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Subject: Health

  • When pharma companies cross red lines

    pharma companiesMarketing practices of pharma companies are under scrutiny after tax officials searched the premises of a drugmaker, and an association of medical representatives moved the Supreme Court alleging unethical marketing practices by drugmakers.

    paharma companiesThe Dolo controversy

    • Bengaluru-based pharmaceuticals company Micro Labs Ltd came under the spotlight recently over the promotion of its anti-fever drug Dolo 650, which was widely used during the covid-19 pandemic.
    • Surprisingly, this drug which contained paracetamol was widely endorsed by doctors all across the India.
    • The Supreme Court last week ordered the central government to respond to a petition filed on the issue of unethical marketing practices by drug makers.
    • The Income Tax department too has accused it of claiming unallowable expenses made on freebies meant to boost sales.

    How do drugmakers incentivize doctors?

    • While many medical professionals claim that financial incentives do not influence their practice, some say that private sector doctors are enticed by pharmaceutical companies’ marketing agents to promote their drugs.
    • Pharma companies’ sales executives visit doctors to brief them about new drugs or a new drug component.
    • They try to impress upon them to prescribe their brands and in return, doctors are offered some gifts name reminders such as pens, writing pads, books and sometimes expensive gifts and holidays.
    • Such benefits extended to doctors depend upon the kind of drug, the disease burden etc.

    pharma companiesIs this a widespread industry practice?

    • A government doctor said no pharma firm can sustain without marketing its drug.
    • It mostly happens when there is an outbreak, or if there is great demand for a particular drug or when a drug is being launched.
    • Unlike in the case of other products, the decision to buy a drug is not made by the consumer, but by the doctor.
    • This makes pharma a marketing-driven industry.

    Are hospitals incentivized too?

    • Yes; doctors at a top private hospital which treated a large number of covid-19 patients said drug giants do try to incentivize hospitals.
    • The possibilities increase when a large corporate hospital chain operating across the country buys a drug in bulk.
    • A doctor at a corporate hospital does not have any control over the drugs sold in the in-house pharmacy of the hospital.
    • Doctors running small clinics see limited patients, and they do not have pharmacies; so, the issue of incentivization does not arise.

    What does the I-T dept find wrong in this?

    • While pharma companies treat freebies as a marketing expense which is deducted while computing their taxable income, getting the beneficiary of this spending to report it as his income has been a challenge.
    • In some cases, tax officials have denied promotional expenses as a deduction.
    • Hence, the government introduced a 10% tax to be deducted at source (TDS) effective 1 July, so that doctors and social media influencers report such benefits in their tax returns and pay tax on what it is worth.

     

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  • What rules govern Disposal of Seized Narcotics?

    The Narcotics Control Bureau (NCB) has destroyed 30,000 kg of seized drugs at four locations – Kolkata, Chennai, Delhi and Guwahati — in the virtual presence of Union Home Minister.

    Destruction of Seized Narcotic Drugs

    • Section 52-A of the Narcotics Drugs and Psychotropic Substances (NDPS) Act, 1985 allows probe agencies to destroy seized substances after collecting required samples.
    • Officials concerned must make a detailed inventory of the substance to be destroyed.
    • A five-member committee comprising the area SSP, director/superintendent or the representative of the area NCB, a local magistrate and two others linked to law enforcement and legal fraternity is constituted.
    • The substance is then destroyed in an incinerator or burnt completely leaving behind not any trace of the substance.

    Exact procedure that is followed

    • The agency first obtains permission from a local court to dispose of the seized narcotic substances.
    • These substances are then taken to the designated place of destruction under a strict vigil.
    • The presiding officer tallies the inventory made at the storeroom with that material brought to the spot.
    • The entire process is videographed and photographed.
    • Then one by one, all the packets/gunny bags of the substance/s are put in the incinerator.
    • As per rules, committee members cannot leave the place until the seized drugs have been completely destroyed.

    Which agency is authorized to carry out such an exercise?

