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Subject: Social Justice

  • Centre must make way for states in Covid fight

    The States are better equipped to deal with the health emergencies and the Centre needs to augment them in their efforts. The article deals with this issue.

    Role of the States in health crisis

    • Covid-19 pandemic is a national crisis calling for concerted efforts by both, the Government of India (GoI) and state governments.
    • Health is a state subject, and the states have been pioneering many health programmes on their own, some with support and funding from the GoI, for a very long time.
    • The number of employees in the health wing of the GoI is negligible as compared to that in any state government.
    • The GoI must help them, motivate them to do better and assist them in their task.
    • Also, the GoI must and can play a major role is in vaccination.

    Role of the Central government

    • It must try to augment supplies by encouraging companies to produce more and through imports/gifts.
    •  However, whatever it procures must be allotted to states in proportion to their eligible population.
    • State governments must be involved in this policy.
    • The vaccination policy may be left to the state governments based on the allocation. 
    • The GoI must also augment supplies of critical medical goods through imports and donations from friendly nations in view of their acute shortage.
    • It must distribute them to the needy states transparently and equitably.

    Steps that need to be taken

    • Lockdowns need to be lifted in a calibrated manner depending on local conditions.
    • Lockdowns are not the solution, they just buy breathing time which can be used by governments to ramp up capacity.
    • State governments must set up efficient and well-functioning control rooms and telemedicine centres to guide people on home treatment and timely admission to hospitals.
    • The private sector can also be fully involved in these efforts.
    • Bed capacity must be increased in both private and public sectors, with all necessary requirements such as oxygen, medicines, and health workers.
    • It is also important to put in place a standard guidance protocol for health workers and control rooms to guide patients through the disease.
    •  Enforcement of masks and distancing in public places must go on till the country is fully vaccinated.
    • The measures suggested above require hard work and efficient management by state governments, by a team of reputed professionals and civil servants.
    • Daily briefing by a professional, not a politician, is the need of the hour at both the Centre and state level, giving some confidence and assurance to the public.

    Consider the question “In dealing with the health crisis the Union Government and the State governments are better placed for certain roles.  In light of this, examine the important role of the States in dealing with the Covid pandemic and how the Union government can complement it.”

    Conclusion

    The central government must realise that states are on the forefront in this war, and therefore, play a supporting and proactive role. It has only a minor, behind-the-scenes role in the health sector.

  • Challenges in Vaccinating All

    Reoriented vaccine policy

    • The foremost challenge in vaccination in India has been a supply deficit.
    • Announcing a reoriented vaccine policy recently, the Prime Minister announced a coherent path forward.
    • Starting from June 21, the Union government will take charge of 75 per cent of the total procurement, and provide vaccines to states at no cost.
    • The government has reserved 30 crore vaccines with Hyderabad-based Biological-E by facilitating an advance payment of Rs 1,500 crore.
    • Fortnightly updates on the supply of vaccines to states are being taken to ensure transparency and efficiency in planning.

    Dealing with two complex challenges

    • Two other complex challenges that need immediate focus are vaccine hesitancy and the much-discussed digital divide in the country.

    1) Challenge of vaccine hesitancy

    • Contextualised and curated approaches are crucial.
    • The WHO has put forth the BeSD (behavioural and social drivers) vaccination model, which emphasises “motivation” as the vanguard of human psychology during a vaccination drive.
    • Vaccination coverage could be increased by incentivising and motivating citizens.
    • Unfortunately, in India, misinformation, disinformation and misplaced beliefs have led to fears about the potential harmful effects of vaccines.
    • The diversity of India necessitates community engagement at the local level to counter this narrative of misinformation.
    • A successful information campaign requires dissemination through mediums that invoke trust.
    • Local languages and dialects should be used to engage people via local radio, television channels and regional newspapers.
    • Another network that can be leveraged at the district level is that of the ASHA workers and the auxiliary nurse-midwives.
    • These are trusted local figures.

