Social Issues

What is the News?

The caretakers of patients with ‘rare diseases’ are not satisfied with the National Policy for Rare Diseases 2021. The Union Health Ministry recently released the policy.

Rare Diseases: WHO defines a rare disease as a lifelong disease or disorder that often highly weakens an individual. It has a prevalence of 1 or less per 1000 population. Example: Haemophilia, Thalassemia, Sickle cell anaemia, auto-immune diseases among others.

• However, every country has its own definition for rare diseases.
• The US  defines rare diseases as a disease or condition that affects fewer than 200,000 patients in the country.
• Likewise, the EU defines rare diseases as life-threatening or chronically debilitating (weakening) condition. It should affect no more than 5 in 10,000 people.

About National Policy For Rare Diseases,2021:

• Aim: The policy aims to lower the incidence and prevalence of rare diseases based on an integrated and comprehensive preventive strategy. The strategy includes awareness generation, counselling programmes, providing affordable Health Care among others.

Key Features of the National Policy For Rare Diseases,2021:

• Categorisation: The policy categorizes rare diseases into three groups:
  • Group 1: Disorders amenable to one-time curative treatment;
  • Group 2: Diseases requiring long term or lifelong treatment; and
  • Group 3: Diseases for which definitive treatment is available, but challenges are to make an optimal patient selection for benefit.
• Government Support:
  • The government will provide Financial support of up to Rs. 20 lakh under the Umbrella Scheme of Rashtriya Arogya Nidhi for treatment of those rare diseases listed under Group 1.
  • Moreover, Beneficiaries for such financial assistance would not be limited to BPL families. About 40% of the population, eligible under Pradhan Mantri Jan Arogya Yojana, will also be eligible for assistance.
  • Further, for group 2, the State Governments can consider supporting specific patients. It includes a rare disease that can be managed with special diets or hormonal supplements or other relatively low-cost interventions (Diseases listed under Group 2).
• Voluntary Crowdfunding: The government has said that it will assist in voluntary crowd-funding for the treatment of Group 3. It is because it will be difficult to fully finance the treatment of high-cost rare diseases of Group 3.

Objections to the Policy:

• The policy offers no support to patients awaiting treatment since the earlier National Policy for Treatment of Rare Diseases 2017 was kept on hold.
• The policy has left patients with Group 3 rare diseases to fend for themselves. It has absolutely no consideration for Group 3 patients who require lifelong treatment support.

Rashtriya Arogya Nidhi scheme:

It provides financial assistance to patients living below the poverty line and who are suffering from major life-threatening diseases, to receive medical treatment.

Source: The Hindu

What is the News?

Union Health Minister launches the Tribal TB Initiative to achieve the goal of  TB Mukt Bharat.

About Tribal TB Initiative:

• Aim: Firstly, Tribal TB Initiative aims to address the problem of Tuberculosis in Tribal Population.
• Secondly, the initiative will initially focus on 161 districts across 18 identified States. It will focus on vulnerability mapping, active case finding, and promote behavioral change at the ground level.
• Thirdly, TB Mukt Bharat initiative aims at the elimination of TB by 2025.

Why was this initiative launched?

• Over 104 million tribal populations live in India. It spreads across 705 tribes and accounts for 8.6 % of India’s population.
• This tribal population is highly vulnerable to TB due to physical remoteness, malnutrition, poor living conditions, and lack of awareness. Hence, the initiative is launched to focus on these areas.

Note:

• Lakshadweep and the district of Badgam in Jammu and Kashmir have been declared TB Free on World TB Day 2021.
• The Government of India has increased the Budget allocation for TB in India four-fold in the last 5 years.

Other Tribal Health-Related Initiatives:

• ALEKH: It is an e-newsletter that is to be released on a quarterly basis. It will showcase the works of different stakeholders involved in improving the health and nutrition of tribals.
• Swasthya Portal: It aims to provide health and nutrition-related information to the tribal population of India.

Source: AIR

Health Minister Appointed as Chairman of “Stop TB Partnership Board”

What is the News?

Indian SARS-CoV-2 Consortium on Genomics (INSACOG) has been doing genome sequencing of Covid-19 Variants. It has found a unique “double mutant” virus variant in India. This variant has a unique combination of mutations, not seen anywhere else in the world.

What is Double Mutation?

• Double Mutation is when two mutated strains of a virus come together and form a third strain.
• The one reported in India is the result of the combination of E484Q, and L452R strains. The L452R strain is found in California in the United States, while, the E484Q strain is indigenous.

Is this double Mutant COVID Variant Harmful?

• Mutation in the virus is a normal process. But some mutations help the virus in defending itself from vaccines or antibodies or linking to a spike in cases.
• However, the capability of double mutant coronavirus variant in increased infectivity or in making COVID-19 more severe is still uncertain.
• Hence, INSACOG will submit details of this variant to a global repository called GISAID. If it qualifies, it will be classified as a “variant of concern”(VOC).
• Variant of concerns requires appropriate public health actions, such as
  • Notification to WHO under the International Health Regulations,
  • reporting to CDC,
  • local or regional efforts to control spread,
  • increased testing, or research to determine the effectiveness of vaccines and treatments against the variant

Note: So far, only three global Variants of Concern (VOCs) have been identified: the U.K. variant (B.1.1.7), the South African (B.1.351) and the Brazilian (P.1) lineage.

About INSACOG:

• Indian SARS-CoV-2 Consortium on Genomics(INSACOG) is a grouping of 10 National Laboratories. It was established by the Ministry of Health and Family Welfare(MoH&FW).
• Aim:
  • Firstly, to monitor the genomic variations in the SARS-CoV-2 on a regular basis through a multi-laboratory network.
  • Secondly, to ascertain the status of a new variant of SARS-CoV-2 in the country.
  • Furthermore, to establish a surveillance system for early detection of genomic variants and determine the genomic variants in the unusual events/trends.
• Coordinated by: The Department of Biotechnology (DBT) along with MoH&FW, ICMR, and CSIR coordinate it.
• Significance: The knowledge generated through this vital research consortium assists in developing diagnostics and potential therapeutics and vaccines in the future.

Global Initiative on Sharing All Influenza Data(GISAID) Initiative

• The GISAID Initiative was launched on the occasion of the 61st World Health Assembly in 2008.
• In 2010, Germany became the official host of the GISAID Initiative through a public-private partnership.
• Aim: It aims to promote rapid sharing of data of all influenza and COVID virus sequences globally. Moreover, it helps to understand, how the viruses evolve, spread, and potentially become pandemics.
• Headquarters: Munich, Germany.

Source: The Hindu

What is the News?

The most common symptoms of Covid-19 are anosmia and ageusia. However, several people are also experiencing parosmia. It is characterized by a change in perception of odours.

Anosmia: It is the partial or complete loss of the sense of smell. This loss may be temporary or permanent.

Ageusia: It is a condition, characterized by a complete loss of taste function of the tongue.

About Parosmia:

• Firstly, Parosmia is a medical term. It describes a condition in which affected individuals experience distortions in the sense of smell.
• Secondly, a person with parosmia is able to detect certain odours. But they might experience the smell of certain things as different and often unpleasant. For example, coffee may smell like burnt toast.
• Thirdly, Causes: People who are recovering their sense of smell following a loss from a virus or an injury typically experience parosmia.
• And lastly, Parosmia is a temporary condition and is not harmful in itself.

Source: Indian Express

What is the News?

Candida Auris (deadly hospital pathogen) identified for the first time in the Andaman and Nicobar Islands.

About Candida Auris:

• Candida Auris or C.auris is a multidrug-resistant fungus. It presents a serious global threat to human health.

Origin of Candida Auris:

• Candida Auris was first identified in 2009 in a patient in Japan. The fungus emerged in more than 40 countries across five continents in the last decade.
• The fungus is mostly found in tropical marshes and marine environments, outside hospital environments.
• However, it is an emerging pathogen, thus very little is known about the Candida Auris so far.

Symptoms of C.Auris:

• C.Auris infections can show no symptoms before turning into a fever and chills. These symptoms don’t go away despite the use of medicines and can lead to death.
• C.auris survives on the skin before entering the body through wounds. Once in the bloodstream, it causes severe illness and can lead to death.

Why  C.Auris is harmful? C.Auris is considered dangerous because of three reasons:

• Fisrtly, C.Auris is often multidrug-resistant. It means that it is resistant to multiple antifungal drugs commonly used to treat Candida infections.
• Secondly, it can survive and persist within the hospital environment for prolonged periods. It is capable to survive on dry environmental surfaces for prolonged periods. It means that it adapts well to survival outside human host settings as well.
• Lastly, C.Auris is difficult to identify with standard laboratory methods, and it can be misidentified in labs without specific technology. Misidentification may lead to inappropriate management.

Vulnerable Population:

• C.Auris can get deadly for immunocompromised patients. The incidence of deaths from this fungal infection is high in countries such as the US and the UK, but its prevalence is less in Indian hospitals.

Treatment:

• Echinocandins, a class of antifungal drugs, can treat most of the C.auris infections. However, some C. auris infections have been resistant to antifungal medications making them more difficult to treat.

Source: Indian Express

Synopsis- Need transparency and timely data sharing to build public trust in the COVID-19 vaccination programme.

Introduction-

• Major European countries, including Germany, France, Italy, and Spain have halted the use of AstraZeneca’s COVID-19 vaccine. This is followed by the warnings of harmful blood clots in some recipients.
• However, the World Health Organization (WHO) and the European Medicines Agency have ruled out any correlation between AstraZeneca’s vaccine and blood clots.

Data on Blood Clot:

According to a study based on the U.S. population, about 1,000 to 2,000 blood clots occurs every single day in the human body.

In the recent AstraZeneca’s COVID-19 vaccine case, there are only 40 blood clot cases reported due to that.

But people are reluctant to get the vaccine due to these types of events. Further, it would lead to a negative effect on the vaccination push.

What are the reasons behind  the impediments to vaccination programmes?

1. No proper vaccine efficacy data available – There is uncertainty and suspicion regarding the side effects of the Covid-19 vaccine.
   • The risks associated with COVID-19 vaccines have not been fully investigated as these vaccines were issued under the Emergency Use Authorizations.
   • The National Committee on Adverse Events Following Immunization has no proper details about the serious adverse events following immunization.
2. Transparency and prompt data sharing: There is lack of transparency and data sharing in vaccination programmes. It could lead to a lack of trust in the vaccine.

Suggestions to improve vaccination programmes

• Firstly, transparency and timely data sharing about the vaccine, and open public health communication will win public trust and faith in vaccines.
• Secondly, like the U.S. Centers for Disease Control and Prevention, India should also create data on adverse vaccine effects.
• Lastly, vaccine hesitancy is the main obstruction in the smooth vaccination drive. And so, it must resolve immediately.

Source- The Hindu

What is the News?

Union Minister for Health and Family Welfare appointed as the Chairman of the Stop TB Partnership Board. The Minister will serve a 3-year term commencing July 2021.

About Stop TB Partnership:

• Stop TB Partnership was established in the Year 2000.
• Aim: The aim is to eliminate tuberculosis as a public health problem.
• Significance: It is a unique international body as it aligns all countries in the world to fight against TB.
• Amsterdam Declaration: In 2000, Stop TB Partnership gave a call for collaborative action from ministerial delegations of 20 countries with the highest burden of TB.
• Partner organizations: It has 1500 partner organizations. It includes international, non-governmental, and governmental organizations and patient groups.
• Secretariat: Geneva, Switzerland.

India’s Initiatives against Tuberculosis:

• Firstly, India has committed to eliminating TB in the country by 2025, five years ahead of the global deadline of 2030.
• Secondly, National Strategic Plan (NSP) for TB Elimination (2017-2025): It is a framework to provide guidance for the activities of various stakeholders to reduce the burden of TB mortality and morbidity. It aims to work towards the elimination of TB in India by 2025.
• Thirdly, Nikshay Poshan Yojana: It is a direct benefit transfer (DBT) scheme to provide nutritional support to TB patients.
• Lastly, TB Harega Desh Jeetega’ Campaign: This campaign aims to improve and expand the reach of Tuberculosis care services across the country by 2022.

 Source: PIB

What is the News?

The World Health Organization (WHO) announced an initiative called the “Global Breast Cancer Initiative”.

About Global Breast Cancer Initiative:

• Aim: The initiative aims to reduce global breast mortality by 2.5% by 2040.
• The initiative will particularly focus on reducing deaths in low-income countries. There the progress to tackle the disease is relatively slow.
• Key Features of the Initiative:
  • Guidance to Governments: Under the initiative, WHO will work with other UN agencies. They will provide guidance to governments on how to strengthen systems for diagnosing and treating breast cancer. It is expected to improve capacities to manage other types of cancer.
  • Evidence-based Technical Package: An evidence-based technical package will also be provided to countries as part of the initiative. It will incorporate existing WHO cancer tools and products.

About Breast Cancer:

• Breast cancer is the most common form of cancer in women. It is responsible for one in six cancer deaths among women and has overtaken lung cancer as the world’s most commonly diagnosed cancer.
• Survival Rates: Breast cancer survives for five years after diagnosis exceeds 80% in most high-income countries. However, it is 66% in India and 40% in South Africa.

Source: Down To Earth

Synopsis: India registers a high number of gestational diabetes cases, which are bound to increase in the future. This coupled with low awareness and poor testing potential calls for immediate action.

Background:

• Diabetes is a metabolic disease that causes high blood sugar. The hormone insulin moves sugar from the blood into your cells to be stored or used for energy. 
• If a person is having diabetes, the body either doesn’t make enough insulin or can’t effectively use the insulin it makes.
• India has 7 crore cases of diabetes and almost 3.5 crore prediabetes cases. 
• Further, Type 2 diabetes is most common, it is preventable with some lifestyle changes. However, very less focus is placed on Gestational diabetes.

About Gestational Diabetes:

• It is a transitory form of diabetes occurring in pregnant women.
• South Asian women are at higher risk of development as shown by data from the International Diabetes Federation. It estimates that 25% of south Asian women would develop it.
• In India, it is assumed to be more prevalent in urban areas (30%) than rural areas (10%). Further, assuming a 10% rate of development, the figure for gestational diabetes comes around 27-30 lakh women every year.

Impact of Gestational Diabetes:

1. First, it enhances complications during pregnancy. This includes preeclampsia (fits during pregnancy), prolonged and obstructed labor, need for assisted delivery, postpartum hemorrhage, etc.
2. Second, the above complications can cause a spike in maternal and neonatal mortality rates.
3. Third, if not death, then the probability of developing other problems is quite high.
   • Type 2 diabetes gets developed in almost 50% of women.
   • Children also are at high risk of obesity, type 2 diabetes, and cardiovascular diseases.   

Challenges in Managing Gestational Diabetes:

1. First, there is a lack of awareness regarding gestational diabetes due to which, it gets noticed after the complication has occurred.
2. Second, our health system also lacks the capacity for providing robust and timely testing.

Way Forward:

• There should be a prompt and adequate implementation of national guidelines on the diagnosis and management of gestational diabetes.
• The single test procedure suggested by Dr. V. Seshiah (a pioneer in the field of diabetes and pregnancy) and subsequently approved by the World Health Organisation should be adopted for better diagnosis.
• In order to spread awareness, the 10th march can be celebrated as National Gestational Diabetes Awareness Day. 
  • The Diabetes Study Group of India recommended this step as it would be an act to recognize Dr V. Seshiah’s contribution to the field of diabetes and pregnancy for more than 40 years.

Source: The Hindu

Synopsis: National Digital Health Mission aims to build digital health infrastructure in India. But there are many hurdles in developing comprehensive digital health data.

Introduction:

Recently on Independence Day, our Prime Minister announced National Digital Health Mission. The Mission aims to develop the backbone for integrated digital health infrastructure in India. Developing countries with significant health challenges like India critically need such an infrastructure.

The NDHM will help in developing the diagnostics and management of health services. Apart from that, the NDHM will also help in achieving broader public health monitoring, research, socio-economic studies, prioritizing resource allocation and policy interventions, etc.

Digitization can make healthcare more organized, effective, and efficient. But we must know that Digitization can’t substitute the fundamentals like an investment in nutrition and welfare, primary healthcare services and healthcare professionals, etc.

What is the prerequisite to digital health infrastructure?

Before going completely digital, certain things are essential to achieve the desired social objectives. They are,

1. India needs to carefully develop various ways to fulfil the “health needs of the public”. India needs to carefully examine the following things and their improvement with digitization. Such as,
   • Ways of facilitating better diagnosis and management,
   • Understanding of the data structures for effective health services
   • Alleviate health problems with digitization such as malnutrition and child stunting, etc.
2. Challenges with Privacy: It may also create tensions between a collection of digital health data and individual rights to privacy. For example, many countries like UK, Sweden, the US, etc. attempted to build digital health infrastructures they were not successful due to serious privacy-related controversies.
3. Linking the digital health data to other sectors: This data may be linked to other sectors such as banking and services with adequate access to data. This creates two types of challenges.
   • Not linking the digital health data with other sectors will make the potential uses of digital health data very limited.
   • Complete interlinking of digital health data will create various problems such as privacy violation, the vulnerability of data to profit-motivated pharma companies, etc.
4. Design of Digital health data operations: Access to digital data requires identifying and understanding the complexity in various data sources such as immunisation records, data in government and private hospitals, diagnostic centres, etc. The design should also include an understanding of data generation frequency, error models, sharing and other operational requirements, etc.
5. Building an effective system that can generate people’s trust requires building a transparent process. That process should have openness and public consultations in all spheres of development.  This includes avoiding “crony expertise”, rejecting poorly-conceived designs and ideas, etc.

So, developing a comprehensive digital health infrastructure not only depends on the health sector alone. Instead, it also depends on e-governance and the administration of digitisation in India.

Synopsis: Coronil Launch event is in controversy again. Ministers and public figures must not be seen as endorsing drugs whose efficacy is in doubt

Background

At a recent event, Haridwar-based Patanjali announced that its Coronil Ayurveda medicine recognized as a “supporting measure in COVID-19” by Ayush Ministry. Ministry awarded the Certificate of Pharmaceutical Product (CoPP) as per the WHO certification scheme.

After receiving certification, the export of medicine has become possible. This event was presided by Union Health Minister Harsh Vardhan and Transport Minister Nitin Gadkari.

The company claimed that it is the first evidence-based medicine to fight COVID-19.

This event attracted several criticisms. Indian Medical Association (IMA) criticized this promotion as unethical and a “blatant deceiving of the people of the country”.

What are the issues associated with the launch of Coronil?

1. Firstly, Patanjali is a private company and coronil is the product of it. As per code of act, Doctors are barred from promoting any drugs and Dr Harsh Vardhan (health minister) is an ENT surgeon.
2. Secondly, Baba Ramdev claimed at the event that WHO endorsed Coronil. Whereas, WHO South-East Asia in a tweet refused any such endorsement.
3. Third, the publication of a randomized clinical trial of Coronil in a research journal was also put forward as an endorsement by that magazine. These publications are nothing but an initial requirement that put forward the report in front of subject experts.
4. Fourth, the published report reveals that medicine was tested only on 95 patients. All of them were asymptomatic and mildly symptomatic but confirmed as RT-PCR positive. This number is very small. Moreover, a large population with mild or no symptoms recovers without any external intervention.

However, it is not the only case, where a drug approved without any solid research. DGCA previously approved itolizumab by Biocon, which was tested only on the sample of 30. Approval of Covaxin also was in a haste and lacked solid scientific evidences.

Ayurveda and patient safety

What is the news?

The Ministry of Health & Family Welfare has launched operational guidelines for integration of NAFLD(Non-Alcoholic Fatty Liver Disease) under NPCDCS (National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke).

About NPCDCS (National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke):

• Launched in: It was launched in 2010. It aims to prevent and control Non-Communicable Diseases(NCDs).
• Implemented under: National Health Mission(NHM).
• Objectives: The objectives of the programme include awareness generation for the prevention of NCDs. Some important constituents of this program are screening, early detection, management and referral to an appropriate level health facility.

About Non-Alcoholic Fatty Liver Disease(NAFLD):

• It is a term for abnormal accumulation of fat in the liver despite the absence of harmful alcohol use, viral hepatitis or medications.
• Prevalence of NAFLD in India: As per studies, the prevalence of NAFLD is around 9% to 32% of the general population in India. There is a higher prevalence among overweight or obesity and those with diabetes or prediabetes.

Stages of NAFLD: The main stages of NAFLD are:

• Simple Fatty Liver Disease – It is a largely harmless build-up of fat in the liver cells. It may only be diagnosed during tests carried out for another reason.
• Non-Alcoholic steatohepatitis(NASH) – Mere deposition of fat in the liver is termed steatosis. It is characterized by inflammation of the liver.
• Fibrosis – It is where persistent inflammation causes scar tissue around the liver and nearby blood vessels. But the liver still able to function normally.
• Cirrhosis – It is the most severe stage after years of inflammation. At this stage, the liver shrinks and becomes scarred and lumpy. This damage is permanent and can lead to liver failure (where your liver stops working properly) and liver cancer.

Is NAFLD Curable?

• Once the disease develops, there is no specific cure available, and health promotion and prevention aspects targeting weight reduction, healthy lifestyle can prevent the mortality and morbidity due to NAFLD.

Source: PIB

After oils, FSSAI caps Trans Fatty Acids(TFAs) in foods

What is the News?

Recently Union Health Minister launched Intensified Mission Indradhanush (IMI) 3.0 in India. After the launch, States and UTs have started the implementation of the IMI 3.0.

Development of Immunisation Programme in India:

1. Ministry of Health and Family Welfare introduced the Immunization Programme in India in 1978. It was released in the name of ‘Expanded Programme of Immunization’ (EPI).
2. In 1985, the EPI programme was modified as ‘Universal Immunization Programme’ (UIP). This was to be implemented in a phased manner to cover all districts in the country. Despite being operational for many years, UIP able to fully immunize only 65% of children in their first year of life.
3. Mission Indradhanush:
   • It was launched in 2014. The aim of the mission was to ensure full immunization with all available vaccines for children up to two years of age. Further, the mission aims to vaccinate pregnant women who were either unvaccinated or partially vaccinated under UIP.
   • Diseases covered for Vaccines: Under the mission, vaccination is provided free of cost against 12 vaccine-preventable diseases. Such as Diphtheria, Pertussis, Tetanus, Polio, Measles, Rubella, severe form of Childhood Tuberculosis, Rotavirus diarrhoea, Hepatitis B, Meningitis & Pneumonia caused by Haemophilus Influenzae type B, Pneumococcal Pneumonia and Japanese Encephalitis.
   • However, under Mission Indradhanush, Vaccination against Japanese Encephalitis and Haemophilus influenza type B is provided only in selected districts of the country.
4. Intensified Mission Indradhanush(IMI)
   • It was launched in 2017. The aim was to vaccinate each and every child up to two years of age. Apart from that, IMI also vaccinates all those pregnant women who have been left uncovered under the routine immunisation programme/UIP.
   • Special attention was given to unserved/low coverage pockets and urban slums with a migratory population.
   • Special vaccination drives were conducted under IMI. These drives aimed to ensure full immunisation coverage in 90% of select districts and cities by 2018.
5. Intensified Mission Indradhanush (IMI) 2.0
   • It was launched in December 2019. It aimed to achieve targets of full immunization coverage in 272 districts of 27 States. Full immunization of 652 blocks in Uttar Pradesh and Bihar also targetted. Hard-to-reach and huge tribal populated region were chosen as blocks
   • The mission has a focus on urban, underserved population and tribal areas.
   • IMI 2.0 also had Inter-ministerial and inter-departmental coordination.
6. Intensified Mission Indradhanush (IMI) 3.0
   • It aims to cover children and pregnant women who missed the routine immunisation during the COVID-19 pandemic.
   • Beneficiaries from migration areas and hard to reach areas will be targeted.
   • The mission will follow the COVID-Appropriate Behaviour(CAB) approach during the immunisation activities.
   • States have been asked to follow a “staggered approach” (Staged approach) to avoid crowding at the vaccination sites.
   • The vaccination sessions will be planned in such a way that not more than 10 beneficiaries will present at the session site at one given point in time.

1. Source: The Hindu 

[Answered]Explain how vaccines work? Discuss the significance of vaccination and mention various challenges regarding vaccination in India.

Synopsis: India can turn into a hotspot for zoonotic diseases (diseases that spread from animal to human), if not controlled now. Research must be proactive as this could be a larger crisis than the COVID pandemic.

Introduction 

During the covid-19 pandemic, Scientists developed tools to study the virus more effectively. Further, they also set up channels to test the efficacy of the Food and Drug Administration (FDA) approved drugs. But the challenges of Zoonotic diseases still exist.

Vulnerability of India to Zoonotic diseases:

Global meta-analyses mention that Zoonotic diseases are likely to emerge in areas with many mammal species. As per the analysis, high land use and land cover change, and high human population density are the reasons for zoonotic diseases.

1. According to Global meta-analyses, India can be a hotspot for the possible emergence of zoonotic diseases in the world.
2. India’s approach to addressing zoonotic diseases has mainly been reactive. This is evident as the research and public health intervention usually begin when there is an outbreak. 

Challenges in controlling Zoonotic diseases?

There are several scientific challenges that exist in zoonotic diseases. They are,

1. One cannot predict the zoonotic disease pandemic. This is evident from the recent Covid pandemic.
2. It is hard to collect viral and bacterial samples from biodiversity. Collecting samples is nearly impossible from wild reservoirs like bats and rodents.
3. It is impossible to monitor and control biodiversity hotspots. Further, the government cannot detect the transmission of the pathogen from one hot spot to another.
4. Moreover, it is difficult to predict the evolutions of pathogens and their relation with the hosts (animals). It is also evident in the COVID pandemic.

Suggestions:

Scientists have to conduct interdisciplinary research and sustained efforts to reduce challenges. So, Scientists from various domains have to come forward and work for a common cause just like they did for covid testing and vaccinations. 

Read Also:-

[Answered] What is ‘One Health’? Discuss its need and significance in context of rising zoonotic infections.

Introduction

Recently Telangana government has achieved 100% tap water connections to all schools and Angan Wadi Centres (AWCs) under 100 day Special Campaign. The other states like Andhra Pradesh, Himachal Pradesh, Goa, Haryana and Tamil Nadu also achieved this target.

Under the Jal Jeevan Mission (JJM) the central government also aims to provide Functional Household Tap Connection (FHTC) to every rural household in India by 2024. Further, the recent budget expanded the Jal Jeevan Mission to urban areas as well. But to provide clean drinking water, the government has to do much more than just providing the water connections.

