📰 Vaccination lag in rural India points to a looming crisis
Only about 15% have been immunised outside urban areas
•Even as the second COVID-19 wave shows signs of easing, the spread of cases in rural areas and the relatively lower vaccination numbers there points to a burgeoning crisis. During the first wave (which peaked in September 2020), the COVID-19 cases started piling up in urban areas initially and spread to rural areas (including semi-rural ones) constituting 65% of all cases.
•The second wave also followed a similar pattern. The split was 52%-48% in urban/semi-urban vs rural/semi-rural areas in March 2021 and by mid-May, the estimated case load split was 65% in rural/semi-rural areas vs 35% in urban/semi-urban areas. These percentages are also skewed due to the lack of adequate testing facilities in many parts of rural India.
•Adding more cause for concern is the fact that the rise in registered cases has not seen a concomitant increase in vaccination in rural areas. While more than 60% of cases were from the rural and semi-rural districts, only an estimated 12%-15% of inhabitants have received at least one dose of the COVID-19 vaccine by May 14.
•In contrast, an estimated 30% of residents in urban and 19% in semi-urban areas have received at least one shot. In terms of being fully vaccinated (both doses), only an estimated 2.6% of rural residents received them by May 14, even as an estimated 7.7% of urban dwellers had received both doses.
Vaccination helps
•Data from some States show that the daily confirmed cases have decreased among the vaccinated higher age groups, while the infections among the non-vaccinated continue to rise during the second wave. Experts have also said that vaccines effectively prevent severe disease even if a vaccinated individual gets infected.
•The lower vaccination numbers in semi-rural and rural areas suggest that the impact of the pandemic will be more severe there, as is being reported anecdotally from ground reports in several parts of north India, in particular.
New naming system should go live soon: WHO Chief Scientist Soumya Swaminathan
•The World Health Organisation (WHO) would unveil a system of naming viruses that would be inspired from the way tropical storms are named, WHO Chief Scientist Soumya Swaminathan told The Hindu.
•“The new naming system should go live soon - yes it will be names like hurricanes. This is so as not to stigmatise and deincentivise countries from making their sequencing results public. It will also be easier for the lay public to remember rather than these complicated lineage numbers,” she said in an email.
•The WHO and health and science agencies across the world, for instance the Indian Council of Medical Research, the United States’ Centres for Disease Control and the Public Health England refer to viruses and their variants by formal lineage names, which are a combination of letters and names that point to the relationships between different variants. To the trained eye, variants such as B.1.1.7 and B.1.617 suggest that they have certain mutations in common and as well clues to their evolutionary history.
Stigmatising places
•However, because virus names and their associated diseases have frequently been named after geographical places where outbreaks were first reported or samples first isolated—such as the West Nile virus or Ebola—they are also considered to be stigmatising. But popular usage of the virus has frequently referred to place names, with early references to SARSCOV2 as the “Wuhan virus”. With the discovery of important variants of the virus being linked to increased infectiousness, B.1.1.7 started to be known as the ‘UK variant’ and B.1.351 as the ‘South African’ variant.
•And India’s Health Ministry, in the aftermath of B.1.617 that was popularly called the ‘Indian variant’, issued a press release decrying the media’s use of the name. In several prior briefings on international variants of concern, the Ministry and other government officials have routinely referred to these variants by their country of origin.
•The dilemma of having names that don’t stigmatise places but also are amenable to popular use has to an extent been solved by the system of naming hurricanes, or tropical cyclones.
•The World Meteorological Organisation leaves it to countries that surround a particular ocean basin to come up with names that are then used by rotation. This was a practice that began in 2004 and until then cyclones, like virus names, had alphabetical references. The Odisha super cyclone of 1999, for instance, was never named and in the meteorological books was known as BOB 06 (referencing its origin in the Bay of Bengal). The cyclonic storm in the Arabian Sea, Tauktae, which passed over Gujarat, for instance, was proposed by Myanmar. Cyclone Gati last year was a name chosen by India.
