MA Jinnah’s first nominated Cabinet was more accommodative as compared to the Pakistani politics of today — he nominated JN Mandal, a Hindu, as the first Law Minister; Zafarullah Khan, an Ahmadiyya, as the Minister for Foreign Affairs and many Shias (like Jinnah himself) — a plurality that is unthinkable now. The Pakistani Military shared the spirit of the times with the rise of General Musa Khan, a Shia Hazara, as the Commander-in-Chief of the Pakistan Army (1958-1966). Another mercurial officer was Air Marshal SA Changezi, who famously refused to meet Afghan King Zahir Shah during a visit to Pakistan, owing to the perceived mistreatment of fellow Hazaras in Afghanistan. Now, Pakistan’s slide towards religious intolerance has constitutionally declared Ahmadiyyas as “non-Muslims”, whereas Shias and offshoots (20-25 per cent of Pakistan’s population) are routinely attacked and persecuted. However, given the even more conservative moorings across the Durand Line in Afghanistan, the discrimination of minorities is more intense — the imminent return of the Taliban in Kabul signals not just the return of puritanical absolutism and revisionism, but also the targeted brutality onto its Shia/Hazara populace (approximately 15 per cent of the population).

The recent car bombing in front of the Sayed-al-Shuhda school in the Hazara-dominated neighbourhood of Kabul horrifically killed 85, mostly schoolgirls between 11 and 15 years, in an augury of the times ahead. Despite the timeline of this attack coinciding with the holy month of Ramadan, this area had earlier seen similar bloodshed with attacks on maternity hospitals, schools and tutoring centres. While the Afghan Taliban did deny any role in this specific attack and attributed it to another group, Islamic State–Khorasan Province, the beleaguered fate of minorities like the Hazaras looks ominous. Like the Taliban, which is a project of the Pakistani “establishment”, the Islamic State-Khorasan Province was also formed by a Pakistani Taliban commander, Hafiz Saeed Khan — most members were formerly with the Pakistani Taliban (Tehrik-i-Pakistan), mostly from the Orokzai Pashtun stock. Irrespective of the groups, the Hazaras and other Shias like Ismailis have faced the brunt of relentless persecution throughout history, but for the relative reprieve in the Hamid Karzai-Ashraf Ghani dispensations.

Across the unaccepted borders with Pakistan, the Shias and Hazaras in particular, face the brunt of terror groups like Lashkar-e-Jhangvi, who remain committed to exterminate the Shias. These virulent sectarian groups have close ideological ties with the Taliban (on both sides) and have conducted spectacular and deadly attacks against the Shias — even the suicide bomber who killed former Pakistani Prime Minister Benazir Bhutto (who too was a Shia) belonged to Lashkar-e-Jhangvi. Quetta in Baluchistan is home to biggest settlement of the oppressed Hazaras in Pakistan, as also the unfortunate killing ground for most sectarian terror attacks — relaying the inevitable dangers of the State recklessly pandering to majoritarian-sectarianism to solidify itself. However, the dangers to suchlike “minorities” are multiplied when the sovereign Government itself runs the risk of passing on to the likes of the Taliban, which seems likely with the leaving of the US/NATO troops from Afghanistan.

While sectarianism is one cut of endangered “minority” status in Afghanistan, ethnicity is the other. Therefore, the Tajik and Uzbek, who may be essentially of Sunni denomination, are not spared the wrath of the Taliban or the Islamic State-Khorasan Province. Such persistent animus and diminishment led the Hazaras to form their own militias like the now-fragmented, Abdul Ali Mazari’s Hezb-e-Wahdat, or the comparatively new Hazara warlord, Abdul Ghani Alipoor, who is now popularly seen as an effective vanguard against the fury of the Taliban. But these ethnic warlords are recklessly volatile, fickle and known to shift allegiances with the proverbial “exchange of suitcases”, exposing their community to severe persecution. The endless cycle of sectarian wars in Afghanistan was exemplified by the reprisal attacks by the Taliban in Mazar-i-Sharif township in 1998 — thousands of Hazaras were searched out and killed in a systemic house-to-house killing frenzy as the Taliban was believed to shoot “anything that moved”. As always, Pakistani hand in the Talibani advance was omnipresent as many Pakistani soldiers had accompanied the Taliban march. The Hazaras were apparently made to pay a price for the killing of several thousand Taliban soldiers a year earlier, after a failed attempt by the Taliban to takeover Mazar-i-Sharif in 1996.

Now the dangerous snake pit created and abetted by the Pakistani “establishment” has managed to wear out the US/NATO troops, the sectarian and ethnic minorities in Afghanistan are left vulnerable. Pakistan has bequeathed its cancerous and manipulative approach onto the warlords and other terror groups operating in Afghanistan, and like its blood-soiled streets of Quetta — the augury of future Afghanistan for “minorities” (like in Pakistan) is dark and foreboding.