Important aspects of Jal Jeevan Mission

The JJM aims to envisage a supply of 55 litres of water per person per day. Important aspects of the Jal Jeevan mission are,

1. The JJM will focus on integrated demand and supply-side management of water at the local level.
2. It will implement source sustainability measures to recharge and reuse through greywater management, water conservation, rainwater harvesting.
3. The Mission will converge with other Central and State Government Schemes to achieve its objectives of sustainable water supply management across India.
4. The JJM will generate maximum community participation in the form of ‘Jan Andolan to achieve the target.

Other schemes aimed towards providing Drinking water

1. Swajal Yojana: It is a community-owned drinking water program for sustained piped drinking water supply powered by solar energy. It was launched in 115 aspirational districts of India.
2. Jal Mani Programme: It aims to provide value and quality addition to the ongoing Rural Drinking Water Supply Programme to mainly address the water quality. The aim is achieved by installing Stand-Alone Purification System in rural Schools
3. Atal Bhujal Yojana: It is a Central Sector Scheme aims to improve groundwater management through community participation in identified priority areas in seven States

What are the advantages of providing clean drinking water?

1. India will face fewer water-borne diseases. According to a study, more than 21% of the country’s diseases are water-related. In 2015 alone, India lost over 1 lakh children under the age of five due to diarrheal diseases. It is preventable if India provides clean water to its population.
2. Fulfilling SDG: By providing clean water and sanitation to all, India can achieve Sustainable Development Goal 6 (clean water and sanitation for all). Along with that, India can also achieve other SDGs as well such as good health and well-being, etc.
3. Recharge of groundwater level: According to NASA (National Aeronautics and Space Administration), India’s water tables are declining at the rate of 0.3 meters per year.  Clean water through wastewater management may reduce the demand for groundwater. This will improve the groundwater table.
4. JJM and other schemes provide employment opportunities. Successful implementation of the National Skill Development Mission has created a pool of skilled manpower in plumbing, masonry, fitting, electricity, etc. The JJM implementation will utilize their skills and also provide employment opportunities to the migrant labours returning home.
   • For example, Recently Ministry of Jal Shakti deployed labourers returning to their homes due to the COVID-19 pandemic in the Jal Jeevan Missions.
5. Better local infrastructure – Apart from solving the drinking water problem, the schemes will also improve better infrastructure facilities especially in rural India. Infrastructure facilities will be in the form of water management structures, supporting infrastructures in-home, streets, etc.

What are the challenges associated with providing clean drinking water?

1. Water is a state subject. So, Centre intervention in this domain is limited. The States also look into the issue of drinking water problem as their individual problem (not the problem of other states). This leads to interstate disputes for water and prevents them from enacting a holistic solution.
2. India doesn’t have enough water for its population. India has 16% of the global population, but only 4% of freshwater resources. One billion people in India are living in water-scarce areas. So, providing enough drinking water to all is a great challenge with limited resources.
3. Providing quality piped water will be a great challenge. In the majority of the Metro cities and Urban areas, demand for water is higher than the supply. To compensate for the deficit, local authorities mix the surface & groundwater.
4. Moreover, NITI Aayog report mentions nearly 70 percent of the country’s freshwater sources are contaminated. So it is impossible to ensure that quality water alone is supplied to homes.
5. The “slippage” problem in India: Wide temporal and spatial variation of monsoon result in the slippage problem. For example, India receives 75% of its total rainfall during the four months-long monsoon season alone. So, there is a higher chance that drying up of the water source or collapse of the created facilities will create the problem of drinking water again in the earlier cover areas of schemes such as Jal Jeevan Mission.
6. Reducing per capita availability of water in India is also a challenge. The Per capita availability was at 1816 cubic meters in 2001. But it reduced to 1545 cubic meters in 2011. Further, It is expected to reduce to 1367 cubic meters in 2031. In such a scenario Providing 19.02 crore, pipe connections will increase the demand for drinking water and reduce the per capita availability of water.

Suggestions to improve access to drinking water

1. Providing clean drinking water needs a few corrections at the ground level. Such as,
   • Artificial Recharge Techniques such as Rainwater Harvesting Systems in houses and localities should be mandatory. This will increase the Groundwater level in Indian villages.
   • Government has to encourage local participation in water conservation by steps such as an awareness campaign.
2. The government has to enact a specific plan for water-stressed states and water-stressed areas like the Hiware Bazar model of local-level water regeneration.
   • Hiware Bazar is a village in Maharashtra’s drought-prone Ahmednagar district. Within a decade it changed from the water-stressed region to one of the most prosperous villages of the country. They achieve this by regenerating their natural resources such as forests, watersheds, and soil with local Panchayat.
3. The government can explore the options of Pricing water used by well-off sections and agriculture. This fund can be used in the maintenance of the pipes and drains.
4. Mandatory compliance: The sources, as well as the quality of water in the country, need to be maintained on a war front basis. The government can ensure mandatory compliance of local bodies to the Bureau of Indian Standards on water quality. This will ensure quality water at the local level.
5. The government has to explore technological solutions in drinking water management. Such as establishing water treatment plants in water storage facilities to remove toxic inorganic pollutants and dissolved solids.

India cannot provide clean drinking water to people at the expense of depletion of the existing resources. It will take India, a step closer to the ground-zero level. At the same time, India cannot wait till the present population depletes the water resources. So, It is high time for the government to act on water conservation along with the aim of achieving clean drinking water for all.

What is the News?

A study was conducted to estimate the cost of ensuring WASH (water, sanitation and hygiene) in healthcare facilities for one year across India. The study was published in  BMJ Global Health journal.

What is WASH?

• The term “WASH in health care facilities” refers to the provision of water, sanitation, health care waste management, hygiene and environmental cleaning infrastructure, and services across all parts of a facility.

Key Findings of the study:

• The study estimates that improving WASH across the public healthcare facilities in India and maintaining this for a year would cost $354 million in capital costs. Further, it will need $289 millions as a recurrent expense (all payments other than for capital expenses like maintenance, electricity, rent, etc).
• The most costly interventions were providing clean water, linen reprocessing, and sanitation. Similarly, the least expensive were hand hygiene, medical device reprocessing, and environmental surface cleaning.

Impact  of  Poor WASH Facilities:

• A 2019 joint global baseline report by WHO and UNICEF had pointed out that globally, one in four healthcare facilities lacked basic water servicing. Further, one in five health care facilities had no sanitation service and 42% had no hygiene facilities.

Significance of providing WASH facilities:

• WASH will reduce deaths: Approximately, the death of 3 lakh children under five years can be prevented each year.
• Achieving SDGs: The status of WASH in healthcare facilities is an important issue in development. Ensuring availability and sustainable management of water and sanitation is one of the 2030 sustainable development goals.
• Infection prevention and control: The WASH interventions can help reduce healthcare-associated infections. Especially among the mother and neonates across the Indian healthcare system.
• Cost-effective intervention: In 2012, the WHO report calculated ‘For every dollar invested in sanitation, there will be a $5.50 gain’. This will be in the form of lower health costs, more productivity, and fewer premature deaths, etc.

Source: The Hindu

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Sri Lanka settles “Currency Swap Facility” with India

Synopsis: The empirical evidence shows that the idea of the complete elimination of COVID viruses in a selected few countries is not feasible. Rather, it will only increase the socioeconomic disparities thereby making the goal of elimination infeasible.

Background

1. A recent article published in The Lancet has advocated for “elimination strategy”, it is also known as the zero-COVID-19 strategy for eliminating the virus.
2. Zero-COVID-19 strategy means that the replication of the virus will be reduced to the least so that no new cases will occur in a defined geographical area.
3. The elimination strategy has the following three elements,
   • Rapid reduction in the number of infections to zero.
   • Creation of virus-free green zones and
   • Prompt outbreak management when new cases occur occasionally.
4. Rich countries are working on this strategy by vaccinating each and every citizen.
5. However, this strategy of the complete elimination of the virus is not suitable for every country.

Why this strategy is not suitable for all countries?

Complete elimination of the virus by vaccination is only suitable for geographically isolated countries such as New Zealand. It can afford strict border control measures. Even here, it is difficult because of the following reasons,

• First, the virus will be in circulation in the countries from each other. So, the threat of a Virus outbreak will stay for a while.
• Second, the Virus is mutating at a very fast pace. Universal vaccination will not be helpful against new variants. It is difficult to consistently upgrade vaccines.
• Third, a zero-COVID-19 strategy will worsen global health inequities. The idea of creating green zones for free travel will benefit richer countries and alienate poorer nations.
• Fourth, the experience from the elimination of other diseases shows that the complete elimination of the COVID virus is not possible. For example,
  • • Measles and neonatal tetanus are present for more than 20 years. It caused nearly 25,000 newborn deaths in 2018. Despite the global efforts for vaccination it still remains a major public health challenge in the developing world.
    • Polio, eradicated from Southeast Asia, is still endemic in Afghanistan and Pakistan.
    • Also, according to immunologists surveyed by the science journal Nature the Covid virus will become endemic in certain countries.

What are the Solutions?

Instead of isolated strategies for a few countries, global leadership and resources to vaccinate the vulnerable population are required.

• First, disease control measures should be implemented globally. The vaccine coverage for vulnerable populations across the globe should be increased.
• Second, the current pace of vaccination needs to be increased by 4.3 times to vaccinate 6.4 million persons per day.
• Third, along with this, mapping of elderly and persons with comorbidities needs to be done on a priority basis for vaccination.
• Fourth, there is a need to strengthen epidemiological and genomic surveillance for COVID-19.
• Fifth, a plan for the goal of achieving Universal Health Coverage (UHC) is required. Because the COVID-19 pandemic has reversed the gains made in other health programmes like tuberculosis control.

Thus, the idea of eliminating virus in a selected few countries should be replaced with a pragmatic goal of controlling COVID-19, not elimination. Since the zero-COVID-19 strategy comes with zero evidence of feasibility, focusing on it will result in wastage of our attention, funds, and time.

Synopsis: The COVID 19 pandemic has given an opportunity to India for combating other respiratory diseases like Tuberculosis (TB). The learnings from the pandemic can be used to control the spread of TB.

Background:

• The first case of COVID 19 was reported on 30th January 2020. After that, the disease claimed the lives of 1,54,000 people and infected 10.7 million in India.
• However, with robust efforts, the government managed to control its spread. Due to this, the country is not facing a brutal second wave as suffered by other countries.
• The number of active cases is decreasing since mid-September and people are getting back to their normal lives.
• The focus should now be shifted to other respiratory diseases like TB.

About Tuberculosis:

• It is a contagious infection that usually attacks your lungs. But can infect other parts like your brain and spine. 
• It is a bacterial disease caused by Mycobacterium tuberculosis and affecting mankind for 3000 years.
• Furthermore, it is a disease with the ability to damage multiple organs which enhances mortality risks.

Issues with Tuberculosis:

As per World Health Organisation (WHO), India has more than 10 million active cases of TB. 4 lakh lives are lost per year due to TB and shares 1/4th of the global burden.

1. First, It causes a disproportionate impact on the poor who live in overcrowded spaces and lack proper nutrition.
2. Second, numerous myths and stigma are associated with the disease which discourages reporting and proper treatment.
3. Third, it has become very difficult to control if multi-drug resistance gets developed or a person is already suffering from diabetes or  HIV.

Using COVID 19 Lessons to combat TB:

• First, the PM must take a lead to sensitize the masses about the disease. It was done by him in the case of COVID 19, to induce behaviour change. 
• Second, the concept of physical distancing can be effective in curtailing the spread. The droplets from one person will not reach another if the due distance is maintained.
• Third, patients, as well as nearby family members, must wear masks to curb the spread of infection.
• Fourth, improved detection techniques developed during COVID can be used to replace the traditional sputum tests. This would ensure better diagnosis and quick results.
• Fifth, in order to improve tracking and contact tracing, the focus should be on instant notification techniques.
• Sixth, awareness is developed around respiratory diseases. It can be used to build community-led participation and burst the stigma surrounding TB.
• Lastly, the enthusiasm shown by media and coordination shown by governments in tackling COVID-19 should also be carried forward to TB. 

India has set a target TB elimination by 2025 which is 5 years prior to the sustainable development goals target. This can be achieved if COVID 19 learnings are aptly adopted in combating TB. 

Ayurveda and patient safety

What is the News?

During an address to 9 neighboring countries, PM suggested Special Visa Scheme. The address was part of a workshop on “COVID-19 management: exchange of good practices in tackling pandemic and the way forward”.

Participation: The countries that participated in the workshop include: Afghanistan, Bangladesh, Bhutan, Maldives, Mauritius, Nepal, Pakistan, Seychelles, and Sri Lanka.

Key Takeaways from the address:

• Special Visa Scheme: PM suggested considering a special visa scheme for doctors and nurses. It will help them to travel quickly within the region during health emergencies at the request of the receiving country.
• Regional Air Ambulance: The Civil Aviation Ministries from the neighboring countries can coordinate a regional Air Ambulance agreement for medical contingencies.
• Data on COVID-19 vaccines: The countries could come together to create a regional platform for collating, compiling, and studying data about the effectiveness of COVID-19 vaccines among our populations.

Source: The Hindu

Synopsis: The government has come up with an integrated health and well-being budget for 2021-22. It would help meet the current and upcoming challenges created by the COVID-19 pandemic.

Background:

• The pandemic struck India in March 2020 and exposed the vulnerabilities of the Indian health care system.
• Although India’s performance in tackling the pandemic was better than various developed countries. But its impact on the economy and society was significant.
• It was therefore imperative to come up with a strong health and wellbeing budget to develop resilience against the ill effects of the pandemic. The health budget was prepared in this context of Atma Nirbhar Bharat Abhiyan.

Government measures for strengthening ‘health and wellbeing’:

• A Production linked incentive scheme is announced to boost the manufacture of pharmaceutical and medical devices.
• 35000 crore rupees has been allocated for the development of COVID-19 vaccine. Mission COVID Suraksha has been launched to improve indigenous vaccine testing and development. Further coverage of pneumococcal vaccine will also be enhanced.
• Pradhan Mantri Garib Kalyan Yojana (PMGKY) was launched to provide free food grains to 800 million beneficiaries.
• One Nation One Ration Card (ONORC) will target 690 million beneficiaries covering 32 states/UTs.
• Jal Jeevan Mission (JJM) has been given substantial allocation.
• There would be an expansion of health and wellness centres under Pradhan Mantri – Atmanirbhar Swasth Bharat Yojana (PMANSBY). It would also involve using a 13,192 crore Finance Commission grant for strengthening the primary health system.
• Allocation for the Pradhan Mantri Jan Arogya Yojana (PM-JAY) has not changed in comparison to last year.
• There has been a 40% increase in Budget of the Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) ministry.

Significance:

• First, the nature of allocation strengthens the vision of making India Atma Nirbhar.
• Second, initiatives like Mission COVID Suraksha will help India sustain its position of being the vaccine hub of the world. Significant allocation towards vaccine development will also ensure all the citizens are able to get vaccinated in due time.
• Third, PMGKY and ONORC will help in ensuring food and nutritional security in the country.
• Fourth, a reduction in diseases namely Malaria, Polio and Diarrhoea would be seen due to substantial allocation towards JJM. This is explained by a report released by the Johns Hopkins Bloomberg School of Public Health in 2019.
• Fifth, focusing on capital expenditure through schemes like PMANSBY is a welcome step for strengthening the health system. Earlier the capital expenditure used to constitute only a small fraction of health allocation.
• Sixth, an improvement in AYUSH ministry’s budget will allow the country to focus more on preventive care and integrated treatment. 
• Lastly, integration of health with well-being (Water, Sanitation and Nutrition) would help in improving the outcomes. Both National Health Policy, 2017 and Economic Survey have stressed the interdependence of these sectors.  

Way Forward:

India’s commitment towards health has allowed it to successfully deliver 8 million doses of COVID vaccine to health and frontline workers. This is the fastest vaccination drive in the world.

• Allocation towards schemes like PM-JAY should be enhanced. A 20% decline was seen in infant mortality rate (IMR) between 2015-20 in states which adopted the scheme in comparison to a 12% in IMR decline in states which didn’t adopt it as per the economic survey.
• The states must increase their health spending to 8% of their respective budgets by 2022 as recommended by the National Health Policy and Finance Commission. This would reduce the burden on the Centre and ensure effective spending.

The Union Budget has effectively prepared the ground for tackling the upcoming challenges in the health sector. This should be coupled with other reforms so that the resilience capacity of the country gets enhanced. This would help in achieving the vision of universal health coverage by 2030 as part of sustainable development goals.

Synopsis: The COVID-19 pandemic disrupted Normal health Services in India. The telehealth services like Remote Shared Medical Appointments (SMAs) should be used.

Background:

• The March 2020 lockdown reassigned healthcare professionals towards COVID-19 specific duties.
• This deviated the focus from other healthcare domains in India and across the world. 

How Covid-19 disrupted normal Health care services:

• As per a survey of WHO, Essential services like immunization and childcare got disrupted in the majority of the 105 countries surveyed.
• Around 45% of low-income countries witnessed a disruption in 75% of services. While this figure for high-income countries was only 4%. 
• Impacts on India: 
  • Fear of transmission and lockdown resulted in the fall of diagnostic services. In tuberculosis detection cases 50% fall was reported from April-December 2020. Whereas, in antenatal care visits  56% decline was observed during the first half of 2020.  
  • The inequalities got widened when people in rural and remote areas were not able to travel to cities for getting specialized care.
  • However, the use of technology helped to mitigate the impact.

Virtual Consultation India 

1. The E-Sanjeevani platform of the Indian Government provides virtual consultations to patients. It includes patient-to-provider and provider-to-provider consultation.
2. A hub and spoke model used for this platform. It connected smartphone-equipped rural wellness centres to specialist doctors located in cities.
3. Private players and non-governmental organizations also used the technology for reaching out to patients.

However, given the scale of India’s population which is devoid of healthcare, a switch towards remote shared medical appointments is needed.

About Remote Shared Medical Appointments:

• Remote Shared Medical Appointments virtualizes the process of in-person shared medical appointments (SMAs). It is an effective practice in the US for more than 2 decades.
• Thus, It involves the virtual interaction of a doctor with multiple patients having similar issues.
• Advantages:
  • Patients get more time with doctors.
  • This process develops a sense of bonding among patients.
  • This process provides better productivity as patients learn from each other’s questions.  

Utility for India:

1. SMAs have been very effective in the case of diabetes. It is notable that India is home to the largest number of diabetes patients.
2. Aravind hospital in Puducherry has shown the potential of SMAs to combat glaucoma, a disease that causes gradual blindness.
3. Offering this facility through the E-Sanjeevani platform can help the country meet the healthcare gap in rural India.
4. SMAs will encourage people interaction and attract supplementary providers like physiotherapists and optometrists.
5. The current COVID-19 vaccine drive will also be strengthened as providers can offer sessions to burst the myths related to vaccine efficacy.   

Way Forward:

1. The switch to a new technique of healthcare delivery will require adequate training and mentoring of both providers and patients.
2. Collaboration with training platforms like ECHO is desired to encourage the adoption of virtual SMAs. It trains primary healthcare providers in multiple states.
3. India is blessed to have very low data rates where 1.5 GB data/day is easily affordable for many Indians. This automatically gives the country a significant edge towards augmenting telehealthcare.
4. Further, the strengthening of digital health services will also be in line with WHO’s Global strategy on Digital health. It would help in realizing the dream of ‘Health for All”.

Synopsis:  The government is focussing on the vaccination of frontline sanitation workers. However, the most vulnerable among them, Manual scavengers, did not gethe attention they deserve. 

Introduction 

India is far behind in understanding sanitation workers and their different categories. Manual scavengers belong to the lowest strata of unprotected sanitation workers.

Many people in India believe that manual scavenging is already eliminated since it is legally banned. However, the ground reality is very different.

• Sanitation workers can be categorized into Faecal sludge handlers, Sewage treatment plant sanitation workers, Toilet sanitation workers, public transportation site sanitation workers (railway, roads), Sewer and drain sanitation workers, Sanitation-waste intersection workers, Etc.
• Manual Scavengers are workers discarding human excreta manually, in any form.

The risk involved in septic cleaning among manual scavengers is the highest. One sanitation worker dies every five days. Waste recovery sanitation workers perform the work of manual scavenging as they come in regular contact with unprotected bio-medical waste, animal faeces.

Why sanitation workers should be included in priority population for vaccines?

Vaccination of sanitation workers should be prioritized due to following reasons:

• First, several laws banning this practice are not working properly on the ground. Sewer deaths continue to happen. Caste and economics have a role to play in the deprivation.
• Second, the absence of a policy for the protection of the sanitation workers resulted in the loss of many lives during the initial days of the pandemic. These cases are not even mentioned in the records of the National Commission of the Safai Karmachari (NCSK).  The Safai KarmacharI Andolan (SKA) has had far better data.
• Third, there is no social security, no accountability in the actual expenses of the rehabilitation schemes. Even no definite provision for healthcare or pension is provided.
• Fourth, the representation of sanitation workers is not involved during creation of policies for them. 
• Fifth, sanitation workers are prone to long-term diseases. In many cases, they don’t even live till the age of retirement. Their children suffer from malnutrition, TB, and cholera because of their habitation around the waste generated by the cities. 
• Lastly, the sanitation workers worked full time to ensure safety for the people during the pandemic. 

Way forward

The government must urgently prioritize vaccination for manual scavengers without giving the argument that they have already developed “herd immunity”.

What is the News?

The World Bank released a report titled “Traffic Crash Injuries and Disabilities: The Burden on Indian Society”. It highlights the Socio-Economic impacts of road accidents in India.

About the Report:

• Published by: World Bank in collaboration with SaveLIFE Foundation.
• The report highlights the socio-economic impact of road accidents. It analyses the  Medical care access and post-accident financial distress of various categories of people.
• The data was collected from Uttar Pradesh, Bihar, Tamil Nadu, and Maharashtra — a State each from northern, southern, western, and eastern regions.

Key Findings:

Road accidents in India:

• India tops the world in road crash deaths and injuries. It has 1% of the world’s vehicles but accounts for 11% of all road crash deaths. It is witnessing 53 road crashes every hour and killing 1 person every 4 minutes.
• India has seen around 4.5 lakh road accidents in the past year. It resulted in at least 1.5 lakh deaths over the past few years.
• According to a 2018 World Health Organization report, India tops the world in road crash deaths, with more than 400 fatalities per day.

Socio-Economic Impact of Road accidents in India:

• There are more fatalities from road crashes among poor families compared to rich families. The risk of a victim undergoing disability after a crash was also 2 times more likely among poor families.
• The socio-economic burden of road crashes is disproportionately borne by poor households. Accidents result in a decline of 75% of total household income among low-income groups. Whereas, the decline among high-income groups is only 54%. It underlines poor access to insurance schemes among the less privileged.
• Impact on Women: About 50% of women were severely affected by the decline in their household income after a crash. About 40% of women reported a change in their working patterns post-crash. While around 11% reported taking up extra work to deal with the financial crisis.
• Urban-Rural Divide: The severe impact of the decline in income was highest among poor households in rural areas (56%) compared to those in urban areas (29.5%).
• Insurance Coverage: There is an asymmetry in insurance coverage. About 1/4th  of respondents from high-income households (24%) said that they received compensation.  Whereas, among poorer respondents, only 14%  received compensation.

Recommendations:

• There is a need to institutionalize post-crash emergency care and make health infrastructure and coverage more accessible and inclusive.
• The central and state governments should provide a social security net for crash victims from low-income households through state support.
• The Central government should create schemes to increase insurance coverage and penetration for low-income households.

Source: The Hindu

Source: Indian Express

Gs2: issues Relating to Development and Management of Social Sector/Services relating to Health.

Synopsis: Four important issues ailing the health sector did not find a place in the budget.

Background

1. The budget allocation for the health sector in 2021-22 was (24 lakh crore) 137 % more than the previous year (69,000 crores).
2. However, the actual share of Health and Family Welfare was only a third of the total allocation of Rs. 24 lakh crore.
3. This is because, the increase in budget for ‘Health wellbeing’ also included funds for drinking water, sanitation, nutrition, AYUSH, health research, vaccination as well as grants assigned by the 15th Finance Commission.
4. Also, a new centrally-sponsored scheme PM Aatmanirbhar Swasthya Bharat Yojana was announced as a part of Budget 2021-22.
5. Even in this case, the funds allocated to this new scheme will be materialized only when the programmes are implemented.

What are the critical issues that have not been addressed by the Budget 2021-22 in the health sector?

Despite the above measures introduced in the Budget 2021-22, it has failed to address the four critical issues ailing the health sector. They are

1. First, the Budget has failed to find a solution to bring down the costs of outpatient treatment.
   • Under Aayushman Bharat, 50 crores of eligible poor people are entitled to cashless hospitalisation. However, the cost of drugs, the high cost of high-end diagnostics leads to high out-of-pocket expenditure before a patient needs hospitalisation.
   • This ultimately reduces the number of people using affordable health care services. It defeats the very purpose of Aayushman Bharat.
2. Second, Insurance coverage for the middle class is not adequate. Under the Ayushman Bharat health Programme, only 50-crore poor people are covered.
   • Whereas another  10 per cent organised sector employees are covered by different government or employer generated medical coverage schemes.
   • Still, around 30 crore Middle-Class Indians are without any state-supported medical insurance.
3. Third, the Budget has failed to give effect to the 2017 National Health Policy recommendation. The Policy recommended for grading of clinical establishments to protect consumers rights. The states are not implementing the model Clinical Establishments Act 2010.
4. Fourth, the need for a separate Empowered Medical Tribunal as recommended by 2017 National Health Policy, is not been addressed. The complexities of medical negligence or malpractice cannot be addressed by The Consumer Protection Act 1986. Thus, a separate health regulator on the lines of the State and Central Regulatory Commissions is critical for the health sector.

What needs to be done?

• A viable solution is required to reduce out of pocket expenditure in outpatient care services. This will make public health services affordable.
• Some international models can be analysed for health care funding:
  • In Germany and France, health care is funded through mandatory contributions of both employer and employees.
  • The Canadian model: The Canada Health Act of 1984 makes federal cost-sharing a government responsibility. Healthcare entitlements in Canada are also portable across the country.
• The Employees State Insurance Corporation scheme created in 1948 could also be modified and used to cover white-collar employees in the unorganized sector.
• Public health and hospitals can be brought on the concurrent list of the Constitution as recommended by the 15th Finance Commission. This will bring uniform principles and regulations throughout the state and ensures standards in consumer protection.

What is the News?

According to a report by the Ministry of Social Justice and Empowerment(SJE), 70% of callers to KIRAN (mental health rehabilitation helpline) are male.