    2) Bridging the digital divide

    • It is important to introduce solutions that bridge the digital divide.
    • A toll-free helpline number 1075 has been activated for those without internet.
    • Similarly, districts can explore missed-call campaigns, which could ensure that minimal infrastructure is being optimised for processing high-volume user requests.
    • Even though the reported adverse events following immunisation stands at only 0.012 per cent, dedicated representatives can provide vaccine-related pre- and post-counselling to individuals.

    Way forward

    Startups could help bridge digital divide

    • The devastating effects of the second wave in rural areas have prompted fintech startups to enable vaccine registration.
    • PayNearby has helped over 8 lakh citizens register through its network of agents called “digital pradhans”, who are present in kirana, ration, mobile and hardware stores, frequented regularly by rural users. 

    Use points of contact for publicising benefits of vaccine and registration

    • Almost 81 crore beneficiaries, 75 per cent of whom are in rural areas, procure ration from 5,46,165 fair price shops across India.
    • There are over 11 lakh business correspondent outlets in India working mostly in rural areas to advance the mission of financial inclusion.
    • A network of around 1,54,965 post offices (as on March 2017) exists in India of which 1,39,067 are in the rural areas.
    • Such points of contact can be leveraged as dedicated units for publicising the benefits of Covid vaccines and as physical locations for vaccine registration

    Direct engagement with citizens

    • The Prime Minister recently described district officials as “field commanders” in our efforts against Covid.
    • This ambit should move beyond just the district bureaucracy to the extensive network of public services. 
    • A stellar example of direct engagement also stems from the success of the Swachh Bharat Abhiyan.
    • Direct engagement with citizens contributed greatly to the operational success of previous immunisation campaigns like the pulse polio programme.

    Consider the question “What are the factors responsible for vaccine hesitency? Suggest the ways to deal with it.”

    Conclusion

    Thinking local and utilising established networks to create culturally resonant messages is the need of the hour to reduce vaccine hesitancy, bridge the digital divide and achieve vaccine saturation.

     

  • South Asia’s healthcare burden

    The article contrasts the public healthcare system in South Asian countries with that of their Southeast Asian peers and highlights the shortcomings.

    Subpar public healthcare system

    • Super spreader events, a fragile health infrastructure neglected for decades, citizens not following health protocols, and logistical mismanagement were the factors responsible for the destruction in the second Covid-19 wave.
    • What has exacerbated the situation is a subpar public healthcare system running on a meagre contribution of a little over 1% of India’s Gross Domestic Product (GDP).
    • While the private medical sector is booming, the public healthcare sector has been operating at a pitiful 0.08 doctors per 1,000 people, World Health Organization’s (WHO) prescribed standard ois1:1000.
    • India has only half a bed available for every 1,000 people, which is a deficient figure even for normal days.
    • Bangladesh and Pakistan fare no better, with a bed to patient ratio of 0.8 and 0.6, respectively, and a doctor availability of less than one for every 1,000 people.
    • While ideally, out-of-pocket expenditure should not surpass 15% to 20% of the total health expenditure, for India, Bangladesh and Pakistan, this figure stands at an appalling 62.67%, 73.87% and 56.24%, respectively.

    Lack of investment in healthcare

    • Major public sector investments by the ‘big three’ of South Asia, i.e., India, Pakistan, and Bangladesh, are towards infrastructure and defence, with health taking a backseat.
    • While India has the world’s third-largest military expenditure, its health budget is the fourth-lowest.
    • Indian government in this year’s budget highlighted an increase of 137% in health and well-being expenditure, a closer look reveals a mismatch between facts and figures.
    • In Pakistan, even amidst the pandemic, the defence budget was increased while the spending on health remained around $151 million.
    • Not too far behind is Bangladesh, with decades of underfunding culminating in a crumbling public healthcare system.
    • Major public sector investments by the ‘big three’ of South Asia, i.e., India, Pakistan, and Bangladesh, are towards infrastructure and defence, with health taking a backseat.
    • A quick look at pre-pandemic sectoral allocations explains the chronically low status of human development indicators in the three countries.