(The writer, a military veteran, is a former Lt Governor of Andaman & Nicobar Islands and Puducherry. The views expressed are personal.) 

(Courtesy The Pioneer)

The second wave of Covid-19 caught Delhi completely unawares and exposed the fault lines in the capital's healthcare infrastructure. It is well known that Covid-19 treatment requires oxygen. Yet, Delhi did not have any plan of action when it came to managing it. We were completely dependent on oxygen supply from other states. The Union government continued to increase Delhi's quota of oxygen. The Delhi government, on the other hand, was accusing the Centre of not doing enough.  For days, oxygen mismanagement caused heavy losses. There were casualties, due to oxygen shortage, reported in Jaipur Golden Hospital and Batra Hospital, who complained of an unresponsive administration on the ground.

During the Court proceedings, the Delhi government was reprimanded for being unable to get its act right. The Delhi High Court told the government to put its house in order or let Centre take over. Even after Centre's upward revision of Delhi's quota of oxygen, the Delhi government did not have enough tankers to lift the oxygen and supply it to hospitals. Later, it was revealed that Delhi does not have storage facilities to store oxygen that was supplied by the Centre and was forced to return the excess oxygen.

 It is predicted that the third wave might be more alarming than the current wave and impact our children more. Therefore, it is imperative that we begin preparing for the third wave from day one. Till now, preparations initiated by the Delhi government seem inadequate and unsatisfactory. Delhi needs to move in the direction of becoming self-reliant in oxygen production. In order to accomplish this, I have written to Delhi Chief Minister Arvind Kejriwal to make following policy interventions:

• Fast track installation of PSA oxygen generation plants from the PM Cares Fund in Delhi
• Provide subsidy and simplify process to encourage industry to set up oxygen plants in Delhi
• Relax norms for private nursing homes who are 100?pendent on oxygen cylinders to set up storage units (oxygen tanks) within premises
• Mandate installation of oxygen plants in all government hospitals and incentivise private hospitals to install oxygen plants within premises

 Besides oxygen, it is critical to ramp up Delhi's healthcare infrastructure. Delhi's 'unique healthcare model' turned out to be an empty boast when the tragedy struck. The much-publicized Mohalla clinics could not be used to treat even one patient infected with Covid-19. In fact, many of these were seen submerged in piles of garbage or lay abandoned like a haunted house.

The people of Delhi deserve to be treated and not left to die. Therefore, the Delhi government needs to move beyond making cosmetic changes and doing photo-ops.  The need of the hour is to operationalise hospitals that are non-functional. Build more isolation centres as well as identify already existing infrastructure such as mohalla clinics, community centres, schools and so on that could be turned into isolation centres and equipped with oxygen cylinders and concentrators.

Apart from physical infrastructure, our medical staff also needs to be expanded to reduce the burden on existing workforce. The current wave has taken a serious toll on the physical and mental health of medical professionals and supporting staff. We must support them by filling up vacancies of medical professionals and supporting staff in Category B, C and D and train them on Covid management at a large scale.

For children, special preparations need to be made to ensure that they receive timely care. Special pediatric wards equipped with oxygen supply should be made mandatory in every hospital. Tie-up with Central agencies on specialized treatment for children to keep the administration updated on any advancements in this regard.

To minimize the impact of future waves, vaccination needs to be undertaken on a mission mode. It is important to keep politics aside and start the process of placing orders with vaccine manufacturers. Though the Centre is already delivering vaccines free of cost to Delhi for people above 45 years of age, it is in the purview of states to procure more vaccines as per the needs from vaccine makers in India and abroad, subject to approvals.

This is the time to act and ensure that no life is lost due to systemic failures and misplaced priorities of the Delhi government.

The author is Member of Legislative Assembly, Delhi, representing the Bharatiya Janata Party from Rohini. The views expressed are personal. 

(Courtesy The Pioneer)

At a time when COVID-19-induced patient load is overwhelming, it is critical to ensure that factors such as climate change do not add to the disease burden. In these trying times climate change made worse by rising methane levels has the potential to add to the health miseries unless urgent mitigatory measures are applied. The global methane emissions too are anything but under control as per a report by the United Nations Environment Program (UNEP).

The UNEP report has underlined the urgent need to reduce the human-caused global methane emissions especially from the agricultural sector with its livestock emissions from enteric and manure fermentationcontributing up to 32 per cent of global methane emissions. Even though the carbon dioxide levels dropped during the coronavirus pandemic,however, the same did not happen with methane as the concentration in the atmosphere reached record levels last year, according to the data from the United States National Oceanic and Atmospheric Administration. This is worrisome as methane being an extremely powerful greenhouse gas is responsible for about 30 per cent of global warming.

