27 Mar 2021: Indian Express Editorial Analysis

Indian Express Editorial Analysis
27 March 2021

1) Pandemic is an opportunity to re-imagine TB care

GS 2: Health

Government Policies & Interventions

 

CONTEXT:

  1. A novel virus SARS-CoV-2, which had only just been described, overtook an ancient bacteria, tuberculosis or TB, as the leading infectious cause of death.
  2. Mortality from COVID-19 exceeded the daily toll of 5,000 deaths from TB. Suddenly the 10 million or so deaths annually from TB paled into insignificance when compared to the 85 million annual mortality from COVID-19.

 

WORLD TB DAY

  1. World TB Day is observed on 24 March each year to raise awareness and understanding about one of the world’s top infectious killers and catalyze action to address its devastating health, social, and economic impact around the world.
  2. March 24 marks the day in 1882 when Dr Robert Koch announced that he had discovered the bacterium that causes TB, which opened the way towards diagnosing and curing this disease.
  3. The theme of World TB Day 2021 - ‘The Clock is Ticking’ –conveys the sense that the world is running out of time to act on the commitments to end TB made by global leaders.
  4. This is especially critical in the context of the COVID-19 pandemic that has put End TB progress at risk, and to ensure equitable access to prevention and care in line with WHO’s drive towards achieving Universal Health Coverage.

 

 

STATISTICS:

  1. Provisional data compiled by the World Health Organization (WHO) from 84 countries indicates that an estimated 1.4 million fewer people received care for tuberculosis (TB) in 2020 than in 2019 - a reduction of 21% from 2019.
  2. In the group of 10 high-burden countries with the largest reported shortfalls compared with 2019, the overall shortfall was 28%. With many people with TB unable to access care, WHO estimates that half a million more people may have died from TB in 2020 alone.
  3. TB remains one of the world’s top infectious killers. 

 

 

LOOMING IMPACT AND SYNERGIES OF THESE TWO AIRBORNE DISEASES:

  1. One as old as human civilisation, and the other unknown till a year ago. It is now clear that patients with TB are more prone to COVID and if they do contract the disease their need for hospitalisation and ICU is higher, so is the mortality rate of such patients, whose lungs are already weak.
  2. The huge TB patient population of India is thus a vulnerable one, and if patients with latent TB are also at higher risk from TB, as some experts feel they are, then the alarm should be ringing as 40 per cent of all Indians are believed to be latently infected.
  3. These airborne diseases affect the same population. Perhaps it is no coincidence that diabetes, overcrowding, poverty and air pollution are amongst the most common bio-social determinants of not just TB, but also COVID-19.
  4. It is projected that the COVID pandemic has already pushed an additional 100 million below the poverty line: A population which will then be more vulnerable to the ravages of TB as well.

 

PROBLEMS FACED BY TB PATIENTS:

  1. TB is a disease that is very unforgiving of irregularities in follow up or treatment and we are only now seeing large rebounds in the numbers of patients, many of whom have developed drug resistant (MDR or XDR) TB due to irregular visits to DOTS centres. This applies to private clinics as well.
  2. The world’s largest and longest lockdown spelt misery for this country’s huge TB population. Suddenly patients found it impossible to access TB services and large numbers of them dropped off the radar. TB notifications declined dramatically which means these patients “disappeared” without access to diagnosis or treatment for the many months of the lockdown.
  3. The path to successful TB diagnosis and cure is a long and winding road at the best of times, with nine months to two years of uninterrupted treatment being the norm.
  4. The hurdles posed by COVID proved insurmountable and sadly many patients gave up the race. Scared to leave their houses, lacking the transport to reach TB centres, the woes of these patients multiplied with drug stock-outs and shortages of TB. 
  5. Economic and nutrition packages that had been promised to poorer TB patients also took a hit as did services for the HIV-affected. All these directly and indirectly added another level of complexity to the suffering of our Indian TB patients.
  6. Sadly, the collateral damage from COVID on TB is long lasting and runs deep. It threatens to set back by many years the fragile recent gains made by India’s National TB programme (NTP).

 

WAY AHEAD:

  1. This crisis is, therefore, also an opportunity to reimagine TB care. To reinvest in our underfunded and overburdened paradigms of TB care, which are already beginning to look dated and uninspired. 
  2. Investing and fast-tracking the TB drug and vaccine pipeline is a need of an hour. It is scandalous that TB has a single vaccine which is a century old whilst 12 COVID vaccines, discovered at breathtaking scientific speed, are already in deployment across the globe with over 70 in Phase 3 trials and 175 in pre clinical stages.
  3. Ensure effective infection prevention and control measures, to protect the health and safety of health workers, staff, and patients.
  4. Scale up simultaneous testing for TB and COVID-19, taking into consideration similarity of symptoms (cough, fever and difficulty breathing), and based on exposure or presence of risk factors.
  5. Promote access to people-centered prevention and care services.
  6. Stand against stigma and discrimination and promote the human rights of the most vulnerable.
  7. Build and strengthen community, youth and civil society engagement to close gaps in care.

 

CONCLUSION:

  1. Every crisis it is said, is an opportunity in disguise, and telemedicine helped us reach out to our most difficult XDR-TB patients.
  2. Masks have become the new norm, and our TB patients are thus less destigmatised and less likely to transmit infection in crowded communities.

