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Subject: Social Justice

  • What is Immunity Passport?

    In a bid to ease travel restrictions amid the coronavirus pandemic, countries like Denmark, Estonia, Israel, Chile, UK have announced a new ‘immunity passport.’

    Try this question form mains:

    Q.Discuss various ethical issues evolved during the outbreaks of pandemics (of the scale of COVID-19).

    Immunity Passport

    • They are the recovery or release certificate or a document attesting that its bearer is immune to a contagious disease.
    • The concept has drawn much attention during the COVID-19 pandemic as a potential way to contain the pandemic and permit faster economic recovery.
    • The can be used as a legal document granted by a testing authority following a serology test demonstrating that the bearer has antibodies making them immune to a disease.

    Ethical issues involved

    • Issuing ‘immunity certificates’ to people who have recovered can be an ethical minefield.
    • Doctors do not generally prefer immunity to be induced by natural infection compared with vaccines. It seems logical, but there are multiple challenges.
    • There might be long-term health complications in those who had COVID-19, whereas the vaccine will have minimal or no adverse health consequences.
    • There is a danger that similar arguments will be made for other vaccine-preventable diseases for which we have a universal immunisation programme.

    Public health risk

    • People whose livelihood has have been affected would be encouraged to adopt risky behaviour so as to get infected rather than taking precautions to stay protected from the virus.
    • This would lead to a sharp increase in cases across the country with huge numbers requiring hospitalization.
    • Such a situation would lead to testing capabilities getting overwhelmed, crumbling of the health-care systems and increased deaths.

    Threats over malpractices

    • Immunity certification will include a system for identification and monitoring, thus compromising privacy.
    • Other contentious issues would be profiteering by private labs performing tests, and the menace of fake certificates which we have already seen in some Indian states.
    • In the end, an immunity passport will further divide the society with different ‘haves’ and ‘have-nots’.

    Way forward

    • We need to look at COVID-19 with a sense of balance and not hysteria.
    • Terms such as immunity passports may not have relevance as we do not know anything about specific kinds of immune responses and the duration of protection in people.
    • There is currently not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an ‘immunity passport’ or ‘risk-free certificate’.
    • The permission to travel or work should be decided on a case by case basis, according to the principles of ethics while dealing with a pandemic.

  • First steps in India’s journey to universal health care

    The article highlights the issues with India’s approach in achieving universal health care and issues with it.

    Learning from the experience of Thailand

    • About 20 years ago, Thailand rolled out universal health coverage at a per capita GDP similar to today’s India.
    • What made this possible was a three decade-long tradition of investing gradually but steadily in public health infrastructure and manpower.
    • This meant that alongside the availability of funds, there also existed robust institutional capacity to assimilate those funds.
    • This is important because enough evidence exists on weak fund-absorbing capacities particularly in the backward States in India.

    Budgetary allocations for health

    • The Union Ministry of Health and Family Welfare budget for 2021-22, viz. ₹73,932 crore, saw a 10.2% increase over the Budget estimate (BE) of 2020-21.
    • Also, a corpus of ₹64,180 crore over six years has been set aside under the PM Atma Nirbhar Swasth Bharat Yojana, (PMANSBY).
    • ₹13,192 crore has been allocated as a Finance Commission grant.
    • These allocations could make the first steps towards sustainable universal health coverage through incremental strengthening of grass-root-level institutions and processes.

    Two important and prominent arms of universal health coverage in India merit discussion here

    1) Insurance route for achieving universal health coverage and issues with it

    • The Pradhan Mantri Jan Arogya Yojana (PM-JAY) has stagnated at ₹6,400 crores for the current and a preceding couple of years.
    • Large expenditure projections and time constraints involved in the input-based strengthening of public health care have inspired the shift to the insurance route.
    • However, insurance does not provide a magic formula for expanding health care with low levels of public spending.
    • Beyond low allocations, poor budget reliability merits attention.
    • Another related issue is the persistent and large discrepancies between official coverage figures and survey figures (for e.g. the National Sample Surveys, or NSS, and National Family Health Survey) across Indian States.
    • Such discrepancies indicate that official public health insurance coverage fails to translate into actual coverage on the ground.
    • Robust research into the implementational issues responsible for such discrepancies and addressing them is warranted.
    • Without the same, the PM-JAY’s quest for universal health coverage is likely to be precarious.
    • Finally, even high actual coverage should not be equated with effective financial protection.
    • For example, Andhra Pradesh has among the highest public health insurance coverage scores (71.36%, NSS 75), but still has an out-of-pocket spending share much above the national average.