The UNEP report calls for cutting down methane emissions by 45 per cent to avoid worst consequences.If achieved it would prevent a rise in global warming by up to 0.3 degrees Celsius by 2045. Besides, it will help prevent 2,60,000 premature deaths, 7,75,000 asthma-related hospital visits annually, and 25 million tonnes of crop losses. In India, the agri sector contributes to nearly 47 per cent of the anthropogenic methane emissions.

The European Commission for instance had adopted the European Union Methane Strategy in October 2020 which has outlined measures to cut methane emissions in Europe and internationally.India has the potential to reduce methane emissions in the agriculture, waste and energy sectors.

India must begin by addressing the losses and waste in the food sector. A UN report pegged domestic food waste in India at 68.7 million tonnes annually. This waste releases immense quantities of methane. Implementing behavioural change methods can help reduce waste and diverting the waste towards energy generation can help reduce methane emissions. Improvement in livestock management, encouraging adoption of health diets focused on vegetarian can reduce methane emissions by 65-80 million tonnes per year and help script a low methane emissions future for India.In the agriculture sector the adoption of zero tillage practice, coupled with efficient use of fertilisers and better management of water in rice crops can go a long way in gaining control over the carbon footprint of the agriculture sector.

These measures are excellent ways to get a handle on the runaway methane levels in India.However, the government must not fritter away the precious progress made through these measures. One such activity is the continuing usage of coal in India. The government must urgently look towards dialling down coal usage and lend scalability to alternative sources of energy. This must be combined with reducing the mining activities and closing the abandoned coal mines effectively so that they do not keep leaking methane.

Rising methane emissions can have disastrous consequences for human's and environment alike. India must rein in the emissions before they assume unmanageable levels.

(The author is an environmental journalist. The views expressed are personal.) 

(Courtesy The Pioneer)

On January 16,2021, the Covid-19 vaccination programme was launched with much fanfare by Prime Minister Narendra Modi. It was touted as the only ray of hope after a year of human suffering. An ambitious project to vaccinate 1.3 billion population in a two-dose regimen, an event of this magnitude had never been attempted in India before. Although India has been one of the largest exporters for vaccines in the last decade, several questions were raised: Does India have the capacity to manufacture 2.6 billion doses? Does India have adequate infrastructure to manage distribution, transportation and storage of vaccines that may require sub-zero temperature? Does India have the trained manpower and facilities at the last mile level (primary health care centres) to administer the doses successfully to its population spread far and wide in the interiors of the country.

The questions were uncomfortable and rightly so as barely four months into the programme, the entire vaccination drivehas been put in peril due to scarcity of vaccines, lack of resources at the primary healthcare level and people's reluctance to get themselves vaccinated. 

This article adopts a supply chain management approach to propose solutions that can be leveraged to add order to the vaccine programme, mitigate bottlenecks and increase the supply and distribution of vaccines. Supply chain management is the facilitation of of flow of goods from the raw material suppliers to the manufacturers, dealers, distributors, retailers and finally to the customer; it is also the management of bilateral and seamless flow of information end-to-end. The principles of supply chain management advocate creating strong networks and integrated relationships between the different echelons of the chain.

Procurement of Raw Materials

Two major constraints to sourcing of raw materials for Covid 19 vaccine were identified as: 1) raw materials and technologies needed for the fight against COVID-19 are under intellectual property protection and therefore inaccessible to many countries 2) US has invoked Defence Protection Act that prevents the export of critical materials to encourage domestic production. The US has assured that it willexpedite export of raw materials, but when is the question. Meanwhile,an international agreement that compels majority of countries to remove or not create trade barriers that disrupt the global flow of raw materials for making vaccines, should be in place.Many petitions have been filed to waive off the patents of Covid-19 vaccines so that production can be expanded rapidly. In this context, it makes sense to invest in the R&D and clinical trials of indigenous vaccine developed in India.Alternate supplier base from other countries such as Russia should be developed to procure and supplement raw materials for large-scale commercial production while strictly adhering to the biosafety standards.

Managing Manufacturing Capacity

The manufacturing process of Covid-19 vaccine is complex and requires specialized production capacity. Moreover, adjuvant materials such as consumables, single-use reactors bags, filters, culture media, and vaccine ingredients are needed in large volumes to complete production.India's manufacturing capacity and capability for vaccines was not questioned earlier as the country houses the largest vaccine manufacturer in the world and exports 60 per cent of its production to other countries as part of the UNICEF immunization programme. However, with Covid 19 vaccines, the production capacity has been severely over-estimated for two reasons:1) India manufactures vaccines largely intended for children, therefore it was presumptuous to assume that this high capacity would easily be transferred to making adult vaccines. Moreover,India's decision to export vaccines to the rest of the world was premature as the combined production of Covishield (60 million per month) and Covaxin (five million per month) is insufficient to service domestic demand, leave alone create export surplus.India now needs to invest in expanding the manufacturing capacity along with conducting clinical trials to ensure continuous and seamless production. Rather than relying on one manufacturer, the Union and state governments should consider public-private partnerships, advanced purchase agreements, incentives and benefits with concessional loans to propel vaccine production.