📰 Electoral bonds worth ₹695 crore sold during recent Assembly polls, highest amount in Kolkata
The SBI has, however, declined to name the political parties that encashed the electoral bonds.
•The State Bank of India sold electoral bonds worth ₹695.34 crore from April 1 to April 10, when the elections to the Assemblies of Tamil Nadu, Puducherry, West Bengal, Assam and Kerala were in full swing, according to a Right to Information reply by the bank.
•The amount sold was the highest-ever for any Assembly elections since the scheme started in 2018, according to the numbers provided in the reply.
•All but ₹2,000 of the electoral bonds sold in the 16th phase of the scheme were encashed, the reply showed. Predictably, the sale of electoral bonds shot up during the elections in comparison to the previous tranche in January when bonds worth ₹42.10 crore were sold, the reply showed.
•The highest amount of electoral bonds were sold at the Kolkata branch (₹176.1 crore), followed by New Delhi branch (₹167.5 crore) and Chennai branch (₹141.5 crore), according to the RTI reply. Hyderabad and Mumbai branches sold ₹91.5 crore worth of electoral bonds each, while ₹15 crore worth of bonds were sold at the Gandhinagar branch, ₹5 crore in Jaipur, ₹4.15 crore in Guwahati and ₹3 crore in Panaji.
•During the 16th phase of the scheme, 972 out of the 974 electoral bonds were enchased, with over half the amount — ₹351 crore — being encashed at the New Delhi branch of SBI, the reply showed. The rest of the amount was encashed at Bhubaneshwar (₹116 crore), Chennai (₹106 crore), Hyderabad (₹63.5 crore), Kolkata (₹55 crore) and Mumbai (₹3.8 crore).
•In its May 14 reply to a query filed by Bihar-based RTI activist Kanhaiya Kumar on April 16, SBI declined to name the political parties that encashed the electoral bonds, saying it was “third party personal information” that was exempted under the RTI Act.
•The bank also declined to share the details of how much commission it had earned from the sale of electoral bonds since the scheme started in 2018, saying the information was of “commercial confidence in nature” and its disclosure would “harm the competitive position of the bank”. Mr. Kumar, however, pointed out that the SBI was the only bank authorised to sell electoral bonds by the government.
•Started by the government in 2018, the bonds scheme allows any Indian citizen or company to purchase the bonds sold by the SBI in denominations of ₹1,000, ₹10,000, ₹1 lakh, ₹10 lakh and ₹1 crore and give them to political parties anonymously.
📰 Sri Lanka’s China-backed tax haven clears final hurdle
Top court rejects pleas challenging Colombo Port City
•A Chinese-funded tax-free enclave billed as Sri Lanka’s answer to Dubai and Singapore cleared the final legal hurdle on Tuesday as the Supreme Court in Colombo ruled it could go ahead with only minor tweaks.
•The largest single foreign investment in Sri Lanka is one of several massive Asian infrastructure projects funded by China as Beijing increases its regional footprint.
•Sri Lanka’s top court rejected 19 petitions challenging the “Colombo Port City Economic Commission” Bill and approved the $1.4-billion project subject to minor amendments which the government immediately said it accepted. Project officials have said they hope the brand new “Port City”, an area of reclaimed land, will attract billions of dollars for trade, banking and offshore services similar to what is available in Dubai and Singapore, two of its potential competitors.
•Named the “Colombo Port City” because of its proximity to Colombo’s main harbour, the sea reclamation — carried out with considerable Chinese labour — completed in 2019 has doubled the size of Colombo’s financial district by adding 269 hectares.
•Under the proposed legislation expected to be passed by Parliament, the Port City will be administered by a commission with unprecedented powers to fast track investment approvals. ll transactions within the Port City will be denominated in foreign currency and all salaries earned by any worker will be tax-exempt.
