💥Join UPSC 2027,2028 Mentorship (July Batch) + XFactor Notes & Microthemes PDF
Talk to Mentor

Civilsdaily

Login

Subject: Health

  • Positive response

    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.

  • Explained: Epidemic Diseases Act, 1897

    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.

  • [pib] Regulating Content of Trans-Fat in Oils and Fats

     

     

    The limit of trans-fats to be not more than 5% is prescribed under Food Safety and Standards (Food Products Standards and Food Additives) Regulations, 2011 for vanaspati, bakery shortenings, bakery and industrial margarine and interesterified vegetable fats/oils.

    What are Trans Fats?

    • Artificial Trans fats are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid.
    • Since they are easy to use, inexpensive to produce and last a long time, and give foods a desirable taste and texture, they are still widely used despite their harmful effects being well-known.

    Why this move?

    • Studies have recently shown that 60,000 deaths occur every year due to cardiovascular diseases, which in turn are caused due to high consumption of trans fats.
    • Since the impact of trans fats on human health is increasing exponentially, it is very important to create awareness about them.

    Standards for Trans-fats

    • A draft notification to limit trans-fat to be not more than 2% by weight of the total oils/fats present in the processed food products in which edible oils and fats are used as an ingredient on and from 1st January, 2022 was issued on 28.08.2019. 
    • Standards prescribed under various regulations of FSSAI are enforced to check that they comply with the standards laid down under Food Safety and Standards Act, 2006, and the rules and regulations made thereunder.
    • In cases where the food samples are found to be non-conforming, recourse is taken to penal provisions under Chapter IX of the Food Safety and Standards Act, 2006.

  • Tracking the big three

    Context

    The article focuses on the top three Sustainable Development Goals (SDGs) of the United Nations, namely poverty elimination, zero hunger, and good health and well-being by 2030.

    India’s record on extreme poverty, hunger and health

    • Decline in extreme poverty: The World Bank’s estimates of extreme poverty- measured as $1.9/per capita/per day at purchasing power parity of 2011- show a secular decline in India from 45.9 per cent to 13.4 per cent between 1993 and 2015.
    • Elimination of extreme poverty 2030: If the overall growth process continues as has been the case since, say, 2000 onwards, India may succeed in eliminating extreme poverty by 2030, if not earlier.
    • Zero hunger by 2030: Given the overflowing stock of food grains with the government, and a National Food Security Act (NFSA) that subsidises grains to the tune of more than 90 per cent of its cost to 67 per cent of the population, there is no reason to believe that India can also not attain the goal of zero hunger before 2030.
    • Health- a real challenge: The real challenge for India, is to achieve the third goal of good health and well-being by 2030. India’s performance in this regard, so far, has not been satisfactory. as per the National Family Health Survey (NFHS 2015-16)-
      • In 2015-16, almost 38.4 per cent of India’s children under the age of five years were stunted.
      • 8 per cent were underweight.
      • 21 per cent suffered from wasting (low weight for height).
      • The situation in some states like Bihar, Jharkhand and Uttar Pradesh is even worse.
    • Global Hunger Index ranking of India: No wonder, the Global Hunger Index (GHI) ranks India at 102 out of 117 countries in terms of the severity of hunger in 2019.

    What are the various targets set on the nutrition problem?

    • Target on reducing the problems of underweight children: The National Nutrition Strategy, 2017, aims to reduce the prevalence of underweight children (0-3 years) by three percentage points every year by 2022 from NFHS 2015-16 estimates.
      • Why this is an ambitious target? This is an ambitious target given the decadal decline in underweight children from 42.5 per cent in 2005-06 to 35.8 per cent in 2015-16 amounts to less than 1 per cent decline per year.
    • Targets set in National Nutrition Mission: Similar targets have been set by the National Nutrition Mission (renamed as POSHAN Abhiyaan), 2017.
      • To reduce stunting by 2 per cent.
      • Under-nutrition by 2 per cent.
      • Anaemia (among young children, women and adolescent girls) by 3 per cent.
      • Low birth weight by 2 per cent.

