Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

Why in the News?

Negotiations on the Pathogen Access and Benefit Sharing (PABS) framework under the recent WHO Pandemic Agreement (May 2025) are set to begin again. This highlights a long-standing global inequity: countries that share pathogen data, mainly low- and middle-income countries (LMICs), continue to receive minimal benefits from vaccines and treatments developed using that data.

What is PABS Framework?

1. The Pathogen Access and Benefit-Sharing (PABS) System, established under Article 12 of the WHO Pandemic Agreement adopted in May 2025, is a global framework designed to ensure that the sharing of dangerous pathogens is matched by the equitable sharing of the vaccines and treatments derived from them. 
2. While the core Agreement was adopted in 2025, the PABS Annex containing the specific operational rules is currently being finalized by an Intergovernmental Working Group (IGWG). The IGWG aims to conclude negotiations by May 2026 for presentation at the 79th World Health Assembly.

Core Pillars of the PABS Framework: 

The system operates on a “grand bargain” principle intended to rectify inequities seen during the COVID-19 pandemic: 

1. Rapid Access: Member States commit to quickly sharing biological materials (pathogens) and their Digital Sequence Information (DSI) with the World Health Organization (WHO) and designated laboratory networks.
2. Mandatory Benefit-Sharing: In exchange for this data, manufacturers using PABS materials must provide 20% of their real-time production of pandemic-related products (vaccines, diagnostics, etc.) to the WHO for global distribution.
   1. 10% as free donations.
   2. 10% at affordable, not-for-profit prices.

Why do pathogen-sharing countries fail to receive proportional benefits?

1. Structural Inequity: Low- and Middle-Income Countries (LMICs) share pathogen samples via WHO but lack binding guarantees for access to vaccines or diagnostics.
2. Innovation Asymmetry: Developed countries control pharmaceutical R&D, enabling them to monopolize end products.
3. Voluntary Framework Failure: Existing systems rely on goodwill rather than enforceable obligations.
4. Example: During COVID-19, LMICs contributed samples but faced vaccine hoarding by high-income countries.

How did COVID-19 expose failures in global health equity?

1. Vaccine Apartheid: High-income countries hoarded vaccines; LMICs experienced prolonged shortages.
2. Data Evidence: Africa received only 3-14% of global vaccine supply.
3. COVAX Limitations: Delivered ~1/5th of WHO’s 2 billion dose target by mid-2021.
4. Economic Impact: Delayed vaccination caused 1.3 million preventable deaths and $28 trillion global economic loss (IMF).
5. Drug Inequality: Ebola drug Inmazeb cost ~$6,000 per treatment, unaffordable for poorer nations.

What does the PABS framework aim to change structurally?

1. Legal Linkage: Connects sample-sharing with mandatory benefit-sharing obligations.
2. Access Mandate: Requires pharmaceutical companies to provide 20% of real-time production during pandemics.
3. Pricing Mechanism: Ensures at least half of allocated doses are free and the rest at reasonable prices.
4. Capacity Building: Includes provisions for technology transfer and licensing to expand production in LMICs.

Why is there resistance from developed countries and industry?

1. Innovation Concerns: Binding mandates may reduce incentives for private pharmaceutical investment.
2. IP Protection: Firms resist compulsory sharing of intellectual property and technology.
3. Bureaucratic Burden: Concerns that compliance mechanisms may delay research and innovation.
4. Example: EU favors voluntary systems like Global Initiative on Sharing All Influenza Data (GISAID) over binding legal frameworks.

What are the limitations of existing global mechanisms?

1. Non-binding Agreements: Current frameworks lack enforcement provisions.
   1. Enforcement Void: Current WHO systems (like the PIP Framework) are limited in scope (mostly influenza) and lack the “teeth” to penalise a company that refuses to share its patents during a crisis.
2. Fragmented Governance: Multiple overlapping systems reduce accountability.
3. Technological Gaps: LMICs lack manufacturing capacity despite access to data.
4. Example: WHO’s existing system ensures access to data but not equitable outcomes.
5. The GISAID Paradox: While GISAID is excellent for surveillance, it provides zero guarantees for equity. A country can upload thousands of sequences to help track a variant but still be the last to receive the vaccine developed from that very data.

Is there a viable middle path between equity and innovation?