    2) Comprehensive primary care

    • Health and Wellness Centres — 1,50,202 of them — offering a comprehensive range of primary health-care services are to be operationalised until December 2022.
    • Of these, 1,19,628 would be upgraded sub health centres and the remaining would be primary health centres and urban primary health centres.
    • Initially, most States prioritised primary health centres/urban primary health centres for upgradation over sub health centres, since the former required fewer additional investments.
    • Till February 2, 58,155 health and wellness centres were operational, of which 34,733 were sub health centres and 23,422 were primary health centres/urban primary health centres.
    • This means that of the remaining 92,047 health and wellness centres to be operationalised by December 2022, 84,895 will be sub health centres.
    • This offers huge cost projections.
    • The current allocation of ₹1,900 crore, an increase of ₹300 crore from previous year, is a paltry sum in comparison.
    • Since 2018-19, when the health and wellness centre initiative began, allocations have not kept pace with the rising targets each year.
    • Additional funding under the PMANSBY and Finance Commission grants is reassuring, but a greater focus on rural health and wellness centres would be warranted.
    • Two untoward implications could result from under-investing and spreading funds too thinly.
    • Continuing the expansion of health and wellness centres without enough funding would mean that the full range of promised services will not be available, thus rendering the mission to be more of a re-branding exercise.
    • Second, under-funding would waste an opportunity for the health and wellness centre initiative to at least partially redress the traditional rural-urban dichotomy by bolstering curative primary care in rural areas.

    Consider the question “What are the challenges in adopting the insurance model in achieving the universal health coverage in India?” 

    Conclusion

    COVID-19 has prodded us to make a somewhat stout beginning in terms of investing in health. The key, and the most difficult part, would be to keep the momentum going unswervingly.

  • FSSAI caps transfats in foods

    The FSSAI has amended its rules to put a cap on trans fatty acids (TFAs) in food products just weeks after it tightened the norms for oils and fats.

    What are the new rules?

    • Food products in which edible oils and fats are used as an ingredient shall not contain industrial Trans fatty acids more than 2% by mass of the total oils/fats present in the product, on and from 1st January 2022.
    • In December, the FSSAI had capped TFAs in oils and fats to 3% by 2021, and 2% by 2022 from the current levels of 5%.
    • The 2% cap is considered to be the elimination of trans fatty acids, which is to be achieved by 2022.

    What are Trans Fats?

    • Trans fatty acids are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid, increase the shelf life of food items and for use as an adulterant as they are cheap.
    • They are present in baked, fried and processed foods as well as adulterated ghee which becomes solid at room temperature.
    • They are the most harmful form of fats as they clog arteries and cause hypertension, heart attacks and other cardiovascular diseases.

    Why need such regulation?

    • As per the World Health Organisation (WHO), approximately 5.4 lakh deaths take place each year globally because of intake of industrially-produced trans-fatty acids.
    • The WHO has called for the elimination of industrially-produced trans-fatty acids from the global food supply by 2023.
    • The latest FSSAI rules signal the completion of the process of regulating trans fats in India.
    • The move will make a big difference in the health harm caused by this unwanted ingredient.
    • This allows FSSAI and the State-level food safety machinery to focus on implementation and enforcement of the WHO recommendations.

  • The unmet health challenge

    The article analyses the allocation for the health sector in the Budget and highlights the need for more allocations.

    Need to increase spending on health

    • The Economic Survey argues for the need to increase public spending on healthcare to 2.5-3 per cent of the GDP — it’s about 1.5 per cent currently.
    • The Survey points out that there is not much difference in terms of outcomes and quality between healthcare services in the private sector and such services in public centres.
    • The Economic Survey, therefore, calls for strengthening the National Health Mission (NHM) along with Ayushman Bharat.
    • NHM was initiated in 2005-06 to strengthen public health services.
    • The Ayushman Bharat provide social insurance, thereby financing private sector services with public funds. 
    • The Economic Survey makes a strong pitch for greater regulation of health services in the private sector.