    • Every law enforcement agency competent to seize drugs is authorized to destroy them after taking prior permission of the area magistrate.
    • These include state police forces, the CBI and the NCB among others.

    Why destroy seized drugs?

    • The hazardous nature of narcotic drugs or psychotropic substances, their vulnerability to theft, substitution, and constraints of proper storage space are among the reasons that make agencies destroy them.
    • There have been instances when seized narcotics were pilfered from the storeroom.
    • To prevent such instances, authorities try to destroy seized drugs immediately after collecting the required samples out of the seized substances.

     

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  • Monkeypox outbreak: It’s time to act, not panic

    Context

    Monkeypox was previously limited to the local spread in central and west Africa, close to tropical rainforests, but has recently been seen in various urban areas and now in more than 50 countries.

    About monkeypox

    • A virus belonging to the poxviruses family causes a rare contagious rash illness known as monkeypox.
    • This zoonotic viral disease (a disease transmitted from animals to humans) has hosts that include rodents and primates.
    • It is a self-limiting disease with symptoms lasting two to four weeks and a case fatality rate of 3-6 per cent.
    • Symptoms: A skin rash on any part of the body could be the only presenting symptom.
    • Swollen lymph nodes are another distinguishing feature. Aside from these, other symptoms of a viral illness include fever, chills, headache, muscle or back aches, and weakness.
    • Mode of transmission: Touching skin lesions, bodily fluids, or clothing or linens that have been in contact with an infected person can result in transmission.
    • It’s also worth noting that monkeypox does not spread from person to person through everyday activities like walking next to or having a casual conversation with an infected person.
    • Treatment: Monkeypox is mostly treated by managing symptoms and preventing complications if it is diagnosed.
    •  In the minor proportion who are immunocompromised, complications can occur; pulmonary failure was the most common complication with a high mortality rate.

    Containment Measures

    • Because symptoms usually appear 5-21 days after exposure, people with rashes, sores in the mouth, rash, eye irritation or redness, or swollen lymph nodes should be monitored.
    • When symptoms appear, it is critical to isolate the infected from other people and pets, cover their lesions, and contact the nearest healthcare provider.
    • It is also critical to avoid close physical contact with others until instructed to do so by our healthcare provider.
    • It is preferable to use home isolation whenever possible.
    •  Priority should be given to educating grassroots workers about symptoms, specimen collection, disease detection, acquiring sample collection equipment, and maintaining cold storage of specimens.
    •  Increased surveillance and detection of monkeypox cases are critical for controlling the disease’s spread and understanding the changing epidemiology of this resurging disease.
    • Preventive health measures, such as avoiding infected animal or human contact and practising good hand hygiene, are the best option.

    Vaccines and drugs

    • In the US, pre exposure vaccination with JYNNEOSÂź is available to healthcare workers and lab workers exposed to this group of poxviruses.
    • The smallpox vaccine is 85 percent effective against the disease.
    • Another vaccine, ACAM2000, is a live vaccinia virus vaccine that is otherwise recommended for smallpox immunisation and can also be used for high-risk individuals during monkeypox outbreaks.
    • In addition, Tecovirimat, an antiviral drug used to treat smallpox, is recommended for monkeypox.
    • Challenges: Smallpox vaccination programmes have been discontinued for the past 50 years, resulting in a scarcity of effective vaccines.
    • There are approved drugs and vaccines, but they are not widely available to scale up controlling monkeypox.

    Why WHO declared it as international concern?

    •  The increase in monkeypox cases in a short span of time in many countries necessitated the declaration of public health emergency of international concern  (PHEIC) and additional research studies.
    • It is unclear whether the recent sudden outbreaks in multiple countries result from genotypic mutations that alter virus transmissibility. SARS-CoV-2 and monkeypox virus co-infection can alter infectivity patterns, severity, management, and response to vaccination against either or both diseases.
    • As a result, there is a need to improve diagnostic test efficiency.