1. Tiered Obligations: Lower commitments during normal times, stronger during pandemics.
2. Global Fund Mechanism: Supports LMIC manufacturing without overburdening companies.
3. Incentive-based Sharing: Rewards companies that share IP rather than coercing compliance.
4. Balanced Governance: Combines legal enforceability with flexibility in implementation timelines.

What are the broader implications for global health security?

1. Future Pandemic Preparedness: Ensures faster and equitable response mechanisms.
2. Trust Deficit Reduction: Addresses Global South concerns about exploitation.
3. Geopolitical Stability: Prevents vaccine nationalism and supply chain disruptions.
4. Emerging Risks: Addresses threats like mpox, engineered pathogens, and AI-driven bio-risks.

Conclusion

The PABS debate reflects a deeper structural imbalance in global health governance where risks are shared but rewards are concentrated. Without enforceable equity mechanisms, future pandemics risk repeating COVID-19’s failures. A balanced framework combining legal mandates, incentives, and capacity-building is essential to ensure that global cooperation translates into equitable outcomes.

PYQ Relevance

[UPSC 2020] Critically examine the role of WHO in providing global health security during the Covid-19 pandemic.

Linkage: The PYQ covers GS-II (International Institutions, Global Health Governance) by evaluating the effectiveness and limitations of WHO in managing pandemic response. It links to current issues like WHO Pandemic Agreement and PABS, highlighting the need for stronger enforcement, equity, and coordination in global health security.

Why in the News?

The Economic Survey flagged rising digital addiction and screen-related mental health disorders, particularly among children and adolescents. The Union Budget announced strengthening of mental health infrastructure, including establishment of a second campus of NIMHANS in North India and upgradation of premier institutions in Ranchi and Tezpur. Despite increased allocation from ₹683 crore (2020-21) to ₹1,898 crore (2024-25), mental health spending remains about 2% of total health outlay.

What is the Scale of India’s Mental Health Burden?

1. Suicide Burden: Accounts for nearly one-third of global suicides; depression and addiction contribute significantly to disease burden.
2. Economic Impact: Mental health conditions impose an estimated economic loss of $1.03 trillion between 2012 and 2030.
3. Treatment Gap: 70-92% of individuals with mental disorders lack proper treatment due to low awareness, stigma, and workforce shortages.
4. Human Resource Deficit: 0.75 psychiatrists per 1,00,000 population against the recommended 3 per 1,00,000.
5. Adolescent Vulnerability: Rising digital addiction and screen-related disorders flagged in the Economic Survey.

What Institutional Measures Have Been Announced?

1. National institute of mental health and Neuro Sciences (NIMHANS) Expansion: Establishes second campus of National Institute of Mental Health and Neurosciences in North India.
2. Institutional Upgradation: Upgrades premier institutions in Ranchi and Tezpur to improve regional access.
3. Centre of Excellence Expansion: Sanctions over 20 Centres of Excellence to train postgraduate students in mental health.
4. Advanced Treatment Infrastructure: Establishes 47 PG departments in mental health.
5. Primary Healthcare Integration: Integrates mental health services under Ayushman Arogya Mandirs and Health and Wellness Centres.
6. Tele-MANAS Helpline: Provides 24×7 free mental health support via toll-free number 14416 and 1-800-891-4416; operational across 36 States/UTs and supported by 23 specialised mentoring institutes.

How Has Budgetary Allocation Evolved?

1. Allocation Increase: Raises allocation from ₹683 crore (2020-21) to ₹1,898 crore (2024-25).
2. Relative Share: Maintains mental health share at approximately 1% of total health budget and about 2% of national health outlay.
3. Historical Underfunding: Reflects long-standing low fiscal prioritisation despite rising burden.

Where Do Structural Gaps Persist?

1. Low Budgetary Share: Limits impact due to marginal share within overall health expenditure.
2. Underutilisation of Funds: Prevents full utilisation of allocated funds at national level.
3. Institution-Centric Focus: Directs significant funds towards tertiary institutions such as NIMHANS and Centres of Excellence.
4. Limited Community-Based Models: Weakens early intervention and preventive mental health services.
5. Capacity Constraints: Maintains shortage of trained professionals, with only 9% gap reduction in access to mental healthcare.

What Approach is Required Going Forward?

1. Affordable Access: Ensures continuity of care and long-term treatment.
2. Preventive Focus: Reduces years lived with disability through early detection.
3. Human Resource Strengthening: Expands trained workforce capacity.
4. Community Integration: Integrates mental well-being into school curricula and workplace policies.
5. Whole-of-Community Model: Mainstreams mental health beyond hospital-centric systems.

