Editorials - 29-04-2021

The people of India are entitled to a full and honest account of what led more than a billion people into a catastrophe

The struggle to breathe, or asphyxia, is the most terrifying human experience. Something one takes for granted, which we do more than a dozen times every minute, suddenly becomes an ordeal. I know how this feels having lived through tormenting bouts of asthma in my younger years and, more recently, when I found myself trapped under a raft in the freezing, raging, Zanskar river in Ladakh. The memories of gasping for air and the fear of dying are seared into my brain. Death typically comes as a relief from the terror, as multiple organ systems collapse due to the lack of oxygen, a colourless, odourless, tasteless gas which we are not even aware of until we cannot get enough of it. Oxygen. A word which should signify vitality and exuberance, but which in recent weeks has become synonymous with death and suffering. Who would have ever imagined that the India of 2021 which boasts sending rockets to the stars and manufactures oxygen on an industrial scale, would one day be unable to supply oxygen to save her own people.

The trauma of asphyxia

The word ‘trauma’ typically evokes extreme events such as rape, sexual abuse and war-related violence. This is not surprising given that the word gained currency as a medical condition in the aftermath of the Vietnam war when tens of thousands of soldiers from the United States returning from the brutal conflict exhibited a range of distressing symptoms, giving birth to the diagnosis of Post-traumatic Stress Disorder (PTSD). But the truth is that trauma can occur in many more diverse ways, and it is only now, with COVID-19 sweeping the world, that gasping for air has been recognised as a traumatic event. What ties these seemingly unconnected experiences together is that they all evoke the same intense emotions: a toxic brew of extreme fear and utter helplessness. These experiences, especially when sustained over hours or days, literally leave an imprint in the brain so that the hallmark features of PTSD symptoms such as nightmares, flashbacks and feeling on edge, recur at any time, sometimes triggered by a totally unrelated event which bear similarity to the trauma.

A recent study from the United Kingdom (https://bit.ly/2SbDysD) of over 13,000 survivors of COVID-19 reported a strong correlation between the severity of the infection and subsequent PTSD. While just over 1% of the patients reported breathing problems or hospital admission, the prevalence of PTSD in the months which followed were staggering: 35% of the sickest, and 15% of even those who only needed home assistance. The most prominent symptoms were frightening intrusive images of being breathless or ventilated. Thus, for those who do survive these nightmarish moments on the edge of life, the ordeal is far from over. Even as we struggle to keep those gasping for air alive, we must simultaneously attend to the long-term mental health consequences of survivors, a task even more daunting in a country where trauma-related mental health problems are barely even acknowledged.

A traumatised country

But there is also another kind of trauma which is sweeping across India, as millions of stories of suffering, despair and death percolate into the consciousness of every person. There has been a feverish rise of anxiety and fear across the population, twinned with helplessness as the comfort of knowing that there is a government which they can rely on has evaporated. India has been engulfed, in a matter of a few weeks, into the world’s most serious humanitarian crisis, fuelled not just by a more infectious strain of the virus, but also a stunning level of arrogance, greed, incompetence and complacency. The terror reminds me of the weeks that followed the brutal lock-down imposed on the same population a year ago, without any warning or preparation. A year on, the horrors have returned to their lives, only this time for exactly the opposite reason: the state did nothing at all as tens of thousands, and then hundreds of thousands, of people were getting infected every day, watching millions congregate at religious festivals and election rallies, oblivious or uncaring about the inevitable cataclysm this would lead to.

The concept of collective trauma has emerged only in recent times, in the aftermath of terrifying events which have affected entire populations, such as following the 9/11 attacks in New York or disasters such as the tsunami in 2004. These events were followed by a dramatic increase in symptoms of psychological distress, including the cardinal features of trauma, for months and years after the event itself had passed into history. And so we also must prepare the country for healing from this mass traumatic experience and we can draw upon lessons from other humanitarian crises to guide our actions. Most immediately, we must find a place to park our anger and rage, as justified as these reactions may be, and search for the compassion lurking beneath it, and support in any way we can the efforts of the thousands of civil society organisations to support those who are gasping for air, not forgetting the continuing support they will need after they can breathe again. The outpouring of community action we are witnessing is a soothing balm for the anxiety many are experiencing as they fear that the state seems to have collapsed.