Kiran helpline(1800-599-0019):

• Launched by: It was launched by the Department of Empowerment of Persons with Disabilities(DEPwD). The Department works under the Ministry of Social Justice and Empowerment (SJE).
• Purpose: It aims to offer support for mental health through experts. Support includes early screening, psychological support, distress management, mental wellbeing psychological crisis, and referrals to mental health experts.
• It offers this support in 13 languages for any individual, family, NGOs, parent associations, professional associations, rehabilitation institutes, hospitals, etc.

Key Findings of the report:

• The helpline received 13,550 new calls of which 70.5% were from males and 29.5% from females.
• The majority of callers (75%) were in the age group of 15 to 40 years, while others were older, in the 41 to 60 age group.
• Majorly the challenges faced by the callers were related to anxiety, depression, pandemic-related challenges, suicidal tendency, substance abuse, and miscellaneous.
• Most of the calls were from the North zone, followed by West, South, East, and North East.

Source: The Hindu

What is the News?

The Finance Minister has launched a new scheme titled “PM Atma Nirbhar Swasth Bharat Yojana”. In general, The scheme aims to develop capacities in the health care system over 6 yrs.

PM Atma Nirbhar Swasth Bharat Yojana:

• Type: It is a Centrally Sponsored Scheme
• Aim: The scheme aims to
  • Improve primary, secondary, and tertiary care health systems,
  • Strengthen existing national institutions in Health sector
  • Create new institutions, to cater to detection and cure of new and emerging diseases.
• Duration of the Scheme: Six Years
• Features of the Scheme: The scheme will support in the setting up of
  • Rural, Urban Health and Wellness Centres
  • Integrated Public Health Labs
  • Critical health care hospital blocks
  • National institution for One Health
  • Regional research platform for WHO South-East Asia Region,
  • 9 Biosafety Level III laboratories and 4 regional centres of National Institutes for Virology.
  • Strengthening National Centre for Disease Control (NCDC) and 5 regional branches of it
  • Expanding the integrated health information panel.

Source: The Hindu

Synopsis:  The recent findings of ICMR’s 3^rd serological survey can be used to revalidate the vaccination policy of India.

Background

• The ICMR’s third serological survey findings were published at a press conference recently.
• However, the specific details of the course of the infection are not released. It will be made public later, in a peer-reviewed journal.

What are the latest findings of ICMR’s 3^rd serological survey?

• The findings show that nearly one out of five Indians (270 million) may have been infected.
• The report finds a three-fold rise in infections compared to August.
• Also, people who got infected in the age group of 10-17 years has increased 5 times (in percentage terms) compared to August.
• The serological survey of doctors, nurses, and paramedical staff reveals that nearly 25% of them had been infected. This is significantly above the national average.
• The survey findings cautioned that “Still, 80% of Indians are vulnerable”.
• But there is no information on the efficacy of antibodies against mutating virus strains.

What can be inferred from this result?

• Despite, the Experts pointing towards the declining trend in infections and increasing herd immunity among the population. We need to accept that the danger is still there.
• The survey highlights the need for vaccination and continuing with physical distancing and masking norms.
• There is also a rise in the spread of infection among teenagers and children. Rural India also facing an increase in infections. So the vaccine policy needs a course correction.
• So, it would be wise to rethink the vaccination policy to prioritize vaccination for children along with old age people, frontline workers, and peoples with morbidity.

What is the News?

Indian Council of Medical Research(ICMR) has released the third round of the Serological Survey.

Facts:

• Serological Survey: It is conducted to assess the prevalence of a disease in a population. It is done by detecting the presence of specific antibodies that are produced against the virus.
• How was the survey conducted? The survey used an antibody test. The test was designed specifically to check for antibodies produced against the spike protein.
  • Spike Protein: Coronaviruses including SARS-CoV-2 get their name from the “corona” or crown shape, created by the protein “spikes” on their surface. These spike proteins bind with human proteins to initiate the process of infection.

Key Findings:

• Nearly one in five Indians which is around 21.5% had been infected by the coronavirus until December 2020.
• Urban Slums: The urban slums have reported the highest seroprevalence with 31.7% and was followed by urban non-slums(26.2%). The lowest was in rural areas at 19.1%.
• Children: The seroprevalence among children aged 10-17 years was around 25.3%.
• Health Care Workers: Nearly 26% of doctors and nurses and 25.4% of paramedical staff have coronavirus antibodies. It underlines their higher risk of being exposed to coronavirus infections than the general population.
• Women vs Men: There were more women (22.7%) as compared to men (20.3%) who were found to have antibodies against the Covid-19 virus.

Source: The Hindu

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Syllabus: GS 2 – Health related issues

Synopsis: Countries should refrain from engaging in vaccine battles and focus on global cooperation.

Introduction 

Almost all countries across the globe are in need of access to vaccines. But the developed countries are mindlessly collecting approved vaccines.

Only the countries in the global south like China and India are helping out other countries.

How are rich countries engaging in vaccine battles?

As per a few reports, the advance purchase contracts made by some countries for potential vaccine procurement are way above their need. It would vaccinate their population many times.

• For example, the EU population can be vaccinated two times, the US and the UK four times, and Canada six times.
• 82% of Pfizer’s production in 2021 and 78% of Moderna’s have already been advance purchased by leading countries. 

Advanced countries are engaged in vaccine battles as they believe that an early vaccination will bring back normalcy in their countries. Concepts of Public good and global cooperation are missing from the scene.

What is India’s stance?

On the other hand, India is exporting a major percentage of the approved doses. Its initial shipment to the least developed countries will be free of cost.

Exports from India are helping other nations, especially its neighbouring countries. For example, Brazil has received 2 million doses of vaccine from India.

India’s approach supports the need for coordinated international efforts to bring COVID-19 under control.

Solutions

The COVAX project is a program based on funding from high and middle-income countries. It is a global risk-sharing mechanism for shared obtaining and fair distribution of COVID-19 vaccines. 

This project aimed to deliver 2 billion doses by the end of 2021. But it is facing challenges from rich countries due to their excessive vaccine procurement, directly from suppliers.

But now as U.S. President Joe Biden has decided to join the COVAX project,  expectations from the project are high. India, which is a hub of cost-effective vaccines, would be instrumental in its success.  For example, Covishield, the Oxford University-AstraZeneca vaccine produced in India costs only $3 per dose; Covaxin is priced at $4.2. 

The way forward

The development of vaccines should have shown global cooperation between the North and the South. But the democratic world is suffering from increasing democratic tendencies. 

What is the News?
The Centre for Justice, Law and Society(CJLS), Jindal Global Law School has undertaken a study to analyse the feasibility of setting up Medical Boards. Boards are proposed in the Medical Termination of Pregnancy(MTP) (Amendment) Bill, 2020.

 Background:

• MTP Amendment Bill,2020: The Bill seeks to amend Medical Termination of Pregnancy (MTP) Act, 1971. It was passed in the Lok Sabha in 2020 and is likely to be brought before the Rajya Sabha during the Budget Session.
• Medical Board: The Bill proposes the constitution of a Medical Board in every State and Union Territory. These boards will decide on abortions in cases of foetal abnormalities where pregnancies are over 24 weeks. Each Board will have a gynaecologist, a radiologist or sonologist, a paediatrician, and other members prescribed by the governments.

 Key Findings of the study:

• It found that the constitution of a Medical Board to decide on the termination of pregnancy is unfeasible. 82% of these posts are lying vacant in the country,
• Between 2015 and 2019, the shortfall in specialists posts was between 71% and 81.8%.
• The shortfall was more in the North-East states of Sikkim, Mizoram and Manipur. Arunachal Pradesh and Meghalaya had a 100% shortage of paediatricians.

Additional Facts:

Other key Features of MTP Amendment Bill, 2020:

• Abortion: The Bill allows abortion to be done on the advice of one doctor up to 20 weeks, and two doctors in the case of certain categories of pregnancies between 20 and 24 weeks.
• Special Categories: It has enhanced the gestation limit from 20 to 24 weeks for ‘special categories’ of women. It includes survivors of rape, victims of incest and other vulnerable women like differently-abled women and minors.
• Protection of Identity: It also states that the name and other particulars of a woman whose pregnancy has been terminated shall not be revealed.

Source: The Hindu

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Syllabus: GS 3

Synopsis: One year has been passed when the first confirmed case was reported in India. What are the lessons that India Should learn from this Pandemic?

Introduction 

India’s first confirmed case of Sars-CoV-2 was reported exactly a year ago. Experts with the help of a modeling-based study predicted that the country could have hundreds of millions of cases and a few million deaths by July 2020.

What were the challenges faced by people during the pandemic?

There was a sudden decrease in economic activities, low job opportunities, slowing of the economy. Impacts further worsened due to lockdowns.

• One of the most disturbing visuals that came from the pandemic was the migrants walking back to their villages on the highways.
• People who tested positive for the virus and the frontline workers were discriminated against in society. 
• An excessive amount of unreliable information i.e. “infodemic” became a major obstacle in effective response to the pandemic.

What were the steps taken to deal with the pandemic?

Pandemic highlighted the need for strengthening the Indian health system and boost public health services.

1. Firstly, COVID-19 specific services which include testing, contact tracing and treatment facilities were scaled up. 
2. Secondly, in order to achieve self-sufficiency, the production of personal protective equipment (PPE) coverall, testing kits, and ventilators was increased in India. 
3. Thirdly, researchers and scientists worked together to develop new testing kits, to conduct clinical trials on treatment procedures and vaccines. 
4. Fourthly, two SARS CoV-2 vaccines were approved in India and vaccination started at the beginning of 2021. The COVID-19 vaccines manufactured in India are being used in other countries as well.

What are the lessons learnt from the pandemic?

India has reported nearly 10.7 million confirmed cases and 1,53,000 deaths in the last year. Five lessons which should be learnt are mentioned below: 

• First, the pandemic has widened the inequalities in the society as the poor and vulnerable sections were the worst affected.  The government should urgently increase investment in strengthening health systems to address inequities and reduce poverty.
  • This will prepare the country for future pandemics and help in accelerating economic growth. 
• Second, Stronger health infrastructure is possible by interventions in various areas, such as:
  • Governance and leadership.
  • Health financing and health information system.
  • Providing services and delivery.
  • Health infrastructure and workforce.
  • Medicines, diagnostics, and vaccines.
• Third, the hospital-dominated medical care system needs to be changed to a more inclusive health system for the lower section. 
  • Community clinics could be set up along with a strengthened primary healthcare system in both rural and urban areas.
• Fourth, states and the union government should spend more on health care and public health services. Laboratories and disease surveillance systems should be well-developed. The provision of mental health services via teleconsultation can be effectively used.
• Fifth, sustain the three-way partnership between policymakers, technical experts, and community members which have been formed for pandemic response. 
  • This would help in ensuring that health policies are informed, effectively implemented, and services widely used by the community. People’s participation and community engagement was important and need to be continued post the pandemic.

Way forward 

• These learnings should be used to create a stronger healthcare system in India, which will provide accessible, available, affordable, and quality healthcare services to each and every citizen of this country.

What is the News?

The COVID Performance Index has been released by the Lowy Institute, an Australian think-tank.

Facts:

• COVID Performance Index: The index aims to rank the best-performing countries in their response to the pandemic. It measures the impact of geography, political systems, population size, and economic development on COVID-19 outcomes, for a conclusion.
• Measuring Indicators: To assess the performance of countries, the index tracked six measures of COVID-19 in the 98 countries for which data was available. The six indicators are:
  • Confirmed cases
  • Confirmed deaths
  • Confirmed cases per million people
  • Confirmed deaths per million people
  • Confirmed cases as a proportion of tests
  • Tests per thousand people.
• An average across indicators was then calculated for individual countries in each period and normalized to produce a score from 0 (worst performing) to 100 (best performing).

Rankings:

1. India: India has been ranked at 86 out of 98 countries in the index.
2. Topped by: New Zealand has topped the index followed by Vietnam, Taiwan, Thailand, and Cyprus.
3. Bottom Countries: The United States has been placed at 94 and Brazil at the bottom of the index.
4. South Asia: Sri Lanka was the best performing nation in South Asia ranking at 10, while the Maldives was at 25, Pakistan at 69, Nepal at 70, and Bangladesh at 84.
5. Region-wise: The countries in the Asia-Pacific region did a better job at controlling the pandemic while Europe and the US were quickly overburdened by the COVID-19 cases.
6. China was not included in the index due to a lack of publicly available data on testing.

Factors that played the role in the Performance of countries:

1. Population size: Smaller countries with fewer than 10 million people consistently outperformed their larger counterparts throughout 2020.
2. Levels of economic development or differences in political systems between countries had less impact on the handling of Covid-19 outcomes.
3. Democratic countries have found to be marginally more successful than other forms of government in their handling of the pandemic.

Source: The Hindu

Why in News?
Economist Intelligence Unit (EIU) has released the ‘Asia-Pacific Personalized Health Index’.

India has been ranked 10th out of 11 Asia Pacific countries in the index.

Facts:

Asia-Pacific Personalised Health Index

• The index measures the progress of Asia Pacific countries in adopting personalised healthcare. It includes enabling the right care to be tailored for the right person at the right time.
• Countries covered: The index ranks 11 countries of Asia Pacific namely Australia, China, Japan, India, Indonesia, Malaysia, Singapore, South Korea, Taiwan, Thailand, and New Zealand.
• Indicators: It measures performance against 27 different indicators of personalised health across four categories called ‘Vital Signs’. These include:
  • Health Information Indicator: It takes into account data, infrastructure, and technical expertise driving personalized healthcare.
  • Health Services Indicators: It takes into account planning, organization, and delivery of services with respect to personalized healthcare.
  • Personalized Technologies indicator: It takes into account the devices, applications, platforms, and reimbursement structures that will drive personalized healthcare based on the needs of stakeholders.
  • Policy Context indicator: It takes into account the polities, frameworks, partnerships, people, and drivers that will facilitate personalized healthcare.

Other Takeaways from the index:

• Topped by: Singapore has topped the index followed by Taiwan (2nd), Japan (3rd), and Australia (4th).
• Bottom in the index: Indonesia was ranked 11th in the index.

Source: Indian Express

Why in News?
The Ministry of Health & Family Welfare has released the Longitudinal Ageing Study of India (LASI) Wave-1 Report.

Facts:

 About LASI:

• About the study: It is a full-scale national survey of scientific investigation. It investigates the health, economic and social determinants and consequences of the ageing population in India. It was commissioned in 2016.
• Conducted by: The National Programme for Health Care of Elderly, Ministry of Health & Family Welfare. It undertakes the Study through International Institute for Population Sciences(IIPS), Mumbai in collaboration with Harvard School of Public Health, University of Southern California, USA, United Nations Population Fund(UNFPA) and National Institute on Ageing.

Key Findings:

Self Rated Health:

• Every fourth Indian above the age of 60 and every fifth Indian above the age of 45, reported poor health.
• The prevalence of poor self-reported health (SRH) in those above 60 (24%) is twice than in the 45-59 age group.
• Among these age groups, a higher percentage of women and individuals from rural areas reported poor health.

Disabilities among ageing Population:

• About 8% of Indians aged 45 years and above, reported having at least one form of impairment. The prevalence is almost twice among senior citizens(10.5%) than those between 45 years and 59 years.
• A high percentage of senior citizens in rural areas had a physical or mental impairment than their urban counterparts.
• The major disabilities reported are locomotive impairments (five per cent), followed by visual (three per cent), mental (two per cent), hearing (two per cent) and speech impairments (one per cent).
• Karnataka and Dadra & Nagar Haveli have the highest proportions of senior citizens with disabilities. Meghalaya, Lakshadweep, Haryana and Himachal Pradesh reported the least.

Additional Facts:

• According to the Elderly in India: Profile and Programmes, 2016, senior citizens comprised 21% of Indians with some form of disability.
  • Disability: It is an umbrella term for impairments and physical limitations hindering the smooth activity and participation in daily social life.
• A decade of Healthy Ageing: The United Nations has declared 2021-2030 as the “Decade of Healthy Ageing”. It called upon governments, civil society, international agencies, and others to come together to improve the lives of older people in their families and the communities in which they live.

Source: Down To Earth

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Syllabus: GS 3

Synopsis: Mutation of the coronavirus has become a new threat for the world. India must take precautionary measures to deal with it.

Introduction 

New SARS-CoV-2 variants have emerged independently in several countries and the virus is changing very quickly.  If it continues to change, currently available vaccines will become ineffective.

Why do viruses mutate?

All the viruses carry a genetic code in the form of RNA or DNA. The DNA is replicated as the cells multiply and this process may cause random errors in the new DNA.

Errors in DNA can be corrected by the enzymes present in the cell. However, RNA doesn’t contain enzymes, thus errors caused in RNA cannot be corrected. It causes more genetic changes (mutations)in RNA than DNA viruses.

How are vaccines tested for efficiency against emerging variants?

• Indirect tests are conducted in labs. It will find if variant virus escapes antibodies developed after natural infection or vaccination.
• Antibodies that neutralize the original virus are tested on the variant viruses. 

Are the emerging variants vulnerable to vaccines?

• The emerging variants from South Africa could pose a challenge to current vaccines. Not enough information is available yet for the Brazil variant.
• However, the studies have only tested antibody responses. Vaccines also increase cellular immunity to eliminate infection which has not been tested.

The evidence currently does not suggest that vaccines are failing. 

• However, Moderna and Pfizer/BioNTech have agreed that their vaccines have had reduced protection against the South African variant. Both the companies are now working on developing new vaccines to fight these variants.

What steps should India take in this situation?

There is no local transmission of the new variants in India until now. Only the UK variant viruses have been found in travellers coming to India. 

1. Firstly, India should strictly implement masks and limit crowds. It should also do the contact tracing of people infected with the new UK variant. 
2. Secondly, India should also put a ban on travel from South Africa and Brazil just like the US did. India must also be cautious of people with a history of travel to South Africa since October 2020, and Brazil since December 2020.
3. Thirdly, the most efficient way to catch emerging variants is increased genomic surveillance. So far, there are only about 5,000 SARS-CoV-2 sequences from India in public databases, which accounts for only 0.05 percent of confirmed cases. 

The setting up of an inter-ministerial group -Indian SARS-CoV-2 Genomics Consortium (INSACOG) to increase genomic surveillance is a step in the right direction. India should take more such steps. 

What is the news?
An expert body is looking into Bharat Biotech’s application for testing its  Covid-19 vaccine, BBV154. This is an Intranasal Vaccine.

What is Intranasal Vaccine?

• Vaccines are administered as injectable shots into the muscles(intramuscular). Or the tissue just between the skin and the muscles(subcutaneous).
• However, with intranasal vaccines, the solution is sprayed into the nostrils and inhaled instead of injecting it.

Benefits of Intranasal Vaccine:

• The nasal route has excellent potential for vaccination due to the organized immune systems of the nasal mucosa.
  • It is non-invasive, Needle-free.
  • Ease of administration – does not require trained health care workers.
  • Elimination of needle-associated risks (injuries and infections).
  • High compliance (Ideally suits for children and adults).
  • Reduces the overall cost of a vaccination drive as for example BBV154 requires a single-dose regimen.

Potential Setbacks of Intranasal Vaccine:

• Past attempts to develop intranasal vaccines, including for measles flu, have not been very successful.
• These vaccines use live, weakened viruses, but have never cleared clinical trials.
• Only a live attenuated influenza flu vaccine has been licensed through this route of delivery.

Source: Indian Express

What is the News?
Indian Council of Medical Research (ICMR) and the National Institute of Virology(NIV) study found Covaxin effective against the new UK variant of Covid-19.

About the Study:

• The study has found that Covaxin has a good neutralization capacity against the U.K variant of the COVID-19 virus. This capacity was the same against the strain used for making the vaccine.

How were the neutralization studies carried out?

• Under this study, the virus isolated from people is grown in the lab using cell lines. When viruses successfully grow in them, the pathogenic effects of the viruses are observed in the cells.
• The sera (the protein-rich liquid separated from blood after it is clotted) taken from vaccinated people are then added to the cell line culture system and its ability to prevent the virus from causing pathogenic effects is observed.
• In this case, the sera taken from vaccinated people were able to neutralize the virus and hence prevent pathogenic effects being produced in the cell lines containing the virus.

Further Reading on Vaccines

Source: The Hindu

Why in News? 

The Ministry of Health and Family Welfare has announced the upgradation of Co-WIN software. It is to cater to more sessions per site and change in site location. 

 Facts: 

• CoWIN App: It is a digitalised platform by the Ministry of Health and Family Welfare (MoHFW).  
• It allows Indian citizens to apply for a Covid-19 vaccine shot and helps agencies in keeping a track of Covid-19 vaccination programmes. 

• Modules: The Co-WIN app comes with five modules namely –  

• • Administrator module: The admins will be able to track the information provided by citizens of India. They will also be responsible for creating sessions. By this app, respective vaccinators and managers will receive relevant notifications and alerts on the relevant information. 
  • Registration Module: Citizens who are not frontline health workers can register for the vaccine via the ‘Registration Module’. Photo identity will be required for registration. 
  • Vaccination module: It will verify the beneficiary details and update vaccination status.  
  • Beneficiary Acknowledgement Module: It will send SMS to beneficiaries and also generate QR-based certificates after one gets vaccinated.  

• • Report Module: It will prepare reports of how many vaccine sessions have been conducted, how many people have attended those, how many people have dropped out etc. 

• What are the new features in the enhanced version? 

• • The enhanced version allows planning and scheduling the sessions for the entire week and works for the enhanced safety of the beneficiaries. These new features are being enabled in the vaccinator module. 

Article Source

Why in News?  

India will officially start its vaccine diplomacy with the name “Vaccine Maitri” under  its  Neighborhood First policy. 

• • Vaccine Diplomacy: It is the use of vaccines to increase a country’s diplomatic relationship with  other countries. 

 Key Features of Vaccine Maitri 

• India will supply Made-in-India Covid-19 vaccines to its neighboring and key partner countries Under its Neighborhood First policy. 
• Bhutan and Maldives will be the first to get the vaccines followed by Bangladesh, Nepal, Myanmar and Seychelles.  
• Sri Lanka, Afghanistan and Mauritius will also get doses once they give necessary regulatory approvals. 
• Pakistan has not been named as a neighboring country which will get the vaccine.  
• Vaccine will be Supplied to the partner countries in a phased manner, keeping in mind the demand. 

Earlier Diplomacy measures by India: 

• India had earlier supplied Hydroxychloroquine, Remdesivir and Paracetamol tablets as well as diagnostic kits, ventilators, masks, gloves and other medical supplies to a large number of countries during the pandemic. 
• Under the Partnerships for Accelerating Clinical Trials(PACT) programme, India has also provided training to several neighbouring countries to enhance and strengthen their clinical capabilities  

 Additional Facts: 

• PACT programme: It has been launched for supporting COVID-19 vaccine development activities in partnering countries.  

• • The initiative is being implemented by Biotechnology Industry Research Assistance Council(BIRAC) and Clinical Development Services Agency(CDSA) under the aegis of the National Biopharma Mission and Ind-CEPI Mission of DBT. 

Synopsis: Health Experts are calling federal prisons a “breeding grounds for uncontrolled transmission” of the virus. There is an urgent need of decongesting them. What are the ways to decongest Indian prisons?

Background

• In India there are around 1,400 prisons, ‘housing’ over 5 lakh prisoners. These prisoners are facing the threat of Covid pandemic, with no organisational support.
• Whereas, in the countries such as U.K and U.S, activists are strong enough to influence public policy and voice against human rights abuse in prison.
• Also, these Countries have accurate data over the impact of pandemic on prisoners in public domain. For example
  • The data from Texas state shows that the pandemic has killed more than 230 people in prisons, 80% of whom had not been convicted of a crime.
  • Similarly, The United Kingdom Ministry of Justice figures shows that prisoners testing positive in October stood at 1,529, with five deaths.
• However, India lacks such crucial data on Prison Statistics in public domain and also such statistics are not being demanded of our criminal justice system.

How a lack of effective criminal laws is affecting under-trial prisoners in India?

According to the Prisons Act of 1894, prisons come under the exclusive responsibility of State governments. Over the years, despite being upgraded to the status of correctional homes, these prisons are facing the challenge of Congestion of Under Trial Prisoners (UTPs).

• According to the National Crime Records Bureau’s report for 2019 out of 4.5 lakh prisoners, 3.3 lakh are ‘under-trial prisoners’, i.e., investigation or trial is supposed to be ‘in progress’.
• These UTPs are detained under Section 167 of the Code of Criminal Procedure (CrPC) which provides for “Procedure when investigation cannot be completed in 24 hours”.
• The original Cr.PC of 1898 specified the period of detention as 15 days. Later, through amendments, it was extended to periods that can go up to 90 days and, in some exceptions, to an indefinite period.
• Out of 3.3 lakh, about 2.2 lakh are either not likely to be even charge-sheeted, or they are likely to be acquitted.”
• This is a huge violation of the basic human rights of UTPs, who are already facing the issue of inadequate healthcare facilities and torture by other rowdy prisoners.
• Moreover, it is a huge injustice to the families of the UTPs. For example, their children are denied a normal childhood, proper education, and are exploited by a cruel section of the society and are forced to take to the path of crime.

What needs to be done?

Pandemic provides an opportunity for an immediate review of all prisoners’ vulnerability to the epidemic,

• First, we need to conduct repeated testing in all prisons, especially sub-jails. An arrangement for the isolation and hospitalization of who testing positive needs to be planned.
• Second, to de-congest prisons, the Code of Criminal Procedure (Amendment) Act, 2005, which contains the much-needed Section 436-A needs to be activated.
  • it provides for an under-trial to be released on a personal bond, with or without sureties if the under-trial has spent half of the period of prescribed imprisonment in detention.
• Third, ‘Prisons’ is purely a ‘State subject’. But it is imperative of the centre to support the states as the Constitutional responsibility of handling infectious and contagious diseases listed in the Concurrent List.

It is the duty of the state to vaccinate inmates at the ‘Hospitals of Correction’. It is similar to anyone in a state hospital may rightly expect to be vaccinated on a priority against the virus.

Read more about prison reforms

News: Bharat Biotech has come out with a fact sheet about the process involved and who should avoid taking the Covaxin vaccine. 

 Facts: 

• Covaxin: It has been indigenously developed by Hyderabad-based Bharat Biotech in collaboration with the Indian Council of Medical Research(ICMR). 

• Type of vaccine: It is an inactivated vaccine. It means it is made by using particles of the coronavirus that were inactivated by making them incapable to infect or replicate. Injecting particular doses of these particles serves to build immunity by helping the body create antibodies against the dead virus. 