    Learning from Southeast Asia

    • Southeast Asia has prioritised investments in healthcare systems while broadening equitable access through universal health coverage schemes.
    • Vietnam’s preventive measures focused on investments in disease surveillance and emergency response mechanisms.
    • Even countries like Laos and Cambodia are making a constant effort towards improving the healthcare ecosystem.
    • All have done much better than their South Asian peers.

    Conclusion

    Learning from the devastation unleashed by the pandemic, South Asian countries must step up investment in their public healthcare sectors to make them sustainable, up to date and pro-poor; most importantly, the system should not turn its back on citizens.

  • Operation Pangea XIV

    More than 1.10 lakh web links, including websites and online marketplaces, have been taken down in the operation Pangea XIV.

    Operation Pangea XIV

    • Code-named “Operation Pangea XIV”, the exercise was coordinated by Interpol.
    • It involved the police, customs, and health regulatory authorities of 92 countries against the sale of fake and illicit medicines and medical products.
    • Indian agencies also participated in the operation, said an official of the Central Bureau of Investigation that is the nodal body for the Interpol in the country.
    • It showed that criminals were continuing to cash in on the huge demand for personal protection and hygiene products due to the COVID-19 pandemic.

  • [pib] SAGE (Senior-care Ageing Growth Engine) Initiative

    The Ministry of Social Justice and Empowerment has launched the SAGE (Seniorcare Aging Growth Engine) initiative and SAGE portal for elderly persons.

    SAGE Initiative

    • The SAGE will be a “one-stop access” of elderly care products and services by credible start-ups.
    • The start-ups will be selected on the basis of innovative products and services.
    • Their products should be able to provide across sectors such as health, housing, care centers, apart from technological access linked to finances, food and wealth management, and legal guidance.
    • The start-ups who have applied will be selected by an independent screening committee of experts.
    • A fund of upto Rs.1 crore as one-time equity will be granted to each selected start-up.

    Why need such initiative?

    • India’s elderly population is on the rise as per surveys.
    • The share of elders, as a percentage of the total population in the country, is expected to increase from around 7.5% in 2001 to almost 12.5% by 2026, and surpass 19.5% by 2050.
    • There is an urgent need to create a more robust eldercare ecosystem in India, especially in the post-COVID phase.

  • Different types of fungus due to Covid

    Context

    As India is still reeling under the second wave of COVID-19 pandemic, Black, White and Yellow Fungus infections have brought along unending woes, pressuring the already stressed healthcare system. These fungal infections have been attributed to COVID-19 and led to prolonged morbidity and mortality in COVID-19 patients

    Black Fungus

    What is black fungus (Mucormycosis)?

    • Mucormycosis, previously known as zygomycosis and sometimes called black fungus, is a serious fungal infection, generally in people with less ability to fight infection.
    • Mucormycosis is a rare but serious infection that is caused by a group of moulds called mucormycetes.
    • It mainly affects people who have health problems or take medicines that lower the body’s ability to fight germs and sickness.
    • It reduces the ability to fight environmental pathogens.
    • It can also happen on the skin after a burn, cut or other type of skin wound through which the fungus enters the skin. It can also affect the brain
    • People having co-morbities, variconazole therapy, uncontrolled diabetes mellitus, immunosuppression by steroids or prolonged ICU stay can get predisposed to the fungal infection.

    Types of Mucormycosis

    • Sinuses and brain (rhinocerebral): Most common in people with poorly controlled diabetes and in people who have had a kidney transplant.
    • Lungs (pulmonary): The most common type of mucormycosis in people with cancer and in people who have had an organ transplant or a stem cell transplant.
    • Stomach and intestine (gastrointestinal): More common among young premature and low birth weight infants, who have had antibiotics, surgery, or medications that lower the body’s ability to fight infection.
    • Skin (cutaneous): After a burn, or other skin injury, in people with leukaemia, poorly controlled diabetes, Graft-versus-host disease, HIV and intravenous drug use.
    • Widespread (disseminated): When the infection spreads to other organs via the blood.