Vaccine Mid-Mile Logistics

Although India has escalated its cold chain infrastructure to facilitate smooth transportation of vaccines across the country, it needs to invest further in logistics infrastructure as the vaccines need to bestoredand transported at temperatures 2-8 degrees from the point of manufacture to the point of administration. Temperature integrity needs to be maintained at all times as25 per cent vaccines degrade by the time they reach their destination due to temperature errors. Thus, need of the hour is to create public-private and public-public partnerships to outfit transportation modes, storage hubs, packing stations, dangerous goods handling areas and health centers with freezers.

India's primary healthcare centers which are last mile storage and administration points are ill-equipped to handle these vaccines.Ancillary items like syringes and glass vials need to be madein adequate quantities along with proper training of healthcare workers who can immediately respond to any emergencies.  Verifiable transcript of the vaccine's lifecycle and journey needs to be documented as counterfeiting is rampant in the pharmaceutical supply chain.

The Indian government has done well to launch the Co-Win appand a dedicated 24x7 hotline and this has brought visibility and transparency to the front-end operations, but same visibility needs to be extended to the back-end of the supply chain.

For this, a supply chain info-directoryneeds to be established that can help suppliers and purchasers traverse the volatile and uncertain environment. The info-directiory would serve as a central repository of demand and supply data, including information on the needs of different states and regions, confirmed purchase orders, supplies and manufacturing capacity for input materials and finished products, delivery times, and so on. Moreover, Chain of Custody also needs to be established to ensure tracking of vaccines in the supply chain and prevent counterfeiting of data and systems.

The challenges to vaccinatethe Indian population against Covid-19at the earliest are humungous.The supply scenario in India has been unpredictable for Covid vaccine due to multiple reasons: lack of raw materials, limited manufacturing capacity, inadequate transportation and logistics infrastructure and insufficient trained manpower. On the demand side, although the population numbers are fixed, demand remains uncertain at the micro level due complications suffered by some patients, misinformation regarding the efficacy of the vaccine and new information related to the highly mutant strain of the virus makes matters worse, creating scepticism over the effectiveness of the overall vaccination programme.

The author is Director, CII School of Logistics, Amity University. The views expressed are personal. 

(Courtesy The Pioneer)

On the day Nepalese Prime Minister KP Sharma Oli failed to prove his majority in the House of Representatives, he had published an appeal in The Guardian, requesting the UK Government and the international community for assistance in Nepal’s fight against COVID-19. The article received significant backlash within his country. The people were unconvinced since Oli has left no stone unturned to turn Nepal into a political mess; beginning with his quest to remain in power, to misusing the office of the President. Despite losing majority in the House, Oli was invited to form a minority Government. Within days, the same Parliament has been dissolved again, and new elections have been scheduled for November. Noteworthily, Nepal is experiencing the worst of COVID-19 amid rising cases, fatalities and looming doubts over the supply of vaccines from international manufacturers. The shadow of corruption in procuring vaccines and medical equipment is dark enough to be seen. So, a plea from Oli is nothing but a mockery of good governance and a forced blindfold on the international community to overlook. Oli has become an authoritarian leader who disrespects the will of the people, political mood and remains unbothered by what the country is facing.

If anyone can be held responsible for paralysing Nepal in every sphere, it’s the present-day “Oli-garchy”. The apex court has nullified Oli’s earlier attempt to dissolve Parliament, and ill-intended overnight ordinances on political parties were withdrawn by the President amidst opposition. He was once again challenged to prove his majority, but he failed. Currently, unashamed, Oli continues to be the caretaker Prime Minister. Voices are emanating from the Army veterans, civil society and the democratic forces to hold Oli responsible for the current crisis. These are the same voices that fought an autocratic monarchy for more than a decade to establish an envisaged democratic order in the Himalayan country. However, in less than 15 years, leaders like Oli have done no good but fueled the ethnic divide, economic slowdown, soured relations with India and institutionalised corruption. When Nepal became the world’s sixth Communist-ruled country in 2008, questions were asked whether Communism and democracy could coexist. With parties like the CPN-UML led by Oli and the Maoists in Nepal, self is prioritised before ideology, nation and people. Therefore, Nepal needs a second wave of democracy to re-establish institutions in the truer sense with education, medical and economy at the priority. 