    Way forward

    • Plan for pandemic preparedness: This is not the last such difficulty we will face, as the world is still witnessing more such public health crises.
    • Zoonotic diseases are caused by various factors, including unchecked deforestation, climate coupled with a failure to prioritise public health, poverty, and climate change.
    • Instead, a robust plan for pandemic preparedness should be accelerated, guided by a single health agenda.
    •  The world is yet to recognise emerging and re-emerging infectious diseases as a genuine threat.
    • The immediate priority is to strengthen the surveillance infrastructure, including hiring public health professionals and field workers who can participate in outbreak detection and response during many future PHEICs.

    Conclusion

    Without prioritising public health strengthening, the threat of new and re-emerging infectious diseases, as well as the enormous social and economic challenges that accompany them, is real and grave.

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  • IIT-Bombay to help treat Mumbai’s Sewage with new tech

    To prevent sludge and sewage from stormwater drains from flowing into the sea, Brihanmumbai Municipal Corporation (BMC) has planned in-situ treatment of sewage from the drains with the help of N-Treat Technology developed by IIT-B.

    What is N-Treat technology?

    • N-Treat is a seven-stage process for waste treatment that uses screens, gates, silt traps, curtains of coconut fibres for filtration, and disinfection using sodium hypochlorite.
    • According to the detailed project report for N-Treat, it is a natural and environment-friendly way of sewage treatment.
    • It’s setup takes place within the nullahs channels that is through the in-situ or on-site method of treatment, and does not require additional space.

    What does the process involve?

    (1) Screening

    • The first stage involves screening to prevent the entry of floating objects such as plastic cups, paper dishes, polythene bags, sanitary napkins, or wood.
    • IIT-B has proposed to install three coarse screens, the first with 60 mm spacing for removal of large floating matter, the second with 40 mm spacing, and the third with 20 mm spacing.

    (2) Slit trap

    • The second stage has proposed construction of a silt trap, which creates an inclination and ‘parking spot’ on the bed of the nullah for sedimentation.

    (3) Bio zones

    • The next three stages are installation of ‘bio zones’ in the form of coconut fibre curtains that will act as filters and promote growth of biofilm to help in decomposition of organic matter.
    • A floating wetland with aquatic vegetation planted on floating mats has been proposed.

    (4) Florafts

    • Aside from a floating bed on the surface, IIT-B has proposed suspending floating rafts vertically, called florafts.
    • Their hanging roots would provide a large surface area for passive filtration as well as development of microbial consortium.
    • In the floating wetlands, plants acquire nutrition directly from the water column for their growth and development, thus reducing the organic as well as inorganic pollutants.
    • The final stage for sewage treatment will include disinfection using sodium hypochlorite, to kill the bacteria in the water.

    How will it be used by BMC?

    • A senior civic official said: “BMC approached IIT-B to submit a Detailed Project Report for the project.
    • The N-Treat method suggested to the civic body is cost-effective, as it does not require manual pumping, and saves electricity, and does not require extensive manpower for maintenance.”
    • The floating matter will be removed daily, silt deposits from the silt traps will be removed once in four months, and plants will be trimmed as required.
    • The floating matter collected every day will be disposed of at the nearest municipal waste collection point daily.

     

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  • Rise in Unvaccinated Children in India

    The number of children in India who were unvaccinated or missed their first dose of diphtheria-tetanus-pertussis (DTP) combined vaccine doubled due to the pandemic, rising from 1.4 million in 2019 to 2.7 million in 2021, according to official data published by the WHO and UNICEF.

    Why in news?

    • This data signifies that the world recorded the largest sustained decline in childhood vaccinations in approximately 30 years.
    • There was an increase in zero dose.
    • This is the first time ever there has been a decline in evaluated coverage in immunisation for India as a whole.

    Vaccination measures in India

    • Intensified Mission Indradhanush (IMI) 4.0: India started IMI 4.0 from February 2022, which is expected to further reduce the number of unvaccinated children.
    • India’s Universal Immunisation Programme (UIP): It provide free vaccines to all children across the country to protect them against Tuberculosis, Diphtheria, Pertussis, Tetanus, Polio, Hepatitis B, Pneumonia and Meningitis due to Haemophilus Influenzae type b (Hib), Measles, Rubella, Japanese Encephalitis (JE) and Rotavirus diarrhoea. (Rubella, JE and Rotavirus vaccine in select states and districts).