Healing through truth

But, long-term recovery of the collective trauma will need resolution of the pent-up rage that is burning a hole in our souls. This will need the equivalent of the Truth and Reconciliation Commissions which have served to heal the collective traumas of events which affected entire populations, such as apartheid in South Africa. Such an independent Commission would document the facts behind the tragedy unfolding across India, hold individuals and institutions accountable, and offer a path towards restorative justice to heal a deeply wounded nation. Last week, when the Delhi High Court issued an order to the Central Government to ensure the supply of oxygen, I was puzzled by its statement that “As it stands, we all know this country is being run by God.” I will never know who was being referred to as God, but I am assuming it must be the spiritual being we pray to in our myriad places of worship. If so, then we must ensure that this is not the final judgment of the apocalypse that has befallen India. The people of this country are entitled to a full and honest account of what led more than a billion people into a catastrophe, if only to put at rest our troubled minds, restore the fractured trust between the people and the state, and be better prepared for the next pandemic.

Vikram Patel is The Pershing Square Professor of Global Health at Harvard Medical School, and a member of the Lancet Citizen’s Commission on

Re-imagining India’s Health System

Tackling the problem would mean engaging the health, agricultural, trade and environment sectors

Since January 2020, there have been over three million deaths globally on account of COVID-19, starkly exposing the vulnerabilities of health systems to infectious diseases, even in the richest countries. The speed of COVID-19’s spread across international borders has underscored the need for cross-national cooperation around surveillance, monitoring and disease notification — the key activities that underpin our ability to minimise the impact of acute public health events and maintain global health security. As serious as the current health and economic crisis is, COVID-19 may just be the harbinger of future crises. Antimicrobial resistance (AMR), the phenomenon by which bacteria and fungi evolve and become resistant to presently available medical treatment, is one of the greatest challenges of the 21st century. World Health Organization Director-General Tedros Adhanom Ghebreyesus said in July 2020, “AMR is a slow tsunami that threatens to undo a century of medical progress”. AMR is already responsible for up to 7,00,000 deaths a year. Unless urgent measures are taken to address this threat, we could soon face an unprecedented health and economic crisis of 10 million annual deaths and costs of up to $100 trillion by 2050.

Diverse challenges

AMR represents an existential threat to modern medicine. Without functional antimicrobials to treat bacterial and fungal infections, even the most common surgical procedures, as well as cancer chemotherapy, will become fraught with risk from untreatable infections. Neonatal and maternal mortality will increase. All these effects will be felt globally, but the scenario in the low- and middle-income countries (LMICs) of Asia and Africa is even more serious. LMICs have significantly driven down mortality using cheap and easily available antimicrobials. In the absence of new therapies, health systems in these countries are at severe risk of being overrun by untreatable infectious diseases.

The challenges are complex. Drug resistance in microbes emerges for several reasons. These include the misuse of antimicrobials in medicine, inappropriate use in agriculture, and contamination around pharmaceutical manufacturing sites where untreated waste releases large amounts of active antimicrobials into the environment. All of these drive the evolution of resistance in microbes. This is compounded by the serious challenge that no new classes of antibiotics have made it to the market in the last three decades, largely on account of inadequate incentives for their development and production. A recent report from the non-profit PEW Trusts found that over 95% of antibiotics in development today are from small companies, 75% of which have no products currently in the market. Major pharmaceutical companies have largely abandoned innovation in this space.

Tackling these diverse challenges requires action in a range of areas – in addition to developing new antimicrobials, infection-control measures can reduce antibiotic use. A mix of incentives and sanctions would encourage appropriate clinical use. At the same time, it is critical to ensure that all those who need an antimicrobial have access to it; 5.7 million people worldwide die annually because they cannot access drugs for infections that are treatable. Further, to track the spread of resistance in microbes, surveillance measures to identify these organisms need to expand beyond hospitals and encompass livestock, wastewater and farm run-offs. Finally, since microbes will inevitably continue to evolve and become resistant even to new antimicrobials, we need sustained investments and global coordination to detect and combat new resistant strains on an ongoing basis.

The way forward

There is room, however, for cautious optimism. A multi-sectoral $1 billion AMR Action Fund was launched in 2020 to support the development of new antibiotics, and the U.K. is trialling a subscription-based model for paying for new antimicrobials towards ensuring their commercial viability. This means that the government will pay upfront for these new antimicrobials, thereby delinking the life-saving value of the drugs from the volume of sales and providing an incentive for their production in market conditions that do not do so. Other initiatives focused on the appropriate use of antibiotics include Peru’s efforts on patient education to reduce unnecessary antibiotic prescriptions, Australian regulatory reforms to influence prescriber behaviour, and initiatives to increase the use of point-of-care diagnostics, such as the EU-supported VALUE-Dx programme. Beyond human use, Denmark’s reforms to prevent the use of antibiotics in livestock have not only led to a significant reduction in the prevalence of resistant microbes in animals, but also improved the efficiency of farming. Finally, given the critical role of manufacturing and environmental contamination in spreading AMR through pharmaceutical waste, there is a need to look into laws such as those recently proposed by India, one of the largest manufacturers of pharmaceuticals, to curb the amount of active antibiotics released in pharmaceutical waste.