•Western countries, as well as regional power India, have long expressed concern over growing Chinese influence in strategically placed Sri Lanka.
•U.S. ambassador Alaina Teplitz told reporters last month that an unintended consequence of the Port City could be “a haven for money launderers and other sorts of nefarious actors.”
•However, the Supreme Court noted that “laws which seek to prevent money laundering and terrorist financing... apply within the area of authority of the Colombo Port City.”
📰 Stormy start: On handling severe cyclones
Accurate forecasts and resilience-building hold the key to handling severe cyclones
•Millions of people wearied by the onslaught of the coronavirus have had to contend with a furious tropical cyclone that has left a trail of death and destruction before making landfall in Gujarat. Cyclone Tauktae swelled into an extremely severe cyclonic storm, dumping enormous volumes of water all along the west coast, and caused loss of life in Kerala, Karnataka, Goa, Maharashtra and Gujarat, before weakening overland. To thousands who had to be evacuated to safe locations, this year’s pre-monsoon season presented a double jeopardy, caught as they were between a fast-spreading virus variant and an unrelenting storm. Many coastal residents would have felt a sense of déjà vu, having gone through a similar experience last year, when the severe cyclonic storm, Nisarga, barrelled landwards from the Arabian Sea, pounding Alibaug in Maharashtra as it came ashore. The cyclones in both years spared densely populated Mumbai. The twin crises have, however, strained the capacities of multiple States, especially the coastal ones, although the impact of the storm was considerably mitigated by disaster response forces. Once again, the value of creating a trained cadre, supported by the defence forces in rescue and relief work, is seen. The heralding of the 2021 monsoon season by a cyclone comes as another reminder that the subcontinent is at the confluence of more frequent, extreme weather events originating in the Bay of Bengal and the Arabian Sea every year.
•How well India is prepared to handle cyclones depends on developing greater expertise in forecasting and disaster mitigation, and crafting policies to increase resilience among communities. Last year, the India Meteorological Department (IMD) launched an impact-based cyclone warning system from the October-December season designed to reduce economic losses by focusing on districts and specific locations, and incorporating such factors as population, infrastructure, land use and settlements. The IMD also claimed that its accuracy of forecasts, for instance, in plotting landfall location, is now better. Together with ground mapping of vulnerabilities, this is a promising approach to avoid loss of life and destruction of property. The importance of precise early warnings cannot be overemphasised, considering that the Arabian Sea has emerged as a major source of severe cyclones, and their intensity is aggravated by long-term rise in sea surface temperatures linked to pollution over South Asia and its neighbourhood. Climate-proofing lives and dwellings is a high priority now, a task that warrants a multi-sectoral approach: to build sturdy homes of suitable design, create adequate storm shelters, provide accurate early warnings, and ensure financial protection against calamities through insurance for property and assets. Governments must rise up to the challenge.
📰 Delete and control: On ICMR's dropping of plasma therapy
The ICMR must assess evidence and be very specific with recommendations on treatment
•The Indian Council of Medical Research (ICMR) has finally dropped its espousal of convalescent plasma therapy (CPT) as treatment for moderate COVID-19 in its latest guidelines. In its guidelines of April 22, CPT was already on its last legs, with the advisory recommending that it is advisable only in early moderate disease, or within seven days of symptoms. These updates flow from periodic reviews of medicines and treatment protocol by a task force of doctors and experts of the ICMR. Practising doctors are not legally bound to follow these recommendations to the T but are expected to circumscribe their treatments within the guidelines. Last year, the ICMR, in one of the definitive clinical trials in the world, demonstrated that CPT neither saved lives nor improved patient outcomes but was equivocal about it in public. This gave leeway to some States, particularly the Delhi government, which openly disavowed the ICMR’s findings, encouraging several doctors to put the onus on hapless caregivers to source such plasma from those who had recovered from the illness. The clamour for plasma had birthed its own kind of ecosystem. There were apps designed to connect donors to recipients, an inevitable black market, and, if the plasma did not seem to be working, the tendency was to blame the quality of plasma rather than recognise the futility of the treatment.