    Break-up of allocation in Budget on health (and well being)

    • The finance minister described “health and well-being” as one of the pillars of the budget in her budget speech and announcing a 137 per cent increase in allocations for it.
    • She placed healthcare, water and sanitation and nutrition as the key components of this pillar.
    • However, the figures in the budget documents reveal a different story.
    • There is an absolute increase of 9.6 per cent in allocations for the Department of Health and Family Welfare that includes NHM and Ayushman Bharat.
    • A 26.8 per cent increase for the Department of Health Research and 40 per cent increase for the AYUSH Ministry do not add up to much since each of them are only 3-4 per cent of the total health budget.
    • A Finance Commission grant of Rs 13,000-crore and Rs 35,000-crore for COVID-19 vaccination are one-time allocations and, therefore, do not strengthen the overall system.
    • The core health service and research ministries (H&FW and AYUSH) have together received only an 11 per cent increase.
    • Even in COVID times, the health services get only 2.21 per cent of the total central budget — down from 2.27 per cent in the 2020-21 budget.
    • Computing for inflation, the increase in allocation for health services alone disappears and actually becomes negative.
    • Water and sanitation received a 179 per cent increase from Rs 21,518 crore to Rs 60,030 crore already earmarked for the flagship schemes, Swachh Bharat and Jal Jeevan Mission.
    • But allocation for nutrition decreased by 27 per cent, with the “new” Poshan 2.0 merely combining the poorly performing Supplementary Nutrition Programme and Poshan project.
    • Added together, health, water and sanitation and nutrition make up the claimed 137 per cent increase in allocation to “health” services — with a real decline in healthcare and nutrition.

    Pradhan Mantri Atma Nirbhar Swasthya Yojana (PMANSY)

    • Finance Minister also announced a new scheme, the Pradhan Mantri Atma Nirbhar Swasthya Yojana, to support the almost 29,000 health and wellness centres in the country.
    • The scheme also envisages the creation of public health laboratories and critical care hospital blocks and virology institutes.

    Concerns with PMANSY

    • PMANSY has an announced allocation of Rs 64,180 crore over six years, but it does not find a place in the present budget documents.
    • But these additional activities could have been slotted in the NHM.
    • Since 2014, the allocation for NHM has been on the wane.
    • Therefore, even the marginal 1.33 per cent increase (from Rs 27,039 crore to Rs 30,100 crore) is a demonstration of the government’s realisation that public services do matter.
    • The allocations of about Rs 10,000-Rs 11,000 crore each year for the PMANSY is not enough for making the public services capable of “universal health coverage”.
    • The High-Level Expert Group on Universal Health Coverage had estimated that by 2020, we need a 114 per cent increase in sub-centres and primary health centres, 179 per cent increase in community health centres and a 230 per cent increase in sub-district and district hospitals.
    • Getting anywhere close to this requires doubling of real allocations every year over a five-year period to reach something like 10 per cent of the budget.
    • In the present budget, it declines to a mere 2.21 per cent.

    Way forward

    • If such public provisioning for universal health coverage can’t be done, then effective low-cost rationalised service system options have to be designed.
    • Insurance schemes only create the mirage of affordability of health services while adding to peoples’ expenses.
    • Community and public services are indisputably the most cost-effective for any society.

    Consider the question “Examine the benefits of the idea of health and well being under which health, water and sanitation and nutrition are clubbed together.”

    Conclusion

    Water and sanitation are meaningful for health, but not if it only inflates the allocation to “Health and Wellbeing”. What we need is the real increase in spending on health.

  • Pradhan Mantri Matru Vandana Yojana (PMMVY)

    The government’s maternity benefit scheme, or Pradhan Mantri Matru Vandana Yojana, has crossed 1.75 crores, eligible women, till the financial year 2020, the Centre informed Parliament.

    PMMVY

    • The PMMVY is a maternity benefit program introduced in 2017 and is implemented by the Ministry of Women and Child Development.
    • It is a conditional cash transfer scheme for pregnant and lactating women of 19 years of age or above for the first live birth.
    • It provides partial wage compensation to women for wage-loss during childbirth and childcare and to provide conditions for safe delivery and good nutrition and feeding practices.
    • Under the scheme, pregnant women and lactating mothers receive ₹5,000 on the birth of their first child in three instalments, after fulfilling certain conditionalities.
    • In 2013, the scheme was brought under the National Food Security Act, 2013 to implement the provision of cash maternity benefit stated in the Act.
    • The direct benefit cash transfer is to help expectant mothers meet enhanced nutritional requirements as well as to partially compensate them for wage loss during their pregnancy.