While the range of initiatives that seek to control the emergence and spread of AMR is welcome, there is a need to recognise the limitations of a siloed approach. Current initiatives largely target individual issues related to AMR (such as the absence of new antibiotics, inappropriate prescription and environmental contamination) and consequently, narrowly defined groups of stakeholders (providers, patients and pharmaceutical companies). Regulating clinician prescription of antimicrobials alone would do little in settings where patient demand is high and antimicrobials are freely available over-the-counter in practice, as is the case in many LMICs. Efforts to control prescription through provider incentives should be accompanied by efforts to educate consumers to reduce inappropriate demand, issue standard treatment guidelines that would empower providers to stand up to such demands, as well as provide point-of-care diagnostics to aid clinical decision-making.

Policy alignment is also needed much beyond the health system. Solutions in clinical medicine must be integrated with improved surveillance of AMR in agriculture, animal health and the environment. This means that AMR must no longer be the remit solely of the health sector, but needs engagement from a wide range of stakeholders, representing agriculture, trade and the environment with solutions that balance their often-competing interests. Finally, successful policies in individual countries are no guarantee of global success. International alignment and coordination are paramount in both policymaking and its implementation. Indeed, recent papers have proposed using the Paris Agreement as a blueprint for developing a similar global approach to tackling AMR.

With viral diseases such as COVID-19, outbreaks and pandemics may be harder to predict; however, given what we know about the “silent pandemic” that is AMR, there is no excuse for delaying action.

Jehangir Cama is an industry research fellow at the Wellcome Trust-funded Translational Research Exchange@Exeter Centre, based in the Living Systems Institute, University of Exeter, U.K., and Zubin Cyrus Shroff is a health systems specialist whose work informs health policymaking in LMICs

What is being asserted by the community is the right of representation in the affairs of the management of temples

In the article, “The last word on the state and temples” (The Hindu, Editorial page, April 22, 2021), in the absence of any answer as to whom temples would be entrusted to — if the government were to cede its control — the writer enters the realm of imagination and divines an answer — “powerful private interests”. No doubt the problem of hierarchical division in Hindu society is prevalent. But the issue of government control of temples is distinct from the issue of throwing open Hindu religious institutions to all classes and sections of society. To confuse the two is constitutionally misleading. Separate pieces of legislation exist — the [Madras] Temple Entry Authorisation Act, 1947 — to address these issues.

A myth

A myth is trotted out to justify sovereign control of temples: that Hindu temples were supervised and managed by kings, who “habitually employed ministries to supervise temples and charitable bodies”. Like many myths the colonials perpetuated, this too must be disabused: there is not a shred of historical source to support this claim. On the contrary there are inscriptions, cast in stone, that attest that temples were managed wholly and entirely by local communities.

Before turning to the solution, it would seem sensible to ask the question.

State in religion

Why is the community demanding that the government stay away from temples? Unbridled corruption; theft and destruction.

If the gross mismanagement of financial resources and indisputable corruption by the state along with the loss and destruction of temple antiquities were not sufficient reasons for the government to relinquish its (mis)management, a mere glance at state legislations will reveal a deeper malady. The state has assumed the role of religious functionaries to determine who will be heads of Mutts and the authority to conductpoojas. For example, The Shri Jagannath Temple Act, 1954 entrusted the committee appointed by the state with the task of ensuring the performance ofseva pooja. When the Act was questioned by the Raja of Puri before the Supreme Court, inRaja Birakishore vs The State Of Orissa, the Court made a revelation: the performance of apujais in fact a secular act and, therefore, the state is justified in its regulation.

The exercise of state regulation of secular aspects of religion was taken to extreme lengths when the Court ruled that the state, by appointing temple priests, was exercising a secular function (Seshammal & Ors, Etc. Etc vs State Of Tamil Nadu). Whatever style of secularism we subscribe to, surely the Indian state is not to tell the believer how he/she is to offer worship to the deity nor is it to tell the custodian of the deity how she will be appointed.