Who should not get the Covaxin? 

• During the first phase, experts are analyzing the behaviors of vaccines among different types of patients. They have recommended not to vaccinate if a person: 
  • has any history of allergies 
  • has a fever 
  • has a bleeding disorder or are on a blood thinner. 
  • is immune-compromised or are on a medicine that affects your immune system 
  • is pregnant or breastfeeding. 
  • has received another COVID-19 vaccine 
  • Has Any other serious health related issues as determined by the Vaccinator/Officer. 

Article Source

News: The Ministry of Health and Family Welfare has released the data on COVID-19 vaccination.

Facts:

Key Highlights of the Data:

• India has vaccinated the highest number of persons on the first day under its COVID-19 vaccination program. This is much higher than many other countries such as the USA, the UK and France.
• Around 2.24 lakh beneficiaries have been given COVID-19 vaccines in the first two days of India’s countrywide vaccination drive against the novel coronavirus infection.
• 447 cases of AEFI (Adverse event following immunization) have been reported. Most of the cases are minor and only three of the cases required hospitalization.
  • According to WHO, Any untoward medical occurrence which follows immunization and does not necessarily have a causal relationship with the usage of the vaccine is known as AEFI.

Article source

News: Council of Scientific and Industrial Research(CSIR) has conducted a pan-India Sero-survey tracking nearly 10,000 employees to study the prevalence of Covid-19. The study concluded Smokers and vegetarians were found to have lower seropositivity. So they may be at a lesser risk of getting infected by the coronavirus.

Facts:

Key Highlights of the Survey:

Source: The Hindu

 Presence of Antibodies: The survey took samples of 10,427 adult individuals working in its laboratories or institutions and their family members to assess the presence of antibodies to SARS-CoV-2.It found 1,058 (10.14%) had antibodies against Covid.

• However, the neutralising antibodies that protect against the virus waned after infection but were at detectable levels even after six months — a proxy for the period of effectiveness of future vaccination and general immunity.
• Symptoms: About three-fourths of the respondents could not recall having experienced a single one of the symptoms commonly associated with the disease.
• Lesser Risk Group: Smokers and vegetarians were found to have lower seropositivity indicating that they may be at a lesser risk of getting infected by coronavirus.
• Blood Group: Those with blood group ‘O’ may be less susceptible to the infection, while people with ‘B’ and ‘AB’ blood groups were at a higher risk.
• Class Bias: There was also a distinct class bias in those affected. Those who work from home and able to access private transport were nearly twice less likely to be exposed to the virus than the outsourced staff involved with sanitation and security and using public transport.

Article source

Synopsis: Government has released a Vaccine Fact sheet that contains guidelines for administering both vaccines (Covaxin and Covishield). 

Background 

• Union Health Ministry has sent a comprehensive fact sheet for both vaccines (Covaxin and Covishield) to all states and immunisation officer.  
• The Centre has also asked the states and immunisation officers to disseminate the fact sheet to all programme managers, cold chain handlers, and vaccinators before the rollout. 

What is this fact sheet? 

The fact sheet contains the general guidelines that should be followed during the initial phase of the Covid-19 vaccination drive, while vaccinating the priority group (3 crore people). 

The fact sheet contains the guidelines on the following aspects,  

• • Physical specifications such as dosage, cold chain storage requirements. 
  • Specific guidelines on contraindications (a factor due to which the vaccine is to be withheld to certain categories of people)  
  • Guidelines on adverse events   
  • Details on special precautions. 

Now we will examine in detail, the exceptions, precautions, and possible adverse events that are mentioned in the fact sheet. 

First, the general guidelines in the fact sheet contain the following directives to ensure that proper care is taken while administering the vaccine. 

• • Only people over the age of 18 years are eligible for vaccination. 
  • Since 2 doses of vaccines are required per person, every Person should be administered the same vaccine in both the dosage. It is to deal with the issue of possible interchangeability. 
  • While administering the vaccine to a person with a history of any bleeding or coagulation disorder, platelet disorder, clotting factor deficiency, or coagulopathy, it should be done with caution. 
  • Both Vaccines have to be stored at +2°C to +8°C and needed to be protected from light. If it is found frozen it has to be discarded. 

Second, the specific guidelines on contraindications. The three categories of people for whom the vaccine should not be administered. They are, 

• • Persons who have shown a history of an allergic reaction. 
  • People who show an immediate or delayed onset of an allergic reaction to vaccines or injectable therapies, pharmaceutical products, and food items. 
  • Pregnant and lactating women.  

Third, guidelines on temporary contraindications. 3 categories of persons for whom vaccination is to be deferred for four-eight weeks. They are, 

• • Persons showing active symptoms of SARS-CoV-2 infection. 
  • Covid-19 patients who have been treated with anti-SARS-Cov-2 monoclonal antibodies or convalescent plasma. 
  • Acutely unwell and hospitalised patients (with or without intensive care) due to any illness. 

Fourth, the fact sheet under not contraindicated, specifically mentions that persons suffering from following health conditions can get vaccinated. However, the response to the Covid-19 vaccine may be less in these individuals. They are; 

• • Persons with a past history of Covid-19 infection. 
  • Persons with a history of chronic diseases and comorbidities (cardiac, neurological, pulmonary, metabolic, and malignancies). 
  • Persons with immunodeficiency or HIV, and patients on immune suppression due to “any condition” can be administered with the Covid-19 vaccine.  

Fifth, the fact sheet has also separately mentioned the Possible Adverse Reactions for both the vaccines along with the required precautions to be taken during the adverse reaction. 

Guidelines provide the list of mild adverse events and rare adverse events that may follow the vaccination from both Covishield and Covaxin. It also provides for the precautions and medication that will be required in the above cases.  

For example; In case of Mild adverse events for Covishield like myalgia (deep muscle pain), malaise (a feeling of overall discomfort), common painkiller paracetamol may be used. 

How Covid-19 vaccines administered in other countries have performed till now? 

Though the overall performance is found to be safe so far, there were few adverse events recorded in a small section of the population. For example, in the case of the US,  

• The US Centers for Disease Control (CDC), monitoring by the Vaccine Adverse Event Reporting System detected 21 cases of anaphylaxis (a severe, life-threatening allergic reaction that occurs rarely after vaccination) out of a reported 1,893,360 first doses of the Pfizer-BioNTech vaccine. 
• Whereas in the case of Modern’s mRNA vaccine, which was authorized for emergency use in the US, the CDC said data is still limited.

Synopsis: Government has issued strategic guidelines for the effective rollout of COVID vaccine program. There are challenges in the way of the Vaccine program that should be tackled as soon possible. 

Strategic guidelines for COVID vaccine programme 

With limitations of Vaccine related to efficiency and efficacy in mind, government has framed strategic guidelines for COVID vaccine programme 

• Guidelines were framed using the knowledge acquired over three decades of implementing the Universal Immunisation Programme. It aims to aims to cover 30 crore people by July 2021. 
• It has specified involvement of 19 departments, donor organisations and NGOs at the national, state, district and block level in the roll out of COVID vaccine programme. 
• The guidelines have also clearly mentioned the priority criteria. Citizens eligible for the first round of COVID vaccine programme includes the following, 

• • • The caregivers and front-line workers working under the department of health, defense, municipalities, and transportation. 
    • Persons above the age of 50.  
    • And persons below the age of 50 who suffers from comorbidities such as diabetes, hypertension, cancers, and lung diseases are all included. 

• The strategic guidelines have also clearly stated in detail, 
  • • The skills, roles, and responsibilities of the required human resources. 
    • The quantum of logistics required for delivering vaccines at point of use.  
    • The requirement of physical infrastructure, monitoring systems based on digital platforms, and feedback systems for reporting adverse events. 

However, it has been criticised that the guidelines are ideal and have failed to provide solutions for real-time issues of our health system.  

What are the challenges involved in effective rollout of COVID vaccine programme? 

There are many challenges to roll out COVID vaccine programme. They are, 

• First, unequal distribution of cold storage facilities among states. For example, out of the 28,932 cold chain points, half are in the five southern states, Maharashtra and Gujarat. 

• • Whereas the eight states in the North and Odisha that account for over 40 per cent of the country’s population have only 28 per cent of the cold chain points.  

• Second, pertaining issues in our health care sector such as poor human resources, a weak private sector, poor safety and hygiene standards, frequent power outages, poor infrastructure will reduce the capacity to implement the vaccine programme with speed, quality, and accuracy. 
• Third, a massive immunization programme for 30 crore people can distort the routine health service delivery and affect other immunisation drives, and can lead to exhaustion of health care workers. 
• Fourth, acquiring the data for under the 50s with comorbidities will be challenging though we have data for the above-50-year-olds in the electoral rolls. 

• Fifth, there are also challenge of tackling Fudging, false certification, and siphoning off vaccines to private facilities in the event of vast price differences between private hospitals and public hospitals. 
• Sixth, the non-availability of efficacy data could result in huge wastage and gives scope for errors and duplication during the procurement and supply of vaccines. 
• Seventh, the trust among the people on COVID vaccines are decreasing leading to suspicions and fears due to various reasons such as  

• • • Non-transparency of data on either of the two vaccines proposed for use in the program. 
    • Opacity with which the licenses were given etc. For example, have not completed the Phase 3 trials that confirm the safety and efficacy of the vaccine.  
    • Above all, India hasn’t signed the advance purchase agreements for vaccines that have completed Phase 3 trials from other countries. 

What is the way forward? 

• First, avoid the complexity of listing the priority groups throughout our country. It should be replaced by covering the complete area in one go, instead of sequencing them into different groups.  

• • • The areas could be ranked on the basis of a vulnerability index based on disease burden, caseload of COVID infections, demographic profile, health-seeking behavior and availability of infrastructure, etc. 

• Second, to create confidence in the community we need to establish an independent team of experts under the aegis of the WHO to ensure adherence to recruitment standards, consent conditions, adverse event record management, compensation standards. 
• Third, to build trust about vaccination programme we need to plan for large–scale public education and information programme through State- and local-level networks where people are informed, sensitised and their feedback was taken.  
• Fourth, People should be involved in decision-making. For this Local leader from public figures, religious leaders, self-help groups, the media, and even educational institutions need to participate to help citizens understand its importance and build trust 
• Fifth, Science, evidence, and data analytics need to be extensively used for effective policymaking. 
• Finally, vaccination is not a complete solution to end the epidemic. We need to adopt safe behavior through a communication strategy. For this, the government can use its experience of controlling the HIV/AIDS epidemic.  

The need of the hour is a winning strategy against epidemic that has drained us economically, socially and psychologically.  Government needs to understand that the effective way of improving uptake of the vaccine while reducing costs is by creating participatory frameworks of engaging experts and communities and building effective and reliable public information, and transparency.

News: Bhabha Atomic Research Centre(BARC) Mumbai has developed an Eye Cancer therapy. It was the first indigenous Ruthenium 106 Plaque for the treatment of Ocular Tumors.

Facts:

• Ruthenium-106: It is a radioactive form of the rare heavy metal ruthenium. It is a “platinum group” metal similar to platinum.
• How is it produced? It is produced from the fission or splitting of uranium-235, the type of uranium used in nuclear fission reactors, so it’s found in spent nuclear fuel.
• Uses: It is used in medicine for cancer radiation therapy, especially for eye and skin tumors. It is also used in radioisotope thermoelectric generators that power satellites.
• Harmful to Humans: High doses of ruthenium are toxic and carcinogenic when ingested. The material is strongly retained in the bones.

Article Source

Synopsis: Many issues have been highlighted in the Phase-3 trial of Bharat Biotech’s COVID-19 vaccines. Those issues could have been avoided after HPV vaccine trial controversy. 

Introduction 

In a previous case, Human papilloma virus (HPV) vaccine trial was carried out on nearly 23,500 girls in the 10-14 age group in Vadodara, Gujarat and Khammam without proper consent. Almost eight years later the Supreme Court of India criticized the government for its inability to take action on illegal clinical trials carried out in India by multinational countries. 

Present situation of the approval process in India suggests nothing much has changed. 

• The phase-3 clinical trial of Bharat Biotech’s COVID-19 vaccine resembles the HPV vaccine because it seems that the trial is suffering from serious violations. 
• The ICMR which has assigned the task of promulgating research ethics guidelines is also the cosponsor of the Covaxin trial. 

What are the problems in the Covaxin phase 3 trial? 

After the 2013 SC order, The Indian regulator made audio-video recording of the informed consent of each individual participant mandatory in 2019. Written consent from the participant had to certainly be taken before the audio-video recording. 

However, the process was not followed properly; 

• Firstly, no efforts were made to explain and inform the participants about the pros and cons of taking part in the trial instead; they were deceived by the trial site to think they were getting a COVID-19 vaccine for free. 
• Secondly, many participants didn’t know about their rights to get free medical care in case of any adverse events. 

• • Many aware participants sought medical help from private practitioners whereas some of the participants don’t possess mobile phones, thus medical follow-up was not possible.  

• Thirdly, not enough time was given to discuss with the family before signing the consent form. At least in a few instances, the consent was taken after vaccination, which is a serious violation.  

• • Participants were not given a copy of the consent form and other documents to prove their participation. 

• Fourthly, 700 participants in the trial were illiterate and there is no evidence that an impartial witness was present during the entire informed consent process to attach his/her signatures to the consent form.   
• Fifthly, communities living close to the hospital have told the media that they were offered ₹750, and luring people in trial for money is unethical.  

• Although the company maintained that the amount was the reimbursement for the transportation and loss of wages, an open announcement of remuneration was unethical.   

• Lastly, it is not yet confirmed that institutional ethics committee approved the advertisement for inviting people to the trial, in lieu of money.   

Way forward 

• India has already approved 2 vaccines for restricted use and the virus spread slowing down, so enrolling participants will be more challenging. Therefore, a thorough and impartial inquiry will bring back confidence in clinical trials. 

News: Union Minister of Health and family Welfare has inaugurated the 5th National Kayakalp Awards.

Facts:

• National Kayakalp awards: It was launched by the Ministry of Health and Family Welfare in 2015 as part of the Swachh Bharat Abhiyan to ensure hygiene, sanitation and cleanliness in Public Health Facilities in India.
• Aim: The award recognises and facilitates those District Hospitals, Sub-divisional hospitals, Community Health Centres, Primary Health Centres and Health & Wellness Centres in the public healthcare system who have achieved high levels of cleanliness, hygiene and infection control.
• Parameters: The parameters on which the performance of the facility would be judged are as follows: 1) Hospital/Facility Upkeep 2) Sanitation and hygiene 3) Waste Management 4) Infection control 5) Support Services and 6) Hygiene Promotion.
• Assessment: The assessment of these parameters are done sequentially through a three tier system – internal assessment followed by peer assessment and then external assessment.
• Significance: The success of Kayakalp has been internationally applauded during the 72nd World Health Assembly, held on 20-28th May 2019. The success of Kayakalp was also duly recognized in Global Baseline Report 2019 published by WHO, UNICEF and JMP.

Additional Facts:

• Swachh Swasth Sarvatra: It was instituted by the Ministry of Health & Family Welfare (MoHFW) & Ministry of Drinking Water and Sanitation (MDWS) in 2016 under Swachh Bharat Mission.
• Aim: To strengthen Community Health Centres in open defecation free (ODF) blocks across the country along with behavioural change to enable them achieve higher levels of cleanliness and hygiene with the goal of making India free of open defecation.
• Objectives: The Three broad objectives of this scheme are:-
  • Enabling Gram Panchayat where Kayakalp awarded PHCs are located to become ODF.
  • Strengthening Community Health Centre (CHC) in ODF blocks to achieve higher level of cleanliness to meet Kayakalp standards through a support of Rs 10 Lakh under NHM.
  • Build capacity through training in Water, Sanitation and Hygiene (WASH) Of nominees from covered PHC and CHC.

Article Source

Synopsis: Government should strive to formalise the work of community workers such as Anganwadi, ASHA and National Health Mission workers to make them accessible for various social security benefits such as safety, insurance, risk allowance and fixed wages etc.

Background

• In India, there are about a lakh ASHA worker, 1.3 million Anganwadi workers and another 1.2 million Anganwadi helpers. (Community workers)
• At present, community workers are classified as “honorary workers” and are denied of minimum wages, leave and other conditions that is available to formal workers.
• Even in the best paid states, this honorarium is not even close to the government-mandated minimum wages offered to workers doing comparable jobs.
• Also, the state by preferring to call them as “volunteers “denies the opportunity to recognise their crucial work as care service providers.
• This led to the two-day nationwide strike by Anganwadi, ASHA and National Health Mission workers demanding safety, insurance, risk allowance and fixed wages during the pandemic

What is the importance of community workers to society?

• Firstly, during the COVID-19 the Accredited Social Health Activists (ASHA) and Anganwadi workers, women “volunteers” functioned as the frontline warriors in the battle against the pandemic.
• Second, these community workers serve as the connecting link between the community and the state machinery. This was very much visible when there was uncertainty and fear of the virus.
• Third, the services of community workers are essential to facilitate localised approaches to problems as they have robust contacts at the grass roots.

What is the way forward?

• Firstly, there is an urgent need to recognise Community workers as workers. It can be done by Implementing the recommendation of Parliamentary Standing Committee on Labour to formalise the work of community workers.
• Second, Recognition of care work in the public sphere could also help in settling the issue of gendered and unequal division of house work and unpaid care burden.

It is high time that the state recognises the contributions of these women and accept them as workers. The recognition of ASHA and Anganwadi volunteers as workers will be a tribute to their contribution during the pandemic and also it gives a fresh start towards the structural understanding of women’s labour and their status in the labour market leading to Gender sensitive policy making

News: After bird flu (avian influenza) was confirmed in Kerala, Rajasthan, Madhya Pradesh, Haryana, and Himachal Pradesh, high alert has been sounded in several states which have been reporting deaths of birds, including crows and migratory species.

Facts:

• Bird flu or avian influenza: It is the name used to describe a viral infection that is reported mostly in birds but has the potential to affect humans and other animals.
• Common Strain: The most common strain of the virus that causes severe respiratory disease in birds is H5N1; various other strains like H7, H8 too, cause infection.
• Origin: The virus was first reported in geese in China in 1996.Since then, outbreaks have been reported periodically across the world. India reported the presence of the virus in Nandurbar, Maharashtra, in 2006.
• Human Transmission: The H5N1 virus can jump species and infect humans from the infected bird. The first case of H5N1 infection in humans was reported in Hong Kong in 1997 when a poultry farm worker caught the infection from infected birds.
• Human-Human Transmission: The high mortality rate in humans almost 60% is the main cause of concern about the spread of bird flu. However, in its present form, human-to-human infection is not known — human infections have been reported only among people who have handled infected birds or carcasses.
• Current Situation in India: Currently, samples from Rajasthan, Madhya Pradesh, and Kerala have tested positive for the A (H5N8) strain of the virus, while samples from Himachal Pradesh have shown the presence of A (H5N1).Most infections have been reported either in wild birds, crows or migratory birds.
• Is India’s Population Vulnerable to Bird Flu? Experts have said that the chances of the H5N1 virus infecting humans is comparatively low in India as compared to South East Asian countries mainly because both meat and eggs in India are eaten well-cooked which sees them being exposed to over 100 degrees Celsius. Thus the chances of humans contracting the virus from eating chicken and eggs is extremely rare.

Article Source

Synopsis: Avian influenza must be stopped before continuous spread amongst humans. 

Influenza type A viruses cause Bird flu, a highly contagious viral disease. Normally birds are carriers of this virus, takes it across the continent, though unaffected themselves, affect a large population of other birds. 

These viruses mainly affect poultry birds such as chickens and turkeys. Although rare, this virus sometimes also affects mammals such as pigs, horses, cats, and dogs.  

H5N8 and H5N1 are subtypes of avian influenza Virus:  

• H5N8 has been found in crows in Madhya Pradesh and Rajasthan.  
• H5N1 strains have been found in ducks in Kerala and migratory birds in Himachal. 

Introduction 

The highly pathogenic avian influenza subtypes named as H5N1 and H5N8, have been reported in Rajasthan, Madhya Pradesh, Himachal Pradesh, and Kerala. 

• Death count of poultry birds in Haryana is in thousands followed by Jharkhand and Gujarat. The cause of death in these three States is still unidentified.  
• Crows in Rajasthan and Madhya Pradesh, migratory birds in Himachal Pradesh, and poultry in Kerala have been targeted by the two subtypes of the virus. 

• • • Tests have confirmed H5N1 is responsible for the deaths of over 2,000 migratory birds in Himachal Pradesh. 
    • H5N8 has been recognized as the cause of deaths of thousands of poultry in Kerala, and hundreds of crows in Rajasthan and Madhya Pradesh. 

What is the origin of the spread of the virus and its causes? 

A European Food Safety Authority report revealed that 561 avian influenza discoveries were made between August-December in 15 European countries and the U.K.  

• H5N1 and H5N8 were two of three subtypes found in Europe, these were mainly found in wild birds along with a few poultry and captive birds.  
• Migratory birds have been largely responsible for spread of the virus into India during winter. It spreads further through movement of local residential birds and poultry. 
• Genetic analysis suggested that a tenacious transmission of this virus strain is coming from wild birds in Asia to west-central Europe. 
• Movement of men and material from poultry farms has also been a cause for the further blowout. 

What is being done to stop the spread? 

• Firstly, more than 69,000 birds which included ducks and chickens were culled in Alappuzha and Kottayam in accordance with India’s 2015 national avian influenza plan, in an attempt to stop the spread. 
• Secondly, all the states have been asked to be watchful of any unusual deaths or disease outbreak signs amongst birds, particularly migratory ones as they are considered to be one of the causes of the spread. 
• Thirdly, states have been asked to disinfect and dispose of the dead birds properly, biosecurity of poultry farms needs to be strengthened. 

Conclusion 

• It is very rare that avian influenza viruses cross the species barrier and directly infect humans but mutations in the virus can create a new avian influenza virus which can result in continuous transmission between humans, leading to genesis of pandemic influenza.  
• Hence, it is suggested to carry out genome sequencing of virus samples to track the evolution of the virus.

Introduction  

The permission of two COVID-19 vaccinats for emergency use is nearing. There is now hope of an end to the pandemic. But for the administration of vaccination and treatment properly and skillfully, a trained and effective workforce is required. 

Present strength of healthcare workers in India 

• In India, over 4,00,000 frontline workers have been trained to respond to COVID-19. 
• However, this includes people with no prior experience also. Thousands have been trained for (1) contact tracing, (2) quarantine strategies, (3) ventilator management, (4) personal protective equipment, and (5) psychological issues. 

In this context, Project Echo provides a cost effective way if ncreasing our workforce – both number wise and qualitywise.

What is project ECHO? 

India was a recipient of an effective global innovation called Project ECHO.  

• ECHO is a low-cost way out for growing the size of health workers in underserved communities to offer patients with the best possible care and facilities.  
• ECHO was utilised as a strategy for treating Hepatitis C in the beginning but now is being used for newly trained experts in HIV, malaria, tuberculosis, addiction, mental health, and many other conditions. 
• Under this project, health workers, nurses and doctors are trained through video conferencing technology. They learn speciality care from subject matter experts and from each other’s community informed knowledge.  
• ECHO provides the ability to spread healthcare workers in the most remote areas of the country and give them training similar to what a healthcare worker in one of our largest cities would receive. 

What needs to be done before the vaccine arrives? 

India is led by the Serum Institute of India which has the largest manufacturing capacity in the world. However, certain aspects need to be figured out and planned before the COVID-19 vaccine becomes widely available: 

• Firstly, real skills need to be cultivated for planning out the following: 

• • Delivery system of these vaccines needs to be figured out. 
  • Storage and handling of the vaccines. 
  • India needs to overcome cultural and religious obstacles for those who are unwilling to accept a vaccine. 
  • People need to be counselled about the side-effects of the vaccine. 

• Secondly, more trained health experts are required to support vaccine treatment. 
• Thirdly, further preparation of the ECHO model can be done to identify new healthcare workers who can be trained to be COVID-19 experts.

Synopsis: Overall trends of NFHS data suggest an improvement in population control, use of modern contraception, reproductive and child health, immunisation and social determinants of health. 

Introduction  

The National Family Health Survey-round 5 (NFHS-5) covers about 6.1 lakh sample households to provide estimates for 707 districts. In the first phase, data from 22 states and UTs has been released from the latest survey conducted in 2019-2020. 

What are the major findings in the first phase of the report? 

• One, the data on Total Fertility Rate (TFR) has come down to 2.1 or below (replacement level) in all states and UTs. Bihar (3), Meghalaya (2.9) and Manipur (2.2) are exceptions in this.  
• Two, the data shows that the overall use of modern methods of contraception has increased in 20 out of 22 states. The most dominant method being female sterilisation. 

• Three, the data confirms that the number of women marrying before the legal age has reduced in 17 out of 22 states and UTs, with Nagaland, Maharashtra, Jammu & Kashmir and Sikkim as the top performers. 

• • •  Indicators on teenage marriage and childbearing have also improved in 17 states/UTs. 

• Four, 17 of 22 states/UTs saw an increase in antenatal care visits during the first trimester (Nagaland, Bihar and West Bengal saw the highest rise). 
• Five, the data shows consumption of IFA tablets by pregnant women for 180 days or more has increased in almost all states/UTs (except Karnataka) albeit this has not resulted in reduction in anaemia levels among pregnant women. 

• • • There is a need to consider adding IFA tablets which contain more natural sources of iron, folic acid and other micronutrients in the diet. 

• Six, 14 out of 22 states and UTs had more than 90 percent of new-borns delivered in institutional facilities and 14 out of 22 states/UTs have seen a drop in neonatal mortality. 

What does the NFHS data suggest on the indicators of women empowerment? 

Women’s empowerment is a widespread concept. However, indicators like household decision making, control over personal hygiene choices and possessions like bank accounts and mobile phones are decent indirect means for evaluation. 

• The data indicates that the majority of women (80 percent) participated in at least three household decisions. 
• Hygienic methods of protection during menstruation are being used by more than 64 per cent of younger women in each of the 22 states/UTs, except Bihar at 59 per cent. 

• Personal possessions such as mobile phone and bank account have increased to over 70 per cent across each of the 22 states/UTs of India (except Nagaland) in 2019-2020 amongst women. 

What does the NFHS data indicate about the public health in India? 

• All states and UTs show a drastic increase in the number of households with a constructed toilet, improved drinking water and clean cooking fuels which are the indicators critical in improving public health in India.  
• There has been a rise in malnutrition rates, wasting and underweight children in half of the states which reported an increase in exclusive breastfeeding and adequacy of diets.  

