Subject: Social Justice

Why in the news?

The NFHS-6 factsheet released in 2026 omitted data on “households using clean cooking fuel”, an important indicator previously included in NFHS-5.

Key Highlights

• NFHS-6 showed: Households with electricity increased to: 98.3%.
• However, data on: Access to clean cooking fuel was removed from the factsheet.

About NFHS

The National Family Health Survey (NFHS):

• Is India’s largest household health survey.
• Conducted by: International Institute for Population Sciences
• Under: Ministry of Health and Family Welfare

Clean Cooking Fuel in NFHS-5

NFHS-5 (2019-21) reported:

• Only 58.6% households had access to clean cooking fuel.
• About 40.6% households still depended on Firewood, Dung cakes, and Biomass fuels.

[2019] Consider the following:
1. Carbon monoxide
2. Methane
3. Ozone
4. Sulphur dioxide
Which of the above are released into the atmosphere due to the burning of crop/biomass residue?

[A] 1 and 2 only

[B] 2, 3 and 4 only

[C] 1 and 4 only

[D] 1, 2, 3 and 4

Why in News?

The Ministry of Health and Family Welfare released the National Health Accounts (NHA) Estimates 2022-23 showing a decline in Out-of-Pocket Expenditure (OOPE) and a rise in government health spending.

Key Findings

Decline in Out-of-Pocket Expenditure (OOPE)

• OOPE share in Total Health Expenditure (THE):
  • 64.2% in 2013-14
  • 43.4% in 2022-23
• Indicates reduced financial burden on households

Reasons for Decline

Ayushman Arogya Mandirs

Over 1.8 lakh wellness centres providing:

• Free drugs and diagnostics
• Teleconsultation
• Maternal and child healthcare
• Non-communicable disease services
• Preventive healthcare

Increased Government Spending

• Government health expenditure rose:
  • From 1.15% of GDP (2013-14)
  • To 1.43% of GDP (2022-23)
• Reached 1.84% during COVID-19 in 2021-22

Other Key Trends

• Rise in Per Capita Government Health Expenditure: Increased from ₹1,042 to ₹2,786 between 2013-14 and 2022-23
• Increase in Social Security Expenditure: Rose from 6% to 9.9%
• Growth in Private Health Insurance: Increased from 3.4% to 9.2%

What is OOPE?

• Out-of-Pocket Expenditure refers to direct payments made by households for healthcare services at the point of use.

Significance

• Better healthcare access
• Reduced catastrophic health expenditure
• Progress toward Universal Health Coverage (UHC)
• Strengthening preventive healthcare

Challenges

• OOPE still remains high at 43.4%
• Pharmaceutical expenses continue to drive household spending
• Rural and regional disparities persist

[2023] Consider the following statements:
Statement-I: India’s public sector health care system largely focuses on curative care with limited preventive, promotive and rehabilitative care.
Statement-II: Under India’s decentralized approach to health care delivery, the States are primarily responsible for organizing health services.
Which one of the following is correct in respect of the above statements?

[A] Both Statement-I and Statement-l are correct and Statement-II is the correct explanation for Statement-I.

[B] Both Statement-I and Statement-II are correct and Statement-is not the correct explanation for Statement-l.

[C] Statement-l is correct but Statement-II is incorrect.

[D] Statement-I is incorrect but Statement-Il is correct.

Why in the News?

The recent Ebola outbreak in Uganda has revived concerns over whether repeated animal-to-human spillovers could trigger a future pandemic. The concern is significant because Ebola outbreaks are increasingly occurring in urban areas, unlike earlier outbreaks largely confined to remote forests. However, experts argue that despite rising spillover risks, Ebola still lacks the sustained human-to-human transmission needed for a pandemic.

What is Ebola disease?

Ebola disease, or Ebola virus disease (EVD), is a rare but severe and highly fatal illness caused by a group of viruses in the genus Orthoebolavirus. It is characterized by viral hemorrhagic fever, causing widespread inflammation, internal bleeding, and organ failure.