(Courtesy The Pioneer)

COVID-19 is a national disaster. There is a national task force in place handling the pandemic centrally. However, when it comes to the procurement of vaccines, the one and only element to fight the virus with, it is being done in a decentralised manner, with the Centre and the States both in a race to get hold of as many doses as they can from the market, even from abroad. Why is procurement not a national task being taken up by the Centre? The question has been doing the rounds since the third phase of the Government’s vaccine policy was announced earlier this month. Delhi’s Deputy Chief Minister Manish Sisodia made a pertinent point to bring out the pointlessness of such an exercise when he asked rhetorically what if the States asked the districts to procure their own vaccines, just like the Centre is asking the States to? The Chief Minister of Punjab, Captain Amarinder Singh, has already said that US pharma giant Moderna has refused to supply the vaccine directly to the State, saying it deals with requests only from the Government of India and not from the States or private companies. The Supreme Court a fortnight ago asked the Centre why cannot it buy 100 per cent of the requirement and why cannot the Centre follow the national immunisation programme policy with respect to the procurement of COVID-19 vaccines?

The control of infectious diseases falls in the Concurrent List and is, therefore, said to be a shared responsibility between the Centre and the States; that is how the former’s argument goes. However, former Health Secretary K Sujatha Rao pointed out that all these years, the Union Government was supplying vaccines and drugs to the States under the National Programme and that it was for the first time that the Centre was leaving the States alone to buy vaccines on their own and at a price to be determined by the manufacturers. The Centre is the nodal agency to facilitate nearly all aspects of vaccination. It is the Centre, not the States, that can persuade the United States for the raw materials; can help the suppliers expand production capacity; approve more vaccines and balance the domestic supply with obligations of the Indian manufacturers under Covax. Procuring vaccines is a logical extension of the Centre’s job. The current policy has created a divide of sorts: The Centre lowered the threshold age for vaccination to 18 years but will not vaccinate the nearly 90 crore people in the 18-45 age group. It is left to the States while the Centre takes care of the older, high-risk categories. Where will that leave Punjab? Where will that leave the other States if the rest of the pharma companies react like Moderna? The vaccination, obviously, cannot stop. The Centre will then be forced to retract its policy; something it can do voluntarily and without compulsion today. 

(Courtesy The Pioneer)

The death of patients due to depletion of oxygen in some hospitals in Delhi and in many other States in the past weeks along with the shortage of beds and drugs for COVID-19 patients has shaken the nation’s conscience. Apart from Delhi, dreadful stories of criminal negligence and utter incompetence, leading to the death of COVID patients due to oxygen shortage, are surfacing from many States.

In Karnataka, 24 COVID patients lost their lives on May 2 and 3 when the district hospital in Chamarajanagara ran out of oxygen. A three-member committee appointed by the High Court indicted the district administration and the hospital authorities for their failure to supervise the crisis and said the oxygen shortage was the result of callousness at various levels.

Reports from Goa were equally grim as over 80 patients in the Goa Medical College and Hospital reportedly lost their lives because the hospital ran out of oxygen. While the hospital authorities claim not all of these cases can be linked to depletion of oxygen, one hears that this institution had a very primitive system of oxygen supply and insufficient storage capacity. The Goa Bench of the Bombay High Court also had to step in and press for speedy action to resolve the logistics issues.

In Haryana, such deaths were reported in hospitals in Gurugram, Rewari and Hisar while the cities in Maharashtra that were hit by oxygen shortage included Kandri, Malegaon and Nasik. And, as if all this was not enough, there have been disastrous fires in hospitals in several States.

An analysis of the death of COVID patients due to oxygen shortage shows that such incidents have occurred in Delhi, Maharashtra, Madhya Pradesh, Gujarat, Rajasthan, Uttarakhand, Punjab, Haryana, Uttar Pradesh, Karnataka, Telangana, Andhra Pradesh, Tamil Nadu and Goa, a total of 14 States — half the number of the States in the country. And the elected Governments are run by a wide range of political parties, including the BJP, the Congress, AAP, Shiv Sena, YSR Congress, the Telangana Rashtra Samithi and the DMK. The Maharashtra Government is run by a coalition of eight parties, including the Shiv Sena, the Congress, the NCP and the SP. The DMK-led coalition in Tamil Nadu has the Congress, the CPI, the CPM and the MDMK, among others.

While everyone is indulging in the blame game, it must be noted that the Prime Minister has chosen not to blame anybody. However, some fundamentals must be understood. Under the Constitution, the State Governments are primarily responsible for hospitals and their disasters. The sharing of powers between the Centre and the States is delineated in the Seventh Schedule, which lists the items that fall within the domain of each entity.

Item six in the State List in this Schedule states: “Public health and sanitation; hospitals and dispensaries.” In other words, public health and the management of hospitals and dispensaries is wholly the responsibility of the States and they cannot get away by pointing fingers at somebody else. The States also have the duty to prevent spread of infectious diseases (Item 29 in the Concurrent List). Therefore, no State can claim that it was helpless or powerless to deal with these issues.

