📰 One lakh tonnes of free food grain distributed so far under PMGKAY
In the first 10 days, grains have reached 2.03 crore of 80 crore beneficiaries: Food Ministry
•Out of the 40 lakh tonnes of free food grain promised under the Pradhan Mantri Garib Kalyan Anna Yojana for May, one lakh tonnes have been distributed so far, Food Secretary Sudhanshu Pandey said on Monday.
•In the first 10 days, PMGKAY grains have reached 2.03 crore of the 80 crore beneficiaries, with 13 States and union territories having started distribution, according to the Ministry data provided in a virtual press briefing. The States which have started distribution of the 5 kg of free rice and wheat include Andhra Pradesh, Arunachal Pradesh, Haryana, Himachal Pradesh, Jharkhand, Karnataka, Maharashtra, Tripura and Uttarakhand.
•The progress is on expected lines, given the eight-month experience of implementing the PMGKAY during the first wave of COVID-19 in 2020, said Food Ministry Joint Secretary S. Jagannathan. He added that 34 States had already begun lifting food grains from the Food Corporation of India’s stock, and 15.5 lakh tonnes had been lifted so far.
•Asked about the needs of migrant workers affected by the lockdown, as well as others without ration cards, Mr. Pandey said that “this time, migrants are not facing that kind of crisis” as there was during last year’s lockdown. There was also no national lockdown this year, but only State and local lockdowns, he said, noting that migrants who reached home would be able to avail ration in their villages, while those still in the cities would make use of the ration card portability scheme. The Centre was also selling its food grain stock at a discounted rate to NGOs and to State governments for those with State ration cards, he said.
Plea by activists
•However, Right to Food activists have filed an intervention application in the Supreme Court’s suo motu case on migrant workers, saying that migrants are facing distress during the current local lockdowns as well, and seeking a resumption of last year’s scheme to give free food grains to those without ration cards as well. In an open letter to the Chief Justice on Monday seeking an urgent listing of their plea, petitioners Harsh Mander, Anjali Bhardwaj and Jagdeep Chhokar said payment of minimum wages as cash transfers and appropriate transport facilities for migrant workers were needed as well.
•With regard to edible oil prices, which had shot up over 50%, Mr. Pandey said the release of imported stock stuck at Kandla and Mundra ports due to COVID-19 related clearance issues would help to ease the situation.
It was responding to criticism that its inoculation push is crumbling
•The COVID-19 vaccination drive is the “biggest” ever and “completely different” from the immunisation drives of the previous decades, the Union government on Monday responded to criticism that its inoculation push is crumbling.
•The government said that unlike the vaccination campaigns of the past, the COVID-19 immunisation drive did not have the “luxury” of time.
•Scientists, in those years, had the breathing space to research and develop. There was time to manufacture and distribute vaccines unlike in the case COVID-19, which crashlanded on humanity. The current need for vaccination was both “emergent and urgent”. Critics and experts have said the government has many a lesson to learn from the polio immunisation drive conducted decades ago.
•“This drive to vaccinate each and every adult person in the country is completely different from other vaccinations conducted by the country in the past in more than one way... The vaccines [for COVID-19] are developed very recently throughout the world and therefore, their production has also started very recently. Another peculiar feature of this vaccination is that the vaccine requires two doses, separated by four to eight weeks,” the government reasoned in a 218-page affidavit filed in the Supreme Court.
•A three-judge Bench led by Justice D.Y. Chandrachud could not hear arguments on the affidavit due to technical glitches during the virtual hearing. The hearing was adjourned to Thursday.
•In the affidavit, the Centre assured the equitable allocation of vaccines to States. It said it had determined, in consultation with the vaccine manufacturers, the State-wise “pro rata” population of those within the target age of 18 and 44.
•“Each State will procure only that quantity so that there is no disparity in availability of vaccines between the States inter se either based upon difference in their bargaining power or otherwise,” the government pointed out. It said each State government had been informed about the number of vaccines it would receive in May.
“View India as one unit”
•The Centre asked the States to maintain discipline and view India as “one unit”. The efforts to combat the virus should be “pan Indian”. One State should not try to procure vaccine at the cost of other States.