Transmission & Origins

1. Animal to Human: It is a zoonotic disease originating in wildlife. Fruit bats are considered the natural host, and the virus can spread to humans via contact with infected animals or consumption of “bushmeat”.
2. Human to Human: Spread requires direct contact with bodily fluids (blood, saliva, sweat, vomit, feces, urine, etc.) of an infected person. It is not an airborne disease.
3. Contaminated Objects: It can also be contracted by touching surfaces, needles, or clothing contaminated with these fluids.

Are Climate Change and Ecological Disruptions Increasing Ebola Spillover Risk?

Spillover risk refers to the possibility of a disease-causing pathogen (virus, bacteria, etc.) jumping from animals to humans.

1. Habitat Disruption: Deforestation, mining, and agricultural expansion increase human interaction with fruit bats, considered natural reservoirs of Ebola, raising spillover chances.
2. Changing Disease Ecology: Altered rainfall and temperature patterns affect wildlife movement and feeding behaviour, increasing contact between animals and humans.
3. Human Encroachment: Expansion of settlements into forest ecosystems exposes communities to infected wildlife through hunting, farming, and bushmeat consumption.
4. Urbanisation Effect: Ecological stress combined with migration increases the possibility of outbreaks emerging closer to densely populated areas.
5. One Health Imperative: Rising spillover risk strengthens the need for an integrated human-animal-environment health approach for surveillance and prevention.

Why Does Spillover Risk Not Automatically Translate into Pandemic Potential?

1. Pandemic Requirement: Pandemic-capable viruses require efficient and sustained human-to-human transmission, particularly across large populations and geographies.
2. Transmission Constraint: Ebola spreads primarily through direct contact with infected bodily fluids, unlike airborne respiratory viruses.
3. Biological Limitation: Not all viruses possess the evolutionary capacity to adapt for sustained human transmission.
4. Urban Presence is not equal to Pandemic: Mere entry into urban centres does not ensure global spread unless the pathogen sustains continuous chains of transmission.
5. Comparative Insight: Respiratory viruses such as COVID-19 spread rapidly due to aerosol transmission, unlike Ebola’s contact-based spread.

How Has Ebola’s Epidemiological Pattern Changed Over Time?

1. Historical Pattern: Earlier outbreaks occurred largely in remote forested regions, limiting transmission.
2. Urban Shift: Recent outbreaks increasingly involve urban settings, raising concerns over higher transmission opportunities.
3. Uganda Outbreak: The current outbreak has renewed attention to changing disease geography and regional vulnerability.
4. Increased Frequency: WHO has highlighted growing concerns over the frequency and scale of Ebola outbreaks.
5. Cross-Border Risk: Urbanisation and increased mobility raise possibilities of international exportation of isolated cases, though sustained spread remains unlikely.

What Makes Ebola Different from Pandemic Viruses?

1. Transmission Mode: Ebola spreads through blood, saliva, sweat, tears, vomit, faeces, breast milk, semen, and contaminated surfaces, requiring close contact.
2. Incubation Period: Symptoms generally emerge after 2-21 days, allowing surveillance and containment opportunities.
3. Symptom Visibility: Severe symptoms such as fever, headache, sore throat, vomiting, diarrhoea, bleeding, and organ dysfunction enable faster case identification.
4. Lack of Airborne Spread: Ebola fundamentally differs from influenza or coronaviruses due to the absence of efficient airborne transmission.
5. Geographic Containment: Major outbreaks have historically remained regionally concentrated, despite occasional international spread.

How Serious Is the Threat of Repeated Ebola Outbreaks Despite Low Pandemic Risk?

The threat of repeated Ebola outbreaks remains severe and critical, because even though the virus is highly unlikely to trigger a global pandemic, its localized impact completely devastates the regions it strikes.

1. Health System Fragility: Repeated outbreaks expose weaknesses in infrastructure, surveillance, and healthcare delivery systems, particularly in vulnerable countries.
2. Economic Burden: Outbreaks strain already fragile economies through healthcare expenditure, movement restrictions, and productivity loss.
3. Public Health Disruption: Healthcare systems divert resources from routine immunisation and essential services.
4. Humanitarian Impact: Fear, stigma, and mortality affect social cohesion and trust in institutions.
5. Regional Instability: Fragile governance conditions increase outbreak severity and complicate containment.