Distinct aspects

The writer of the article rightly points out that the Constituent Assembly framed the religious liberty clauses keeping in mind the historical prohibition of entry to certain classes and sections of Hindu society. Article 25(2) grants power to the State to enact law on two distinct aspects. Article 25(2)(a) empowers the state to regulate “economic, financial, political or other secular activities which may be associated with religious practice”. Article 25(2)(b) enables the state to enact law to prohibit the exclusion of ‘classes and sections’ of Hindu society to enter into Hindu temples of a public character and also make law for social welfare and reform. Thus, the control of secular aspects associated with religion and the power to throw open Hindu temples to all classes and sections of society are distinct. The control of secular aspects is not a measure of any social reform. Viewed from this standpoint, the Hindu Religious and Charitable Endowments Department is not a “tribune for social justice” as argued in the article nor has it ever guaranteed equal access to worship.

Nowhere does the text of the Constitution permit the state to assume ownership of properties belonging to religious institutions and treat them as state largesse to be siphoned off. The only vestige of authority under the Constitution empowering the state to take over property of religious institutions is under Article 31A(b). Even then it is doubtful that this article covers property belonging to religious sects.

The history of legislative practice of endowment laws reveals the state prerogative in ensuring regulation of only secular activities. As a matter of fact, the Shirur Mutt case, while upholding certain provisions of the 1951 Act, struck down a major portion of the Act characterising the provisions as a “disastrous invasion” of religious liberty. In 1959, the Legislature ‘cured’ the defects pointed out by the Supreme Court, by inserting verbatim the very provisions that the Supreme Court had stuck down in 1954.

Applicable to charities

The Waqf Act justification for the legitimacy of control of Hindu religious endowments is misleading. A reading of the Act reveals that it applies to charities and specifically excludes places of worship such as mosques. In fact the scheme of the Waqf Act supports the argument that the government should not regulate places of worship.

The most fundamental criticism against the release of Hindu temples from government control to the society is two-fold. First, it is asked to whom will the temples be handed over to? Second, once restored to the community, will it not perpetuate class hierarchies? What is being asserted by the community is the right of representation in the affairs of the management of temples. This right of representation can be effectuated by the creation of boards representative of religious heads, priests and responsible members from thedharmik sampradaya.The logic is simple. Members who profess a particulardharmik sampradayawill have its due interest in mind.

British legacy

When the British government realised that a secular government should take no part in the management of religious institutions, it enacted the Religious Endowments Act (Act XX of 1863) repealing the pre-existing Bengal and Madras Regulations. Interestingly, in handing over the religious institutions to the society, it created committees in every district to exercise control over temples. Section 8 of the Act provided that the members of the committee to be appointed from persons professing the religion, for purposes of which the religious establishment was founded or maintained and in accordance with the general wishes of those who are interested in the maintenance of the institution. For this purpose the local government caused an election. In the spirit of equality of all religions, this scheme should be applicable to all religious institutions which would guarantee adequate community representation in the management of their places of worship.

K. Nagarajan is the Treasurer of

the Temple Worshippers Society (TWS)

The Health Ministry’s guidelines for managing COVID-19 ignore evidence, pricing, cost-effectiveness and social relevance

The Health Ministry released its first COVID-19 management guidelines about a year ago. The initial treatment guidelines included hydroxychloroquine, which led to panic buying of the drug. Little was known in those initial months. In the last one year, multiple studies have proven the lack of efficacy of hydroxychloroquine. While most practitioners have moved away from prescribing hydroxychloroquine, it still remains in the guidelines released by the Health Ministry on April 22.

While formulating national-level guidelines, the most important factors are strength of evidence, pricing, cost-effectiveness and social relevance. These guidelines not only disregard evidence, but also show the unawareness of policymakers about the struggles of the common populace and the importance of the aforementioned factors.

Disregarding lack of evidence

While hydroxychloroquine is one example that stands the test of time in terms of disregarding evidence, there are several others. The Indian Council of Medical Research (ICMR) completed a trial on convalescent plasma (of 464 patients), which proved that plasma does not save the lives of those with COVID-19. This was bolstered by further evidence from the U.K. (more than 10,000 patients). The only benefit of convalescent plasma was shown in a small study from Argentina which demonstrated that plasma prevented progression to severe disease in mild cases when high-titre plasma was infused within three days of disease onset. This strict timeline of three days lends plasma little to no translational value in India as plasma titres are seldom available and are expensive. Plus, there is a lag of 2-5 days in RT-PCR results now. Yet, convalescent plasma is mentioned in the Ministry’s guidelines. Similarly, Ivermectin, a drug used against parasites, has been recommended in the guidelines. With no good clinical trials to support its use and the World Health Organization (WHO) recommending against its routine use, one wonders what led to its inclusion.