Over the last month, the Prime Minister has been made the fall guy — a convenient ruse to deflect blame from all other entities. But once we overcome this crisis, we must take stock of what the following entities did or did not do in the first quarter of this year: The Chief Ministers; State Health Ministers; Chief Secretaries; Health Secretaries; the Indian Council of Medical Research and the administrators of all major Government and private hospitals, apart from the Union Government, the Union Health Ministry in particular, the Union Health Secretary and all senior officials in that Ministry. Did any of the administrators of private hospitals who are studio-hopping over the last three weeks and blaming all and sundry for the oxygen depletion, take any measures to augment the supply and storage of oxygen in their hospitals over the past year? But, as stated earlier, this is not the time for this exercise.

It is true that the Centre should have woken up to the disaster much earlier. Rashtriya Swayamsevak Sangh (RSS) chief Mohan Bhagwat summed it up when he said after the first wave of COVID-19: “The Government, administration and public dropped their guard.” However, this is not the time for finger-pointing. “We have to stay positive …. to keep ourselves COVID-negative,” he says. Emphasising the need for positivity at this juncture, Bhagwat referred to a particular phase in World War II when England appeared to be losing the war. Yet, there was a note on Prime Minister Winston Churchill’s desk that read: “There is no pessimism in this office. We are not interested in the possibilities of defeat. They don’t exist.” Bhagwat said India too needs to have such courage and resolve to defeat COVID-19. He is absolutely right. While it is true that not a single family is unaffected by either the COVID illness or consequential bereavement, we have to exhibit superhuman courage, resolve and positivity in the face of personal tragedy to defeat this rampaging scourge.

(The writer is an author specialising in democracy studies. The views expressed are personal.)

(Courtesy The Pioneer)

The 74th World Health Assembly (WHA) takes place from May 24 to June 1. This year's gathering is likely to dominated by COVID-19, but here I want to talk about a different disease-leprosy-and a resolution that was adopted at the WHA exactly 30 years ago.

This resolution called for the elimination of leprosy as a public health problem at the global level by the year 2000, with elimination defined as a prevalence rate of less than 1 case per 10,000 population. It was a landmark resolution for the time.

Leprosy, also known as Hansen's disease, is a chronic infectious disease caused by the bacillus Mycobacterium leprae. It mainly affects the skin and peripheral nerves and is said to be one of the oldest diseases in human history.

Today an effective treatment exists in the form of multidrug therapy (MDT) and with early detection and treatment, the disease is completely curable. But if treatment is delayed, leprosy can cause impairments to the skin, nerves, face, hands and feet, and lead to permanent disability. Together with deep-seatedfearsand misperceptions about the disease, this has subjected persons affected by leprosy as well as their family members to severe discrimination, which continues to this day.

Sadly, amid the coronavirus pandemic, we can see parallels between the discrimination and hostility toward COVID-19 patients, their families and health personnel that has been reported in different parts of the world and society's attitudes toward leprosy.

Following the 1991 WHA resolution, elimination of leprosy as a public health problem was successfully achieved at the global level by the end of 2000, and almost all countries, including India, have replicated that success at the national level. Unfortunately, this does not mean that leprosy has disappeared.

Each year, around 200,000 new cases of leprosy are reported to the WHO, withIndia accounting for more than half of these. There are still endemic areas and scattered hot spots of leprosy in many countries and some three-four million people are living with visible impairments or deformities due to leprosy. Meanwhile, the persistence of stigma and discrimination can inhibit people from seeking treatment.

Since becoming WHO Goodwill Ambassador for Leprosy Elimination in 2001, I have visited some 120 countries and observed the situation on the ground for myself. This has led me to think of leprosy in terms of a motorcycle: the front wheel symbolizes curing the disease, and the back wheel represents eliminating discrimination. Unless both wheels are turning together, we will not reach our ultimate goal of zero leprosy.

As regards the front wheel, the WHO recently published its new Global Leprosy Strategy 2021-2030, which includes the ambitious targets of zero leprosy patients in 120 countries and a 70 percent decrease in new cases detected globally by 2030. In order to achieve these targets, there will need to be commitments and financial support from governments; this is not something the WHO can achieve on its own.

Concerning the rear wheel, I have worked hard to have leprosy recognized internationally as a human rights issue since the early 2000s when I first approached the Office of the UN High Commissioner for Human Rights. One result has beenthe resolution on elimination of discrimination against persons affected by leprosy and their family members, adopted by the UN General Assembly in 2010.But the real measure of success will be when principles and guidelines accompanying the resolution are fully implemented.This must include abolishing or amending laws that discriminate on the grounds of leprosy, of which there are around 100 in India. 

Over the past half-century, in India, the government is working diligently to combat the disease, and in the private sector, NGOs such as the Sasakawa-India Leprosy Foundation and the Association of People Affected by Leprosy (APAL) have an important role to play. But challenges remain. Especially now, during the COVID-19 pandemic, it is important that we do not lose sight of leprosy and continue to build on the progress made.