    Symptoms of Mucormycosis

    The symptoms of Black Fungus infection are:

    For Brain Mucormycosis

    1- One-sided facial swelling
    2- Headache
    3- Nasal or sinus congestion
    4- Black lesions on nasal bridge or upper inside of the mouth
    5- Fever

    For Pulmonary Mucormycosis

    1- Fever
    2- Cough
    3- Chest pain
    4- Shortness of breath

    For Gastrointestinal Mucormycosis

    1- Abdominal pain
    2- Nausea and vomiting
    3- Gastrointestinal bleeding

    Who are at risk of getting infected with Black Fungus?

    1- Diabetes
    2- Cancer
    3- Organ transplant
    4- Stem cell transplant
    5- Neutropenia 
    6- Long-term corticosteroid use
    7- Hemochromatosis (excess of iron)
    8- Skin injury due to surgery, burns, or wounds
    9- Pre-maturity 
    10- Low birth weight 

    Where are these fungi found?

    • Mucormycosis is caused by a group of molds called mucormycetes. It is naturally found in air, water and even food.
    • It enters the body through fungal spores from the air or can also occur on skin after a cut, burn, or skin injury.

    Mucormycosis affecting COVID-19 patients

    • Patients who have high levels of diabetes are at a higher risk of contracting covid-19. When this occurs, they are treated with steroids which compromises their immunity.
    • According to doctors, steroids can prove to be a trigger for mucormycosis. While steroids help in reducing inflammation in lungs they can decrease immunity and increase blood sugar levels in both diabetics and non-diabetic covid-19 patients alike.
    • Medicines used in treating Covid-19 tend to bring down the count of lymphocytes.
    • Lymphocytes are one of the three types of white blood cells whose job is to defend our body against disease-causing pathogens such as bacteria, viruses, and parasites.
    • The reduced count of lymphocytes leads to a medical condition called lymphopenia, making way for opportunistic fungal infection in Covid-19 patients.

    Treatment

    • While it is treated with antifungals, mucormycosis may eventually require surgery.
    • To maintain adequate systemic hydration, the treatment includes infusion of normal saline (IV) before infusion of amphotericin B and antifungal therapy, for at least 4-6 weeks.

    Life after surgery for mucormycosis

    • Mucormycosis can lead to loss of the upper jaw and sometimes even the eye.
    • Be it the eye or upper jaw, these can be replaced with appropriate artificial substitutes or prostheses.

    Yellow Fungus

    • Yellow Fungus, dangerous than white or black fungus, is another fungal infection that has been attributed to COVID-19. Health experts say it is a fatal infection.
    • Yellow Fungus is commonly found in reptiles.
    • Yellow fungus initially develops by the presence of moulds (a type of fungi) in the environment. It may be present with unnecessary fatigue, rashes, burning sensation on skin etc.
    • It may not start from the lungs but it invades internal organs of the body and affects the entire functioning.

    Potential causes of yellow fungus

    • Prolonged use of steroid.
    • Contaminated environment.
    • Uncontrolled diabetes.
    • Unhygienic or dirty surroundings.
    • Unhygienic habits.
    • Lesser immunity.
    • Co-morbidities.

    Symptoms of Yellow Fungus

    • Weight loss
    • Reduced appetite
    • Lethargy
    • Pus leakage
    • Sunken eyes
    • Organ failure

    Treatment

    • Like mucormycosis, the treatment for yellow fungus is Amphoteracin-B injection

    Prevention

    • Keep your room, home and surroundings as clean as possible
    • Remove stale food and fecal matter immediately to check bacterial and fungal growth.
    • Keep the humidity of the room and home under check as excessive humidity promotes bacteria growth. Just like for Covid patients maintaining clean air flow inside the room and homes is necessary.
    • Coronavirus positive patients must immediately start treatment so complications like yellow fungus do not develop.