•Last week, it took a letter by a clutch of concerned public health professionals to India’s Principal Scientific Adviser as well as results from a trial, published in The Lancet, spanning around 11,000 patients — that again found no benefit — to demote CPT. Further evidence is emerging that CPT may be contributing to the evolution of coronavirus mutations that, together, may have been the final nail in the coffin. However, this is not the end of the road for treatments with limited scientific basis finding a mention in the ICMR guidelines. Hydroxychloroquine and the anti-parasitic drug, ivermectin, continue to find a place for the treatment of mild disease despite a specific mention of “low certainty of evidence”. There is an argument that doctors, battling a disease that has so far defied a predictable treatment regime, cannot always observe the necessary clinical equipoise. Unlike doctors on the frontline, a collective of experts such as the ICMR taskforce, has the comfort and the distance to dispassionately assess evidence and be very specific with its recommendations. Publicising these at regular intervals serves to educate the public about the evolving nature of treatment and be better prepared as future patients and caregivers. This will work better towards easing the pressure on doctors as well as in improving trust in systems that are designed to offer the best possible expertise.
📰 Repoliticise urban planning
The Tamil Nadu government should reclaim the lost political vision in city planning
•In the last few decades, Tamil Nadu, the most urbanised among the major States, has lost its political vision in city planning. Housing policies and urban planning have been presented as a techno-bureaucratic exercise, preventing the political leadership from taking ownership and responsibility. In the process, the citizens find their needs unrepresented. With large urban projects on the anvil and the third master plan for Chennai on the drawing board, it is time for the Dravida Munnetra Kazhagam (DMK) government to repoliticise planning and adopt a vision consistent with its people-friendly promises.
Planning of the past and present
•For long, the State government stood apart with its innovative planning practices. In 1948, it produced a comprehensive housing report and impressive solutions for the housing shortage. As early as the 1960s, it created a comprehensive plan for Chennai. It set up the Slum Clearance Board in 1971, the first of its kind in India. The then DMK government adopted a radical policy to make the State slum-free. The iconic photograph of then Chief Minister M. Karunanidhi taking a boat ride in the rejuvenated Cooum is a telling example of how urban development projects remained an essential part of the political agenda. Former Chief Minister Jayalalithaa supported solar-powered greenhouse schemes for the rural poor. State leadership directly associated itself with planning policies, and building liveable cities was central to political action.
•What changed over time? First, policymakers depoliticised planning and presented it as a mere technical exercise of allocating resources such as land and money. They deployed what political scientists Matthew Flinders and Jim Buller describe as ‘institutional and preference-shaping tactics’ to achieve this. Institutions were created to give experts a longer rope, reduce political interference, and avoid short-term considerations in planning. However, they are meant to function within the parameters set by the elected political leadership. This appears increasingly absent in Tamil Nadu.
•As Flinders and Buller point out, using the ‘preference-shaping tactic’, institutions create a choiceless situation by offering the opinions of experts as the only solution. They exclude contesting views from public discussion. There is no political moderation of expert-driven agendas. While theorists may argue that depoliticisation improves efficiency, on the ground, as planning and policies keep failing, the credibility of politicians erodes significantly.
•A telling example of depoliticised planning is the Tamil Nadu Affordable Urban Housing and Habitat Policy, 2020. It thrives on ambiguity and opaqueness. It has reduced state role and allows the market to take care of low-income housing without providing any information on shortage, household incomes, and affordable housing prices. It remains silent on the numbers of households that cannot afford the housing supplied by the market. On the contrary, early plans, such as the 1948 report, offered empirical evidence, transparent assessment, and a clear political agenda. That report acknowledged that 75% of the population in Chennai belonged to the low-income group with an income of ₹50 or less a month. These families could not afford houses built by the market at the cost of ₹5,000. The government then took full charge of providing housing for lower-income households. Similarly, in 1971, the government admitted that the Housing Board had failed to deliver since it had diluted its mission by focusing on higher-income groups. The government created a separate board and invested its resources in low-income housing.