The author is WHO Goodwill Ambassador for Leprosy Elimination; Japanese Government Goodwill Ambassador for the Human Rights of Persons Affected by Leprosy; Chairman, The Nippon Foundation. The views expressed are personal.

COVID times will someday get chronicled.The coverage will have a special place in history. The experience will add to human endeavour to be healthy. The responses to the virus have been diverse in different parts of the globe. Solutions in the field to meet the situation have somethings in common, but much in diversity. Understandable because of the changing variables in different countries in terms of sophistication of technology, application of science and how exhaustive planning is. And then there is the pharmaceutical sector, evolving from drug producer to vaccine creator, its profit motive never completely written off.

There are many protocols for response to COVID circulatingin the world. From the World Health Organisation to the designated bodiesin nation states they all have some kind of a protocol they have adopted. In India, the protocol which has the highest authority is that of the Indian Council of Medical Research. Instead of comparing protocols, it is purposeful  to realise that each one is a sincere effort to find a solution in terms of the empirical evidence available to that given agency. It also dependson research competency.

Possibly,several of these respected protocols are among themselves at different stages of evolution. Illustratively, in one research environment an elevated D-Dimer, (a sign of thrombosis), is taken as something which has to be responded to with anti-coagulants of different types, compositions and potency. In another environment, research points out the abundant use of ambulation, plenty of fluid intake and letting nature take its course. In certain other environments, response to Covid requires quick use of steroids. The pros and cons of these approaches cannot and need not be analysed here. More to the point, it is this lack of uniformity which can and does cause a problem in the range of responses.

Add to it the fact of bulging numbers and how there are simply not enough qualified doctors. Apart from the sheer numbers of patients, it is also because physical examination has become a rarity and teleconsultation has become the norm. It ultimately boils down to chance as to what kind of doctor one has access to. It is these issues that will ultimately determine the effectiveness of the response to the disease.  

Each patient is unique and whereas standard protocols do go a distance they do not necessarily enable an organic progression that can fully respond to a patient's need. When this is coupled with less than total reliability of the screening tests of the disease, the level of confidence the line of treatment evokes becomes ambiguous. Under the circumstances, there needs to be a far greater accessibility of medical solutions so that the patient has an intelligent choice of what works for him or her.

One can make out some of the complexities of and shortcomings in our Covid responses. Singapore, Taiwan and now in the United States of America have succeeded in overcoming the problems. So much so that in parts of the US they are considering stopping usage of masks, media reports say. The point is a simple:one has to collectively create a climate of evidence-based protocols making allowances for individual characteristics of body system. There is no crash course to achieve this target. What can be done is strengthen a policy framework for enabling it. It will take time. The journey must begin somewhere.

(The writer is a well-known management consultant of international repute. The views expressed are personal.) 

(Courtesy The Pioneer)

The last eight to 10 weeks have shaken the very foundation of how we perceived and deconstructed the 'idea of India.' For all our commitment to inclusive development and 'Sabka Saath, Sabka Vikas,' hopelessness and despair are writ large - irrespective of our class hierarchies. From the power elite in the metropolitan centres to ordinary citizens in the peripheries, suddenly we have been caught unawares; however united in grief. But this united-in-grief moment has exposed us to the hollowness of the institutions we thought were robust. 

While the first wave of Covid-19 last year brought out the vulnerabilities of the working-class population, particularly the labourers and migrant workers, the second wave transcended these class hierarchies and barricades and engulfed the entire nation. Visuals of people helplessly running for ICU beds, oxygen cylinders, and external institutional support shall remain etched in our collective memory forever. The spin doctors of the establishment have been playing around with data, numbers, statistics. Still, the nation's 'collective conscience' does not always accept manipulation from a regime or its para-troopers. An alternate discourse is being woven around empty catchphrases of 'inculcating positivity,' especially when a large part of the nation grieves in want of some recognition and assurance, let alone timely assistance.

Sadly, the establishment has repeatedly failed to take cognizance of how the nation and its people are evolved enough to deconstruct the 'subjectivity' behind the objectivity of data. Those in power must remember the deaths and cases are no longer distant or remote. The nation, her people - the most important actors in a democracy can now see, witness, and perceive the casualties up-close - not in a detached or a clinical manner, which the dispensation would like us to interpret as. Most regrettably, it will be a travesty of truth to club Covid-19 deaths and death staking place as a result of scarcity of healthcare services and delayed treatments. An overwhelmingly high number is reported to have said goodbye to their near and dear ones on account of abysmal health infrastructure. Covid-19 first hit us in 2020. For a country that has a 90 percent-plus workforce employed in the informal sector, a country whose mainstay is agriculture; having not considered warning signals hinting at a poor emergency health care system, inadequate rural capacities, limited oxygen infrastructure, and grave implications of Covid-19 on villages and the urban poor -such absolute lack of preparedness cannot ever be forgotten or forgiven.   