    About Intensified Mission Indhradhanush (IMI) 4.0

    • IMI 4.0 aims to fill gaps in the routine immunisation coverage of infants and pregnant women hit by the Covid-19 pandemic and also aims to make lasting gains towards Universal Immunization.
    • It will have three rounds and will be conducted in 416 districts across 33 states.
    • Unlike the past, each round under IMI 4.0 will be conducted for seven days, including Routine Immunization (RI) days, Sundays, and public holidays.

    Mission Indradhanush (MI)

    • Mission Indradhanush (MI) was launched in 2014 with the goal to ensure full immunization with all available vaccines under Universal Immunization Programme (UIP) for children up to two years of age and pregnant women.
    • It targets achieving 90% full immunization coverage in all districts.
    • Under MI, all vaccines under the Universal Immunization Program (UIP) are provided as per National Immunization Schedule.
    • UIP provides free vaccines against 12 life-threatening diseases, mentioned above.

    Back2Basics: Universal Immunisation Programme

    • The Expanded Programme on Immunization was launched in 1978.
    • It was renamed as UIP in 1985 when its reach was expanded beyond urban areas.
    • UIP is one of the largest public health programmes targeting close to 2.67 crore newborns and 2.9 crore pregnant women annually.
    • Under UIP, Immunization is provided free of cost against 12 vaccine-preventable diseases.
    • The two major milestones of UIP have been the elimination of polio in 2014 and maternal and neonatal tetanus elimination in 2015.
    • To speed up the coverage, Mission Indradhanush was planned and implemented to rapidly increase the full coverage to 90%.

     

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  • Kerala reports India’s first Monkeypox Case

    The first known lab-confirmed case of monkeypox in India has been reported in a 35-year-old man in Kerala.

    What is Monkeypox?

    • The monkeypox virus is an orthopoxvirus, which is a genus of viruses that also includes the variola virus, which causes smallpox, and vaccinia virus, which was used in the smallpox vaccine.
    • It causes symptoms similar to smallpox, although they are less severe.
    • While vaccination eradicated smallpox worldwide in 1980, monkeypox continues to occur in a swathe of countries in Central and West Africa, and has on occasion showed up elsewhere.
    • According to the WHO, two distinct clade are identified: the West African clade and the Congo Basin clade, also known as the Central African clade.

    Its origin

    • Monkeypox is a zoonosis, that is, a disease that is transmitted from infected animals to humans.
    • Monkeypox virus infection has been detected in squirrels, Gambian poached rats, dormice, and some species of monkeys.
    • According to the WHO, cases occur close to tropical rainforests inhabited by animals that carry the virus.

    Symptoms and treatment

    • Monkeypox begins with a fever, headache, muscle aches, back ache, and exhaustion.
    • It also causes the lymph nodes to swell (lymphadenopathy), which smallpox does not.
    • The WHO underlines that it is important to not confuse monkeypox with chickenpox, measles, bacterial skin infections, scabies, syphilis and medication-associated allergies.
    • The incubation period (time from infection to symptoms) for monkeypox is usually 7-14 days but can range from 5-21 days.
    • There is no safe, proven treatment for monkeypox yet.

     

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  • Is India really ahead of the West in terms of reproductive rights?

    Context

    Contrary to the grandstanding since the overturning of the landmark Roe V. Wade judgment, the truth is that India is not ahead of the West in terms of reproductive rights.

    Medical Termination of Pregnancy (MTP) Act

    • Abortion in India has been a legal right under various circumstances for the last 50 years with the introduction of Medical Termination of Pregnancy (MTP) Act in 1971.
    • The Act was amended in 2003 to enable women’s accessibility to safe and legal abortion services.
    • Abortion is covered 100% by the government’s public national health insurance funds, Ayushman Bharat and Employees’ State Insurance with the package rate for surgical abortion.