While evidence was ignored, the importance of pricing and cost-effectiveness was also overlooked. Remdesivir, in shortage now, is being black-marketed across India, although it has no value in saving lives. The only marginal benefit it may have is in reducing the hospital stay, with a trade-off of increasing the cost of hospitalisation by the steep price of the drug in the black market.

Last year, when hydroxychloroquine was touted as the wonder drug, it ran out of stocks in the market, precipitating a crisis for patients who needed it chronically. Similarly, this year, budesonide inhalers have been included as an option for mild patients based on results of two clinical trials. With more than 80% of COVID-19 patients having only mild symptoms, patients with asthma and chronic obstructive pulmonary disease (COPD) may run out of inhalers. Moreover, according to the PRINCIPLE trial, a trial only in pre-print, budesonide improves only self-reported symptoms in mildly sick patients. It does not yet translate into saving lives or reducing hospital admissions. The larger social relevance of budesonide is still in question. Policymakers should have waited for the final publication, worked with industry to scale-up production of budesonide, and bolstered supply chains till the final results came in, rather than hastily making recommendations that may trigger panic buying and a crisis for patients who actually need it.

Missing from guidelines

What is missing from the guidelines is the lack of guidance on drugs being used for COVID-19. Misused drugs include Azithromycin, Doxycycline, Favipiravir, Itolizumab and Coronil. These are not mentioned in the guidelines, but practitioners are busy prescribing them. This may cause more harm than good.

Lastly, absence of any mention of monoclonal antibodies from Regeneron or Eli Lilly in the guidelines, the most efficacious antivirals in COVID-19 till date, is baffling. COVID-19 is an administrative nightmare. A stark difference in messaging on COVID-19 management compared to the messaging of the WHO or other trusted sources like the Center for Disease Control and Prevention and the National Institutes of Health, U.S. will only create confusion. With the available evidence, and keeping cost-effectiveness and the social relevance of the Indian health system in context, the focus of COVID-19 treatment guidelines should be on oxygen delivery, steroids and anti-coagulants. More treatment does not necessarily lead to better outcomes but will definitely lead to higher out-of-pocket expenditure and healthcare-related bankruptcies and debts. The guidelines should be re-written in cognisance of the current strains on the healthcare system.

Anup Agarwal was the lead author of the ICMR-led Trial on convalescent plasma (PLACID trial) and is a physician at Rehoboth Mckinley Christian Hospital Healthcare Services, Gallup, New Mexico, U.S.

Leveraging existing schemes and providing universal social security is of utmost importance

India is one of the largest welfare states in the world and yet, with COVID-19 striking in 2020, the state failed to provide for its most vulnerable citizens. The country witnessed multiple crises: mass inter- and intra-migration, food insecurity, and a crumbling health infrastructure. The extenuating circumstances of the pandemic has pushed an estimated 75 million people into poverty. The second wave has brought even the middle and upper-class citizens to their knees. Economic capital, in the absence of social capital, has proven to be insufficient in accessing healthcare facilities. Illness is universal, but healthcare is not.

Absorbing shocks

The country has over 500 direct benefit transfer schemes for which various Central, State, and Line departments are responsible. However, these schemes have not reached those in need. The pandemic has revealed that leveraging our existing schemes and providing universal social security is of utmost importance. This will help absorb the impact of external shocks on our vulnerable populations.

An example of such a social protection scheme is the Poor Law System in Ireland. In the 19th century, Ireland, a country that was staggering under the weight of poverty and famine, introduced the Poor Law System to provide relief that was financed by local property taxes. These laws were notable for not only providing timely assistance but maintaining the dignity and respectability of the poor while doing so. They were not designed as hand-outs but as necessary responses to a time of economic crisis. Today, the social welfare system in Ireland has evolved into a four-fold apparatus that promises social insurance, social assistance, universal schemes, and extra benefits/supplements.

A similar kind of social security system is not unimaginable in India. We have seen an example of a universal healthcare programme that India ran successfully — the Pulse Polio Universal Immunisation Programme. In 2014, India was declared polio-free. It took a dedicated effort over a number of years. However, it shows us what is possible. With the advancements in knowledge and technology, a universal coverage of social welfare is possible in a shorter time frame.