    Four areas India needs to focus to achieve the set targets

    • India has to focus on four key areas:  If India has to make a significant dent on malnutrition by 2030.
    • First- Mother’s education.
      • Multiplier effect: It is one of the most important factors that have a positive multiplier effect on child care and access to healthcare facilities.
      • Increases awareness: It also increases awareness about the nutrient-rich diet, personal hygiene, etc. This can also help contain the family size in poor, malnourished families.
      • Thus, a high priority to female literacy, in a mission mode through liberal scholarships for the girl child, would go a long way towards tackling this problem.
    • Second- Access to improved sanitation and safe drinking water.
      • The Swachh Bharat Abhiyan and Jal Jeevan Mission would have positive outcomes in the coming years.
    • Third-shift in dietary pattern
      • Shift from cereals to more nutritious food: There is a need to shift dietary patterns from cereal dominance to the consumption of nutritious foods such as livestock products, fruits and vegetables, pulses, etc.
      • But they are generally costly and their consumption increases only by higher incomes and better education.
      • Diverting the food subsidy to nutritious foods: Diverting a part of the food subsidy on wheat and rice to more nutritious foods can help.
    • Fourth- Adoption of new agricultural technology
      • Adopt bio-fortifying cereals: India must adopt new agricultural technologies of bio-fortifying cereals, such as zinc-rich rice, wheat, iron-rich pearl millet, and so on.
      • The Indian Council of Agricultural Research (ICAR) has to work closely with the Harvest Plus programme of the Consultative Group of International Agricultural Research (CGIAR) to make it a win-win situation for curtailing malnutrition in Indian children at a much faster pace — and, at a much lower cost than would be achieved under a business as usual scenario.

    Examples from the world

    • Right public policies make the difference: Global experience shows that with the right public policies focusing on agriculture, improved sanitation, and women’s education, one can have much better health and well-being for its citizens, especially children.
    • China’s example: In China, it was agriculture and economic growth that significantly reduced the rates of stunting and wasting among the population and lifted millions of people out of hunger, poverty and malnutrition.
    • Brazil and Ethiopia example: According to FAO, Brazil and Ethiopia have transformed their food systems: They have targeted their investments in agricultural R&D and social protection programmes to reduce hunger in the country.

    Conclusion

    Despite India’s improvement in child nutrition rates since 2005-06, it is way behind the progress experienced by China and many other countries. According to the Global Nutrition Report, 2016, at the present rates of decline, India will achieve the current stunting rates of China by 2055. India can certainly do better, but only if it focuses on this issue.

  • State lethargy amidst cough syrup poisoning

    Context

    A few days ago, 12 children died in Udhampur district of Jammu due to poisoned cough syrup (Coldbest-PC).

    Fourth mass glycol poisoning

    • What was the cause of the poisoning? A team of doctors at the Post Graduate Institute of Medical Education & Research, Chandigarh, attributed the deaths to the presence of diethylene glycol in the cough syrup.
    • What is Diethylene glycol? It is an anti-freezing agent that causes acute renal failure in the human body followed by paralysis, breathing difficulties and ultimately death.
    • This is the fourth mass glycol poisoning event in India that has been caused due to a pharmaceutical drug.

    Measures required and example from the US

    • Preventing further deaths: The immediate concern for doctors, pharmacists and the drug regulators should be to prevent any more deaths.
      • The only way to do so is to account for each and every bottle of the poisoned syrup that has ever been sold in the Indian market and stop patients from consuming this drug any further.
    • The US example in such case: United States Food and Drug Administration (USFDA), in 1937, when the United States faced a similar situation with glycol poisoning.
      • Tracking down every bottle: Entire field force of inspectors and chemists were assigned to the task of tracking down every single bottle of the drug.
      • Even if a patient claimed to have thrown out the bottle, the investigators scoured the street until they found the discarded bottle.
      • This effort was accompanied by a publicity blitz over radio and television.
    • What is being done in India? We do not see such public health measures being undertaken here.
      • Seriousness not communicated to the pubic: Authorities are simply not communicating the seriousness of the issue to the general public.
      • A general statement: At most, the authorities in Himachal Pradesh (H.P.), who are responsible for oversight of the manufacturer of this syrup, have made general statements that they have ordered the withdrawal of the drug from all the other States where it was marketed.
      • Lack of transparency: There is no transparency in the recall process and information about recalls and batch numbers is not being communicated through authoritative channels.
      • No public announcement by the DCGI: There is no public announcement by the Drug Controller General of India (DCGI), which is responsible for overall regulation of the entire Indian market.
      • The suspect product, although manufactured in H.P., has been sold across the country.
      • The website of the DCGI, which is supposed to communicate drug alerts and product recalls, has no mention of Coldbest-PC as being dangerous as of this writing.

    Need for the recall policy

    • No rules or binding guidelines on recall: One of the key reasons why the DCGI and state drug authorities have been so sloppy is because unlike other countries, India has not notified any binding guidelines or rules on recalling dangerous drugs from the market.
    • Warnings to the DGCI on lack of framework: The 59th report of the Parliamentary Standing Committee on Health as well as the World Health Organization (in its national regulatory assessment) had warned the DCGI on the lack of a national recall framework in India.
      • A set of recall guidelines was drafted in 2012 but never notified into law.