    The idea of terminating your pregnancy cannot originate by choice and is purely circumstantial. There are four situations under which a legal abortion is performed:

    1. If continuation of the pregnancy poses any risks to the life of the mother or mental health
    2. If the foetus has any severe abnormalities
    3. If pregnancy occurred as a result of failure of contraception (but this is only applicable to married women)
    4. If pregnancy is a result of sexual assault or rape

    These are the key changes that the Medical Termination of Pregnancy (Amendment) Act, 2021, has brought in:

    • The gestation limit for abortions has been raised from the earlier ceiling of 20 weeks to 24 weeks, but only for special categories of pregnant women such as rape or incest survivors. But this termination would need the approval of two registered doctors.
    • All pregnancies up to 20 weeks require one doctor’s approval. The earlier law, the MTP Act 1971, required one doctor’s approval for pregnancies upto 12 weeks and two doctors’ for pregnancies between 12 and 20 weeks.
    • Women can now terminate unwanted pregnancies caused by contraceptive failure, regardless of their marital status. Earlier the law specified that only a “married woman and her husband” could do this.
    • There is also no upper gestation limit for abortion in case of foetal disability if so decided by a medical board of specialist doctors, which state governments and union territories’ administrations would set up.

    Issues with legal provisions related to reproductive rights in India

    • Lack of rights based approach: The Medical Termination of Pregnancy (Amendment) Act 2021 is far from ideal and has been criticised for not taking a rights-based approach.
    • According to the Act, a pregnancy can be terminated on the following conditions: Grave danger to the physical/mental health of the pregnant woman; foetal abnormalities; rape/coercion; and contraceptive failure.
    • A woman’s right to choose to end the pregnancy even in the first few weeks is still not recognised in India.
    • Systemic barriers: It doesn’t give the pregnant person complete autonomy in ending the pregnancy, instead making them go through various systemic barriers.
    • The final decision falls not on the pregnant person, but on registered medical practitioners (RMP).
    • The constitution of a medical board, a requirement by the Act, is considered a barrier by the World Health Organisation.
    • Excludes transgenders and non-binary persons: Additionally, it uses the word “woman”, thereby leaving out pregnant transgender and non-binary persons who are biologically capable of bearing children.
    • It forces them to identify themselves in the gender-binary ignoring their gender identity.

    Social factors and lack of medical facilities

    • It is important to look through an intersectional lens, and factor in class and caste privilege.
    • Abortion facilities in private medical centres are expensive, available only for those who have the resources.
    • Lack of access: Not all public health centres, especially in rural India, provide abortion facilities.
    • Most unmarried women end up resorting to unsafe abortions in illegal clinics or at home.
    • According to the latest National Family Health Survey 2019-2021, 27 percent of the abortions were carried out by the woman herself at home.
    • According to United Nations’ Population Fund’s (UNFPA) State of the World Population Report 2022, around 8 women die each day in India due to unsafe abortions.
    • It also found that between 2007-2011, 67 percent of the abortions were classified as unsafe.
    • Unsafe abortion was one of the top three causes of maternal deaths.

    Discussion on reproductive rights in India are incomplete without mentioning surrogacy.

    Issues in the Surrogacy (Regulation) Act 2021

    • While well-intentioned, leaves much to be desired.
    • The plethora of regulations one must undergo is antithetical to a dignified standard of living.
    • Exclusionary in nature: Experts have pointed out that the Act is exclusionary in nature, disregards privacy, and also exploits women’s reproductive labour.
    • Only a heterosexual married couple (with certain preconditions) can be the intending parents.
    • It strips the reproductive autonomy of LGBTQ+ persons and single, divorced, and widowed intending parents. It can be seen as a violation to the fundamental right to equality.
    • Experts also believe that regulations, rather than a complete ban on commercial surrogacy, should have been the way forward.
    • Violates right to privacy: The Act requires the intending couple to declare their infertility and reveals the identity of the surrogate, both of which violate the right to privacy.
    • The landmark Puttaswamy judgment discusses bodily privacy – the right over one’s body and “the freedom of being able to prevent others from violating one’s body.”
    • The current reproductive rights regulatory framework falls short in guaranteeing bodily privacy.