• • • Stunting can be affected by multiple factors such as indicators of the mother a child, financial situation, adequacy of diets, water and sanitation facilities, as well as interventions for nutrition promotion and health.  

• NFHS-5 data also show an increase in the rates of obesity in children and risk factors for chronic diseases in adults like hypertension and blood glucose. 

Conclusion  

One should not simplify these results for the whole country because data from phase 2 is yet to come and summary figures may oversee how relative health and nutritional results of the population can be. 

Read more : National Family Health Survey

News: In a bid to curb the spread of the bird flu or avian flu viruses, Central Government has set up a control room in the national capital to monitor the situation and take stock on a daily basis of the preventive and control measures undertaken by the state authorities.

Facts:

• What is Bird Flu or Avian Influenza? It is a highly contagious viral disease caused by Influenza Type A viruses which generally affects poultry birds such as chickens and turkeys.
• How does the bird flu spread? Wild aquatic birds such as ducks and geese are the natural reservoir of Influenza A viruses and the central players in the ecology of these viruses.
  • Many birds carry the flu without developing sickness and shed it in their droppings.Since birds excrete even while flying, they also provide a nice aerosol of influenza virus, shedding it all over the world.
• Symptoms: Unlike in birds, where it generally infects the gut, the avian influenza attacks the respiratory tract of humans and may cause severe respiratory illnesses such as pneumonia or Acute Respiratory Distress Syndrome (ARDS). Its early symptoms include fever, cough, sore throat, and sometimes abdominal pain and diarrhoea.
• Treatment: Antiviral drugs, especially oseltamivir, improve the prospects of survival in humans.
• Bird Flu in India: India notified the first outbreak of avian influenza in 2006.Infection in humans is not yet reported in India though the disease is zoonotic.There is no direct evidence that AI viruses can be transmitted to humans via the consumption of contaminated poultry products.
  • In India, the disease spreads mainly by migratory birds coming into India during winter months i.e. from September – October to February – March.The secondary spread by human handling (through fomites) cannot be ruled out.

Action Plan for Prevention, Control & Containment of Avian Influenza:

• Department of Animal Husbandry and Dairying (DAHD) had prepared an action plan in 2005 which was revised in 2006, 2012 , 2015 and 2021 for guidance of State Government for prevention, control and containment of Avian Influenza in India.The action plan calls for:
  • Strengthening the biosecurity of poultry farms, disinfection of affected areas, proper disposal of dead birds/carcasses
  • Timely collection and submission of samples for confirmation and further surveillance
  • Intensification of surveillance plan as well as the general guidelines for prevention of disease spread from affected birds to poultry and humans.
  • Coordination with the forest department for reporting any unusual mortality of birds was also suggested to the States.
  • To keep a vigil on any unusual mortality amongst birds and to report immediately to take necessary measures.

Article Source

News: A command and control centre has been set up at Airports Authority of India Cargo Logistics and Allied Services Company Limited(AAICLAS) to monitor the movement of COVID-19 vaccines.

Facts:

Source: The Hindu

• What will AAICLAS do? It will be the nodal body for coordinating air transportation of the vaccines across a network of 41 airports with Pune — where vaccine manufacturer Serum Institute of India is located — as the hub.
• Process of Vaccine Transportation:
  • • The 41 airports or cities where transportation efforts will be focused include Karnal, Mumbai, Chennai and Kolkata, each of which has a Government Medical Stores Depot (GMSD) of the Central government’s Ministry of Health and Family Welfare.
    • Once vaccines dispatched by the manufacturers arrive at these four big depots, they will be further distributed across 37 State depots.
    • Thereafter, they will be sent to district depots and finally to the primary health care centres.
    • Each of these centres has a temperature tracker which will upload temperature data on a central server for real time monitoring.

Article Source

News: Swasth Vayu Ventilator has received the approval of the expert committee constituted by Director General of Health Services, Ministry of Health & Family Welfare, Government of India.

Facts:

• Swasth Vayu: It is a ‘Made in India’ non-invasive (involves use of masks or similar device) ventilator developed by the National Aerospace Laboratories(NAL),Bengaluru.
• Key Features:
  • • It is a microcontroller based precise closed-loop adaptive control system with a built-in biocompatible 3D printed manifold and coupler with HEPA filter (Highly Efficient Particulate Air Filter).
    • It also has several advanced features like Bi-level mode(BiPAP), Continuous Positive Airway Mode(CPAP) and Spontaneous modes with provision to connect Oxygen concentrator or Enrichment unit externally.
      Read Also : current affairs for upsc
• Significance:
  • • The ventilator is ideal for treating Covid-19 patients in wards, makeshift hospitals, dispensaries and homes.
    • The major advantage of this machine is also that it is simple to use without any specialized nursing, cost effective, compact and configured with majority of indigenous components.

Article Source

News: Kerala was placed on high alert after an outbreak of bird flu was confirmed in Kottayam and Alappuzha districts.

Facts:

Source: The Hindu

• Bird Flu: It refers to the disease caused by infection with avian (bird) influenza(flu) Type A viruses.These viruses occur naturally among wild aquatic birds worldwide and can infect domestic poultry and other bird and animal species.

 Read more:-UPSC Syllabus 2021

• Can it infect Humans? It can occasionally infect humans as well, although human-to-human transmission is unusual.
• How does it spread to Humans? By close contact with a) Infected Poultry b) Pigs and c) Surfaces Contaminated by Infected Birds and their droppings.
• Common Symptoms of Bird Flu in Humans: Fever, Sore Throat, Cough, Muscle Aches, Difficulty in Breathing, Pneumonia, Pain in abdomen, diarrhoea among others.

Article source

News: National Medicinal Plants Board (NMPB), Ministry of AYUSH has launched a Consortia of Medicinal Plants.

Facts:

• Why was the NMPB Consortium launched? The NMPB Consortia aims to address/deliberate on the following issues: Quality planting material, Research & Development, Cultivation and Trade of medicinal plants/market linkage.
• Medicinal Plant Species Covered: In the first phase NMPB consortia is proposed for following medicinal plant species:
  • Ashwagandha (Withaniasomnifera)
  • Pippali(Piper longum)
  • Aonla (Phyllanthus Emblica)
  • Guggulu (Commiphorawightii)
  • Shatavari (Asparagus racemosus).
• Seed to Shelf Approach: To establish the linkage between the farmers and manufacturers, a ‘Seed to Shelf’ approach is also being introduced. Wherein, aspects related to Quality Planting Materials(QPM), Good Agricultural Practices(GAP’s), Good Post Harvest Practices (GPHP’s) would be addressed.

Additional Facts:

• National Medicinal Plants Board(NMPB): It was established in 2000 under the Ministry of AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha & Homoeopathy).
• Aim: Its main objective is the development of the medicinal plants sector through developing a strong coordination between various ministries/ departments/ organizations for implementation of policies / programs on medicinal plants.

Article source

News: Central Drugs and Standards Committee(CDSCO) has approved the COVID-19 vaccines COVISHIELD and COVAXIN for restricted use in emergency situations. Initially, the 3 crore medical personnel considered at the highest risk for COVID-19, would be given the vaccine for free.

Facts:

Source: The Hindu

COVISHIELD:

• It is a vaccine developed by the Serum Institute of India based on the Oxford AstraZeneca vaccine named ChAdOx1 vaccine (also christened AZD1222) i
• Type of vaccine: It is made from a weakened version of a common cold adenovirus that causes infections in chimpanzees.
• Effectiveness: The overall efficacy of the vaccine was found to be 70.42% — well below vaccines from Pfizer and Moderna but above the 50% threshold set by many regulators.
• Dosage, protection duration and storage: The vaccine has been recommended for the approval of two full doses administered around 4-6 weeks apart. Immune response could last at least a year. The vaccine can be stored at temperatures between 2°C and 8°C.

COVAXIN:

• It has been indigenously developed by Hyderabad-based Bharat Biotech in collaboration with the Indian Council of Medical Research(ICMR).
• Type of vaccine: It is an inactivated vaccine and is made by using particles of the coronavirus that were killed making them unable to infect or replicate. Injecting particular doses of these particles serves to build immunity by helping the body create antibodies against the dead virus.
• Effectiveness: The vaccine is safe and provides a robust immune response. The vaccine is yet to complete late-stage human clinical trials in India and no efficacy rate has yet been made public.
• Dosage, protection duration and storage: The vaccine will be administered in two doses and stored at 2-8° degrees Celsius. The efficacy of the vaccine is to be determined only after 14 days post the second dose.

Article Source

This article has been developed based on the Indian Express article “Turning point”.

Synopsis- The Drug Controller General of India (DCGI) approved two vaccines — the indigenously developed Covaxin, and Covishield. There are several concerns associated with the hasty approval of vaccines.

About Vaccines

COVISHIELD:

• This vaccine is incubated in the laboratories of Oxford University and Swedish-British pharma firm, AstraZeneca. It is manufactured by the Serum Institute of India.
• Type of vaccine: It is made from a weakened version of a common cold adenovirus that causes infections in chimpanzees.

COVAXIN:

• It has been indigenously developed by Hyderabad-based Bharat Biotech in collaboration with the Indian Council of Medical Research (ICMR).
• Approval of this vaccine has raised many concerns as the Vaccine was still undergoing phase-3 clinical trials.

Read More about Vaccines

As per the regulators, Phase I and Phase II clinical trials were conducted on approximately 800 subjects and the results have demonstrated that the vaccine is safe and provides a robust immune response. 

An efficacy trial of this vaccine was initiated in India on 25,800 volunteers, and the data provided till now has been found to be safe, according to regulators.

However, there is no clarity about the type of data available.

Conditions associated with approval

• The emergency use approval is conditional on the vaccine developers submitting details of any adverse effect to the drug regulator, every 15 days. 
• A factsheet with safety details will also be provided to those receiving the first lot of vaccines.

Accelerated approval process in India

The term “Emergency Use Authorisation (EUA)” has been used mainly by regulatory agencies like FDA in the US and some other countries.

The term Emergency Use Authorisation (EUA) has not been used anywhere in rules in India. However, 2019 rules provide for an “Accelerated Approval Process” for granting approval to a drug that is still in clinical trials. The definition of a new drug in the 2019 Rules includes a vaccine.

Conditions for Accelerated Approval Process

• There should be a prima facia case that the drug is of Therapeutic benefits.
• “Accelerated approval may also be granted to a new drug if it is intended for the treatment of a serious, or life-threatening condition, or disease of special relevance to the country, and addresses unmet medical needs,”.
• Approval can be granted even if “remarkable” effectiveness is reported even from phase-II trials.

Approval granted to drugs or vaccines that are still in clinical trials is temporary, and valid only for one year.

Read more – Emergency Use authorisation of vaccines

What are the concerns associated with the hasty approval of vaccines?

India which is regarded as a manufacturer of vaccines, has put its credibility at a stake by this hasty approval of vaccine. It has raised a wave of concerns by scientific and healthcare communities about a “public rollout of an untested product. 

• First, Covaxin has been approved without clinical efficacy data. This vaccine was on the 3^rd stage, which is always a key to prove its efficiency. Government’s approval to this vaccine might hurt India’s credibility in case of any adverse impacts.  

• • Efficacy data is an indication of how effective the vaccine is in preventing the virus attack.

• Second, As regulators have themselves evaded their rules, credibility of regulator at stake- This lack of transparency could lead to a lack of trust in the vaccine. There are several issues with the way the approval has been granted, which can lead to people losing confidence in the regulatory system. 
• Third, approval an untested vaccine makes it nearly impossible to conduct a proper phase-3 trial. 

• • It will be unethical to expect volunteers to participate in a trial where there is only a 50% chance of being administered the actual vaccine, when they have the option of the real dose elsewhere.
• Fourth, While Pharmaceutical giants like Pfizer, Moderna, and AstraZeneca have given a go-ahead only after partial results of vaccine’s abilities in their own populations, In India Covishield has not been tested for vaccine ability among Indian population.
  • As it is a possibility that vaccine response among Indian population may not be the same as among the European Population.  
• Fifth, several data and reports have suggested the Vaccine hesitancy among people due to Emergency Use authorization. Approval without even base-level data will only strengthen this hesitancy among the public.

The rush to approve the COVID-19 vaccine without proper clinical trial may do more harm than good. So, it would be better to wait for the preliminary data from the phase-III trials to come in, and then grant the approval. 

What is the way forward? 

• Government needs to strengthen its vaccine distribution and administration mechanism to meet the need of 1/4^th of the population it is looking to vaccinate in the first phase.
• Immunogenicity of both the vaccines could vary, thus there is a need to understand the adverse effects.
• Prioritising the elderly people needs to be re-examined because the elderly are less mobile and have a lower level of social interaction, they are less likely to spread the virus. So, in the long run, prioritizing the elderly people may not actually minimize the total social and economic cost inflicted by the virus.
• Surveillance and monitoring systems will require to be tweaked as per the efficiency and effectiveness data of the Vaccine.
• Vaccinators required to be educated on the finer details of the two vaccines.

Synopsis- Concerns regarding hasty approval granted to the COVID-19 vaccines despites the lack of adequate efficacy data.  

Background- 

• The Drug Controller General of India (DCGI) approved the Subject Expert Committee’s recommendation for emergency use of Serum Institute of India’s Covishieldand Bharat Biotech’s Covaxin.  
• Covishieldis the same vaccine as developed by Oxford- AstraZeneca, which has got emergency use approval in the UK. 
• In the case of Covaxin, concerns have been raised about the absence of efficacy data, which is generated during Phase 3 of human clinical trials.

However, experts have voiced their concerns on the approval process and the lack of publicly released efficacy data for Covaxin. 

How India’s credibility as manufacturer of vaccine is at stake? 

The hasty nod for Covaxin has put India’s credibility as a manufacturer of vaccines is at a stake and has raised eyebrows in the scientific and healthcare communities about a “public rollout of an untested product. 

• First, Covaxinhas no clinical efficacy data- Bharat Biotch’s Covaxin vaccine is still in stage 3 clinical trials in India and the final results are yet to be released. The recommendation comes despite the lack of efficacy data for Covaxin.  
  • Efficacy data is an indication of how effective the vaccine is in preventing the virus attack.
  • Moreover, the decision is a violation of the criteria in the draft regulatory guidelines for the development of COVID-19 vaccines published by CDSCO, in which it is clear that safety and efficacy data is required for approval of vaccine, but the indigenous vaccine from Bharat Biotech does not have efficacy details because the trials are underway.
• Second, credibility of regulator at stake-This lack of transparency could lead to a lack of trust in the vaccine. There are several issues with the way the approval has been granted, which can lead to people losing confidence in the regulatory system. 
• Third, approval an untested vaccine makes it nearly impossible to conduct a proper phase-3 trial.
  • It will be unethical to expect volunteers to participate in a trial where there is only a 50% chance of being administered the actual vaccine, when they have the option of the real dose elsewhere.
• Fourth, Pharmaceutical giants like Pfizer, Moderna and AstraZeneca have given a go-ahead only after partial results of vaccine’s abilities in their own populations.
• Whereas in India similar data for vaccine ability among Indian population has not been published. As it is a possibility that vaccine response among India population may not be the same as among the European Population.  

The rush to approve COVID-19 vaccine without proper clinical trial may do more harm than good. So, it would be better to wait for the preliminary data from the phase-III trials to come in, and then grant the approval. 

What is the way forward? 

• In light of the intense concerns arising from the absence of efficacy data, the Use of Covaxinshould be treated as extended clinical trials.  
• For the larger scale implementation of vaccines, Government needs to carefully monitor immune response to different vaccines and assess the efficacy across populations.

News: The subject expert committee of Central Drugs Standard Control Organization(CDSCO) has recommended COVID-19 vaccine, Covishield for emergency use authorisation.

Facts:

• COVISHIELD: The Oxford vaccine “AZD1222” is being called Covishield in India. Serum Institute of India(SII) has entered into a manufacturing partnership with Oxford University and Pharma major AstraZeneca to produce this vaccine in India.
• Technology: Covishield is made of a weakened and modified version of adenovirus (a common cold virus) that causes infections in chimpanzees and contains the genetic material of the SARS-CoV-2 virus spike protein. After vaccination, the surface spike protein is produced, priming the immune system to attack the SARS-CoV-2 virus if it later infects the body.
• Efficacy: Researchers claimed the vaccine protected against Covid in 62% of those given two full doses and in 90% of those initially given a half dose.
• Safety: The Lancet publication, a leading medical journal has confirmed that the vaccine was well-tolerated and there were no serious safety events confirmed related to the vaccine.
• Storage: The vaccine can be stored, transported and handled at normal refrigerated conditions (2°C to 8°C) for at least six months.

Article source

News: Union Health Ministry has released a communication strategy to support the Covid-19 vaccine rollout in India that seeks to disseminate accurate and transparent information by alleviating apprehensions and ensuring its acceptance.

Facts:

• About the strategy: The key areas that will be addressed as part of interventions under the strategy are:
  • Giving information on Covid-19 vaccines
  • Addressing vaccine hesitancy
  • Building vaccine eagerness along with maintaining and sustaining Covid appropriate behaviour.

Key Features of the Communication Strategy:

• Using Social Influence: The strategy focuses on using social influence or endorsements from experts and official voices to spell out the process of immunisation, emphasise on the safety and efficacy of vaccines and explain the decision to conduct the drive in a phased manner.
• National Media Rapid Response Cell(NMRRC): A Media Response Cell will be established under its ambit to ensure preparedness through media monitoring and social listening to respond in real time.It will also unfold media and public discourse through extensive monitoring of print, electronic and digital media.
• Involving Community Based Platforms: Government will involve community mobilisers and frontline workers to engage with the community at various levels to build trust and enable greater confidence in the Covid-19 vaccine.
• Adverse Effects due to immunisation: In case of any adverse effects following immunisation (AEFI), the strategy emphasises on supporting the mobilisers and health workforce in managing crisis situations by appealing to the community to stay calm while waiting for a proper diagnosis and prevent aggressive behavior against health workers.

Article source

Read Also:-CURRENT AFFAIRS 2020-2021

News: Government of India has launched the Indian SARS-CoV-2 Genomic Consortia Group(INSACOG).

Facts:

• INSACOG: It has been established to monitor the genomic variations in the SARS-CoV-2 on a regular basis through a multi-laboratory network.
• Composition: It comprises 10 labs (NIBMG Kolkata, ILS Bhubaneswar, NIV Pune, CCS Pune, CCMB Hyderabad, CDFD Hyderabad, InSTEM Bengaluru, NIMHANS Bengaluru, IGIB Delhi and NCDC Delhi).
• Coordinated by: The group is coordinated by the Department of Biotechnology (DBT) along with the Ministry of Health and Family Welfare(MoH&FW), ICMR and CSIR.
• Nodal Unit for Maintaining Database: National Centre for Disease Control(NCDC) will be the nodal unit for maintaining a database of all samples of the new variants of public health significance. The data will be epidemiologically analysed, interpreted, and shared with states for investigation, contact tracing and planning response strategies.
• Other key Functions of the INSACOG:
  • It will establish sentinel surveillance for early detection of genomic variants with public health implications and to determine genomic variants in unusual events or trends such as super-spreader events.
  • Knowledge generated through this vital research consortium will also assist in developing diagnostics and potential therapeutics and vaccines in the future.
  • The group will also closely work with NCDC on activities like SOPs, data annotation, data analysis, data release among others.

Synopsis- There is need for more genome sequencing from samples from all over the world in order to come up with effective approaches to control and prevent COVID-19 infections.  

Background- 

• A new variant of the pandemic SARS-CoV-2 coronavirus is spreading rapidly in Britain and prompting high levels of concern. 
• Six samples of the recent U.K. returnees have been found to be positive with a variant of SARS- CoV-2 virus.
• From 25 Nov-23 Dec, about 33,000 passengers landed at various Indian airports from the U.K. So far, only 114 have been found positive and samples have been sent to 10 INSACOG (Indian SARS-CoV-2 Genomics Consortium) labs for genome sequencing.

Thus, only through detailed epidemiological studies combined with genome sequencing data can we confirm the presence and spread of the variant in India.  

What are the findings related to new stain of coronavirus and will it cause concern in India? 

The genomic analysis undertaken by the COVID-19 Genomics U.K. Consortium found that- 

• First. The new variant of coronavirus is named “VUI 202012/01” and is defined by a set of 23 changes or mutations. Among the 23 mutations, the two of which are particularly worrisome and specifically N501Y makes is more transmissible. 
  • • It includes a genetic mutation in the “spike” protein that can lead to an easy and immediate spread of the virus, making it deadlier. This new variant has 17 mutations that affect the shape of the virus.
• Second, It is about 70% more transmissible- The variant has the potential to increase the number of people a person can infect by over 0.4 

However, it might not be able to spread wildly in India as a sizeable percentage of people are already infected.  

Read more – Mutation in Coronavirus 

Why it is important to undertake more genome sequencing of the virus? 

The genome sequencing study would determine if the COVID patients are carrying the existing strain of SARS-CoV-2 or the mutant strain.  

• First, to understand the evolving nature of the virus–So far, we are doing very less frequent genomic sequencing compared to western nations. For instance, in England, around 10 percent of the infected virus samples are sequenced to study the nature of the virus. 
• Second, to find an immune escape variant of the SARS-CoV-2, [which means a mutation in the virus that allows it to evade the immune system]  
  • • One of the immune escape variants found in genomes from India, known as N440K variant — was found to be in 2.1 percent of the gene sequences in India.
• Third, The N501Y mutation can arise independently here in India. Hence more genome sequencing and genomic epidemiology is needed. 

Steps were taken by the Indian Government regarding this-  

• The genomic surveillance consortium (INSACOG) has been recommended for laboratory and epidemiological surveillance of circulating strains of the SARS-CoV-2 in India. 
• Under this initiative, 5 percent of the positive cases will be tested for Whole Genome Sequencing, from all the States and UT. 

Read Also : Current affairs for upsc

What is the way forward? 

Genome sequencing is very much important of the higher percentage of the samples to understand the evolving nature of the virus. 

Source: The Hindu

News: According to a study by Public Health England, the new mutated variant of the novel coronavirus does not appear to cause more severe illness than other variants.

Facts:

About the Study:

• Under the study, researchers compared 1,769 people infected with the new variant with the same number of people who had different Covid variant. The two groups were matched 1:1 on the basis of age, sex, area of residence and time of testing.
• The study found that 12 of 1,340 (0.89%) people infected with the new variant died within 28 days compared with 10 of 1,360 (0.73%) people infected with virus not belonging to the new variant. Hence, the study has concluded that the difference in case fatality between the two groups is not significant.
• However, the secondary attack rate or the proportion of contacts of confirmed cases that develop disease themselves was higher in people infected with the new variant.

Additional Facts:

• What is a mutation? A mutation means an alteration in genetic material. In an RNA virus such as SARS-CoV-2, proteins are made of a sequence of amino acids. Such a virus contains some 30,000 ‘base pairs’ which are like bricks placed next to each other to form a structure. An alteration in this base can be a mutation, effectively changing the shape and behaviour of the virus.

For Further Read on New Mutant Virus: https://blog.forumias.com/mutated-covid-19-strain-of-uk-spreads-faster/

Source: PIB

News: Union Health Minister of India has been nominated by the Global Alliance for Vaccines and Immunisation(GAVI) as a member of the GAVI Board.

Facts:

• Union Health Minister will be representing the South East Area Regional Office(SEARO)/ Western Pacific Regional Office (WPRO) constituency on the GAVI Board from 1st January,2021 until 31st,December 2023.

What is GAVI?

• Gavi is an international organisation – a global Vaccine Alliance created in 2000.
• It brings together public and private sectors with the shared goal of creating equal access to new and underused vaccines for children living in the world’s poorest countries.
• GAVI has observer status at the World Health Assembly.
• As part of its mission to save lives, reduce poverty and protect the world against the threat of epidemics, GAVI has helped vaccinate more than 822 million children in the world’s poorest countries preventing more than 14 million future deaths.

GAVI Board:

• The GAVI Board normally meets twice a year in June and November/ December and holds an annual retreat, normally in March or April.
• The board is responsible for strategic direction and policy-making, oversees the operations of the Vaccine Alliance and monitors programme implementation.
• With membership drawn from a range of partner organisations, as well as experts from the private sector, the Board provides a forum for balanced strategic decision making, innovation and partner collaboration.

Synopsis: Indian is one of the world’s leading vaccine manufacturer, thus will have better access to vaccines, but the distribution of manufactured vaccine will prove to be a formidable task.

Dry run to test preparedness for the nationwide roll-out of a COVID-19 vaccine kicked off in four States — Assam, Andhra Pradesh, Gujarat and Punjab.

What is dry run of Vaccines?

• A dry run is aimed at testing the planned operations and the laid out mechanisms for Covid-19 vaccination in the state. It will provide insights into any gaps or bottlenecks so that those could be addressed before the commencement of the actual drive.
• Intended beneficiaries of each State, registered on Co-WIN’ app, have been sent text messages, containing info about the time and place of their “COVID-19 vaccination”.

Read – About Co-Win app and platform

• All the beneficiaries will have to register themselves compulsorily on Co-Win platform and provide a photo ID proof upon asking.
• Authorities will prepare a report for the STF, after conducting this dry run. STF will review the report and provide feedback and guidance to the authorities on further actions.
• The report will also be submitted to the Union Ministry of health and Family Welfare.

India’s vaccine distribution infrastructure

India has created a network of Cold Chain Infrastructure for vaccines at various levels. Presently, Vaccine distribution takes place through following process and infrastructures;

1. Vaccines are produced by Manufacturers or procured by suppliers through agreements and arrangements.
2. These vaccines are then delivered to 4 Government Medical Store Depots (GMSDs) in Karnal, Mumbai, Chennai and Kolkata.
3. From these GMSDs vaccines are delivered to state, divisional and regional vaccine stores.
4. They further distribute these vaccines to District Vaccine stores (DVCs). DVCs then deliver vaccines to PHCs, CHCs and Private facilities.
5. From these centers beneficiaries can get themselves vaccinated.

All these distributions take place through insulated Vans and Vaccine carriers.

Some of the important facts and figures

• In Phase-1, Government is aiming at vaccinating 300 million most vulnerable people by August 2021 i.e.  600 million doses till August.
• At present India is having About 27000 cold chain points across the country.
• India’s present distribution capacity is 360 million doses in 8 months for both government and private facilities. It includes the Capacity of Private Cold Chain infrastructure at 200 million and government capacity at 160 million.
• The above capacity includes the infrastructure of the current immunization program, if leveraged for the covid vaccination.
• Due to the electronic vaccine intelligence network (eVIN) system, a real-time supply chain management system, India’s vaccine management has improved

What are the challenges in vaccine distribution in India?