•In contrast, current policies do not disclose the conditions of housing and cities. They do not clearly commit to keeping the sale price of low-income housing within the affordable range in private projects that avail themselves of financial support from state-supported shelter funds. The case of the third master plan for Chennai appears no different. The activities have commenced without any political framework. Will the government agree if the planners again propose a market mechanism to allocate land use and resources? What outcomes do they want the plans to achieve?
The way forward
•As economist Allan Drazen explains, the government must acknowledge the divergent sets of interests and choose the mechanism to negotiate them. Only political leadership can offer a widely accepted framework. The government must take ownership and ensure specific outcomes. The possibilities are merging the Housing Board, which increasingly functions as a developer, with the Slum Board; pooling all land and resources and using them only for low-income housing; enforcing wider consultation; moving away from conventional land use planning; and adopting strategic urban design projects to make spaces for people and safe streets.
📰 Tracking the pandemic’s rural march
States, especially in the north, are facing the brunt of the second wave, made worse by their poor health infrastructure
•When the first wave of the novel coronavirus pandemic hit the country, the central government imposed the strictest lockdown for almost two months. For most of the migrants stuck in urban areas without incomes, jobs and food to survive, the only escape was to walk back to the rural areas where they came from. Migrants walked back thousands of kilometres to return to rural areas not because the villages were best equipped to deal with the pandemic but primarily because it provided them protection from hunger and starvation. During the second wave now, it is the rural areas which are bearing the brunt of the pandemic with most cases being reported from rural areas. And, unlike last time, there is nowhere to go.
Estimates versus the reality
•The second wave was expected at least based on past experience of other countries and of earlier pandemics but also because most scientists predicted it given the changing nature of the virus and the pandemic. However, unlike the last time when it was largely in urban areas, this time it has spread to villages. Also, in contrast to the previous episode, it has spread this time to the rural areas in Bihar, Uttar Pradesh, West Bengal, Jharkhand and Odisha — States which remained largely unaffected by the spread of the pandemic during the first wave. Most of these States are those with a low availability of health professionals and a lower level of health infrastructure. The result has been a much higher level of infections and deaths. Stories of bodies floating in rivers or left buried on the banks are being reported from both Uttar Pradesh and Bihar. While these are stark visuals of the nature of impact that the pandemic has caused on infections and deaths resulting from the infections, these are all estimates; gross underestimates of the actual reality in the rural areas in many of these States.
Neglect of primary care
•The scale of the misery inflicted by the pandemic was expected in most of these States, where the existing health infrastructure has been found lacking. But what made it worse was also complete apathy and a lack of governance in improving the health infrastructure despite knowledge of the second wave of the epidemic.
•As in the latest report of the Rural Health Statistics 2019-20 released by the Ministry of Health and Family Welfare (MOHFW), not only are these States which figure among the States with the worst health infrastructure but are also ones where the situation has worsened over the years. Compared to 10,337 functioning subcentres in rural Bihar in 2005, only 9,112 subcentres were functioning in 2020. The number of community health centres declined during the same period from 101 in 2005 to only 57 in 2020. Despite population growth, during the same period, the number of primary health care centres increased marginally to 1,702 in 2020 compared to 1,648 in 2005.