    Conclusion

    The drug regulator needs to take the urgent steps to avoid the repeat of such tragedies in the future and formulate a policy on the drug recall at the earliest.

  • One country, two viruses

    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.

  • Youth can be a clear advantage for India

    Context

    The demographic dividend is close to five-decade-long demographic opportunities that can be leveraged only with suitable policies and programmes

     The youngest population in the world

    • Median age at 28 years: By 2022, the median age in India will be 28 years.
      • In comparison, it will be 37 in China and the United States.
      • 45 in western Europe, and 49 in Japan.
    • The demographic dividend
      • The working-age population more than non-working: India’s working-age population has numerically outstripped its non-working age population.
      • An extraordinary opportunity: A demographic dividend, said to have commenced around 2004-05, is available for close to five decades.

    The two caveats

    • The demographic dividend is an extraordinary opportunity. There are, however, two caveats.
    • First: Dividend available in different states at different times.
      • India’s population heterogeneity ensures that the window of demographic dividend becomes available at different times in different States.
      • Example of Kerala vs. Bihar: While Kerala’s population is already ageing, in Bihar the working-age cohort is predicted to continue increasing till 2051.
      • Decline in 11 major states by 2031: By 2031, the overall size of our vast working-age population would have declined in 11 of the 22 major States.
    • Second: Many factors that matter for harnessing the dividend
      • Factors that matter: Harnessing the demographic dividend will depend upon the-
      • Employability of the working-age population.
      • Health.
      • Education.
      • Vocational training and skill.
      • Besides appropriate land and labour policies, as well as good governance.
      • Demography is not destiny: India will gain from its demographic opportunity only if policies and programmes are aligned to this demographic shift. Demography is not destiny.

    Need for skills

    • Need for the additional jobs: The Economic Survey 2019 calls for additional jobs to keep pace with the projected annual increases in the working-age population.
    • Lack of education and skills: UNICEF 2019 reports that at least 47% of Indian youth are not on track to have the education and skills necessary for employment in 2030.
      • Possibility of demographic disaster: The projected demographic dividend would turn into a demographic disaster if an unskilled, under-utilised, and frustrated young population undermines social harmony and economic growth.
    • Poor learning outcomes: While over 95% of India’s children attend primary school, the National Family Health Surveys (completed up to 2015-16) confirm that poor infrastructure in government schools, malnutrition, and scarcity of trained teachers have ensured poor learning outcomes.

    What needs to be done?

    • Adopt a uniform school system: A coordinated incentive structure prompting States to adopt a broadly uniform public school system focusing on equity and quality will yield a knowledge society faster than privatising school education can accomplish.
    • Ensure training in line with the market demand: Most districts now have excellent broadband connectivity-
      • Let geography not trump demography: Irrespective of a rural or urban setting, the public school system must ensure that every child completes high school education, and is pushed into appropriate skilling, training and vocational education in line with market demand.
    • Invest and modernise: Modernise school curricula, systematically invest in teacher training so that they grow in their jobs to assume leadership roles while moving beyond the tyranny of the syllabus.
    • Use of technology: Deploy new technology to accelerate the pace of building human capital by putting in place virtual classrooms together with massive open online courses (MOOCS) to help prepare this huge workforce for next-generation jobs.
      • Investing in open digital universities would further help yield a higher educated workforce.

    Focus on women

    • Translating literacy into skill: Growing female literacy is not translating into relevant and marketable skills.
      • A comprehensive approach is needed to improve their prospects vis-à-vis gainful employment.
      • Need of the flexible policies: Flexible entry and exit policies for women into virtual classrooms, and into modules for open digital training, and vocational education would help them access contemporary vocations.
    • The need for equal pay: Equal pay for women will make it worth their while to stay longer in the workforce.
    • The deferred bonus: Economist Yogendra Alagh has written that the significance of this “deferred bonus” (women entering the workforce), could be higher than the immediate benefits of the dividend from shifts in population age structure.