    Conclusion

    The situation in India is far from perfect and we should take this moment to reflect and learn from progressive practices around the world. We should strive for inclusivity, complete bodily autonomy, and reproductive equity.

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  • Performance Grading Index for Districts (PGI-D)

    The Ministry of Education has released the Performance Grading Index for Districts (PGI-D) for 2019 which studied 83 indicators grouped in six categories.

    What is PGI-D?

    • The 83-indicator-based PGI for District (PGI-D) has been designed to grade the performance of all districts in school education.
    • The data is filled by districts through an online portal.
    • The indicator-wise PGI score shows the areas where a district needs to improve.
    • The PGI-D structure comprises a total weightage of 600 points across 83 indicators.
    • They are grouped under 6 categories, viz., Outcomes, Effective Classroom Transaction, Infrastructure Facilities & Students’ Entitlements, School Safety & Child Protection, Digital Learning, and Governance Process.
    • These categories are outcomes, effective classroom transaction, infrastructure facilities and student’s entitlements, school safety and child protection, digital learning and governance process.

    How does the grading scale works?

    • The PGI-D grades the districts into 10 grades with the highest achievable grade being ‘Daksh’, which is for districts scoring more than 90% of the total points in that category or overall.
    • ‘Utkarsh’ category is for districts with score between 81-90%, followed by ‘Ati-Uttam’ (71-80%), ‘Uttam’ (61-70%), ‘Prachesta-I’ (51-60%), ‘Prachesta-II’ (41-50%) and ‘Pracheshta III’ (31-40%).
    • The lowest grade in PGI-D is called ‘Akanshi-3’ which is for scores up to 10% of the total points.

    Performance of the states

    • Rajasthan’s Sikar is the top performer, followed by Jhunjhunu and Jaipur.
    • The other States whose districts have performed best are Punjab with 14 districts in ‘Ati-uttam’ grade (scoring 71-80% on a scale of 100).
    • It followed by Gujarat and Kerala with each having 13 districts in this category.
    • However, there are 12 States and UTs which do not have even a single district in the ‘Ati-uttam’ and ‘Uttam’ categories and these include seven of the eight States from the North East region.

    Significance

    • The PGI-D will reflect the relative performance of all the districts on a uniform scale which encourages them to perform better.
    • It is expected to help the state education departments to identify gaps at the district level and improve their performance in a decentralized manner.

     

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  • Managing Type 1 Diabetes

    Last week, the Indian Council of Medical Research (IMCR) released guidelines for the diagnosis, treatment, and management for type-1 diabetes.

    Why such move?

    • India is considered the diabetes capital of the world, and the pandemic disproportionately affected those living with the disease.
    • Type 1 or childhood diabetes, however, is less talked about, although it can turn fatal without proper insulin therapy.
    • Type 1 diabetes is rarer than type 2. Only 2% of all hospital cases of diabetes in the country are type 1.

    What is Diabetes?

    • Diabetes is a chronic (long-lasting) health condition that affects how your body turns food into energy.
    • Most of the food you eat is broken down into sugar (also called glucose) and released into your bloodstream.
    • When your blood sugar goes up, it signals your pancreas to release insulin.

    What is Type 1 Diabetes?

    • Type 1 diabetes is a condition where the pancreas completely stops producing insulin.
    • Insulin is the hormone responsible for controlling the level of glucose in blood by increasing or decreasing absorption to the liver, fat, and other cells of the body.
    • This is unlike type 2 diabetes — which accounts for over 90% of all diabetes cases in the country — where the body’s insulin production either goes down or the cells become resistant to the insulin.

    How lethal diabetes is?