•The situation in Uttar Pradesh, another large State, is no different with the number of primary health centres declining from 3,660 in 2005 to 2,880 in 2020. While the number of community health centres increased from 386 to 711 during the same period, sub-centres increased only marginally, from 20,521 in 2005 to 20,778 in 2020. The situation with regard to the availability of health professionals is not very different, with most States witnessing a worsening situation. For example, only 29% of specialists were in place in the community health centres in Uttar Pradesh as against the requirement based on official norms. Compared to the norm, Bihar reported the highest shortfall in availability of subcentres, at 58%, followed by Jharkhand, at 44%, and Uttar Pradesh, at 41%, as on July 1, 2020. Similar numbers in the case of primary health care centres were 73% for Jharkhand, 58% for West Bengal, 53% for Bihar and 51% for Uttar Pradesh.
Avoidable events
•Given the state of the rural health infrastructure, it was obvious that the pandemic would lead to catastrophic outcomes once the rural population was exposed to the virus. The lack of governance in this case is not the state of health infrastructure that the State governments inherited but the failure to contain the spread of the pandemic despite the knowledge of the state of rural health infrastructure. This failure to estimate the scale of the havoc created by the pandemic was obvious in the case of the central government — steps were not taken to contain the spread along with augmenting the rural health infrastructure and there were decisions such as prolonged electioneering in some of the States. West Bengal, which has seen the fastest rise in cases, was witness to the longest period of electioneering this time, with no precautions such as social distancing in place. Similar adventurism in the case of Uttar Pradesh saw hundreds of polling officials getting infected and passing away due to the pandemic during the conduct of local body elections in the State. The Maha Kumbh organised in the middle of the pandemic, with millions of devotees participating, further added to the spread of the infection with devotees returning to rural areas in different States. All of these were eminently avoidable, with the resources used to augment and strengthen the rural health infrastructure.
Judiciary and the state
•While all these created the perfect breeding ground for the pandemic to spread to rural areas, the severity of the infections was also a result of the misgovernance of State governments. This bordered on ignorance of the level of severity to outright denial and complete apathy of the health and humanitarian crisis unfolding in the respective States. In most cases, the judiciary at the level of High Courts has stepped in to fill the vacuum created by an absent state. The judicial intervention of the Allahabad High Court last month directing the State government to impose lockdowns in Uttar Pradesh was in turn challenged by the State government in the Supreme Court. Attempts to voice concern over the state of health infrastructure and the spread of the pandemic by helpless citizens was countered with threats of legal action by the Uttar Pradesh government until the Supreme Court stepped in.
•Instead of expanding testing and contact tracing, attempts were made to restrict testing and report a lower number of infections, leading to a sense of complacency within the State administration. The reality in rural areas of most of these States is worse than what is being released to the public through official estimates. This is true for the number of deaths which by all measures appears to be much higher than official statistics. The absence of testing and treatment infrastructure has left the rural population at the mercy of private health providers; a large majority of the population has been left unable to avail the services of private health-care providers. The slow pace of vaccinations in rural areas despite the vulnerabilities has only contributed to the rise in infections and thousands of deaths which could have been easily prevented.
Aggravating rural distress
•Rural areas provided refuge to the majority of the migrant population which had lost jobs and incomes during the first phase. It also helped the economy revive given that rural areas were largely unaffected. However, this time round it is the rural areas which are facing the worst of the pandemic as well as economic distress. Rural wage data as well as data on rural non-farm income available from official and private surveys point to a dismal economic scenario. While many have lost their primary income earner, even for those who managed to recover, it has come at the cost of huge private health expenditure. Many are likely to fall into a debt trap with the usurious rate of interest from the private money lenders pushing them into chronic poverty. For the rest, the loss of jobs and income has come at the cost of depleted savings. Rural areas are not just staring at the worst of the pandemic but also at prolonged economic distress.
•While the pandemic with its uncertain nature is certainly responsible for it, the blame must equally lie with the government, both at the State as well as central levels, for its failure to anticipate and prevent the thousands of deaths.
📰 Planning for future waves of the pandemic
India needs to enhance the surveillance system, vaccinate quickly, and reprioritise healthcare services
•The failure to plan and prepare for multiple waves of COVID-19 in India has resulted in the despair and helplessness we are seeing today. Since more waves are expected, what lessons can we learn from the present in order to plan for the long term? This article speaks of the challenges and the road ahead.