    Health care

    • In India, population health is caught between the rising demand for health services and competition for scarce resources.
    • Impact of economy on rural health: The National Sample Survey Office data on health (75th round, 2018), shows that a deep-rooted downturn in the rural economy is making quality health-care unaffordable.
      • People are availing of private hospitals less than they used to, and are moving towards public health systems.
      • Diverting public investment from However, central budget 2020-21 lays emphasis on private provisioning of health care which will necessarily divert public investment away from public health infrastructure.
    • The Ayushman Bharat Yojana: It links demand to tertiary in-patient care.
      • This promotes earnings of under-utilised private hospitals, instead of modernising and up-grading public health systems in each district.
    • We need to assign 70% of health sector budgets to integrate and strengthen primary and integrated public health-care services and systems up to district hospital levels.
      • Include out-patient department and diagnostic services in every health insurance model adopted, and-
      • Implement in ‘mission mode’ the Report of the High-Level Group, 2019, submitted to the XV Finance Commission.
    • The elderly population in India is projected to double from 8.6% in 2011 to 16% in 2040.
      • This will sharply reduce the per capita availability of hospital beds in India across all major States unless investments in health systems address these infirmities.

    Conclusion

    The policies that we adopt and their effective implementation will ensure that our demographic dividend, a time-limited opportunity, becomes a boon for India.

     

     

     

  • Gearing up to fight the next big viral outbreak

    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.

     

     

     

     

     

     

     

  • Assisted Reproductive Technology Regulation Bill, 2020

     

    The Union Cabinet has approved the Assisted Reproductive Technology Regulation Bill, 2020 to monitor medical procedures used to assist people to achieve pregnancy.

    What is ART?

    • Assisted reproductive technology (ART) is used to treat infertility.
    • Assisted reproductive technology includes medical procedures used primarily to address infertility.
    • This subject involves procedures such as in vitro fertilization, intracytoplasmic sperm injection, cryopreservation of gametes or embryos, and/or the use of fertility medication.

    Highlights of the bill

    • National Board: The Bill provides for a national Board which will lay down a code of conduct to be observed by those operating clinics.
    • Standardization: It will also formulate minimum standards for laboratory and diagnostic equipment and practices to be followed by human resources employed by clinics and banks.
    • National registry: Under the proposed law, a national registry and registration authority will maintain a database to assist the national Board to perform its functions.
    • Confidentiality clause: The Bill will also ensure confidentiality of intending couples and protect the rights of the child.

    Strict punishment:

    • India has one of the highest growths in the number of ART centres and ART cycles performed every year.
    • India has become one of the major centres of this global fertility industry, with reproductive medical tourism becoming a significant activity.
    • This has also introduced a plethora of legal, ethical and social issues; yet, there is no standardisation of protocols and reporting is still very inadequate.
    • The Bill thus proposes stringent punishment for those who practise sex selection; indulge in sale of human embryos or gametes and those who operate rackets.

    Other such Bills

    Taken together, theses proposed legislations create an environment of safeguards for women’s reproductive rights, addressing changing social contexts and technological advances.

    Surrogacy Regulation Bill 2020

    • The Surrogacy (Regulation) Bill, 2020 proposes to regulate surrogacy in India by establishing National Board at the central level and State Boards and Appropriate Authorities in the States and Union Territories.
    • The major benefit of the Act would be that it will regulate the surrogacy services in the country.
    • While commercial surrogacy will be prohibited including sale and purchase of human embryos and gametes, ethical surrogacy to the Indian Married couple, Indian Origin Married Couple and Indian Single Woman (only widow or Divorcee) will be allowed on fulfillment of certain conditions.
    • As such, it will control the unethical practices in surrogacy, prevent commercialization of surrogacy and will prohibit potential exploitation of surrogate mothers and children born through surrogacy.

    Medical Termination Pregnancy Amendment Bill 2020

    • The Medical Termination of Pregnancy Act, 1971 (34 of 1971) was enacted to provide for the termination of certain pregnancies by registered medical practitioners and for matters connected therewith or incidental thereto.
    • The said Act recognised the importance of safe, affordable, accessible abortion services to women who need to terminate pregnancy under certain specified conditions.
    • Besides this, several Writ Petitions have been filed before the Supreme Court and various High Courts seeking permission for aborting pregnancies at gestational age beyond the present permissible limit on the grounds of foetal abnormalities or pregnancies due to sexual violence faced by women.

  • Powering the health-care engine with innovation

    Context

    India needs to tap the potential of the health-care start-ups in India and make the necessary provision to deal with the problems in the adoption of innovations in health-care.