•Recently, the Mamata Banerjee government had criticised the Centre in the apex court on the differential vaccine pricing and how the Centre, at ₹150 a vaccine, had got a cheaper deal than the States. The West Bengal government had also pointed out how bigger States could negotiate better prices with the vaccine manufacturers, leaving smaller States with miniscule resources high and dry.
•Explaining its ‘cheaper deal’, the Centre said it had a “large vaccination programme” and had to place “large purchase orders” for vaccines as opposed to the State governments and private hospitals. “Therefore, this reality had some reflection in the prices negotiated,” it explained.
•On the bigger States allegedly bullying and getting the better of smaller ones over vaccine purchases, the Centre said it had had “informal consultations” with the vaccine manufacturers and ensured that the prices of vaccine would be “uniform” for all the States. The Centre, however, made it a point to mention that citizens would not be affected by the pricing as all the State governments have already declared that they would administer the vaccines free of cost. The affidavit said the Centre encouraged citizens who can afford to pay for their vaccine jabs at private hospitals, as this would “facilitate better access and will reduce the operational stress on the government vaccination facilities”.
Online slotting
•The Centre said vaccination would be done by online slotting and those who did not have online Internet access could take the help of family, friends, NGOs, etc.
•The government shot down the idea of bringing vaccines under a statutory regime at this point of time. “Both manufacturers [one an Indian company and second a licensee of a British company] have taken financial risk in developing and manufacturing these vaccines and it was prudent to take decisions on pricing through negotiations in a transparent consultative process keeping statutory provisions as a last resort,” it stated.
•Different vaccines were differentially priced to foster a competitive market and to attract manufacturers from abroad. This would increase the availability of vaccines in India. “Differential pricing is based on the concept of creating an incentivised demand for the private vaccine manufacturers in order to instil a competitive market resulting in higher production of vaccines and market driven affordable prices for the same,” it observed.
📰 SEBI’s sustainability reporting norms mandate ESG overview
Disclosures must on gender diversity, cybersecurity
•The Securities and Exchange Board of India (SEBI) on Monday issued a circular notifying new disclosure norms on sustainability related reporting for the top 1,000 listed companies by market cap by FY23.
•Such a reporting will now be under a new business responsibility and sustainability report (BRSR) format. The decision was first made at SEBI’s board meeting on March 25.
•“The BRSR is a notable departure from the existing business responsibility report and a significant step towards bringing sustainability reporting at par with financial reporting,” SEBI said in the circular.
•Now, the companies will need to provide an overview of their material environmental, social, governance risks and opportunities and approach to mitigate or adapt to the risks along with financial implications.
•Sustainability related goals and targets and performance and environment-related disclosures covering aspects such as resource usage (energy and water), air pollutant emissions, greenhouse emissions, transitioning to circular economy, waste generated and waste management practices and bio-diversity may have to be provided.
•The social-related disclosures will cover the workforce, value chain, communities and consumers.
•Companies will have to disclose the gender and social diversity of employees, including measures for differently-abled employees and workers, turnover rates, median wages, welfare benefits to permanent and contractual employees / workers, occupational health and safety and trainings. On the community front, companies need to make disclosures on social impact assessments (SIA), rehabilitation and resettlement and corporate social responsibility. For consumers, they have to make disclosures on product labelling, product recall and complaints in respect of data privacy and cybersecurity.
•To give time to companies to adapt to the new requirements, the reporting of BRSR will be voluntary for FY22 and mandatory from FY23. However, companies are encouraged to be early adopters of the BRSR, thus being at the forefront of sustainability reporting, SEBI said.