1. Firstly, to complete the aims of the first phase of the covid vaccination drive, the public sector distribution capacity will need to be expanded 2-3 times.
2. Secondly, there are gaps in the vaccine distribution system. As per the Audit of health ministry in 2017-18, 26% of eVIN cold chain points reported instances of stock out during the period of assessment. More than a fifth of facilities reported wastage of vaccines.
3. Third, Interstate disparity in the distribution of cold chain infrastructure across the country. For instance, roughly 4 cold chain points serve 100,000 population in Gujarat, whereas there is just one cold chain for the same number of people in Jharkhand. 
4. Fourth, unique requirements of the COVID-19 Pandemic such as Identifying beneficiaries, ensuring they show up on the day of vaccination, and administering a second dose after a month, provide vaccine across age groups instead of current programmes focus on particularly vulnerable sections, etc. All these require micro-level planning with a proper collaboration from the top.
5. Fifth, Post-vaccination challenges such as documentation of vaccination and the tracking and investigation of vaccine safety events, all are equally important to create positive public opinion about vaccination.
6. Sixth, India has performed poorly on the analysis by WHO-UNICEF in 2018, it ranked among 89 countries in 51-75 percentile range on effective vaccine management.
7. Seventh, If the present infrastructure of universal immunization programme is used as planned, what will happen to the regular immunization drive, is also a big challenge in front of government.

India is one of the biggest producers of vaccines in the world. Serum Institute of India (SII) alone is a producer of more than 1.5 billion vaccine doses every year and is expected to produce 1 billion doses of the Novavax vaccine by 2021.

As now, the vaccine is being authorized by Emergency Use Authorisation method, Need is to augment the capacity of vaccine distribution on an urgent basis.

Synopsis:  Dry runs aimed at testing the planned operations are essential for Covid 19 vaccination process.

Background

• In the coming weeks, the Phase-3 data of two COVID-19 vaccines tested by Indian manufacturers are expected to be submitted for emergency use approval.
• A countrywide rollout to immunize the four high-risk groups will begin soon in India if any of the vaccines gets the approval.
• So, to be prepared in hand the government has rightly decided to undertake a dry run for vaccine administration. The dry run is expected to be initiated this week in four States of Andhra Pradesh, Assam, Gujarat, and Punjab.

Why the Dry run is essential?

• Though, India has been vaccinating millions of young children with a variety of vaccines each year the aspects of the COVID-19 vaccination Programme are new.
• Firstly, this is the first time a vaccine to be administered outside the universal immunisation Programme and specifically for adults belonging to specific groups.
• Second, there is a need for administering two doses of the vaccine a few weeks apart and enrolling the recipients which is different compared to our running vaccination drives.
• Third, it will allow the administrators to check the usage of the Co-WIN IT platform for management of the entire vaccination process including data entry, allocation of date and time and a drill of session sites with test beneficiaries.
• Fourth, it will also help to test the linkages between planning, implementation and reporting mechanisms.

What are the measures that needs to be ensured during Dry run exercise?

• The first task is to register the recipients of vaccine identified from the from the high-risk groups on the Co-WIN platform to avoid inclusion and exclusion errors.
• When more than one vaccine becomes available, it is essential to ensure that people receive the same vaccine twice and the exercise should confirm that the Co-WIN platform is able to generate the date and time when people can receive the second dose.
• As no COVID-19 vaccine has undergone long-term follow-up for safety during the trial it is very essential to Check and report on all adverse events after the vaccination.
• Regarding storage of vaccines, the existing facilities of the universal immunisation Programme in most districts can be used for storing the vaccines since the vaccines that are at an advanced stage of testing in India do not require ultra-low temperature for delivery and storage.
• Also, the exercise should look at creating additional storage capacity at these facilities to store millions of COVID-19 vaccines as the plan is to vaccinate 300 million people in the four high-risk groups for which it requires 600 million doses. 

Synopsis: The government must examine the principle underlying the triage scheme for optimised use of resources.

Background:

• Over the next 6-7 months, India plans to vaccinate 300 million people against COVID-19 by prioritizing healthcare workers, other front-line workers and everyone who is above 50 years of age.
• To vaccinate 300 million people, India requires 600 million doses as two doses are required per individual.
• However, government will not have problems in acquiring the required number of doses as it has already struck a deal with the Serum Institute to acquire 500 million doses of the AstraZeneca vaccine and also the availability of other vaccines such as Bharat Biotech’s Covaxin and the Russian Sputnik V are also high.
• But the strategies that they have planned for distribution of vaccines needs to be examined.

What are the Issues and dilemmas in the triage scheme?

• First, government’s strategy of prioritizing the elderly people need to be re-examined because,
  • Vaccination drive should have two distinct objectives, one, providing protection to those vaccinated, and two to slow down the speed and spread of the viral transmission.
  • Providing vaccination to healthcare professionals is not in conflict with the above objective because these are individuals who have high levels of exposure and they also act as active disease vectors since they interact with large numbers of people.
  • But, prioritising the elderly people needs to be re-examined because the elderly is less mobile and have a lower level of social interaction, they are less likely to spread the virus. So, in the long run, prioritising the elderly people may not actually minimise the total social and economic cost inflicted by the virus.
  • This suggests that densely populated areas for instance, the Dharavi slum should receive far more attention than they are likely to get under the current strategy.
• Second, the government should permit private suppliers to import and distribute the vaccine in India because,
  • Currently, government’s procurement strategy relies entirely on public resources for distribution and the government plans to bear the entire cost of vaccination without involving private hospitals.
  • But, allowing the private sector to provide additional supplies of the vaccine would not really be a bad policy decision if it would not decrease the availability of the vaccine to the poor.
  • With more and more vaccines getting approval such as the Moderna vaccine in US, there will be a significant boost in the global supply of COVID-19 vaccines which mandates the need for involving private suppliers.
  • Benefits that accrue owing to such decisions are, less waiting time for the less affluent as some of the richer individuals in the target group will opt out of the government distribution system and prefer to get vaccinated at some private outlet owing to increase in supply.
  • Another potential benefit accruing to the entire population is that the larger the numbers who get vaccinated, the lower will be the speed of virus transmission amongst the non-vaccinated.
  • Also, there are some cost benefits, for example, Belgian Minister has revealed that the European Union has agreed to pay for leading COVID-19 vaccines is substantially lower than the prices of Moderna and Pfizer. Given the large size of India’s market India has the bargaining power advantage

Source: UNICEF

News: As the designated COVAX procurement coordinator and procurement agent, UNICEF has launched the COVID-19 Vaccine Market Dashboard.

Facts:

• Purpose: The dashboard is an interactive tool for countries, partners and industry to follow the developments of the rapidly evolving COVID-19 vaccine market and the efforts of the COVAX Facility to ensure fair and equitable access for every country in the world.
• The dashboard will also provide a regularly updated overview of the global research and development pipeline, the projected production capacity, publicly announced bilateral and multilateral supply agreements as well as reported price points.

Additional Facts:

• COVAX: It is the vaccine pillar of the ACT-Accelerator. It is co-led by the Coalition for Epidemic Preparedness Innovation (CEPI), Gavi( the Vaccine Alliance), and the World Health Organization(WHO) – working in partnership with developed and developing country vaccine manufacturers and others.
  • COVAX is the only global initiative that is working with governments and manufacturers to ensure COVID-19 vaccines are rapidly available worldwide to economies of all financial means.
• ACT Accelerator: It is a framework for collaboration. It is not a decision-making body or a new organization. It was set up in response to a call from G20 Leaders in March 2020 and launched by the WHO, European Commission, France and The Bill & Melinda Gates Foundation in April 2020.
  • Goal: The goal of the ACT Accelerator is to end the COVID-19 pandemic as quickly as possible by reducing COVID-19 mortality and severe disease through the accelerated development, equitable allocation, and scaled-up delivery of vaccines.

Synopsis: There has been a divergence in the actual NFHS data and the interpretations by the critics. 

What are the features of  National Family Health Survey report  NHFS report 2019-20? 

• The initial results of NFHS have been released for 2019-20 along with comparable data for the 2015-16 survey. 
• Population coverage of approximately 700 million and 21 states have been covered under the NFHS data. 
• Tabular data for 131 variables have been released for 2019-20. 
• The data show that there has been significant improvement in many of these 131 indicators of social welfare. 

Analysis provided by NFHS has been misinterpreted by the critics. Comment 

It is important to compare India with the rest of the developing world. Trends in hunger, nutrition, inequality, and growth among others can be carefully evaluated in a comparative angle with the help of World Bank data provides. Some of the misinterpreted data is as follows: 

• Firstly, Bangladesh underweight percentage in 2015 was stated as 22 per cent but the World Bank data states it to be 30.1 per cent, which makes it 4.7 percentage points (ppt) lower than India, not 12.8 ppt lower. 
• Secondly, teenage pregnancies in India were 19.9 per cent in 2005 which reduced to 8.7 per cent in 2015 and further got 1 ppt lower in 2019. Hence, net improvement was about 12 ppt in 15 years.  

• Whereas the level was 10 ppt higher constantly in the developing world during the same period. Even then some editorials claimed of worsening of teenage pregnancies in India. 

• Thirdly, welfare improved between 2015 and 2019 according to a very large number of NFHS indicators. A summary of these data is as follows: 

• Child Mortality: Data on three indicators (neo-natal, infant and under-five) show an improvement between 3 and 4 ppt.  
• Immunizations: It improved drastically. For instance, the hepatitis B vaccine percentage (for children 12-23 months) increased from 64.8 per cent in 2015 to 83.6 per cent in 2019.  
• Breast-feeding and diet of children 6-23 months: Average gain of 4 ppt for four indicators. 
• Negative trend in seven young women indicators is 0: Modern birth control methods, age at marriage, teenage pregnancies, and sexual violence all show improvement. The average improvement in these seven indicators is 3.9 percentage points. 
• Negative trend in 15 adult indicators is 0: Average gain is 4.1 percentage points. 
• Other improvements: Some of the indicators show an increase of 9 percentage points and above in households with electricity (9.2 ppt), improved sanitation facilities (17.3 ppt), clean fuel for cooking (18 ppt) and women having a bank account that they use (29.8 ppt increase to a level of 77.2 per cent in 2019). 

The points stated above show a large divergence in factual data and its interpretation. There is improvement in close to a 100 indicators and stagnation in less than 5 indicators. 

The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted based on the representative samples collected from households throughout India.

The NFHS survey provides state and national information for India on various health parameters such as fertility, infant and child mortality, the practice of family planning, maternal and child health, reproductive health, nutrition, anaemia, utilization and quality of health and family planning services.

Who releases the National Family Health Survey?

NFHS is released by the Ministry of Health and Family Welfare (MOHFW).

But the MOHFW designated the International Institute for Population Sciences (IIPS), Mumbai, as the nodal agency. The IIPS is responsible for providing coordination and technical guidance for the survey.

Technical assistance for the NFHS was provided mainly by ORC Macro (USA) but various other organizations assist with specific issues.

Who will fund for National Family Health Survey (NFHS)?

The Survey of this size cannot be carried out with government funds alone. Many international agencies provide funds to carry out the NFHS. They are,

• United States Agency for International Development (USAID)
• The Bill and Melinda Gates Foundation
• Department for International Development (DFID)
• United Nations Children’s Fund (UNICEF)
• United Nations Population Fund (UNFPA)
• MOHFW, Government of India

What is the Goal of National Family Health Survey (NFHS)?

Every National Family Health Survey (NFHS) has two specific goals to fulfill. They are

1. to provide essential data needed by the Ministry of Health and Family Welfare and other agencies for informed decision making and policy and programme intervention purposes.
2. to provide insight regarding important emerging health and family welfare issues

Apart from these two specific objectives, NFHS also helps to monitor the progress of various Sustainable Development Goals (SDGs) especially SDG-3 (Good Health and Well-Being).

How many National Family Health Surveys (NFHS) conducted so far?

There are 5 rounds of National Family Health Surveys (NFHS) conducted so far in India. They are,

1. First Round of NFHS conducted in 1992-93 (NFHS-1)
2. Second Round of NFHS conducted in 1998-99 (NFHS-2)
3. Third Round of NFHS conducted in 2005-06 (NFHS-3)
4. Fourth Round of NFHS conducted in 2015-16 (NFHS-4)
5. Fifth Round of NFHS conducted in 2019-20 (NFHS-5)

The NFHS-1, NFHS-2, NFHS-3 didn’t cover UTs except for Delhi because the objective of the survey then was to provide State-level estimates. (Source)

Since NFHS-4, the survey introduced district-level estimates for many important indicators and also included other UTs to provide holistic information.

5^th round of National Family Health Survey (NFHS-5): (Source)

The MOHFW recently released Phase – I of NFHS-5 comprising data for 22 states/UTs. The Survey was earlier expected to release in July but due to the Covid-19 pandemic the release of the survey got delayed and it is finally released on 12^th December 2020.

The fieldwork in the remaining 14 (Phase-II) States/UTs is currently in progress and expected to be available in May 2021.

The national-level indicators including most of the SDG health indicators are expected to be available by June/July 2021.

Important points regarding NFHS-5:

• The state factsheet released includes information on 131 key indicators.
• The district-level factsheet includes information on 104 key indicators.
• NFHS-5 uses the majority of NFHS-4 key indicators so that it would be comparable with NFHS-4 without any loss of information.

What is new in the 5^th round of NFHS (NFHS-5)?

The NFHS-5 also included district-level estimates which were introduced during the NFHS-4. Apart from that NFHS-5 also included some new topics such as

• Preschool education,
• Disability,
• Access to a toilet facility,
• Death registration,
• Bathing practices during menstruation (menstrual hygiene),
• Methods and reasons for abortion.
• components of micro-nutrients to children,
• frequency of alcohol and tobacco use,
• additional components of non-communicable diseases (NCDs),
• expanded age ranges for measuring hypertension and diabetes among all aged 15 years and above etc.

What are the key findings of NFHS-5? (Source: The Hindu)

• Malnutrition: Of the 22 States and UTs, there is an increase in the prevalence of severe acute malnutrition in 16 States/UTs (compared to NFHS-4 conducted in 2015-16).
  • The percentage of children under five who are underweight has also increased in 16 out of the 22 States/UTs.
  • There is also an increase in the prevalence of other indicators such as adult malnutrition measured by those having a Body Mass Index of less than 18.5kg/m2 in many States/ UTs.
• Anaemia: Anaemia levels among children as well as adult women have increased in most of the States with a decline in anaemia among children being seen only in four States/UTs.
• Obesity: Most States/UTs also see an increase in overweight/obesity prevalence among children and adults, once again drawing attention to the inadequacy of diets in India both in terms of quality and quantity.
• Stunting: The data report an increase in childhood stunting in 13 of the 22 States/UTs compared to the data of NFHS-4.
  • There was a 10-pp (Percentage Point) decline in stunting among children under five between 2005-06 (NFHS-3) and 2015-16 (NFHS-4), from 48% to 38%, averaging 1 pp a year. This was considered to be a very slow pace of improvement.
• Starvation: Volunteers of the Right to Food campaign have listed over 100 starvation deaths based on media and/or verified fact-finding reports since 2015.
• Food insecurity: Field surveys such as ‘Hunger Watch’ are already showing massive levels of food insecurity and decline in food consumption, especially among the poor and vulnerable households.
  • In the Hunger Watch survey carried out in 11 States, two-thirds of the respondents reported that the nutritional quality and quantity of their diets worsened in September-October compared to before the lockdown.
• Jump in Vaccination: The survey has found considerable improvement in vaccination coverage among children aged 12-23 months across all States/UTs.
• Urban-Rural gender gaps in Internet use: There is an urban-rural gap as well as gender divide with respect to the use of the Internet. On average, less than 3 out of 10 women in rural India and 4 out of 10 women in urban India ever used the Internet.
• Increase in bank accounts operated by women: The number of bank accounts that women not only hold but also operate themselves has increased dramatically over the past five years.

Source: PIB

News: Prime Minister will launch Ayushman Bharat PM-JAY SEHAT to extend coverage to all the residents of the Union Territory of Jammu & Kashmir. 

Facts: 

• PM-JAY SEHAT: It aims to ensure Universal Health Coverage by providing free of cost insurance cover to all the residents of the UT of J&K. 

• The scheme will cover the remaining population which has not been covered under the Ayushman Bharat Scheme. 

Key Features of the PM-JAY SEHAT scheme: 

• It provides financial cover up to Rs 5 lakh per family on a floater basis to all residents of the UT of J&K.  

• It provides for operational extension of PM-JAY to 15 lakh (approx.) additional families.  
• The scheme will operate on insurance mode in convergence with PM-JAY.  
• The benefits of the scheme will be portable across the country. The hospitals empaneled under PM-JAY scheme shall provide services under this scheme as well. 

• Significance: With the launch of ‘SEHAT’ Scheme, J&K will be among the first in the country to achieve Universal Health Coverage. 

 Additional Facts: 

• Universal Health Coverage: It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care and enables everyone to access the services, protecting people from the financial consequences of paying for health services out of their own pockets and reducing the risk that people will be pushed to poverty. 
• Ayushman Bharat : It was launched in 2018.It is the world’s largest health insurance/ assurance scheme fully financed by the Centre. 

• It provides a cover of Rs 5 lakh per family annually for secondary and tertiary care hospitalisation for public and private enlisted hospitals in the country. 
• The two flagship programmes under Ayushman Bharat programme are (a) Health and Wellness Centre and (b) Pradhan Mantri Jan Arogya Yojana (PM-JAY). 

Context: The COVID-19 pandemic has put governance under a stress test which exposed how poorly prepared the world’s governments were. 

What was the response of the world leaders to the pandemic? 

The world’s most powerful leaders failed to do their duty to protect the citizens. 

• In Brazil, Jair Bolsonaro irresponsibly refused to get vaccinated, even as his own government has launched a national vaccination campaign. He even remarked that the vaccine might turn people into crocodiles. 
• In India, lockdowns of limited effectiveness, the sight of migrants desperately walking back to their villages and having the second largest number of cases, dented Prime Minister Modi’s popularity. 
• In Russia, Vladimir Putin has hardly spoken even as the virus wraths unchecked across Russia. Further, the citizens are against a vaccine whose ability and safety are inadequately understood because of the opacity of Russia’s protocols. 

Then why people of their country have not held their leaders accountable for the failure in handling this situation? Answer lies in the following propositions that shape the view of general public towards their leaders. 

What are the limits of political accountability exposed during the pandemic? 

Three propositions frame this analysis: 

• Prospective Accountability: It is often understood that the voters vote retrospectively, i.e., give their judgement in the elections by voting based on the incumbent’s record. Instead, they vote prospectively, i.e., against candidates who the voters fear would put the opponents to a disadvantage. 
• Underestimation of collective action: Second, disease, unlike war, does not offer a clear enemy to target. Public health advice that stressed the need for personal responsibility to stay home, wear a mask, washing hands. It underestimated the challenge of collective action predicted on millions of individual responses. 
  • It emphasises person’s responsible for own health, then getting sick is also his own fault. It absolves the govt. off the responsibilities.  
• Poverty of collective empathy: Third, the coronavirus pandemic reveals our inability to empathise with what we do not see. For example, thousands of deaths due to pollution and road accidents go unnoticed, unlike thousands of deaths by COVID-19;  

What is the way forward? 

• Prolonged economic suffering demands government remedy more immediately as without some measure of accountability, democracy loses its power, and so do the people. 

Source: PIB

News: Ministry of Health and Family Welfare(MoHFW) and the Ministry of Electronics and Information Technology (MeitY) has announced its grand challenge for “CoWIN app”.

Facts:

• Aim: To strengthen the COVID-19 Vaccine Intelligence Network (CoWIN) system.
• Eligibility: Indian tech startups, MSMEs, companies and Limited Liability Partnerships(LLPs) registered in India under Companies Act can apply. Further, teams not registered as companies or startups or MSMEs can also participate in the challenge.
• Areas of Focus: The MoHFW has identified seven areas to focus on- 1) High Adherence rate; 2) Portability across India; 3) Vaccine Transportation; 4) Queue management; 5) Report adverse event following immunisation and adverse event of special interest; 6) Learning Management System; and 7) Logistic Management Information System.

Additional Facts:

• What is CoWIN Platform?
  CoWIN: It is a digitalised platform launched by the Ministry of Health and Family Welfare (MoHFW) to help agencies keep a track of Covid-19 vaccination programme and allow Indian citizens to apply for a Covid-19 vaccine shot.
• What is CoWIN-20 app?
  • Government developed an app as part of CoWIN platform named CoWIN-20. for real-time monitoring of Covid-19 Vaccine.
  • The main feature of the app is that it will send real-time data from the cold-storage facilities that store Covid-19 vaccines. This is an extension of eVIN (Electronic Vaccine Intelligence Network)
  • Modules: The app is divided into five modules.These are administrator module, registration module, vaccination module, beneficiary acknowledgement module and report module.
    For example, a front line worker like Health care worker can register themselves in app using the “registration module”. After the registration is done the “beneficiary acknowledgement module” will send an acknowledgement to the person
  • Beneficiary Acknowledgement module will provide QR based Certificate once the person is vaccinated.

Context- New mutated COVID-19 strain discovered in the United Kingdom underlines the need for adherence to Non-pharmaceutical interventions.

More in news-

A new variant of the pandemic SARS-CoV-2 coronavirus is spreading rapidly in Britain and prompting high levels of concern.

Precautionary measures taken by other countries-

• The United Kingdom stood shut off from the rest of Europe after several nations decided to close borders over fears of the new coronavirus strain.
• India too has joined over two dozen countries in banning inbound travel from the UK.

What is this new strain of coronavirus?

Covid-19 mutant strain- It has been named VUI-202012/01 and is defined by a set of 23 changes or mutations. Among the 23 mutations, the two of which are particularly worrisome.

1. N501Y – Has previously been shown to increase how tightly the protein binds to the angiotensin-converting enzyme 2 receptor, its entry point into human cells.
2. 69-70del – leads to the loss of two amino acids in the spike protein and has been found in viruses that eluded the immune response in some immune compromised patients.

Concern with new strain-

• It is about 70% more transmissible- The variant has the potential to increase by over 0.4 the number of people a person can infect.

Mutations, or genetic changes, arise naturally in all viruses, including SARS-CoV-2, as they replicate and circulate among humans. However, these changes, can lead to a quicker spread of Covid-19 between people.

Will vaccines work against this new strain of virus?

According to scientists, Vaccines will be equally effective despite the mutation. So there is no reason to panic.

• This is because vaccines are designed to create antibodies targeting the spike protein and there is also the T-cell immunity that would come into play to clear the virus.
• However, as the virus accumulates more changes, vaccines might require little tweaking.

What needs to be done?

• The emergence of the new variant underlines the compulsion to undertake surveillance following vaccination to track vaccine effectiveness and to look for the appearance of vaccine escape mutants.
• Non-pharmaceutical interventions, including quarantine and social distancing have significantly helped in curbing the transmission of coronavirus and should be followed strictly.

Context: The New welfarism approach followed by the present government can better explain the reason for the overall rise in stunting rates.

Background

• The 5^th round of the National Family Health Survey (NFHS-5) that covers dimensions such as health, nutrition, and the overall quality of lives, has been recently released.
• It provides reliable and independent evidence to assess micro-development performance under this government.
• NFHS-5 has highlighted the dismal performance of country in reducing the malnutrition specifically stunting.
• The findings of NFHS-5 show, how the government policy has consciously adopted the New Welfarism approach providing Tangibles services, instead of providing Intangibles social benefits i.e., improving nutrition level.

What is New welfarism approach?

• The New Welfarism approach is more similar to the Basic Needs approach to development but a very distinctive approach to redistribution and inclusion.
• It does not prioritise the supply of Intangible public services such as basic health, primary education and safety security net.
• Instead, it focuses on tangible essential goods and services, normally provided by the private sector, such as bank accounts, cooking gas, toilets, electricity, housing, water and cash.

What are the findings that supports New Welfarism approach?

• Firstly, Increase in Bank accounts leading to women’s financial inclusion and empowerment: As of 2019, 72 per cent of all women had bank or savings accounts that they report as being able to use themselves.
• Secondly, increase in electricity connections, sanitation facilities, clean fuel: Ninety-eight per cent of all households had access to electricity, nearly 70 per cent to improved sanitation, and 60 per cent to clean cooking fuel.
• Third, increase in beneficiaries: Also, the percentage of households that have gained access to these goods and services each year, has accelerated since 2015
• Fourth, increase in child Stunting rates: The improvements towards child stunting, an intangible service has been disappointing as the overall stunting rates are flattening rather than decreasing and urban rates are rising.

Why the New Welfarism approach focuses on tangible goods more than Intangible goods?

• Ideological dimension: The government believes that Providing tangible goods and services such as bank accounts, cooking gas, toilets, electricity, housing will make a critical difference to the lives of the poor.
• Strategic dimension: Providing tangible goods and services that are relatively easy to deliver, measure and monitor has high electoral opportunity in it. Whereas, providing intangible services such as primary education is difficult to define and less measure and hence difficult to convert into a political advantage.

Thus, the findings clearly explain that the failure on stunting is mainly due to the shift in government policies towards New welfarism approach where the tangible goods and services are prioritised rather than intangible services such as nutrition, education, child stunting etc.

News: The Parliamentary Standing Committee on Home Affairs has submitted its report to the Rajya Sabha Chairman on the management of Covid-19 situation.

Facts:

Key Suggestions given by Panel:

Panel has given suggestion on the four aspects:

1. The country’s preparedness
2. Augmentation of health infrastructure
3. Social impact
4. Economic impact

Source: The Hindu

On Country’s preparedness

• Separate Wing: A separate wing may be formed in the National Disaster Management Authority that will specialize in handling /managing the Pandemics like COVID-19 in the future.
• Center-state coordination mechanism: For providing quick response to such crisis, an effective functional institutional mechanism is needed for coordination between the Centre, states, and Union Territories.

On country’s Health Infrastructure

• Public Health Act: A comprehensive Public Health Act preferably at the National Level with suitable legal provisions to keep checks and controls over private hospitals in times of a pandemic to
  • curb black marketing of medicines
  • check the malpractices like selling of hospital beds
  • denial of the cashless facility
  • variation in levying charges towards consumables such as PPE kits, gloves etc,
• Strengthen Public Health care System: The public sector healthcare delivery system needs to be further strengthened in all the states/ UTs and a uniform healthcare system should be established across the country to deal with the pandemic on a sustained basis in the future.