    Eligibility Conditions and Conditionalities

    The first transfer (at pregnancy trimester) of ₹1,000 requires the mother to:

    • Register pregnancy at the Anganwadi Centre (AWC) whenever she comes to know about her conception
    • Attend at least one prenatal care session and taking Iron-folic acid tablets and TT1 (tetanus toxoid injection), and
    • Attend at least one counselling session at the AWC or healthcare centre.

    The second transfer (six months of conception) of ₹2,000 requires the mother to:

    • Attend at least one prenatal care session and TT2

    The third transfer (three and a half months after delivery) of ₹2,000 requires the mother to:

    • Register the birth
    • Immunize the child with OPV and BCG at birth, at six weeks and at 10 weeks
    • Attend at least two growth monitoring sessions within three months of delivery

    Additionally, the scheme requires the mother to:

    • Exclusively breastfeed for six months and introduce complementary feeding as certified by the mother
    • Immunize the child with OPV and DPT
    • Attend at least two counselling sessions on growth monitoring and infant and child nutrition and feeding between the third and sixth months after delivery

    Before judging this factual information, take this PYQ form 2019:

    Q.Which of the following statements is/are correct regarding the Maternity Benefit (Amendment) Act, 2017?

    1. Pregnant women are entitled to three months pre-delivery and three months post-delivery paid leave.
    2. Enterprises with creches must allow the mother a minimum of six crèche visits daily.
    3. Women with two children get reduced entitlements.

    Select the correct answer using the code given below.

    (a) 1 and 2 only

    (b) 2 only

    (c) 3 only

    (d) 1, 2 and 3

  • Building a robust healthcare system

    The article focuses on the wide variation across the state in terms of the important health parameters and suggests prioritising health.

    Variation across the states

    • The efficacy of the public health system varies widely across the country since it is a State subject.
    • Public health system can be judged just by looking at certain health parameters such as Infant Mortality Rate, Maternal Mortality Ratio and Total Fertility Rate.
    • In Madhya Pradesh, the number of infant deaths for every 1,000 live births is as high as 48 compared to seven in Kerala. In U.P. the Maternal Mortality Ratio is 197 compared to Kerala’s 42 and Tamil Nadu’s 63.
    • The northern States are performing very poorly in these vital health parameters.
    • The percentage of deliveries by untrained personnel is very high in Bihar, 190 times that of Kerala.
    • Since health is a State subject, the primary onus lies with the State governments.
    • Each State government must focus on public health and aim to improve the health indicators mentioned above.
    • Unless all the States perform well, there will be no dramatic improvement in the health system.

    Steps needed to be taken

    • The governments — both at the Centre and the Empowered Action Group States — should realise that public health and preventive care is a priority and take steps to bring these States on a par with the southern States.
    • The Government of India has a vital role to play.
    • Public and preventive health should be his focus by holding the Empowered Action Group States accountable to the SDGs.
    • They must be asked to reach the levels of the southern States within three to five years.
    • An important measure that can make a difference is a public health set-up in these States that addresses primary and preventive health.

    Conclusion

    Unless we invest in human capital, FDI will not help.  Investing in health and education is the primary responsibility of any government. It is time the governments — both at the Centre and States — gave health its due importance.

  • What is Herd Immunity?

    The initial findings of the fifth round of serological survey conducted in Delhi suggest that over 56 percent of the people have developed antibodies against Covid-19 implying achievement of herd immunity.

    Herd Immunity

    • Herd immunity is when a large number of people are vaccinated against a disease, lowering the chances of others being infected by it.
    • When a sufficient percentage of a population is vaccinated, it slows the spread of disease.
    • It is also referred to as community immunity or herd protection.
    • The decline of disease incidence is greater than the proportion of individuals immunized because vaccination reduces the spread of an infectious agent by reducing the amount and/or duration of pathogen shedding by vaccines, retarding transmission.
    • The approach requires those exposed to the virus to build natural immunity and stop the human-to-human transmission. This will subsequently halt its spread.

    Sero-surveys in Delhi

    • The results of the latest serosurvey in Delhi have led researchers and experts to surmise that a large section of the city’s population has already developed antibodies against Covid-19.
    • The presence of antibodies among a large percentage of the population could be a reason for the decline in the daily number of Covid-19 cases.
    • As more people are able to resist infection, it will help to break the chain of transmission of the virus.
    • Five serological surveys have been carried out in Delhi so far, including the present one, which was conducted in January.
    • The survey conducted by NCDC in July last year suggested the presence of antibodies in 23 percent of those surveyed.
    • In August, the survey conducted by the Delhi government showed 29.1 percent had antibodies.