Can Existing Public Health Systems Handle Repeated Ebola Outbreaks?

1. Infrastructure Constraint: Countries facing outbreaks often suffer from fragile healthcare infrastructure, low laboratory capacity, and shortages of trained personnel.
   1. Example: In the May 2026 Bundibugyo virus outbreak affecting the Democratic Republic of the Congo (DRC) and Uganda, inadequate isolation systems and unsafe medical environments immediately caused a severe cluster of infections among the healthcare workers themselves.
2. Surveillance Importance: Rapid identification, contact tracing, isolation, and safe burial practices remain critical.
   1. In the 2025 Ebola outbreak in Kasai Province, healthcare teams had to track down and manually monitor 572 unique contacts across massive, hard-to-reach rural zones to successfully stop the transmission chain
3. Preparedness Gap: Pandemic preparedness systems remain uneven across regions.
   1. The global vaccine emergency stockpile sits at a healthy target of 500,000 doses. But because funding drops between crises, roughly 42,000 precious doses simply expired unused on shelves due to sluggish preventive distribution pipelines
4. Reliance on WHO & International Coordination: Local governments cannot foot the bill or logistics alone, leaving them dependent on global emergency bodies for basic survival.
   1. In May 2026, the WHO had to declare the central African outbreak a Public Health Emergency of International Concern (PHEIC) and use UNICEF’s ultra-cold chain supply network to rush specialized resources to the area within a 7-day window
5. Community Engagement: Local trust-building improves compliance with containment measures.

How Effective Are Existing Ebola Vaccines and Treatments?

1. Vaccine Success: Two approved vaccines, Ervebo and Zabdeno/Mvabea, offer strong protection against the Zaire strain.
2. Strain Limitation: Vaccines currently have limited cross-strain effectiveness, leaving gaps for other Ebola variants.
3. Bundibugyo Challenge: Vaccines for the Bundibugyo strain remain under development.
4. Medical Countermeasures: Expanded therapeutic options improve survival prospects during outbreaks.
5. Research Need: Viral evolution necessitates continued investment in strain-specific vaccines.

Can Artificial Intelligence Improve Ebola Preparedness and Surveillance?

1. Data Analytics: AI supports rapid analysis of large epidemiological datasets.
2. Outbreak Prediction: Machine learning models improve early warning systems and hotspot prediction.
3. Medical Countermeasures: AI accelerates drug discovery and vaccine development.
4. Surveillance Support: Real-time analytics improve disease tracking and response coordination.
5. Resource Allocation: Predictive tools facilitate targeted deployment of healthcare resources.

How Important Is Public Trust in Ebola Outbreak Management?

1. Behavioural Compliance: Trust improves adherence to isolation, contact tracing, and safe burial practices.
2. Institutional Legitimacy: Effective communication reduces misinformation and panic.
3. Community Participation: Local cooperation determines outbreak containment success.
4. Past Lessons: Distrust during previous outbreaks undermined surveillance and treatment efforts.

Conclusion

Repeated Ebola outbreaks underscore that spillover risk and pandemic risk are not synonymous. While urban outbreaks, ecological disruption, and global mobility elevate concern, Ebola’s limited transmission biology constrains sustained worldwide spread. Rising zoonotic threats necessitate stronger surveillance, resilient health infrastructure, vaccine innovation, and trust-based governance to prevent local outbreaks from escalating into larger crises.

PYQ Relevance

[UPSC 2020] COVID-19 pandemic has caused unprecedented devastation worldwide. However, technological advancements are being availed readily to win over the crisis. Give an account of how technology was sought to aid management of the pandemic

Linkage: The Ebola outbreak re-opens debate about pandemic preparedness, disease surveillance, vaccines, and outbreak management, similar to the COVID-19 experience. The article also helps in understanding the distinction between spillover risk and pandemic risk in zoonotic diseases like Ebola.