    Expanding the supply side

    • Need to increase the hospital empanelled: As the scale of this scheme grows, a key area of focus is-
      • To expand the secondary and tertiary hospitals empanelled under PM-JAY and
      • To ensure their quality and capacity while keeping the costs down.
    • The ratio of doctors and beds: At present, there is one government bed for every 1,844 patients and one doctor for every 11,082 patients.
    • 3% hospitalisation under the scheme: In the coming years, considering 3% hospitalisation of PM-JAY-covered beneficiaries, the scheme is likely to provide treatment to 1.5 crore patients annually.
      • This means physical and human infrastructure capacity would need to be augmented vastly.
    • Need for more beds: Conservative estimates suggest that we would need more than 150,000 additional beds, especially in Tier-2 and -3 cities.
    • Long-term strategy: While a comprehensive long-term strategy will focus on expanding hospital and human resources infrastructure, an effective near-term approach is needed to improve efficiencies and bridge gaps within the existing supply and likely demand.
    • Mainstreaming innovation: A strong, yet under-tapped lever for accelerating health system efficiency and bridging these gaps is mainstreaming innovation in the Indian health system.

    Transformative solutions

    • India’s burgeoning entrepreneurial spirit combined with a systematic push for the development of a start-up ecosystem has led to a plethora of innovations in health care.
    • It is estimated that there are more than 4,000 health-care technology start-ups in India.
    • How do start-ups help? Today, start-ups are working to bring-
      • Innovative technologies and business models that leapfrog infrastructure.
      • Human resources.
      • Cost-effectiveness and efficiency challenges in Tier-2 and -3 cities.
    • How other innovations could help?
      • Artificial Intelligence platforms that aid in rapid radiology diagnoses in low resource settings.
      • Tele-ICU platforms to bridge the gap in high-skilled critical care personnel.
      • Centralised drone delivery of blood, medicines and vaccines to reach remote locations cost-effectively and reliably are all no longer just theoretical ideas.
    • Time to implement transformative solutions: It is high time for transformative solutions to make their way into our hospitals, especially in Tier-2 and -3 cities, to turbocharge the way health care is delivered at scale.

    Challenges in mainstreaming healthcare innovations

    • Lack of uniform regulatory standards: One challenge is non-uniform regulatory and validation standards.
      • Regulations evolving in India: Regulatory requirements, specifically for biomedical start-ups, are still evolving in India.
      • As a result, hospitals often rely on foreign regulatory certifications such as FDA and CE, especially for riskier devices and instruments.
      • Government to overhaul standards: The government is now pushing ahead to overhaul Indian med-tech regulatory standards and product standards which will help bridge this trust-deficit.
    • Difficulty in the promotion of start-ups: Another problem in promoting start-ups is the operational liquidity crunch due to a long gestation period.
      • Health-care start-ups spend long periods of time in the early development of their product, especially where potential clinical risks are concerned.
      • Long gestation period: The process of testing the idea and working prototype, receiving certifications, performing clinical and commercial validations, and raising funds, in a low-trust and unstructured environment makes the gestational period unusually long thereby limiting the operational liquidity of the start-up.
    • Lack of framework to adopt innovation: Another hurdle is the lack of incentives and adequate frameworks to grade and adopt innovations.
      • Health-care providers and clinicians, given limited bandwidth, often lack the incentives, operational capacity, and frameworks necessary to consider and adopt innovations.
      • This leads to limited traction for start-ups promoting innovative solutions.
    • Procurement challenges: Start-ups also face procurement challenges in both public and private procurement.
      • They lack the financial capacity to deal with lengthy tenders and the roundabout process of price discovery.
      • Private procurement is complicated by the presence of a fragmented customer base and limited systematic channels for distribution.

    Way forward

    • Identify promising market-ready products: To accelerate the process of mainstreaming innovations within the hospital system in India-
      • We need to focus on identifying promising market-ready health-care innovations that are ready to be tested and deployed at scale.
    • Facilitate standard operational validation studies: There is a need to-
      • Facilitate standardised operational validation studies that are required for market adoption.
      • To help ease out the start-up procurement process such that these solutions can be adopted with confidence.
      • This, in effect, will serve the entire ecosystem of health-care innovators by opening up health-care markets for all.
    • Need to develop an interface between hospital and start-ups: A strong theme in mature health-care systems in other parts of the world is a vibrant and seamless interface between hospitals and health-care start-ups.
      • Through Ayushman Bharat, India has the unique opportunity to develop a robust ecosystem where-
      • Hospitals actively engage with health-care start-ups by providing access to testbeds, communicating their needs effectively and adopting promising innovations.
      • Start-ups as collaborators: Start-ups can be effective collaborators for the most pressing health-care delivery challenges faced by hospitals.

    Conclusion

    The dream of an accessible, affordable and high-quality health-care system for all, will be achieved when we work in alignment to complement each other and jointly undertake the mission of creating an Ayushman Bharat.