On Social Impacts

• National Database on migrant workers should be launched at the earliest as it will help in the identification of migrant workers and also in delivering ration and other benefits to them.
• Inter-state operability of ration cards: It recommended that until the One Nation, One Ration Card is implemented in all states/UTs, inter-state operability of ration cards should be allowed.
• Mid-Day Meal Scheme: Central government should coordinate with local administration through state governments to ensure rations/ allowances are delivered on time.

On Economic Impacts

• Awareness Campaigns: The Government should hold awareness campaigns on cheaper and effective repurposed medicines to prevent panic-buying of expensive drugs by the people.
• Vaccine Authorization: Any vaccine against COVID-19 should be granted emergency use authorisation only after proper consideration and conducting its trials on a sufficient sample size.

Context – The problems in India’s health sector.

What are the issues with healthcare sector in India?

1. Low government spending – Public expenditure on health accounts for only 1.13% of the total health expenditure which is abysmally low when compared to WHO recommendation of 5%.
2. High out of pocket expenditure– Out of pocket expenses account for 62% of the expenditure. This led to an increasing number of households facing catastrophic expenditures due to health costs.

• 85% of the population cannot afford high cost, corporate private health care.

3. Insurance-76% of Indians does not have health insurance. Government contribution to insurance is just 32%. Low insurance penetration forces people to spend out of pocket.

• The behaviour of a private corporate hospital is skewed in favour of profitability.

4. Malpractices in the healthcare sector – Selling substandard and counterfeit medicines, unnecessary hospital admissions and exploitation.
5. Weak government policy– only 1.27 crore people have taken advantage of the Ayushman Bharat scheme out of 12 crore card holders.
6. Dark reality of private hospitals– The insurance backup incentivizes hospitals to expand the bill but the patients do not get attended to in their best interests.
7. Low health workforce density – India’s public system has a shortage of nurses. The ratio of 0.6 nurses per doctor while the World Health Organization specification is three nurses per doctor.
8. 80:20 Rule – Only 20% of people can afford modern health care, 40% cannot afford it at all and the other 40%, the non-poor, pay with difficulty.

• Nearly 7 crore of the non-poor slide into poverty on a year-to-year basis.
• Under-qualified doctors– Due to this, 80% of people routinely reach Registered Medical Practitioners who are not trained to treat patients.

What needs to be done to improve healthcare sector?

• Increase the number of doctors– Ramp up the number of doctors with counterpart obligation to serve in rural areas.
• The Licentiate Medical Practitioner [LMP] – The scheme involves a three-and-a-half year course that leads to a bachelor’s degree in medicine and surgery. Doctors trained under this scheme will work in rural areas.
• Empower graduates of BSc (Nursing) to be nursing practitioners.
• Focusing of primary care– India needs to shifts focus from secondary and tertiary sectors to primary care. PHCs should be made attractive to doctors by providing incentives and making rural service mandatory for medical students.
• States should be incentivized to carry out the appointments of health workers and doctors.

Way forward-

• PHCs should be well-staffed and well-provisioned through a reasonable fee which will cover at least part of the cost.
• Focus should be shifted to preventive healthcare from curative healthcare.
• Policymakers need to focus on the larger picture with steps being taken to reclaim the space under public care.

Source: Click here

News: North Kerala has been put on high alert after an 11-year-old boy died and 20 suspected cases of shigella bacterial infection were reported.

Facts:

• Shigella Infection (shigellosis) is an intestinal infection caused by a family of bacteria known as shigella.
• Transmission: Contaminated food, water are the source of the infection. The bacteria spreads not only through surfaces — touching an infected surface and then touching the mouth — but also from eating food prepared by someone carrying the infection.
• Symptoms: Symptoms include diarrhoea, fever, stomach cramps which can last for seven days.
• Treatment: It is generally done through antibiotics which can shorten the duration of the illness.
• Susceptible Group: Children under age 10 are most likely to get shigella infection but it can occur at any age.
• Precautions: Doctors advise frequently washing hands with soap and running water to avoid infections such as Shigella.

Context- The pandemic provides learning opportunity and opens up possibilities of accelerating Tuberculosis (TB) elimination venture.

More in news-

• Covid-19 has derailed the painstaking efforts of decades and diverted scientific attention from killer diseases like tuberculosis
• COVID-19 lockdowns have resulted in a 30 per cent decline in tuberculosis diagnosis and reporting.
• Researchers estimate that over the next five years, an additional 1.19 million TB cases and 3,61,000 TB deaths may occur in India.

What is Tuberculosis?

Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs.

• TB causes respiratory illness and spread from person to person through the air.
• Mortality rate of 13 per cent — far worse than the 1.3 per cent for COVID-19.

How combating COVID-19 pandemic can help eradicate TB?

1. Raise the awareness of the general masses- The leaders and individuals have realized the devastation an infectious respiratory disease can cause.
2. Behavioural changes– The changes acquired during the pandemic such as cough hygiene, use of masks, physical distancing will further help reduce the transmission of tuberculosis, which is a respiratory illness.

• Doctors and nurses will be less complacent about these measures.

3. Raise investments in the healthcare sector– investments in health systems infrastructure, infection control equipment and personal protection equipment will ensure better airborne infection prevention and control.
4. Boost testing scale-

• COVID-19 has changed the landscape of testing and surveillance.
• The speed of research on new COVID-19 tests and the scale at which testing was applied are lessons to be learned by TB programmes.
• Bi-directional” TB and COVID-19 testing – Greater identification of cases will lead to more persons being isolated and treated.

5. Speed of vaccine development-

• The success of various COVID-19 vaccine platforms and the speed at which the vaccine has been brought to the market gives tremendous hope for TB vaccine candidates.
• Fast-tracking of research, advance purchasing, and research sharing by countries witnessed during the pandemic could apply to the TB vaccine.

6. Several dedicated infectious diseases hospitals have come up as a part of the pandemic response measures, which would contribute in a major way towards tuberculosis care and management.
7. The molecular diagnostic capacity has increased – These multi-platform devices based on cartridge and chip-based technology can decentralize TB diagnosis.
8. COVID-19 has taught to prioritize public health as much as curative and preventive health.
9. The increased uptake of telemedicine and teleconsultation during the pandemic will provide channels of consultation for tuberculosis

What is the way forward?

COVID-19 is likely to expedite the trajectory of TB elimination.

• COVID-19 pandemic has provided an opportunity to boost TB elimination activities through health system strengthening and infectious diseases control.

This article on NFHS-5 results has been developed based on the Indian Express Article under the title ‘Give children weight’ that appeared in the news on 17^th December 2020.

Situation of Nutrition in India as per NFHS-5 survey and other measures

• As per the National Family Health Survey 2015-16 (NFHS-4), 35.7 per cent children below five years were underweight in India compared to Bangladesh (22 per cent) and Nepal (27 per cent). 38.4 per cent were stunted.
• Now as per early estimates of National Family Health Survey 2019-20 (NFHS-5), between 2015-16 and 2019-20,  in 7 out of 10 major states for which data has been released, the proportion of underweight children increased.
• Present data estimates stunting in 36 per cent of children and 34 per cent of children are underweight.
• Some improvements have been seen in determinants of malnutrition such as access to sanitation, clean cooking fuels and women’s status
• The Global Hunger Index 2020 report has given India the 94th rank among 107 countries, much behind Bangladesh, Pakistan, and Nepal.
• As per a UN-FAO report, 194 million people go hungry every day in India, comprising about 23% of the world’s undernourished population.

What are the implications of NFHS-5 Survey estimates?

• Present data suggest that child nutrition in India has not progressed in last 5 years. Particularly, stagnation of stunting rates is alarming, as Height, unlike weight, cannot be reversed in short period of time and becomes permanent after a certain age.
• Stunting in childhood is associated with serious impairments later in life, including lower school achievements.
• Moreover, present data represent the picture before the advent of COVID pandemic. There is a high possibility that child nutrition has deteriorated as several surveys have pointed out severe food insecurity across India in 2020.
• As per the latest survey by Hunger Watch, 2/3^rd of the respondents that are adults from India’s poorest households were eating less nutritious food today than before the lockdown.
• Mid-day meals in schools and anganwadis were discontinued after lockdown and not resumed yet. Some of the states tried to make arrangement like distribution of cash or “take-home rations”, but were not adequate.
• Prolonged closure of anganwadis and schools might have resulted in massive disruption of routine health services — including immunisation.

What are government initiatives for improving nutrition in India?

• The Integrated Child Development Services provides cooked meals and take-home rations to 100 million children under the age of six, as well as to pregnant and lactating mothers.

• The mid-day meal programme in schools takes care of the nutritional requirement of school-going children.
• POSHAN abhiyan: It is India’s flagship programme to improve nutritional outcomes for children, pregnant women, and lactating mothers.

What are the criticisms against government policies?

• Central budget for mid-day meals (Rs 11,000 crore) is lower than what it was in 2014-15 (Rs 13,000 crore). Central allocation for ICDS is also lower today than it was six years ago.
• Poshan Abhiyaan, government’s flagship programme for child nutrition, has been allocated a minuscule budget of Rs 3,700 crore.
• In many states, on the one hand, political parties opposedinclusion of eggs in mid-day meals and take-home rations, on another hand, maternity benefit were restricted to one child per family and Rs 5,000 per child against Rs. 6,000 per child under the NFSA 2013.

What should be done?

The present government needs to allocate more resources for improving the nutrition level among children. The budget should have been increased or kept at the same level.

• Revival of present structure: The forthcoming Budget, for 2021-22 should have adequate provision for increasing nutrition level in the country and Mid-day meals in schools and Anganwadi centers must be revived as soon as possible.
• Nutritious products such as eggs with a fruit option or such for vegetarians should be included in mid-day meals and take-home rations for young children and pregnant women.
• Maternity benefits must be extended to all children with an increase in benefits beyond outdated Rs 6,000 per child.
• Upgradation of anganwadis: ICDS programme must be upgraded and the manpower of 14 lakh anganwadis should be utilised in a way to transform anganwadis into vibrant child development centers at the village level as been done in some southern states along with states like Himachal Pradesh and Odisha.
• Inclusion of pulses: World Food Programme (WFP) includes 60 grams of pulses in its typical food basket, alongside cereals, oils, and sugar, and salt and according to the Global Pulse Confederation, pulses are part of a healthy, balanced diet and have been shown to have an important role in preventing illnesses such as cancer, diabetes, and heart disease. Thus, Pulses should be included in the PDS of India.
• Access to finance and innovations: Inclusive access to finance to strengthen and expand rural supply chains is also crucial. Small landholders need access to financial resources, technology, and innovation to ensure that the produced food reaches from farm to fork.

Present children are the future of our country and a healthy mind resides in a healthy body. As shown in the NFHS-5 survey, more than 1/4^th of underweight children may prove to be the biggest obstacle in becoming a $5 trillion economy within a few years. Global economic and military superpower and require urgent attention.

Context- Early and systematic tracking of high-risk contacts helped Uttar Pradesh step up the fight against COVID-19.

What were the measures taken by UP government to control the outbreak?

Uttar Pradesh is the largest state in the country in terms of population and hence, the battle against COVID-19 becomes more challenging. Several factors distinguish the handling of the pandemic in the state such as –

1. Setting up of ‘Team 11’ – Team 11(which is a cluster of 11 committees) at the state level that comprises top officials and report on a daily basis to the chief minister on the corona situation. The daily review meeting has kept the state machinery on its toes.

• Ministers in charge of Health and Medical Education are also present at these meetings.
• This committee tasked with managing different aspects like –

2. ICCC set up in every district– Integrated COVID Command and Control Centre (ICCC), This is the nerve centre of pandemic management in the district which helps in-

• Sending testing teams to different areas as per plan.
• Ensuring surveillance and contact tracing.
• Sending positive patients to different Covid hospitals or placing them under home isolation.

3. Integrated data management portal– UP government launched an integrated Covid-19 portal (upcovid19tracks.in), set up a digital mechanism that can help the state government combat the pandemic while controlling community transmission of the virus.

• It provides us with the ability to crunch and analyse data on a daily basis.
• Also cajole the districts lagging behind to improve their performance.
• Provide test results to citizens.
• Informs citizens about the nearest COVID-19 test centres where they can get themselves tested free of cost.

4. Widespread use of the drug, Ivermectin – The Uttar Pradesh government has issued a government order for not only use of Ivermectin drug to treat COVID-19 patients but also as prevention too.

• The state government provides free medicines to all patients.
• The combination of ivermectin and doxycyclin to successfully treat over three lakh home-isolated patients with mild symptoms so far.

5. Target testing- The strategy of testing of selected groups helped assess the level of infection in the general population and identify and isolate super-spreaders.

• For example- Before festive season, the administration tested mehndi artists, sweet shop workers, jewelers, those working at places of worship, roadside cracker vendors and were able to isolate more than 12,500 infected persons.

Way forward-

Heavy testing, strategic containment, new innovative ideas and management ideas and Government relied measures helped Uttar Pradesh to keep the positivity rate below 5 per cent throughout the pandemic.

• Continuous monitoring of patients in home quarantine has been an extremely helpful step.
• A combination of government policies and technology-based solutions has been put in place to ensure the safety and well-being of people along with the smooth functioning of the state.

Source: Click here

News: India and the UK Government has launched a Virtual Vaccines Hub. 

Facts: 

• Objective: To distribute vaccines for Covid-19 and other deadly viruses by sharing knowledge on clinical trials and regulatory approvals and get vaccines to people who need them most in a safe, secure and energy-efficient way. 

Previous such collaboration with the UK: 

• This Serum Institute and Oxford University partnership demonstrates the UK-India relationship at its best: a vaccine developed in the UK and made in India 
• According to the British High Commission, India supplies over 50 per cent of the world’s vaccines and 25 per cent of the Britain’s National Health Service’s (NHS) generic drugs. 

Need for Collaboration: 

• The new hub will enable both country experts to share knowledge on clinical trials and regulatory approvals. 
• A global pandemic requires a global solution. Scientific cooperation has made breakthroughs on corona virus vaccines at record-breaking pace 
• The UK-India Vaccine Hub will now build on innovations, to bring COVID crisis and also to an end and protect against future pandemics 
• A closer UK-India cooperation on medicines and vaccines approvals will ensure speedy access for the UK to Indian-produced pharmaceuticals and help safeguard future supplies to the National Health Services of Britain. 
• A closer UK-India relationship is a part of a wider UK Programme to focus on partnerships in the Indo-Pacific region.

Global COVAX initiative: 

Millions of doses made will be distributed to the world’s poorest people through the global COVAX initiative, in partnership with World Health Organization (WHO) and Gavi, the vaccine alliance. 

Context: Recently unveiled India’s COVID-19 vaccine policy, should make adequate allowances for ground realities.

What is India’s plan on vaccinating people?

• Strategy to slow the virus spread: With a definitive cure not yet available for COVID-19, vaccines present the world with the best strategy to slow the virus down.
• India’s plan: The U.K. and the U.S. began vaccinating their people, India has announced its plan and proposed line-up for COVID-19 vaccination.
  • Priority population: As per the government’s strategy, the vaccination is to be given first to health-care workers and then to people over the age of 50, with those over 60 given priority, based on the situation. This will amount to about 30 crore people.
  • Verifying document: The voters’ list for the Lok Sabha and Assembly election polls has been set as the verifying document for the process.
  • Co-WIN: A new digital platform, Co-WIN, will be used for COVID-19 vaccination delivery, and about 1.54 lakh Auxiliary Nurse Midwives working on Universal Immunisation Programmes will be roped in as vaccinators, with more such field staff to be mobilised in collaboration with the States.
  • Cold chain systems: Cold chain systems are to be strengthened across the country to deliver multiple doses.

What are the steps to be taken?

• Perception management: They need to clear the fog on vaccine safety and efficacy among the people.
• Detailed plan: A detailed plan must be prepared for vaccinating children and a breakdown of tasks down to the lowest governance rung, as counties in the U.S. have been doing.
  • Unless the latter is done, a proper estimate of the true challenges of administering vaccines in the field will not be available.
• Tackling vaccine hesitancy: Vaccine hesitancy is a reality and the only way to counter that is to be open and honest about adverse effects and make available relevant information in the public realm.
  • In the past, in some States, vaccination programmes have suffered temporarily because of misinformation about adverse events following shots.

Way forward

• In this case, a long-term follow up of all who receive the vaccine is absolutely essential. For, therein lies the assurance that everyone in the global line list is waiting for.

Source: Click here

News: Doctors have witnessed more than 12 cases of Covid-19 triggered Mucormycosis fungus infection.

Facts:

• Black Fungus or Mucormycosis: It is a serious but rare fungal infection caused by a group of molds called mucormycetes which exist in the environment.
• Symptoms: The symptoms are face numbness, one-side nose obstructions or swelling of eyes or pain.
• Vulnerable Group: Mucormycosis mainly affects people who have health problems or take medicines that lower the body’s ability to fight germs and sickness.
• Transmission: It is acquired when spores produced by the mold are inhaled or much less commonly when they enter the body through a cut or other break in the skin.It does not spread between people or between people and animals.
• Diagnosis: Healthcare providers consider medical history, symptoms, physical examinations, and laboratory tests when diagnosing mucormycosis.
• Treatment: It needs to be treated with prescription antifungal medicine. Often, mucormycosis also requires surgery to cut away the infected tissue.

News: NITI Aayog has released a white paper: Vision 2035: Public Health Surveillance in India.

Facts:

• The document is a joint effort of Health Vertical, NITI Aayog and Institute for Global Public Health, University of Manitoba,Canada.

Vision of the Paper:

• To make India’s public health surveillance system more responsive and predictive to enhance preparedness for action at all levels.
• Citizen-friendly public health surveillance systems will ensure individual privacy and confidentiality, enabled with a client feedback mechanism.
• Improved data-sharing mechanism between Centre and states for better disease detection, prevention, and control.
• India aims to provide regional and global leadership in managing events that constitute a public health emergency of international concern.

Key Features of the Vision:

• The white paper lays out India’s vision 2035 for public health surveillance through the integration of the three-tiered public health system into Ayushman Bharat.
• The building blocks for this vision are an interdependent governance between the Centre and states, a new data-sharing mechanism that involves the use of new analytics, health informatics, and data science including innovative ways of disseminating ‘information for action’.

Context:  The Ministry of Health and Family Welfare has released data fact sheets for 22 States and Union Territories based on the findings of Phase I of the National Family Health Survey-5 (NFHS-5).

What are the worrying findings?

• Malnutrition: Of the 22 States and UTs, there is an increase in the prevalence of severe acute malnutrition in 16 States/UTs (compared to NFHS-4 conducted in 2015-16).
  • The percentage of children under five who are underweight has also increased in 16 out of the 22 States/UTs.
  • There is also an increase in the prevalence of other indicators such as adult malnutrition measured by those having a Body Mass Index of less than 18.5kg/m2 in many States/ UTs.
• Anaemia: Anaemia levels among children as well as adult women have increased in most of the States with a decline in anaemia among children being seen only in four States/UTs.
• Obesity: Most States/UTs also see an increase in overweight/obesity prevalence among children and adults, once again drawing attention to the inadequacy of diets in India both in terms of quality and quantity.
• Stunting: The data report an increase in childhood stunting in 13 of the 22 States/UTs compared to the data of NFHS-4.
  • There was a 10 pp decline in stunting among children under five between 2005-06 (NFHS-3) and 2015-16 (NFHS-4), from 48% to 38%, averaging 1 pp a year. This was considered to be a very slow pace of improvement.
• Starvation: Volunteers of the Right to Food campaign have listed over 100 starvation deaths based on media and/or verified fact- finding reports since 2015.
• Food insecurity: Field surveys such as ‘Hunger Watch’ are already showing massive levels of food insecurity and decline in food consumption, especially among the poor and vulnerable households.
  • In the Hunger Watch survey carried out in 11 States, two-thirds of the respondents reported that the nutritional quality and quantity of their diets worsened in September-October compared to before the lockdown.

What are the steps to be taken?

• Improvements: There are some improvements seen in determinants of malnutrition such as access to sanitation, clean cooking fuels and women’s status, a reduction in spousal violence and greater access of women to bank accounts.
• Interventions: Direct interventions such as supplementary nutrition, growth monitoring, and behaviour change communication through the ICDS and school meals must be strengthened and given more resources.
• Progress on maternity entitlements: Universal maternity entitlements and child care services to enable exclusive breastfeeding, appropriate infant and young child feeding, recognising women’s unpaid work burdens have been on the agenda for long, but not much progress has been made on these.
• Strategy: An employment-centred growth strategy which includes universal provision of basic services for education, health, food and social security is imperative.
• Expansion in social protection schemes: Such as the Mahatma Gandhi National Rural Employment Guarantee Scheme, the Public Distribution System, the Integrated Child Development Scheme (ICDS), and school meals have contributed to reduction in absolute poverty as well as previous improvements in nutrition indicators.

Way forward

• It is hoped that the experience of the pandemic, as well as the results of NFHS-5, serve as a wake-up call for serious rethinking of issues related to nutrition and accord these issues priority.

News: The Ministry of Health and Family Welfare has released the fifth edition of the National Family Health Survey(NFHS).

Facts:

• NFHS: It was conducted after a gap of three years.It contains detailed information on population, health, and nutrition for India and its states and Union Territories.
• This is the Phase 1 of the survey conducted in 17 States and 5 Union Territories(UTs).Phase 2 of the survey will cover other states such as Uttar Pradesh, Punjab and Madhya Pradesh.

Key Highlights:

• Increased malnutrition among children: Several States have reversed course and recorded worsening levels of child (under 5 years of age) malnutrition parameters such as child stunting; child wasting; share of children underweight and child mortality rate.
• More Indians are obese and anaemic: The survey has reported an increased share of men and women who were overweight or obese and anaemic (condition in which a person lacks enough healthy red blood cells to carry adequate oxygen to the body tissues).
• Jump in Vaccination: The survey has found considerable improvement in vaccination coverage among children aged 12-23 months across all States/UTs.
• Better household amenities The share of households having access to some basic amenities has increased in most of the states.
• Urban-Rural gender gaps in Internet use: There is an urban-rural gap as well as gender divide with respect to the use of the Internet.On an average, less than 3 out of 10 women in rural India and 4 out of 10 women in urban India ever used the Internet.
• Increase in bank accounts operated by women: The number of bank accounts that women not only hold but also operate themselves has increased dramatically over the past five years.

Context: Nursing education in India suffers poor quality of training, inequitable distribution, and non-standardised practices.

 In News:

• The year 2020 has been designated as “International Year of the Nurse and the Midwife”.
• Nurses and midwives will be central to achieving universal health coverage in India.

What are the structural challenges affecting nursing sector in India?

• Low number of nurses: India’s nursing workforce is about two-thirds of its health workforce. Its ratio of 1.7 nurses per 1,000 population is 43% less than the World Health Organisation norm. it needs 2.4 million nurses to meet the norm.
• Inequal Distribution: Though the number of nursing education institutions has been increasing steadily, there are vast inequities in their distribution. Around 62% of them are situated in southern India.
• Vacancies: The faculty positions vacant in nursing college and schools are around 86% and 80%, respectively.
• Higher qualifications of postgraduate nurses are not recognised: There is a lack of job differentiation between diploma, graduate, and postgraduate nurses regarding their pay, parity, and promotion. Consequently, higher qualifications of postgraduate nurses are underutilised, leading to low demand for postgraduate courses.
• Outdated and fails to cater to the practice needs: The education, including re-training, is not linked to the roles and their career progression in the nursing practice. There are insufficient postgraduate courses to develop skills in specialties, and address critical faculty shortages both in terms of quality and quantity.
• Lack quality training: Multiple entry points to the nursing courses and lack of integration of the diploma and degree courses diminish the quality of training.
• Largely unregulated: The Indian Nursing Act primarily revolves around nursing education and does not provide any policy guidance about the roles and responsibilities of nurses in various cadres. Nurses in India have no guidelines on the scope of their practice and have no prescribed standards of care.
• Lack of accountability for nurses: The Consumer Protection Act which protects the rights and safety of patients as consumers, holds only the doctor and the hospital liable for medico-legal issues; nurses are out of the purview of the Act. This is contrary to the practices in developed countries where nurses are legally liable for errors in their work

What is the way forward?

• A common entrance exam, a national license exit exam for entry into practice, and periodic renewal of license linked with continuing nursing education would significantly streamline and strengthen nursing education.
• Transparent accreditation, benchmarking, and ranking of nursing institutions too would improve the quality.
• The Indian Nursing Council Act of 1947 must be amended to explicitly state clear norms for service and patient care, fix the nurse to patient ratio, staffing norms, and salaries.
• The exodus of qualified nurses must be contained by Incentivising to pursue advanced degrees to match their qualifications, clear career paths, the opportunity for leadership roles, and improvements in the status of nursing as a profession.
• A live registry of nurses, positions, and opportunities should be a top priority to tackle the demand-supply gap in this sector.
• The National Institution for Transforming India (NITI) Aayog has recently formulated a framework for public-private partnership in medical education that could be referred to develop a model agreement for nursing education.

The disabling environment prevalent in the system has led to the low status of nurses in the hierarchy of health-care professionals. The National Nursing and Midwifery Commission Bill currently under consideration should hopefully address some of the issues highlighted.

Source: Click here

News: A not very common type of malaria, Plasmodium ovale has been identified in a jawan in Kerala.

Facts:

• Malaria: It is caused by the bite of the female Anopheles mosquito, if the mosquito itself is infected with a malarial parasite.
• Types: There are five kinds of malarial parasites — Plasmodium falciparum, Plasmodium vivax (the commonest ones), Plasmodium malariae, Plasmodium ovale and Plasmodium knowlesi.
• Is P Ovale different from other Parasites? P ovale is very similar to P vivax and the treatment modality is the same as it is for a person infected with P vivax.
• Prevalence of P Ovale: P ovale malaria is endemic to tropical Western Africa.It is relatively unusual outside of Africa and where found, comprises less than 1% of the isolates.
• Which Malarial Parasite is prevalent in India? In India, out of 1.57 lakh malaria cases in the high-burden states of Odisha, Chhattisgarh, Jharkhand, Meghalaya and Madhya Pradesh in 2019, 1.1 lakh cases(70%) were cases of falciparum malaria.

Note: According to the World Malaria Report 2020, cases of Malaria in India dropped from about 20 million in 2000 to about 5.6 million in 2019.

News: India’s first indigenous mRNA vaccine candidate HGCO19 has received approval from Indian Drug regulators to initiate Phase I/II human clinical trial.

Facts:

• HGCO19: It is a novel mRNA vaccine candidate developed by Gennova, Pune and supported with seed grant under the Ind-CEPI mission of Department of Biotechnology of Ministry of Science & Technology.