    The relevance of such surveys

    • Carrying out repeated serological surveillance on the same population gives an idea of how the disease is behaving.
    • It is always good to have surveillance regularly to understand the trends.
    • Having robust surveillance is always beneficial, it may not be too close, but it may help us in giving an idea, even of the natural history of the disease.

    What do the data suggest about herd immunity?

    • Many researchers believe that if 60 percent or more of the population has developed antibodies against Covid-19, there is a possibility of acquiring herd immunity.
    • In Delhi, it is quite indicative, as the number of cases is also going down. This shows that we are moving closer towards acquiring herd immunity.

  • Ayushman Bharat for CAPFs

    Union Home Minister has rolled out the ‘Ayushman CAPF’ scheme, extending the benefit of the central health insurance programme to the personnel of all Central Armed Police Forces (CAPFs) in the country.

    Who are the CAPFs?

    • The CAPFs refers to uniform nomenclature of five security forces in India under the authority of the Ministry of Home Affairs.
    • Their role is to defend the national interest mainly against the internal threats.
    • They are the Border Security Force (BSF), Central Reserve Police Force (CRPF), Central Industrial Security Force (CISF), Indo-Tibetan Border Police (ITBP), Sashastra Seema Bal (SSB)

    Ayushman CAPF

    • Under this scheme, around 28 lakh personnel of CAPF, Assam Rifles and National Security Guard (NSG) and their families will be covered by ‘Ayushman Bharat: PM Jan Arogya Yojana’ (AB PM-JAY).
    • For the CAPF, the existing health coverage was not comprehensive as compared to other military forces.

    Do you know?

    The goal of universal health coverage (UHC) as stated in the UN Sustainable Development Goals (SDGs no. 3) is one of the most significant commitments to equitable quality healthcare for all.

    About Ayushman Bharat

    • PM-JAY aims to provide free access to healthcare for 40% of people in the country.
    • It is a centrally sponsored scheme and is jointly funded by both the union government and the states.
    • It was launched in September 2018 by the Ministry of Health and Family Welfare.
    • The ministry has later established the National Health Authority as an organization to administer the program.

    Key features:

    • Providing health coverage for 10 crores households or 50 crores Indians.
    • It provides a cover of 5 lakh per family per year for medical treatment in empanelled hospitals, both public and private.
    • Offering cashless payment and paperless recordkeeping through the hospital or doctor’s office.
    • Using criteria from the Socio-Economic and Caste Census 2011 to determine eligibility for benefits.
    • There is no restriction on family size, age or gender.
    • All previous medical conditions are covered under the scheme.
    • It covers 3 days of pre-hospitalization and 15 days of post-hospitalization, including diagnostic care and expenses on medicines.
    • The scheme is portable and a beneficiary can avail medical treatment at any PM-JAY empanelled hospital outside their state and anywhere in the country.

    Note these features. They cannot be memorized all of sudden but can be recognized if a tricky MCQ comes in the prelims.

    Must read:

    [Burning Issue] Ayushmaan Bharat

  • Problem of control and governance of knowledge in a globalised world

    The article highlights the issues with the criteria applied by the UGC to evaluate the faculty research.

    Impact of UGC standardisation on social sciences and humanities research

    • UGC has been the regulatory body responsible for maintaining standards in higher education, while addressing challenges of globalisation.
    • Processes of UGC mandated standardisation have in particular impacted social sciences and humanities research in Indian universities.
    • Over the years, UGC has linked institutional funding to ranking and accreditation systems like NAAC and NIRF.
    • In order to evaluate institutions, these bodies have evolved  criteria, which rank universities based on faculty research measured by citations in global journal databases like SCOPUS.
    • In comparison, importance granted to research outputs like books or other forms is declining.

    Issues with the criteria

    • The insistence of publication in journals fails to distinguish between the varied trajectory of disciplines.
    • While in STEM (Science, Technology, Engineering, Management) disciplines, research is often highly objective and quantified.
    • In social sciences and humanities research is subjective, analytical and argumentative.
    • In disciplines like history, sociology, politics, philosophy, psychology and literature, researchers spend years writing books that engage with ideas in complex ways.
    • In devaluing books as authentic forms of research, UGC does major disservice to scholars of social sciences and humanities.
    • Due to emphasis on publication, teachers spend most of their productive time writing articles and getting them published, thereby missing out on quality engagement with pedagogy and research.