Conclusion

India’s mental health crisis reflects a structural mismatch between the scale of the burden and the scale of response. Rising suicides, a 70-92% treatment gap, severe psychiatrist shortages, and mental health spending hovering around 1-2% of the health budget indicate systemic under-prioritisation despite recent institutional expansion.

Strengthening tertiary institutions alone cannot address a crisis rooted in access, stigma, affordability, and preventive failure. A shift towards community-based care, workforce expansion, full utilisation of allocated funds, and integration of mental well-being into schools and workplaces is essential to convert policy intent into measurable public health outcomes.

PYQ Relevance

[UPSC 2023] Explain why suicide among young women is increasing in Indian Society. 

Linkage: UPSC frequently frames GS-I Society questions around emerging social vulnerabilities reflected in current data trends. The article highlights India accounting for nearly one-third of global suicides and flags rising mental health distress, making youth and gender-specific suicide patterns directly relevant to contemporary exam themes.

Introduction

Mental health systems globally and in India continue to prioritise biomedical treatment and functional integration. They often overlook lived experiences of distress, social exclusion, and structural vulnerability. There is a need for a fundamental shift: from care as a technical service to care as disability justice, grounded in dignity, equity, and relational accountability.

Reframing Mental Health Care Beyond Treatment

1. Dignity-Centred Care: Positions dignity, rather than cure or productivity, as the primary objective of mental health systems.
2. Disability Justice Lens: Recognises mental illness as shaped by intersecting social, economic, and political structures.
3. Relational Accountability: Frames care as embedded in relationships, not limited to institutional or clinical settings.

Limits of Dominant Psychosocial Disability Models

1. Productivity Bias: Prioritises economic functionality and independence as markers of recovery.
2. Reductionist Integration: Treats community inclusion as an end-state without addressing exclusionary social norms.
3. Invisible Chronic Distress: Marginalises individuals whose suffering does not conform to biomedical recovery trajectories.

Structural Determinants of Mental Distress

1. Material Deprivation: Highlights housing insecurity, income precarity, and food scarcity as persistent stressors.
2. Social Abandonment: Identifies shame, rejection, and relational breakdown as under-recognised drivers of distress.
3. Political and Cultural Loss: Notes erosion of cultural meaning, safety nets, and social identity as contributory factors.

Multiplicity of Explanations for Mental Illness

1. Biological Factors: Includes neurotransmitter alterations and inflammatory markers.
2. Psychological Factors: Covers trauma, grief, and interpersonal loss.
3. Socio-Structural Factors: Integrates caste, gender, class, and institutional neglect into causation analysis.
4. Intersectionality: Emphasises overlapping vulnerabilities rather than single-cause explanations.

Care as Relational and Material Practice

1. Everyday Care Practices: Includes shelter, nutrition, social connection, and safety as therapeutic.
2. Non-Linear Recovery: Rejects uniform timelines and outcome metrics.
3. Shared Responsibility: Frames care as a collective moral obligation rather than individual compliance.

Justice-Oriented Mental Health Engagement

1. Recognition of Harm: Acknowledges that distress often arises from unjust social arrangements.
2. Ethical Accountability: Asks what society owes to those it has marginalised.
3. Transformative Focus: Shifts emphasis from symptom management to social repair.

Implications for Education, Research, and Practice

1. Curricular Reorientation: Calls for training that values lived experience and contextual care.
2. Practice Diversity: Recognises non-specialist and community-based care providers.
3. Interdisciplinary Learning: Supports integration of social theory, ethics, and practice.
4. Systemic Support: Emphasises that professional competence requires institutional backing, not credentials alone.

Conclusion

Mental health care must be reimagined as an ethical, relational, and justice-oriented practice rather than a narrowly clinical intervention. By centering dignity and disability justice, the article calls for a paradigm shift that recognises suffering as socially produced and care as a shared societal responsibility.

PYQ Relevance

[UPSC 2024] In a crucial domain like the public healthcare system, the Indian State should play a vital role to contain the adverse impact of marketisation of the system. Suggest measures through which the State can enhance the reach of public healthcare at the grassroots level.

Linkage: The article directly links to GS-II (Social Justice, Health) by highlighting the limitations of market-centric and outcome-driven public healthcare in addressing mental health and disability. It also enriches GS-IV by framing mental health care as an ethical obligation grounded in dignity, compassion, and justice rather than mere service delivery.