Additional Facts:

• mRNA vaccines: It is a new type of vaccine to protect against infectious diseases.It does not use the conventional model to produce immune response.mRNA vaccine carries the molecular instructions to make the protein in the body through a synthetic RNA of the virus.The host body uses this to produce the viral protein that is recognized and thereby making the body mount an immune response against the disease.
  • Advantages: mRNA-based vaccines are scientifically the ideal choice to address a pandemic because of their rapid developmental timeline.The mRNA vaccine is considered safe as is non-infectious, non-integrating in nature and degraded by standard cellular mechanisms.
• Ind-CEPI mission: It is a Department of Biotechnology mission that aims to strengthen the development of vaccines for the diseases of epidemic potential in India as well as build coordinated preparedness in the Indian public health system and vaccine industry to address existing and emerging infectious threats in India.The mission is implemented by Biotechnology Industry Research Assistance Council(BIRAC).

Source: Click here

News: Lancet Citizens’ Commission on Reimagining India’s Health System initiative has been launched.

Facts:

• Lancet Citizens Commission: It is a first of its kind participatory, countrywide initiative in collaboration with world’s leading health journal The Lancet and the Lakshmi Mittal and Family South Asia Institute, Harvard University.
• Objective: To develop a citizens’ roadmap to achieving universal health coverage(UHC) in India over a period of ten years.
• Principles: The Commission will be guided by four principles:
  • UHC covers all health concerns;
  • Prevention and long-term care are key.
  • The concern is financial protection for all health costs and
  • Aspiring for a health system that can be accessed by all who enjoy the same quality.

News: Asian Development Bank(ADB) has launched a $9 billion vaccine initiative—the Asia Pacific Vaccine Access Facility (APVAX).

Facts:

• Aim: To offer rapid and equitable support to its developing members as they procure and deliver effective and safe coronavirus disease (COVID-19) vaccines.
• Criteria: If a country has to obtain finances under APVAX, then it should fulfil one of the three criteria:
  • It must be procured through COVAX.
  • It should be prequalified by World Health Organization
  • It should be authorised by a stringent regulatory authority.

Additional Facts:

• COVAX: It is an alliance co-led by Gavi, the Coalition for Epidemic Preparedness Innovations(CEPI) and WHO.It aims to accelerate the development and manufacture of COVID-19 vaccines and to guarantee fair and equitable access for every country in the world.
• Asian Development Bank(ADB): It is a regional development bank established in 1966 to promote social and economic development in Asia.
  • Members: 68 members, of which 48 are from within Asia and the Pacific and 19 outside.
  • Headquarters: Manila, Philippines.

Source: Click here

News: World Health Organization(WHO) has released the Global Health Estimates 2019.

Facts:

• Global Health Estimates: The report provides a comprehensive and comparable assessment of mortality and loss of health due to diseases and injuries for all regions of the world.The new data of Global Health Estimates cover the period from 2000 to 2019.

Key Takeaways:

• Top Ten Causes of Death: Ischaemic heart disease, Stroke, Chronic obstructive pulmonary disease, Lower respiratory infections, Neonatal conditions, Trachea, bronchus and lung cancers, Alzheimer disease, Diarrhoeal diseases, Diabetes mellitus, Kidney diseases.
• Noncommunicable diseases make up 7 of the world’s top 10 causes of death.This is an increase from 4 of the 10 leading causes in 2000.
• Global decline in deaths from communicable diseases but still a major challenge in low- and middle-income countries.
• Heart disease caused the most deaths and was responsible for 16% of total deaths.Since 2000, it has seen the largest increase in deaths rising by more than 2 million to nearly 9 million deaths in 2019.
• Alzheimer’s disease and other forms of dementia are now among the top 10 causes of death worldwide.Globally, 65% of deaths from Alzheimer’s and other forms of dementia are women.
• Deaths from diabetes increased by 70% globally between 2000 and 2019, with an 80% rise in deaths among males.
• Life expectancy has increased by more than 6 years between 2000 and 2019 – from 66.8 years in 2000 to 73.4 years in 2019.

Source : Click here

News: A new drug called Molnupiravir has been shown to stop the transmission of SARS-CoV-2 (COVID-19) in 24 hours.

Facts:

• Molnupiravir: It is an experimental antiviral drug which is orally active (can be taken orally) and was developed for the treatment of influenza.
• Developed by: The drug is being developed by the biotechnology firm Ridgeback Biotherapeutics in collaboration with pharmaceutical firm Merck.
• Significance: This is the first demonstration of an orally available drug to rapidly block SARS-CoV-2 transmission and it can be a game-changer

Emergency Use Authorisation (EUA)

This article explains the process of Emergency Use authorization, based on The Indian Express Article “Three Covid-19 vaccine developers seek emergency use approval in India” 

Central Drug Standard Control Organisation (CDSCO) has received applications from 3 vaccine developers seeking Emergency Use Authorisation/Approval (EUA) for their candidate Covid-19 vaccines which are still under trial. These Vaccines are COVISHIELD, COVAXIN, and BNT162b2.

None of the Vaccine developers has yet generated data about the effectiveness of their vaccine from phase-III trials conducted in India.

What is the normal process of Vaccine Development?

In normal circumstances, a Vaccines has to go through several phases, with each phase taking many months to get completed, but in the case of COVID, it is expected that vaccines would be in the market within a year from its start, after seeking Emergency Use Approval (EUA) from their respective governments.

After Pre-clinical testing of Vaccines, it is tested on the human under clinical trials before its mass production.

Clinical trials: It involves testing on humans. There are 3 phases of clinical trials;

1. Phase I of a clinical trial is conducted on a small group of healthy individuals. It only indicates what is the ideal dose required to administer in the next stage, it provides evidence of the vaccine’s ability to generate an immune response and its safety.
   1. The vaccine is not considered safe if it develops any major complication, however little headache and fevers are expected.
2. In phase II, the range of participants is expanded to a few hundred healthy participants to check the immune response system in the body and it also assesses the time period for which antibodies last to provide immunity against the virus.
3. Phase-III involves a very large group of people (Thousands of individuals) to investigate its efficiency among large population groups. Half of the population is administered the actual Vaccine and the other half are administered dummy vaccines.
   1. Individuals administered Vaccines are checked on fixed intervals which can be months in normal conditions to see whether their immune system is responding to the virus or not.

After the Vaccine is successfully tested, it would require regulatory approval before it can be produced in bulk quantity.

Emergency Use Authorisation (EUA)

The term “Emergency Use Authorisation (EUA)” has been used mainly by the regulatory agencies like FDA in the US and some other countries with the following guidelines;

FDA has specified that it would consider an application for EUA only if phase 3 data showed

• it was at least 50% effective in preventing the disease.
• This data needed to be generated from “well over” 3,000 trial participants, “representing a high proportion of participants” enrolled.
• These participants needed to be followed up for any serious adverse effects for at least one month after all dosages had been given.
• EUA can be granted only in a declared public health emergency.

Accelerated Approval Process in India

In India, New Drugs and Clinical Trials Rules, 2019 governs Clinical trials of new drugs and vaccines and their approvals.

But the term Emergency Use Authorisation (EUA) has not been used anywhere in rules in India. However, 2019 rules provide for an “Accelerated Approval Process” for granting approval to a drug that is still in clinical trials. The definition of a new drug in the 2019 Rules includes a vaccine.

Conditions for Accelerated Approval Process

• There should be a prima facia case that the drug is of Therapeutic benefits.
• “Accelerated approval may also be granted to a new drug if it is intended for the treatment of a serious, or life-threatening condition, or disease of special relevance to the country, and addresses unmet medical needs,”.
• Approval can be granted even if “remarkable” effectiveness is reported even from phase-II trials.

Approval granted to drugs or vaccines that are still in clinical trials is temporary, and valid only for one year. 

Examples of granting EUA

• FDA granted its first EUA for use of Tamiflu drug for infants and young children for the treatment of H1N1 infection for the civilian population in 2009.
• Remdesivir or faviparir, are existing drugs approved for other ailments received EUA for treatment of Covid-19, including in India.

Issues in EUA of Vaccines

• Due to tolls or public sentiments, Governments are putting pressure on regulatory bodies to fast-track the entire process of Vaccine development. 
• Lack of transparency about vaccine safety and efficacy may negatively impact people’s confidence and willingness to get vaccinated.
• Some surveys have shown that there is vaccine hesitancy among a certain section of people due to the hastening of the vaccine development process.
• Whereas FDA has formulated its guidelines 50% effectiveness and no. of participants, the Indian regulator has not formulated any such guidelines.
• Another issue with EUA-approved drugs and treatments is that they can reflect and exacerbate already existing inequities in the health system if the vaccine administered is found out to be ineffective. It might create a huge burden on the pocket of poor people.
• There are examples of granting EUA to certain drugs like hydroxychloroquine, a malaria drug in haste, which later proved to be ineffective treatment, and the risks of taking it outweighed any benefits.
• If a drug proved to be ineffective later on, after its administration to a huge population, it would be very harmful to the people’s confidence, economy, and health system of the country.

Way forward

Concerns regarding use of Vaccines can be addressed when all stakeholders are transparent at every stage of development and not by merely sharing guidelines regarding vaccine safety with the States. It is important that those seeking emergency-use authorisation share the safety and efficacy data with the authorities and public immediately.

Context: It has been only nine months since COVID-19 was declared a pandemic on March 11, but the world has changed in previously unimaginable ways.

Discuss the challenges put forth by the pandemic.

• Health systems: The health systems in many of the wealthy countries struggled; some were overwhelmed due to inadequate beds, supplies and healthcare workers who struggled with infection, fatigue and stress, recognising their inability to care for everyone who needed it.
• Damage by virus: Outside the healthcare system, the information epidemic (termed an “infodemic”) in society led to fear, stigma and discrimination that added to the damage caused by the virus.
• Learning: The closure of schools affected the learning of children, with those from disadvantaged backgrounds struggling to cope and frequently giving up.
• Accessibility: Access to non-COVID-19 essential health services was affected, the impact of which will be fully understood in the time ahead.
• Business activities: Reduction in business activities caused massive losses of both formal and informal employment and a fall in economic growth.

How did the countries tried to cope up with the challenges?

• Health services: COVID-19 related health services including hospital beds, intensive care unit (ICU) and ventilator beds were increased even as research on drugs and vaccines kicked off at an exceptional rate.
• Vaccines: Vaccines have moved even faster than drugs with over 300 vaccine candidates being developed, nearly 40 of them undergoing clinical trials.
• The accredited social health activists: ASHA who visited hundreds of households repeatedly during the pandemic to ensure that every possible case is identified as early as possible.

What did the other countries which handled the pandemic successfully do?

• The countries which handled the pandemic best: Thailand and Vietnam have well-functioning health systems designed to deliver primary healthcare services.
  • These countries also have strong preventive and promotive health services as well as a dedicated public health workforce.
• The role of community health workers: In recognising, referring and motivating individuals for therapy was remarkable.
  • Community trust and participation is essential for implementation of non-pharmacological interventions.
  • Dharavi in Mumbai is an example of the difference community participation can make.
• The response to the pandemic was multi-sectoral: Health staff, policy makers and technical experts in multiple domains worked together to identify and implement solutions.
• Quality data: The need for timely and quality data in a health information system was recognised again during the pandemic.

Way forward

• Investments in scientific research:  The solutions that have brought us hope have come from long-term private or public investments in scientific research and developments. It is self-evident that we need to emphasise what is feasible when resources are available.
• National health policy: All we need is commitment and that is outlined in the recent National Health Policy 2017 and reiterated in the report of the Fifteenth Finance Commission, which for the first time has a dedicated chapter on health.

This is an opportunity and should use the challenge posed by the pandemic to accelerate long pending initiatives for health system reforms, accelerating towards universal health coverage, the central goal of the National Health Policy 2017.

Context- The problem with sanitation in India is not lack of infrastructure but the social and cultural stigma attached to it.

What is the state of sanitation in India?

1. Lack of proper toilets– the lack of proper restrooms makes long distance journeys an ordeal for women.

• However, NHAI maintains one restroom every 40-50 Km, but their hygiene standards are not monitored.

2. A high proportion of the population does not have access to “improved sanitation”.

• Improved sanitation is defined as facilities that “ensure hygienic separation of human excreta from human contact”.

3. Work related discrimination-Sanitation workers are compelled to travel to their workplaces in garbage trucks, standing next to the very garbage they clean and collect.

• Neither users nor the sanitation workers feel equal.

4. In spite of a well-funded programme such as the Swachh Bharat Abhiyan in operation, little attention is devoted to this aspect of sanitation.

What are the issues related to scavenging in India?

1. Caste system– Caste hierarchy still exits and it reinforces the caste’s relation with occupation.

• Only country that not only differentiates spaces as pure and impure but also its people.
• The social status of this section has been permanently fixed.
• Government discussions and policies hardly address this stigma.

2. Lack of physical resources– Adequate machinery to clean septic tanks, protective gears and flush toilets are not available.

What are the steps taken by the government to address this problem?

1. Prohibition of Employment as Manual Scavengers and their Rehabilitation Act–
2. Prohibition:The act prohibits the employment of manual scavengers, manual cleaning of sewers and septic tanks without protective equipment, and the construction of insanitary latrines.
3. Rehabilitation:It seeks to rehabilitate manual scavengers and provide for their alternative employment.

• The act ensures the rehabilitation of manual scavengers to be identified through a mandatory survey.
• Mechanized cleaning of septic tanks is the prescribed norm.
• The act also directed the government to pay a compensation of 10 lakh rupees to the family members of those killed in acts of manual scavenging since 1993.

Way forward-

• Adopting technology to end manual scavenging– Government’s move to use machines is a first step towards according dignity and respect to sewer workers.  However, technology’s emancipatory powers will be realized at their fullest only when the states stop living in denial about manual scavenging.
• Direct allocation of funds– Social Justice and Empowerment Ministry said that it would directly transfer funds to ‘sanitation workers’ to buy cleaning machines, instead of contractors or municipal corporations.

Context: Safety and efficacy data for the new vaccine must be known before emergency-use authorisation for vaccines.

Why in news?

• The Pune-based Serum Institute of India has approached the regulator for nod for its vaccine, Covishield, developed by Oxford University.
• AstraZeneca, which is carrying out the phase-3 trials of the Oxford vaccine in four countries, is yet to secure a nod from any of the regulatory agencies.
• AstraZeneca recently gave details of the interim safety and efficacy data involving 131 COVID-19 cases in the phase-3 trials in the U.K. and Brazil. But details of the trials in India are not out yet.

Why fast tracking of vaccine authorization is needed?

• The unprecedented speed in taking the vaccine from the development stage to approval process in less than a year is remarkable but also necessitated by the toll the virus has taken on lives and livelihoods.
• To reduce mortality and morbidity.

What are the concerns associated with authorization of vaccines?

• Regulatory bodies under pressure: to fast-track the entire process.
• Lack of transparency: Opaqueness about vaccine safety and efficacy does no good in gaining people’s confidence and willingness to get vaccinated.
  • For example, Moderna, Pfizer and AstraZeneca took the extraordinary step of publicly sharing the trial protocol, the time points at which interim analysis of phase-3 trial in India will be carried out for safety and efficacy is unclear.
• No checks: the U.S. FDA has clearly spelt out at least 50% efficacy and stipulated a median follow-up duration of at least two months after completion of the full vaccination regimen to assess a vaccine’s benefit-risk profile for emergency-use approval. However, no such conditions have been mentioned by the Indian regulatory agency. The phase-3 trial of Covishield began on September 21 and completed the enrolment on November 12.
• Fear of side effects and vaccine hesitancy: ineffective or unsafe vaccine is worse than not having one.A survey by the London-based Vaccine Confidence Project revealed that though the intent to get vaccinated was 87% in India, 34% respondents were worried about side-effects while 16% were concerned about fast-moving trials.

What needs to be done?

• Need to engage all stakeholders in a transparent manner at every stage and not by merely sharing guidelines regarding vaccine safety with the States.
• It is also important that those seeking emergency-use authorisation share the safety and efficacy data immediately.

For further read about Emergency Use Authorisation : Click here

Source: Click here

News: Government of India has a notification listing out specific surgical procedures that a postgraduate medical student of Ayurveda must be practically trained to acquaint with as well as to independently perform.

Facts:

• How far is surgery part of Ayurveda? There are two branches of surgery in Ayurveda — Shalya Tantra which refers to general surgery, and Shalakya Tantra which pertains to surgeries related to the eyes, ears, nose, throat and teeth.All postgraduate students of Ayurveda study these courses and become Ayurveda surgeons.
• Earlier Regulations for Postgraduate students in Ayurveda: They are guided by the Indian Medical Central Council (Post Graduate Education) Regulations,2016.The regulations allow postgraduate students to specialise in three disciplines of surgery namely Shalya Tantra, Shalakya Tantra, and Prasuti evam Stree Roga (Obstetrics and Gynecology).
• What is the change? Ayurveda practitioners say the notification just brings clarity to the skills that an Ayurveda practitioner possesses.The surgeries that have been mentioned are all that are already part of the Ayurveda course.But there is little awareness about these.
• Indian Medical Association’s(IMA) objections: IMA insist that they are not opposed to the practitioners of the ancient system of medicine.But the notification gives the impression that the skills or training of the Ayurveda doctor in performing modern surgeries are the same as those practising modern medicine. This is misleading and an encroachment into the jurisdiction and competencies of modern medicine.

Context:  Antimicrobial resistance (AMR), a silent pandemic, is growing at an alarming rate.

Why is AMR growing at an alarming rate?

• AMR:  Globally, about 35% of common human infections have become resistant to available medicines.
• About 700,000 people die every year because available antimicrobial drugs (antibiotics, antivirals, anti-parasitic and antifungals) have become less effective at combating pathogens.
• Resistance to second- and third-line antibiotics the last lines of defence against some common diseases are projected to almost double between 2005 and 2030.
• According to a study published in The Lancet, an estimated 58,000 new-born children die annually from sepsis in India alone because antibiotics can no longer treat certain bacterial infections.
• Reasons for AMR:
• Microorganisms develop resistance to antimicrobial agents as a natural defence mechanism. Human activity has significantly accelerated the process.
• The misuse and overuse of antimicrobials for humans, livestock and agriculture is probably the biggest reason for this.
• Research points to the role of environment and pollution in AMR.
  • Once consumed, up to 80% of antibiotic drugs are excreted un-metabolised, along with resistant bacteria.
• Release of effluents from households and health and pharmaceutical facilities, and agricultural run-off, is propagating resistant microorganisms. Wastewater treatment facilities are unable to remove all antibiotics and resistant bacteria.

What are the problems faced?

• Issues faced: In India, there is capacity to treat only about 37% of the sewage generated annually. The rest is discharged into natural water bodies without treatment.
• An analysis of single wastewater discharge from a treatment facility in India catering to drug manufacturers found concentrations of antibiotics high enough to treat over 40,000 people daily.
• Mode of spread: Water may be a major mode for the spread of AMR, especially in places with inadequate water supply, sanitation and hygiene.
• Wildlife that comes into contact with discharge containing antimicrobials can also become colonised with drug-resistant organisms.

What are the key initiatives to tackle AMR?

• UNEP: The United Nations Environment Programme (UNEP) identified antimicrobial resistance as one of six emerging issues of environmental concern in its 2017 Frontiers Report.
• The UN Environment Assembly pressed the need to further understand the role of environmental pollution in spreading AMR.
• GAP: UN agencies are working together to develop the One Health AMR Global Action Plan (GAP) that addresses the issue in human, animal, and plant health and food and environment sectors.
• MoEF&CC: The Ministry of Environment, Forest and Climate Change (MoEF&CC) issued draft standards which set limits for residues of 121 antibiotics in treated effluents from drug production units.
• The Ministry of Health and Family Welfare and MoEF&CC constituted the inter-ministerial Steering Committee on Environment and Health, with representation from WHO and UNEP.

Way forward

• The Centre and State governments in India can strengthen the environmental dimensions of their plans to tackle antimicrobial resistance.
• It is particularly important to promote measures that address known hotspots such as hospitals and manufacturing and waste treatment facilities.

Context- The challenges vaccine poses to qualify as a ‘public health’ intervention in India.

What is the purpose of vaccination?

1. Individual prevention- – The ability to develop immunity by producing antibodies among those individuals who have taken a vaccine shot.

• It builds an adaptive immune system

2. To achieve herd immunity– It is a concept used for vaccination, in which a population can be protected from a certain virus if a threshold of vaccination is reached.

• Herd immunity refers to community protection.
• The threshold coverage is estimated to be around 60% for COVID-19 vaccine to achieve population-level immunity.
• The idea of herd community is to protect the vulnerable.

What are the concerns related to vaccination?

1. Safe immunization– There are three major elements of immunization safety.

• Health care providers must be concerned with the safety of vaccines themselves (their composition),
• Administration of the vaccination (handling, scheduling, and injections),
• And surveillance and evaluation of the immunization program, including documentation of vaccine efficacy and the probability of adverse events.

2. Economic concern-The huge economic resources will be needed to make the vaccine available for a large population.
3. Lack of infrastructure– Vaccines require cold chain infrastructure for storage. Logistical and Infrastructural issues in storage of vaccines hampering it’s penetrability in the rural hinterland.
4. Cost- If open market forces determine the cost of the vaccine and affordability then, the section of society most vulnerable to the disease would get left out.
5. Credibility- ears regarding safety and credibility can be almost impossible obstacles to overcome and must be addressed head-on.

 What are the challenges related to population based vaccination programme?

Priority- Within the country, it is certainly not clear who should be treated first or it should be determined by need, affordability, vulnerability or some other criterion or a combination of all.

The outcome is the clear– If this process target only specific population group then its very purpose will be defeated as the pandemic can infect all groups similarly.

What is the way forward?

• It is safe to demonstrate the success of vaccination as a public health intervention in a small population, like a block or a district, before scaling it up for the national level.
• However, if herd immunity is not the focus, then the key purpose of COVID-19 vaccines will be to ensure individual immunity.
• Protect the vulnerable– Use the first limited supplies of vaccines to protect those most in need, without worrying about the more robust members of the “herd”.

Source: Click here

News: World Health Organization(WHO) has released the World Malaria Report 2020.

Facts:

• Aim: To look at the 20 years of global progress and challenges in the fight against the Malaria.

Key Takeaways:

• Malaria Control: The two decades from 2000 to 2020 was a period of extraordinary success in malaria control: As many as 1.5 billion cases and 7.6 million deaths were averted.
• Burden of Malaria: At least 29 countries accounted for 95% malaria cases globally, with Africa carrying the highest burden.The continent accounted for 94% of the world’s malaria cases and deaths with an estimated 215 million cases in 2019.
• India: India is the only high endemic country which has reported a decline of 17.6% in 2019 as compared to 2018.India has contributed to the largest absolute reductions in the WHO South-East Asia Region from about 20 million cases in 2000 to about 5.6 million in 2019.
• Malaria Free: Sri Lanka was certified malaria free in 2015 and Timor-Leste reported zero malaria cases in 2018 and 2019.
• Concerns: The gains made in malaria control have levelled off in recent years and more so in the wake of COVID-19 as pandemic caused disruptions in essential malaria services.

Recommendations:

• WHO Initiatives: High burden to high impact initiative is a country-led response supported by WHO and the RBM Partnership to End Malaria to reignite the pace of progress in the global malaria fight.
• Examples to implement: The report referred to the Mass Action Against Malaria initiative in Uganda which is an example of a country-led process of political engagement at all levels and multi-sectoral and community mobilisation.
• National Plan for Insecticide Resistance: It has called on countries to develop a national plan for insecticide resistance monitoring and management and draw on the WHO Framework for a national plan for monitoring and management of insecticide resistance in malaria vectors.

Additional Facts:

• Malaria: It is a disease caused by Plasmodium parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes.

Source: PIB, Indian Medicine Industry-RSTV , FDI data of Ministry, Mint,  

Relevance:  

• • Recently PM follows up his 3 city visit by a virtual meeting with 3 more vaccine developers based in Pune and Hyderabad  
  • Ambassadors of 100 countries are scheduled to arrive in Pune on December 4, to visit Serum Institute of India and Gennova Biopharma.   

Sweden has already acknowledged India’s role as the ‘pharmacy of the world’ and is focusing on expanding bilateral cooperation in the areas of health and life sciences in view of the Coronavirus pandemic. 

How big is Indian Pharma Sector? 

• From 2000-2019 Pharma sector alone contributed for FDI inflows worth $16.2bn and it is expected to rise during COVID pandemic. 
• Recent Economic Survey acclaimed Pharma sector as one of the top 5 sector which reduce trade deficit of India 
• More than 80% worlds Anti Retro-viral drugs depend on India 
• India is the largest producer of vaccines even before COVID pandemic and controlled more than 50% of global supplies. 
• Bio-Pharma is the largest sector contributing to 62% of the total revenue 
• It is estimated that medical tourism in the country can grow and become a 9 billion dollars industry this year 
• 20% of global generic medicine has been controlled by India. 

How Indian Pharma Sector is regulated? 

• Under Drugs and Cosmetics Act 1940 (For Source click here) was the central legislation that regulates India’s drug and cosmetic import, manufacture, distribution and sale. 
• The Act clearly defines the spurious drugs, adulterated drugs and mis branded drugs. 
• This also established the Central Drugs Standard Control Organization (CDSCO) 
• The Act establishes the regulatory control over the manufacture and sale of drugs 
• State Health department has to regulate the manufacturing, sales and distribution of drugs 
• Drug Inspectors will control the implementation at ground level. 

Central Drugs Standard Control Organization (CDSCO) Source 

• Central Drug Authority for discharging functions assigned under the Drugs and Cosmetics Act 
• The CDSCO works in the Directorate General of Health services, is a division in Ministry of Health and Family welfare 
• The CDSCO is headed by Drug Controller General of India (DCGI). 
• It was advised by Drug Technical Advisory Board and Drug Consultative Committe 

Potential lead for enormous growth of Pharma Sector: 

• The growing population of over a billion along with diversity among people offers An excellent centre for clinical trials 
• Focus on low cost, efficient drugs lead to growth of the sector in terms of Value and Volume 
• Low cost of production and Low R&D costs in India 
• A huge patient base from domestic and from foreign as a medical tourist 
• Improving healthcare infrastructure in India 
• An increase in lifestyle-related diseases such as diabetes, cardiovascular diseases, and central nervous system. 
• Penetration of health insurance is increased 
• Adoption of patented products by Indian Pharma Sector. 
• Patent expiration and aging population in the US, Europe, and Japan.