Surveillance strategy
•First, while it is easy to blame modellers for failing to predict waves, the reason why they are not able to do so is that clear data are unavailable. There is unreliable testing and under-reporting of cases and deaths even now. This does not instil confidence in any of the modellers to come up with realistic estimates. Under-reporting and manipulated data inputs can only provide faulty projections. The Central and State government should use real-time data by encouraging reliable reporting and initiating standardised definitions. This is the time to have a standardised definition of how many cases are expected per million population. Instead of admiring the efforts of administrations in the areas that have fewer cases, efforts should be made to detect the minimum number of cases, to instil confidence in people that the surveillance system works in the state. This can only be done through the syndromic approach of identifying suspect cases and through a reliable testing strategy which does not change when there is a surge in cases.
•The COVID-19 trajectory in other countries shows that there will be multiple waves in India. In Japan, the health system is crumbling during the fourth wave. Identifying impending waves is very important in mitigating a catastrophe. India missed building containment and mitigation measures while Maharashtra was seeing a surge in cases during the second wave. This lesson should be incorporated into plans for future waves. A strong surveillance system reporting the minimum number of cases will thus provide reliable early markers of an impending wave. Review mechanisms should be strengthened to detect the outbreak in the initial stages and extinguish it before the pandemic spreads to other areas.
•Concurrent genomic sequencing in real-time in the fixed proportion of samples will give us an idea of the likelihood of the variants causing several outbreaks. If the outbreaks in Kerala, Punjab, and Maharashtra were noticed from the results of genomic sequencing, India could have advocated for local lockdowns in high-burden areas and imposed severe restrictions to stop the wide spread of the second wave. We can prevent the adversities of future waves by relying and acting on the inputs of a strong surveillance system.
Vaccinating the population
•Next, through vaccination, we can turn the story around. India can emerge as the world’s biggest exporter of vaccines in addition to helping citizens in the country. The Central government should proactively reach out to all the vaccine manufacturing firms in the west and invite them to collaborate with Indian firms under the ‘Make in India’ programme. India needs to fast-track the manufacturing of all vaccines which have been approved for use by various regulatory authorities through a single-window clearance. India can become a soft superpower if it facilitates faster manufacturing by helping the Indian industry. This is not an unrealistic ambition as the country has already proved how it can scale up testing facilities within a short period of time. At this stage, there needs to be greater impetus in stepping up manufacturing and coverage of vaccines. Not many countries in the world have the wherewithal to manufacture their own vaccines if India cannot cater to the vaccination needs of its own citizens and that of the world.
•With newer variants of concern emerging, it is important to update the vaccines depending on how the virus changes. This provides a clear case and a good business opportunity for setting up manufacturing facilities in both the public and private sectors. Vaccines might be the shot in the arm for our economy. Greater financial allocations, stepping up systems to expand vaccination, applied research, enhancing effective communication, and monitoring effectiveness will solidify India’s role in the future for preventing and managing pandemics.
•Since 2009, the World Health Organization has declared six public health emergencies of international concern, including COVID-19. In the near future, India has to have a system that can respond to newer pandemics in the making. We cannot build reactive systems for each wave and each pandemic. Nearly 60% of known infectious diseases and up to 75% of new or emerging infectious diseases are zoonotic in origin. Respecting the boundaries of animals and preserving the ecosystem in its natural form is important in order to prevent future pandemics. Therefore, the country needs to adopt the ‘One Health’ agenda in its entirety and ensure that environmental health and animal health are given similar priority as human health.