📰 Vaccine skirmishes: On production of COVID-19 vaccine
IPR waiver will not bring immediate benefits; the effort must be to share the stockpile
•The Biden administration’s announcement that it would support a waiver on intellectual property rights (IPR) for the production of COVID-19 vaccines appeared to catch the world off-guard, on both sides of the argument. The original proposal for the relaxation of TRIPS for such vaccines in the context of the ongoing pandemic was drafted at the WTO by India and South Africa last year. Months before it was tabled, during the 2020 U.S. presidential election, erstwhile candidate Joe Biden vowed that should he win, he would “absolutely positively” commit to sharing vaccine technology with countries that needed it, perhaps anticipating the deep chasm of inequality in vaccine access. Now that his administration has proclaimed its intent to fulfil that promise, it must come as a bitter realisation that what sounds like a well-intentioned, pro-developing-countries policy stance has been rebuffed by major EU nations and met with counter-suggestions that might make even the most liberal U.S. Democrats uncomfortable. The first pushback salvo came from Germany which said that it would create “severe complications” for the production of vaccines, echoing the view of major pharma corporations. While French President Emmanuel Macron had appeared relatively less hostile to considering the proposal earlier, he lashed out at the “Anglo-Saxons” for impeding vaccine availability globally by blocking the export of ingredients.
•There are merits to the argument that an IPR waiver, even if it were to become a reality, may not entirely resolve the vaccine deficit issue in countries suffering the worst of the pandemic now. First, the grant of a waiver would have to be accompanied by a “tech transfer” that provides generic pharmaceutical manufacturers with the requisite trained personnel, raw materials and hi-tech equipment and production know-how. Second, there must be a scientifically convincing answer to the question of how any vaccine then produced by these generic manufacturers — in all likelihood, years from now — would pass the tests of safety, immunogenicity and protective efficacy. Third, the impact on global supply chains for vaccine production should be examined so major disruptions might be avoided. Finally, alternative options to urgently address vaccine shortfalls should be considered, including developed nations sharing a significantly greater part of their vaccine stockpiles, particularly in cases where the latter exceed projected domestic need. Indeed, there is speculation that the intention behind Mr. Biden’s waiver proclamation might be in favour of the last outcome, essentially a tactic to persuade pharmaceutical companies to accept less painful measures including sharing some of their technology willingly, agreeing to joint ventures to increase global production expeditiously, and simply produce more doses at affordable prices to donate directly to where the need is most severe, especially India.
📰 A national health service in India
It is time to revive a plan that is modelled on the British National Health Service
•“When we fall sick, we die.” The villager who said that to a student of mine may have got unpleasantly close to the truth about the condition of healthcare in India. The current surge in COVID-19 infections has exposed problems amounting to near-chaos throughout Indian healthcare, even if the pandemic has also brought to light Herculean attempts by medical staff, patients’ families, and governments to try and cope with what has been called a tsunami, one which is rapidly getting worse.
•While those involved in the clinical response are clearly doing their often-desperate best — care staff are at high risk of contracting COVID-19 — the Central and State governments are now coordinating measures within and across their respective jurisdictions. For example, the railways are running special trains carrying oxygen supplies, and the military is also involved in supply chains. The Karnataka government has ordered private hospitals above a certain size to reserve 75% of their beds for COVID-19 patients who will be paid for under a public scheme. Other States have taken similar measures. The Supreme Court has, suo motu, called for a national plan to deliver oxygen and vaccines.
•The responses to the worsening COVID-19 crisis are, nevertheless, not free of tensions. Some private healthcare providers have objected to public authorities’ orders on widened patient access, and the Supreme Court’s call for a national supply plan has been publicly criticised in the political sphere. Some of the problems have occurred on previous occasions. At least one private hospital chain has lost a court action over its failure to treat a government-specified quota of poorer patients; the quota was a condition of help with land allocation to build a hospital.
System under strain
•Yet the current crisis may well redirect national attention to what is only barely recognisable as a system of healthcare. India’s fragmented, often corrupt, urban-centred, elite-focused and wretchedly underfunded agglomeration of clinics, hospitals, and variably functional primary health centres can look like no more than an accidental collection of institutions, staff, and services. India’s public spending on health is set to double in the 2021-22 financial year, but that is from a figure that has long been only a little over 1% of GDP. In certain rural areas, the doctor-population ratio is over 1:40,000.