    • Type 1 diabetes is predominantly diagnosed in children and adolescents.
    • Although the prevalence is less, it is much more severe than type 2.
    • Unlike type 2 diabetes where the body produces some insulin and which can be managed using various pills, if a person with type 1 diabetes stops taking their insulin, they die within weeks.

    How rare is it?

    • There are over 10 lakh children and adolescents living with type 1 diabetes in the world, with India accounting for the highest number.
    • Of the 2.5 lakh people living with type 1 diabetes in India, 90,000 to 1 lakh are under the age of 14 years.
    • For context, the total number of people in India living with diabetes was 7.7 crore in 2019.
    • Among individuals who develop diabetes under the age of 25 years, 25.3% have type 2.

    Who is at risk of type 1 diabetes?

    • The exact cause of type 1 diabetes is unknown, but it is thought to be an auto-immune condition where the body’s immune system destroys the islets cells on the pancreas that produce insulin.
    • Genetic factors play a role in determining whether a person will get type-1 diabetes.
    • The risk of the disease in a child is 3% when the mother has it, 5% when the father has it, and 8% when a sibling has it.
    • The presence of certain genes is also strongly associated with the disease.

     

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  • CoWIN as a repurposed digital platform

    Context

    Seeing its success, other nations have also expressed interest in availing CoWIN and using it as a bridge for erecting their digital health systems. Responding to this incoming interest, our prime minister has offered CoWIN as a digital public good, free of cost, for all nations globally to adopt.

    About CoWIN

    • In late 2020, even before the Covid-19 vaccines had arrived, the Government of India had commenced preparations for launching the world’s largest vaccination drive.
    • This led to the beginning of the CoWIN journey in January 2021.
    • Scalability, modularity, and interoperability: CoWIN, or the Covid-19 Vaccine Intelligence Network, was developed in a record time, with consideration given to scalability, modularity, and interoperability.
    • The platform has been made available in English and 11 regional languages to allow citizens across multiple states to access the platform with ease.
    • To circumvent the lack of digital access, the platform allows for up to six members to be registered under one mobile-number linked account.
    • CoWIN has scaled every 100 million milestone faster than any other platform.
    • It reached the coveted one billion registered user mark which only a handful of platforms have been able to achieve globally, and none in such a short time.
    • A key feature of the platform has been its modularity and evolvability.
    • The CoWIN team has been adept at keeping pace with the changing policy environment and scientific research and developments in the administration of vaccines.
    • It was never that CoWIN became the bottleneck or delayed the implementation of our vaccination policies or drive.
    • Time and again, CoWIN has proved itself as one of the most secure and robust platforms with minimal data input and zero risk of personal data hacks. 

    Major phases of CoWIN

    • The journey of CoWIN was staggered across three major phases, with multiple additions subsequently.
    • In phase 1, the registration process went online where healthcare workers and frontline workers were sent system-generated notifications about their vaccination schedule.
    • In subsequent phases, beneficiaries were allowed both walk-in and online vaccination registration, along with the choice of location and time slot as per their convenience.
    • An assisted mode was also made available through the 240,000+ Common Service Centres (CSCs) and a helpline number.
    • After ensuring successful orchestration using scalability and agile features of the platform to vaccinate individuals over 45 years of age, the APIs of the platform were made available to private players at the beginning of Phase III of the vaccination drive.
    • Once access to its services was opened through APIs, more than 100 applications integrated with CoWIN for providing search, booking and certification facilities to their users.

    Way ahead

    • The inevitable question is what will we do with CoWIN when no further Covid-19 vaccines are to be administered?
    • Repurpose the platform: The decision is to repurpose the platform as a universal immunisation platform.
    • The credentialing service of DIVOC, used in CoWIN, has proven to be a game-changer in the world of digital certificates.
    • CoWIN service is being implemented in five other countries after India and receiving global acceptance for its veracity and sound architecture.
    • There is a proposal for opening the credentialing service for more use cases in health.

    Conclusion

    The story of CoWIN has truly been one of national impact and importance. And while the story started during the pandemic, it won’t end with the pandemic: it will segue into a repurposed digital platform for more health use-cases.

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