    Issues with the process of peer review

    • The process of peer review itself is subjective, and depends upon the knowledge, inclination and availability of time of the particular reviewer.
    • It is often quite challenging for scholars to meet peer-review standards of A-listed journals.
    • This has actually required the UGC to expand its own list, ending up including and subsequently deleting a large number of locally published journals.

    Issue of inaccessibility

    • Publication of research in paywalled journal databases makes research inaccessible for students as universities continue to cut down library budgets.
    • Students and teachers, access articles through pirated sites like Libgen and Scihub, prone to be shut down at any point of time as evident from the litigations.
    • Clearly, access to knowledge is structurally made inequitable in favour of the elite and/or moneyed institutions and their constituents.

    Way forward

    • The above arguments maintain for the possible multiplicity that can emerge as the end-result of research.
    • Interdisciplinary and practice-based research can throw up social and ecological experiments, artworks and performances, and numerous new outcomes yet to be conceived as research outputs.
    • While the UGC hopes to raise the standards to global levels, precarity of employment, longer teaching hours, a dismal student-teacher ratio, lack of sabbaticals, research and travel grants, access to research facilities and office space, adversely impact the research potential of teachers.
    • Regulating research needs to be replaced with facilitating research, allowing minds to think and gestate.
    • Regulations without facilitation will merely bureaucratise the governance of knowledge without generating any pathbreaking insights.

    Conclusion

    The UGC needs to widen its criteria which values publication of a book as much as a research paper in the mandated journal to widen the research in social sciences and humanities.

  • Covid-19 vaccine policy

    The article explains the challenge in the vaccination program for the Covid-19 vaccine.

    Issue of lack of data about the vaccine

    • In the COVID vaccine roll out, there is no clear data for either of the two vaccines proposed for use in the programme.
    • We do not know if they provide protection for life, for a year or six months, its efficacy among the elderly or the very sick or in stopping new infections.
    • Getting such data requires at least three years and cannot be obtained in a few months.

    Guidelines for implementing vaccine programme

    • Given these limitations, the government has drawn up strategic guidelines for implementing an vaccine programme covering 30 crore people by July.
    • The guidelines draw upon the knowledge of running national campaigns acquired over three decades of implementing the Universal Immunisation Programme.
    • These guidelines detail the skills, roles and responsibilities of the required human resources, logistics for delivering vaccines at point of use, physical infrastructure, monitoring systems based on digital platforms and feedback systems for reporting adverse events.
    • The approach involves 19 departments, donor organisations and NGOs at the national, state, district and block level.
    • The guidelines also mention the priority criteria — caregivers, front line workers of the departments of health, defence, municipalities and transportation; persons above the age of 50 and those below 50 having diabetes, hypertension, cancers and lung diseases.

    Issues with the guidelines

    • Of the 28,932 cold chain points, half are in the five southern states, Maharashtra and Gujarat.
    • Combined with poor human resources — doctors, nurses, pharmacists — a weak private sector, poor safety and hygiene standards, frequent power outages, poor infrastructure, the capacity to implement with the expected speed, quality and accuracy is daunting.
    • The immunisation can disrupt routine health service delivery — antenatal care, national programmes like those pertaining to TB or other immunisation drives.
    • While data for the above-50-year-olds is available in the electoral rolls, line listing of the under 50s with comorbidities can be challenging.
    • Not only are urban-rural variations substantial, but urban areas have weak public health infrastructure and a multiple number of private providers due to the poor implementation of the Clinical Establishment Act, 2010.
    • Patient tracking can be problematic.
    • The non-availability of efficacy data could also impact the procurement and supply of vaccines, result in huge wastage, and can introduce scope for errors and duplication.

    Way forward

    • Central to the success of the roll out will be the confidence of the people in the vaccines.
    • Coming out of this messy situation is necessary and one option — as adopted for the polio eradication programme — is to establish an independent team of experts under the aegis of the WHO to ensure the safety of the vaccine.
    • This will create confidence in the community and international authorities as well.

    Conclusion

    it is important to understand that vaccination is an incomplete solution to ending the epidemic, since the virus is mutating. Adopting safe behaviour is.