Robust public health workforce
•The rapid spread of SARS-CoV-2 shows us the importance of timely and efficient public health responses. We can only fight better when we have a battle-ready public health workforce. Unfortunately, our health systems are collapsing. Doctors and nurses have to bear the burden mainly because of a depleted or absent public health workforce. It is an essential to hire front-line workers in public health who can engage in surveillance and contract-tracing, and mobilise people for primary healthcare services, including vaccination. The front-line public health workforce is particularly absent in urban areas, while critical care capacity (oxygenated beds, ICUs) is limited in rural areas. Irrespective of the urban-rural divide, the country needs to reconfigure the health systems to ensure that one Accredited Social Health Activist (ASHA) worker is hired for every 1,000 people, an Auxiliary Nurse Midwife (ANM) and nurse practitioner are hired for every 5,000 people and a hospital with at least 100 beds, including beds with emergency and critical care services, caters to a population of 30,000-50,000.
•It is time to have plans for pandemics. We need to improve the health system and public health and regularly review plans to ensure that we prevent future disasters. For now, it is important to have enhanced surveillance to detect and contain future waves, expand vaccination, and work towards building a robust pandemic preparedness plan.
📰 Engage with U.S. progressives
India should note that it was the progressives who pushed the U.S. to back the TRIPS waiver
•It is tempting to surmise the shift in the U.S.’s approach on providing COVID-19-related aid to India as well as on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) waiver on COVID-19 vaccines, drugs, therapeutics, and related technologies as being driven by the Comprehensive Global Strategic Partnership with New Delhi. But it is more than just that. The development was a result of the determined push by some sections of the political and business class, civil society, and Indian Americans. Besides them, the progressives in the Democratic Party made a big difference.
•President Joe Biden called Prime Minister Narendra Modi in late April expressing the U.S.’s determination to be with India in its most difficult hour. To reduce the negative perception over Vice President Kamala Harris’ tepid response to the crisis in India, the administration arranged for her to address a diaspora event where she brought up her Indian roots and lamented over the deteriorating situation in the country.
•The responses by these top leaders to assuage the Indians and Indian Americans came at a time when a section was seeking to underscore New Delhi’s past folly of banking on Washington in times of need.
Urging Biden to act
•Among the progressives who urged the President to act soon were Congresswoman Pramila Jayapal, Chair of the Congressional Progressive Caucus, and Congressman Rohit ‘Ro’ Khanna, the Democratic vice chair of the Congressional India Caucus.
•Incidentally, while Ms. Jayapal’s comments on human rights violations in Jammu and Kashmir annoyed New Delhi earlier, Mr. Khanna urged the Indian government to maintain democratic norms and allow peaceful protests by farmers, at a meeting of the leadership of the India Caucus with Indian Ambassador to the U.S., Taranjit Singh Sandhu. Irrespective of these positions, the progressives saw the aid and TRIPS waiver through a different prism.
•To contextualise the role of progressives, days ahead of the May 5 decision of the Biden administration on the TRIPS waiver, 110 members of the U.S. Congress wrote to President Biden urging him to support the waiver. The signatories included Ms. Jayapal, Mr. Khanna, and Congressman Raja Krishnamoorthi who represents Illinois. At the same time, Senator Bernie Sanders and nine other Senators made a similar plea to the White House. Thus, the Biden administration’s decision on the waiver and the vaccines, characterised as courageous by many, was a result of the push by the progressives.
•Joining in this effort, the co-chair of the Congressional India Caucus, Brad Sherman, and over 50 colleagues wrote last week to President Biden seeking supply of specific items amid concern that as long the virus persists in India “there is the potential for additional variants that could pose a threat to a vaccinated America”. The overall approach is to work with India in its battle against the second wave and prepare for subsequent ones.
Not to be ignored
•The outreach by Mr. Sandhu and his South African counterpart to members of the U.S. Congress on the waiver notwithstanding, it is evident that the progressives have a grip on policymaking. Its members’ pronouncements on other issues that India finds unpalatable could happen again. But India will have to remain engaged with this section instead of offering a cold shoulder as it did in the recent past. As the adage goes, all politics is local.