•India’s healthcare providers, however, have the task of serving 1.4 billion people, for the overwhelming majority of whom sickness or serious injury of any kind is a matter of lifelong dread. Medical expenses constitute the major reason for personal debt in India, whether the causes are episodic afflictions or, for example, those caused by environmental conditions which none can escape, such as air pollution (which the journal Lancet Planetary Health says this accounted for 1.7 million deaths in India in 2019; the annual business cost of air pollution is currently estimated at $95 billion, which is about 3% of India's GDP).
An idea whose time has come
•In effect, COVID-19 may bring about serious consideration of an Indian national health service. National public discussion of that would be almost unprecedented in India, but the idea itself is not new. In 1946, the civil servant Sir Joseph Bhore submitted to the then government a detailed proposal for a national health service broadly modelled on the British National Health Service or NHS, which was on the way towards legislative approval in Britain. Bhore went further by recommending that preventive and curative medicine be integrated at all levels. The British plan had been drafted in the 1930s, as problems worsened in healthcare services. The fact of the Second World War, in the darkest hours of which a plan was prepared to transform Britain into a post-war social democracy with a comprehensive welfare state and a universal free public health service supporting a mixed economy, may therefore have been catalytic rather than decisive in the creation of the NHS.
•The result is a mighty achievement in public policy, politics, and the provision of top-class universal healthcare, including training, research, and changing engagement with the public as society changes. The service is funded entirely from general taxation. The budget includes payment to general practitioners, most of whom remain private providers but are paid by the state for treating NHS patients. Items listed in general practitioners’ prescriptions incur no charges in the devolved regions of Scotland, Wales, and Northern Ireland, and in practice only a proportion of patients in England have to pay for prescription items. All hospital treatment and medicines are free, as are outpatient and follow-up appointments. The British public share the costs through their taxes, and almost without exception receive treatment solely according to their clinical needs. With about 1.1 million staff, the NHS is the largest employer in the U.K. Its current budget is about 7.6% of GDP, but despite its size and scale, it provides highly localised access to care.
Problems in the NHS
•Of course, problems have arisen. Among them are largely unintended inequalities in the time and attention given to patients of different social classes (this discovery resulted in substantial changes), huge and frequent reorganisations imposed by Central government, and often ideologically driven underfunding. Nevertheless, many senior hospital consultants who were opposed to a public health service when the NHS started have declared unreserved support for it in at least one national conference resolution. An authority on the NHS has said that it is the most loved and trusted institution in the country and is held in even higher regard than the monarchy.
•India now faces a very serious health crisis, possibly the worst since Independence. By all accounts, several areas of the Indian healthcare provision are under severe strain. The precise structure envisaged by Bhore may need some adaptation for today’s society and conditions but dealing effectively with the pandemic may itself require the urgent creation of an Indian National Health Service.
📰 Decoding inequality in a digital world
Technological changes in education and health are worsening inequities
•Virginia Eubanks’ widely acclaimed book, Automating Inequality, alerted us to the ways that automated decision-making tools exacerbated inequalities, especially by raising the barrier for people to receive services they are entitled to. The novel coronavirus pandemic has accelerated the use of digital technologies in India, even for essential services such as health and education, where access to them might be poor.
•Economic inequality has increased: people whose jobs and salaries are protected, face no economic fallout. The super-rich have even become richer (the net worth of Adani has increased). The bulk of the Indian population, however, is suffering a huge economic setback. Several surveys conducted over the past 12 months suggest widespread job losses and income shocks among those who did not lose jobs.
•Worse than the immediate economic setback is that well-recognised channels of economic and social mobility — education and health — are getting rejigged in ways that make access more inequitable in an already unequal society.
The switch in learning
•For a few, the switch to online education has been seamless. Notwithstanding the Education Minister’s statement in Parliament that no one had been deprived of education because of online learning, at least two young students took their own lives because they could not cope — a college student studying in Delhi and a 16-year-old in Goa whose family could not afford to repair the phone he used.