A mature democracy can withstand the gravest of challenges because people, as active participants in democratic processes feel they have a stake in it.However, substantive participation of people is only possible when democracy is perceived to be an entity that does not expire right after the counting days of elections. For very long, we have been taking pride in overstating 'we are the largest democracy' without paying any heed to what constitutes the distinction between 'the largest' and 'the greatest.' These two superlatives mean different things, and the disruption caused during the pandemic has told us in unambiguous terms that we have not only failed the people that make our democracy but have shaken the very foundations of our collective consciousness and all that constitutes our social capital, elements like trust, faith, empathy, and confidence.

One can never overlook that while the pandemic was ravaging different parts of India, supposedly the world's largest political party, was keen on proving its political prowess.Words of caution from diverse sections of the civil society and the opposition were not only ignored but ridiculed. Suggestions or ideas for course correction offered by anybody, whether a former Prime Minister or any political leader, were either ignored or passed off as some 'tool-kit.' Regrettably, 'they' do not wish to change their priorities even amid a pandemic costing us socially, economically, and psychologically. Voices of opposition or dissent within or outside the parliamentary structure are denigrated. Limited attempts at consensus-building are seen - efforts that would have been more inclusive, collaborative, and participatory for the regime that takes pride in introducing concepts of 'cooperative federalism.' And it must show in action that there is a distinction between dialogue and monologue. Communication is meaningless if there is no feedback mechanism between the transmitter and the receiver. Least of all the prime minister and his team can do is to develop the art of listening.

We must remember that counting out, negating, and vilifying the opposition dents a nation's image as a democracy. There are instances galore when policy-making and legislating are being done without the slightest pretence of deliberation. As a result, the judiciary has had to intervene to ensure the basic executive functions properly and saves lives. The critical observations made by different High courts shall remain a living testimony to these impossibly difficult times when personal grief transcended into a state of collective despair reeking of abandon, neglect, and apathy.

The people of this country desperately sought their elected government at the centre to acknowledge what should have been done but could not be done. People also needed to see a genuine sense of regret and remorse so they could have found some consolation, empathic resonance, and a sense of ownership - essential to physical, emotional, and mental healing. Simply put in the context of these haunting images of the destruction caused by the second wave what people from the hinterland to the big cities need to listen to from the government is --We are sorry!!

In times of unprecedented collective grief, healing demands much more than premeditated wet eyes from the top. It demands an immediate course correction at every level. It requires assessing the huge gaps in the public health infrastructure and work on addressing them at a war footing. All ambitious projects including the central vista be put on hold and all the resources be diverted to protect life and save livelihoods. Failing which the grief can turn into anger at a level where it shall be impossible for the regime to contain or deal with. It is amusing to see the audacity of some people who keep repeating -yes! The situation is not good but what is the alternative? Who is the alternative? To all of them a piece of unsolicited advice-When people become an alternative the question is over.

The author is Member of Parliament (Rajya Sabha), represents the Rashtriya Janata Dal. The views expressed are personal.

(Courtesy The Pioneer)

For more than a year now, the Corona pandemic has been playing havoc with people’s lives and livelihood. Hundreds of thousands of people have died within the year, and many have been rendered homeless. The pernicious virus has not only impacted individuals, but also businesses and normal life. The lockdown, which had been seen as an effective tool in the fight against the virus, is now showing side effects. It has brought the nation’s economy to almost its knees. Many industries, like aviation and tourism that provided a huge number of jobs, have been maimed. The indicators suggest that the economy of the country is going through a grim phase and the lockdown is partially responsible for it. The biggest effect of the lockdown has been psychological as many people have postponed their business decisions or curtailed their operations, leading to more job losses and weaker purchasing power in the hands of the people. On the one hand, people have lost jobs and their source of livelihood; on the other, the prices of essential commodities are on the rise. This comes as a double whammy for the people.

For instance, mustard oil that sold for around Rs 120/litre is now selling at Rs 180/litre. Arhar dal, which sold around Rs 90 in March last year, is selling for around Rs 110 a kg. Since several expenses, like the home rent, cannot be curtailed, the daily earners are leaving for their villages and hometowns. This has led to the migration of the workforce in large numbers, having repercussions for various industries. The pandemic, let’s face it, is here to stay. We know that it will not go anywhere, anytime soon. As we approach the end of the second wave, a third wave is staring us in the face; experts say in October, probably. So the businesses in the revival mode will face another jolt then. It is not clear how much has the lockdown helped in containing the disease. In Delhi, the number of cases rose and fell with the rest of the country despite the lockdown. However, the Government doesn’t seem keen on lifting the lockdown. People are already questioning the rationale for going ahead with the lockdown in Delhi when the positivity rate is 3.5 and the total deaths recorded have come down to less than 2,500 a day. It is not only inconvenient to the people but also a great revenue loss for the country. 

(Courtesy The Pioneer)