    White Fungus

    • White Fungus or Candidiasis is a fungal infection caused by a yeast (a type of fungus) called Candida.
    • Candida normally lives on the skin and inside the body, in places such as the mouth, throat, gut, and vagina, without causing any problems.
    • Candida can cause infections if it grows out of control or if it enters deep into the body (for example, the bloodstream or internal organs like the kidney, heart, or brain).
    • The most common species that causes infection is Candida albicans.
    • Patients of white fungus show Covid-like symptoms but test negative; the infection can be diagnosed through CT-Scan or X-ray.

    Cause

    • This infection can be caused due to low immunity, or if people come in contact with things that contain these moulds like water, etc.
    • Children and women are more at risk of contracting the fungal infection.
    • Like the black fungus, white fungus is also more likely to afflict people with compromised immune systems, pre-existing medical conditions, AIDS, a recent kidney transplant or diabetes.

    Symptoms

    • People experience symptoms similar to Covid if it reaches the lungs such as chest infection, despite testing negative for the virus.
    • White fungus affects the lungs as well as other parts of the body including the nails, skin, stomach, kidney, brain, private parts and mouth.

    Diagnosis/Treatment

    • CT scans or X-Rays can reveal the condition.
    • Patients with the white fungus are currently being treated with known anti-fungal medication.

    Prevention

    • Special caution is required of moulds in water that can lead to infection.
    • Proper sanitation is very important.

    Way Forward

    • Use of Steroids must be curbed down in the treatment of Covid to prevent low immunity in patients.
    • The fungus must be dealt as a pandemic and not just a regular post Covid complication.
    • All necessary medicines needed for the treatment of above mentioned Fungus must be made available in the hospital.
    • Government should run awareness campaigns about these funguses as a preventive measure.

  • What are Neglected Tropical Diseases (NTD)?

    The ongoing World Health Assembly has declared January 30 as ‘World Neglected Tropical Diseases (NTD) Day’.

    Neglected Tropical Diseases

    • NTDs are a group of infections that are most common among marginalized communities in the developing regions of Africa, Asia, and the Americas.
    • They are caused by a variety of pathogens such as viruses, bacteria, protozoa, and parasitic worms.
    • These diseases generally receive less funding for research and treatment than malaises like tuberculosis, HIV-AIDS and malaria.
    • Some examples of NTDs include snakebite envenomation, scabies, yaws, trachoma, Leishmaniasis and Chagas disease.

    Significance of global recognition

    • NTDs affect more than a billion people globally, according to the WHO. They are preventable and treatable.
    • However, these diseases and their intricate interrelationships with poverty and ecological systems — continue to cause devastating health, social and economic consequences.
    • A major milestone in the movement to recognize the global burden of these diseases was the London Declaration on NTDs that was adopted January 30, 2012.
    • The first World NTD Day was celebrated informally in 2020. This year, the new NTD road map was launched.

  • Addressing vaccine hesitancy

    The article deals with the issue of vaccine hesitancy and its consequences.

    Why vaccinate?

    • The primary purpose of vaccination is to protect individuals against severe infection.
    • Vaccination also protects populations by providing ‘herd immunity’, if done on a large scale.
    • Globally, vaccinations against polio, small pox, meningitis and so on have seen huge success.

    Need to address the vaccine hesitancy

    • The results of a 2020 Gallup poll, conducted before the vaccine roll-out reveals that 18% of the Indian said that they won’t take the vaccine.
    • But vaccine hesitancy has gone up in India since then, due in part to largely overblown reports of complications or even deaths.
    • The consequences of vaccine hesitancy are disastrous.
    • If herd immunity does not develop, disease outbreaks and pandemics will prevail.
    • The slower the vaccination rate, the wider the spread of infection and the greater the chances of mutations and the emergence of new variants.