•According to National Sample Survey data from 2017, only 6% rural households and 25% urban households have a computer. Access to Internet facilities is not universal either: 17% in rural areas and 42% in urban areas. Sure, smartphones with data will have improved access over the past four years, yet a significant number of the most vulnerable are struggling. Surveys by the National Council of Educational Research and Training (NCERT), the Azim Premji Foundation, ASER and Oxfam suggest that between 27% and 60% could not access online classes for a range of reasons: lack of devices, shared devices, inability to buy “data packs”, etc. Further, lack of stable connectivity jeopardises their evaluations (imagine the Internet going off for two minutes during a timed exam).
•Besides this, many lack a learning environment at home: a quiet space to study is a luxury for many. For instance, 25% Indians lived in single-room dwellings in 2017-19. If between two and four people share a single room, how can a child study? For girls, there is the additional expectation that they will contribute to domestic chores if they are at home.
•Peer learning has also suffered. When students who did not study in English-medium schools come to colleges where English is the medium of instruction, they struggled. Yet, surrounded by English speakers, however falteringly, many managed to pick up the language. Such students have been robbed of this opportunity due to online education.
•While we have kept a semblance of uninterrupted education, the fact is that the privileged are getting ahead not necessarily because they are smarter, but because of the privileges they enjoy.
Need a bed? Have an app
•Something similar is happening with health care. India’s abysmally low public spending on health (barely 1% of GDP) bears repetition. Partly as a result, the share of ‘out of pocket’ (OOP) health expenditure (of total health spending) in India was over 60% in 2018. Even in a highly privatised health system such as the United States, OOP was merely 10%. Moreover, the private health sector in India is poorly regulated in practice. Both put the poor at a disadvantage in accessing good health care.
•Right now, the focus is on the shortage of essentials: drugs, hospital beds, oxygen, vaccines. In several instances, developing an app is being seen as a solution for allocation of various health services. It is assumed that these will work because of people’s experience with platforms such as Zomato/Swiggy and Uber/Ola. We forget that those work reasonably well because restaurants/food and taxis/drivers are available for these platforms to allocate effectively.
•Patients are being charged whatever hospitals like, and a black market has developed for scarce services (such as oxygen). The sensible response to such corrupt practices would be to clamp down on the handful who indulge in them. Instead, those in power are looking for digital options such as making Aadhaar mandatory.
•Digital “solutions” create additional bureaucracy for all sick persons in search of these services without disciplining the culprits. Along with paper work, patients will have to navigate digi-work. Platform- and app-based solutions can exclude the poor entirely, or squeeze their access to scarce health services further.
•In other spheres (e.g., vaccination) too, digital technologies are creating extra hurdles. The use of CoWIN to book a slot makes it that much harder for those without phones, computers and the Internet. There are reports of techies hogging slots, because they know how to “work” the app. The website is only available in English.
Online sharks
•It is also alarming if the pandemic is being used to create an infrastructure for future exploitation of people’s data. The digital health ID project is being pushed during the pandemic when its merits cannot be adequately debated. Electronic and interoperable health records are the purported benefits. For patients, interoperability (i.e., you do not have to lug your x-rays, past medication and investigations) can be achieved by decentralising digital storage (say, on smart cards) as France and Taiwan have done. Yet, the Indian government is intent on creating a centralised database. Given that we lack a data privacy law in India, it is very likely that our health records will end up with private entities without our consent, even weaponised against us (e.g., private insurance companies may use it to deny poor people an insurance policy or charge a higher premium). There are worries that the government is using the vaccination drive to populate the digital health ID database (for instance, when people use Aadhaar to register on CoWIN). No one is asking these questions because everyone is desperate to get vaccinated. The government is taking advantage of this desperation.
•The point is simple: unless health expenditure on basic health services (ward staff, nurses, doctors, laboratory technicians, medicines, beds, oxygen, ventilators) is increased, apps such as Aarogya Setu, Aadhaar and digital health IDs can improve little. Unless laws against medical malpractices are enforced strictly, digital solutions will obfuscate and distract us from the real problem. We need political, not technocratic, solutions.
•More than 10 years ago, we failed to heed warnings (that have subsequently come true) about exclusion from welfare due to Aadhaar. Today, there is greater understanding that the harms from Aadhaar and its cousins fall disproportionately on the vulnerable. Hopefully, the pandemic will teach us to be more discerning about which digital technologies we embrace.
