.
  • Protocols for surveillance: Clearer protocols for all three types of surveillance are needed in all States.
    • And these protocols need to be communicated to health professionals at all levels and the public in local languages.

Conducting stress tests on health system

  • Countries need to do the stress tests for their preparedness to deal with health emergencies.
  • Exposing the crucial gap: Each State in India should do this to expose crucial gaps in areas such as-
    • Adequacy and supply of diagnostic equipment.
    • Health facilities.
    • Hygienic practices, and-
    • Prevention and treatment protocols.
  • Ensuring strong supply chains: Queues of desperate shoppers trying to buy hand sanitizer, face masks and other protective products in Hong Kong and China highlight the need for strong supply chains for products that people need during health emergencies.

The partnership between countries and with the private sector

  • Partnership to ensure supply chains: Partnerships between private and public sectors, and between countries– that can sustain supply chains and bolster the medical capacity of countries struggling to cope.
    • Collaborative approach in Asia: In Asia, collaborative approaches exist, for example, for combating tuberculosis, AIDS and malaria.
  • Need to do more: More is needed to tackle health emergencies on the scale of recent outbreak, particularly on funding.
    • Emergency loan option: There could be an emergency loan facility, with a “deferred drawdown option” as the World Bank uses for disasters, natural or health.
    • The loan option can help augment own resources in times of a public health catastrophe.
  • Investment is the best defence: But the best defence of all is to invest more, and more efficiently, in health and education to prepare populations and strengthen health services.
    • Low health expenditure: Health expenditure by the government in India is less than 5% of Gross Domestic Product, which is low for a middle-income country.
    • Spending at that level limits, among other things, the availability of health professionals during crises.
    • According to WHO, India has only 80 doctors per 1,00,000 people.

Investment in health, education

  • Kerala’s experience: Kerala’s experience in 2018 with the deadly Nipah virus showed the value of investing in education and health over the long term.
  • What measures were taken in Kerala? The availability of equipment for-
    • Quick diagnosis.
    • Measures to prevent diseases from spreading and-
    • Public information campaigns- all helped to keep the mortality rate from the Nipah virus relatively low.
    • Having capable public health professionals helped in the information exchange with WHO and other international bodies.

The relation between environmental degradation and health

  • A new dimension of new pathogens: One of the many dimensions of new pathogens that is getting increased attention is the link with environmental degradation.
  • The relation between pollution and viral respiratory infection: The interaction between particulate matter from pollution and viral respiratory tract infections, especially in the young and the elderly, as well as the malnourished, has been increasingly noted in epidemiological studies.
    • Many of the highest air pollution readings are being recorded in Indian cities.
  • Most vulnerable country: An HSBC study of 67 countries ranks India as the most climate-vulnerable one because of the impact of severe temperature increases and declines in rainfalls.
    • Reasons for vulnerability: The effects of such occurrences are magnified by the high density of the country’s population, the sheer number of people in harm’s way, and the high incidence of poverty.
    • Research is increasingly connecting global warming to vector-borne viruses.

Conclusion

The dangerous trend for disease spillovers from animals to humans can be traced to increased human encroachment on wildlife territory; land-use changes that increase the rate of human-wildlife and wildlife-livestock interactions; and climate change. Protecting the precious biodiversity should be a priority.

 

 

 

 

 

 

 

Coronavirus – Health and Governance Issues

Battling the bugop-ed snap

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Not much.

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


Context

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.

Conclusion

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.

 

 

 

 

Coronavirus – Health and Governance Issues

Novel Coronavirus renamed as COVID-19 by WHOPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Coronavirus, Pneumonia

Mains level : Threats posed by coronavirus outbreak


The World Health Organization (WHO) gave an official name to the disease caused by the novel coronavirus. The death toll from the virus has now crossed 1,000 and the disease has infected tens of thousands of people, the majority of them in China.

COVID-19

  • The disease will be called “COVID-19”; the “CO” stands for coronavirus, “VI” for virus and “D” for disease.
  • The coronavirus itself is called “nCoV-2019”.

WHO nomenclature

  • The WHO, in consultation with the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO), has identified best practices for naming new human diseases.
  1. These best practices apply to a new disease:
  2. That is an infection, syndrome, or disease of humans;
  3. That has never been recognised before in humans;
  4. That has potential public health impact; and
  5. Where no disease name is yet established in common usage
  • Names that are assigned by the WHO may or may not be approved by the International Classification of Diseases (ICD) at a later stage.
  • The ICD, which is also managed by the WHO, provides a final standard name for each human disease according to standard guidelines that are aimed at reducing the negative impact from names while balancing science, communication and policy.

Terms to avoid

  • The agreed best practices include advice on what the disease names should not include, such as geographic location (Middle East Respiratory Syndrome, Spanish Flu, Japanese encephalitis).
  • Disease names should not include people’s names (Creutzfeldt-Jakob disease, Chagas disease), the species or class of animal or food (swine flu, monkeypox etc.), cultural or occupational references (miners, butchers, cooks, nurses etc.) and terms that incite “undue fear” such as death, fatal and epidemic.
  • The use of names such as “swine flu” and “Middle East Respiratory Syndrome” has had “unintended negative impacts” by stigmatising certain communities and economic sectors.

Terms to include

  • The best practices include using generic descriptive terms such as respiratory diseases, hepatitis, neurologic syndrome, watery diarrhoea.
  • They include using specific descriptive terms that may indicate the age group of the patients and the time course of the disease, such as progressive, juvenile or severe.
  • If the causative pathogen is known, it should be used as part of the disease name with additional descriptors such as the year when the disease was first reported or detected.
  • The names should also be short (rabies, malaria, polio) and should be consistent with the guidelines under the International Classification of Diseases (ICD) Content Model Reference Guide.
  • As per the WHO, “severe” should be used only for those diseases that have a very high initial case fatality rate. “Novel” can be used to indicate a new pathogen of a previously known type
  • In the case of the novel coronavirus, “recognizing that this term will become obsolete if other new pathogens of that type are identified”, the WHO has now changed its name.
Coronavirus – Health and Governance Issues

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

Note4Students

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.


Context

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.

Conclusion

“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.

Coronavirus – Health and Governance Issues

Public Health Emergency of International Concern (PHEIC)IOCRPriority 1

Note4Students

From UPSC perspective, the following things are important :

Prelims level : PHEIC

Mains level : Global health emergencies


 

The World Health Organization (WHO) has declared the novel Coronavirus infection a Public Health Emergency of International Concern (PHEIC). In the past decade, WHO has declared public health emergencies for outbreaks including swine flu, polio and Ebola.

What is PHEIC?

Definition: Under the International Health Regulations (IHR), a public health emergency is defined as “an extraordinary event which is determined, as provided in these Regulations: to constitute a public health risk to other States through the international spread of disease; and to potentially require a coordinated international response”.

What criteria does the WHO follow to declare PHEIC?

  • PHEIC is declared in the event of some “serious public health events” that may endanger international public health.
  • The responsibility of declaring an event as an emergency lies with the Director-General of the WHO and requires the convening of a committee of members.

Implications of a PHEIC being declared

  • There are some implications of declaring a PHEIC for the host country, which in the case of the coronavirus is China.
  • Declaring a PHEIC may lead to restrictions on travel and trade.
  • However, several countries have already issued advisories to their citizens to avoid travelling to China, while others are airlifting their citizens from it.

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