    Factors driving vaccine hesitancy

    • The influencing factors include a lack of awareness of the extent of benefits.
    • Fears based on inaccurate information.
    • Lack of access to vaccine.
    • Disinformation, especially on social media.
    • Other factors include civil liberty concepts, cost, cultural issues, and various layers of confidence deficit.

    Way forward

    • To allay vaccine fears, our messaging needs to focus on simple facts.
    • Before attempting to persuade people, we need to understand the basis of their fear, hesitancy and the anti-vax attitude.
    •  By challenging untruths, we inadvertently feed the perception that we are actively suppressing the “real” truth.
    • The objective now should be to reach more people faster with a message that doesn’t just provide more science but includes guidance.
    • Providing practical information through social media, alternatives to apps for those lacking easy access to vaccines, and taking the help of well-informed frontline workers will all help.

    Conclusion

    The possibility of a significant number of people not getting vaccinated thwarts our collective ability to reach the herd immunity threshold against Covid-19. Therefore the issue of vaccine hesitancy needs to be urgently addressed.

  • WHO BioHub: Global Facility for Pathogen Storage

    The World Health Organization (WHO) and Switzerland have signed an MoU to launch a BioHub facility that will allow rapid sharing of pathogens between laboratories and partners to facilitate better analysis and preparedness against them.

    WHO BioHub

    • The BioHub will enable member states to share biological materials with and via the BioHub under pre-agreed conditions, including biosafety, biosecurity, and other applicable regulations.
    • The facility will help in the safe reception, sequencing, storage, and preparation of biological materials for distribution to other laboratories, so as to facilitate global preparedness against these pathogens.
    • It would be based in Spiez, Switzerland.
    • Pathogens are presently shared bilaterally between countries: A process that can be sluggish and deny the benefits to some.

    Its significance

    • This will ensure timeliness and predictability in response activities.
    • The move is significant in the view of the novel coronavirus disease (COVID-19) pandemic and the need to underline the importance of sharing pathogen information to assess risks and launch countermeasures.
    • The move will help contribute to the establishment of an international exchange system for novel coronavirus SARS-CoV-2 and other emerging pathogens.

  • What is Vaccine Tourism?

    A couple of days ago, reports emerged of a Dubai-based tour operator offering a 24-day package tour from Delhi to Moscow that has included two shots of the Russian Sputnik-V vaccine.

    What is vaccine tourism?

    • In India, the term “vaccine tourism” became popular late last year when reports emerged of several tour operators offering packages to the US with the additional benefit of a vaccine shot.
    • Meanwhile, South Africans are said to be flying to Zimbabwe, Canadians and South Americans are traveling to the US for jabs, while tour operators in Europe are offering trips to Russia for Sputnik V shots.
    • It is said that Russia and the Maldives are already working on programs to offer people abroad the chance to get vaccinated during a visit; similar offerings are sprouting in the US as well.

    Why is it gaining popularity?

    • In fact, vaccine tourism is an emerging trend in countries where vaccines are in short supply, or where certain groups are still restricted from being inoculated.
    • Still, there are only a few countries in the world (parts of the US, Russia, Slovakia, Zimbabwe, etc) that don’t restrict their vaccination policy to local residents.
    • Currently, it is not illegal to travel to a foreign country to get vaccinated if air travel is allowed.
    • Recently, Seychelles announced that only vaccinated visitors from India, Pakistan, and Bangladesh who have completed two weeks after their second dose are permitted to travel to and enter the island nation, with proof.

    Can Indians go abroad to get vaccinated for Covid-19?

    • There may be no need for anyone from India to go abroad for vaccination since all eligible Indians will be vaccinated in the country by the end of this year – that too, at the most reasonable rates possible.
    • However, the idea of vaccine tourism is gaining momentum in India.
    • Many Indians, who fled to Dubai just before the international flight ban came into effect last month, are said to be availing of the Chinese vaccine Sinopharm shots in the UAE.

    Not to be confused with Vaccine Passport

    • Sometimes, vaccine tourism is confused with vaccine passports, which is a more regulated practice gaining currency around the world.