 

 

2) Proceed with caution: What to consider before India takes ‘net-zero’ pledge

GS 3: Environmental Pollution & Degradation

Conservation

 

CONTEXT:

  1. Climate change is of great significance for India, both because of its potentially enormous impacts on the country and because India can play a decisive part in the global effort to address it. 
  2. Successive Indian governments have taken differing approaches to this in climate negotiations, but one of the enduring and entirely legitimate planks of our position has been a focus on equity and fairness.

 

IDEA OF NET ZERO:

  1. The “net zero” idea is inspired by an IPCC report that calls for global net emissions – GHG emissions minus removal of GHGs through various means, considered at a global aggregate level — to reach zero by mid-century.
  2. This, in turn, builds on a clause in the Paris Climate Agreement, calling for a balance between sources and sinks of emissions by the second half of the century.
  3. It is worth underscoring that none of this implies that each country has to reach net-zero by 2050. In fact, such an interpretation flies in the face of equity and fairness.
  4. This emergent trend of net-zero announcements is commendable in that it signals a progressive direction of travel and has the apparent merit of presenting a simple and singular benchmark for assessing whether countries are playing their part in addressing the climate challenge. Yet, there are hidden complexities in this formulation.
  5. The use of “net” zero potentially allows countries to keep emitting today while relying on yet-to-be-developed and costly technologies to absorb emissions tomorrow.
  6. Its focus on long-term targets displaces attention from meaningful short-term actions that are credible and accountable. And, it calls into question concerns of equity and fairness.

 

PARIS AGREEMENT:

  1. The Paris Agreement, while urging global peaking as soon as possible, explicitly recognises that “peaking will take longer for developing countries” and that this balance is to be achieved “on the basis of equity” and in the context of “sustainable development and efforts to eradicate poverty”.
  2. It does not advocate undifferentiated uptake of net-zero targets across developed and developing countries, as currently being advocated by many, in particular the US and the UK (the latter is the host of the next climate conference).
  3. Rather, the emphasis in the agreement on equity, sustainable development and poverty eradication suggests a thoughtful balancing of responsibilities between developed and developing countries.

 

INDIA’S POSITION:

  1. Understanding how India can continue to contribute meaningfully to greenhouse gas (GHG) mitigation, consistent with equity and fairness, is particularly important given a slew of forthcoming climate summits, at which we will be expected to deliver an updated pledge.
  2. In particular, India will need to decide whether to join a growing number of countries (over 120 at last count) that have pledged to reach “net zero” emissions by 2050.
  3. India has to play its part in mitigating GHG emissions and contributing to the global effort to meet the Paris Agreement’s “well below 2 degrees Celsius” and aspirational “1.5 degrees Celsius” temperature limit.
  4. Our first nationally determined contribution (NDC) submitted under the Paris Agreement has been rated by observers as compatible with a 2 degrees Celsius trajectory, and we are ahead of schedule in meeting our contribution.
  5. A mid-century net-zero target from India would signal that it does not need the benefit of the caveats that it negotiated into the Paris Agreement and that it is ready to abandon its long-standing position that developed countries should take the lead.
  6. There is definite scope for improvement — both in terms of the specificity, strength and stringency of our contribution and consistency in the domestic mitigation measures we take to fulfill these.
  7. Our next contribution must represent a meaningful progression on our first. However, we need to think long and hard about a mid-century net-zero target for India for multiple reasons.

 

IMPACT:

  1. The crisis calls for India to enhance its mitigation actions. But it is not clear that enhancing mitigation action can definitively deliver net-zero emissions by 2050, given that our emissions are still rising, and our development needs are considerable.
  2. One cannot rule out the possibility that a not fully thought-through mid-century net-zero target would compromise sustainable development.
  3. Moreover, such a major shift in our negotiating position will have implications for the future, including our ability to leverage additional finance and technology to help shift to low-carbon development pathways.
  4. Our 2 degrees Celsius compatible NDC, bolstered by the Prime Minister’s announcement in 2019 that we would achieve 450 GW of renewables by 2030, could be strengthened.
  5. Building on this track record suggests an alternate and equally, if not more, compelling, way to indicate climate ambition in the future than uncritically taking on a net-zero target.
  6. Given the massive shifts underway in India’s energy system, we would benefit from taking stock of our actions and focusing on near-term transitions.
  7. This will allow us to meet and even over-comply with our 2030 target while also ensuring concomitant developmental benefits, such as developing a vibrant renewable industry. 

 

WAY AHEAD:

  1. India can start putting in place the policies and institutions necessary to move in the right direction for the longer-term and also better understand, through modelling and other studies, the implications of net-zero scenarios before making a net-zero pledge.
  2. It would also be in India’s interest to link any future pledge to the achievement of near-term action by industrialised countries. That would be fair and consistent with the principles of the UNFCCC and also enhance the feasibility of our own actions through, for example, increasing availability and reducing costs of new mitigation technologies.

 

CONCLUSION:

  1. India is now rightly recognised for having come of age and becoming a major global power. But coming of age also brings with it the ability to take a stand, and resist being buffeted by the winds of shifting political agendas.
  2. While we, like others, have a responsibility to the international community, we also have a responsibility to our citizens to be deliberate and thoughtful about a decision as consequential as India’s climate pledge.