Ease of application

Existing schemes cover a wide variety of social protections. However, they are fractionalised across various departments and sub-schemes. This causes problems beginning with data collection to last-mile delivery. Having a universal system would improve the ease of application by consolidating the data of all eligible beneficiaries under one database. It can also reduce exclusion errors. The Pradhan Mantri Garib Kalyan Yojana (PMGKY) is one scheme that can be strengthened into universal social security. It already consolidates the public distribution system (PDS), the provision of gas cylinders, and wages for the MGNREGS.

Generally, social assistance schemes are provided on the basis of an assessment of needs. Having a universal scheme would take away this access/exclusion barrier. For example, PDS can be linked to a universal identification card such as the Aadhaar or voter card, in the absence of a ration card. This would allow anyone who is in need of foodgrains to access these schemes. It would be especially useful for migrant populations. Making other schemes/welfare provisions like education, maternity benefits, disability benefits etc. also universal would ensure a better standard of living for the people.

To ensure some of these issues are addressed, we need to map the State and Central schemes in a consolidated manner. This is to avoid duplication, inclusion and exclusion errors in welfare delivery. Alongside, a study to understand costs of welfare access for vulnerable groups can be conducted. This will help give a targeted way forward. The implementation of any of these ideas is only possible through a focus on data digitisation, data-driven decision-making and collaboration across government departments.

Madhuri Dhariwal is Senior Lead, Organization Development, Indus Action

With vaccines in short supply, more effort must go into curtailing wastage

In the days ahead, Indian adults below 45 will begin registering for a COVID vaccine that on paper will be available from May 1. Amid a crisis of vaccine supply, the Health Ministry had said that a little over one crore vaccines remain in stock with States. An additional 57 lakh would be made available to States over the weekend. The Centre has so far provided nearly 16 crore vaccine doses to States of which the total consumption including wastage is 14.8 crore doses. Maharashtra led the table of vaccines administered with 1.5 crore doses followed by Rajasthan (1.3 crore), Uttar Pradesh (1.25 crore) and Gujarat (1.23 crore). These were also the States that had so far received the maximum number of vaccines, again in that order. Among large States, Tamil Nadu reported a high percentage of vaccine wastage, nearly 8.83%. Only Lakshadweep had a higher 9.76%. Assam, Manipur and Haryana ranked after Tamil Nadu in percentage wastage of vaccines, at 7.7%, 7.4% and 5.72%. The Andaman and Nicobar Islands, Arunachal Pradesh, Goa, Himachal Pradesh, Kerala, Mizoram, Odisha were the States that had reported no wastage.

That a certain number of vaccines will be wasted is built into the Centre’s planning process. In its operational guidelines on COVID-19 vaccination, the Wastage Multiplier Factor has been calculated at 1.11, assuming an allowable programmatic wastage of 10%. This number is factored into how many vials are allocated to States for supply of vaccine to each administrative unit. Wastage in unopened vials can occur due to reasons such as the vaccine reaching its destination after its expiry date; if it has been exposed to temperature outside its normal bounds; suspected contamination and poor vaccine administration practices. Data seem to suggest that six of the top States or Union Territories that are reporting the highest proportion of wastage are the northeastern States, Lakshadweep and Dadra and Nagar Haveli where the relative difficulty of transporting goods — especially those as fragile as vaccine vials — is known. There ought to be deeper analysis for why Tamil Nadu with above average medical infrastructure ends up wasting close to 9% of its vaccines even though it is within acceptable bounds. In the days ahead, there will be more vaccines and manufacturing facilities which could translate to shorter transportation distances and reduced wastage. With the exponential increase in vaccine demand expected in the next six months, there will also be challenges in administration and demand for skilled administrators who will be part of the management of logistics. These ancillary support staff too have to be developed by States along with planning for vaccine supply to enable a smooth, speedy rollout.

New norms, under HC nudge, will help prevent a fresh surge after counting day

Amid criticism that it did not enforce steps to curb the spread of COVID-19 during the protracted campaign for Assembly elections in four States and one Union Territory with sufficient vigour, the Election Commission of India has now banned victory processions after the results are declared on May 2. It has also restricted to two the number of persons who can accompany the winning candidate to meet the Returning Officer and collect the election certificate. These are significant steps to prevent any escalation in the already alarming infection rate. Further, the ECI has come up with measures at counting centres, including a stipulation that agents cannot enter the counting hall without producing either a negative test report for COVID-19 or final vaccination reports. While such stringent norms are welcome, it is regrettable that the enforcement of earlier norms for COVID-appropriate behaviour by political parties, candidates and their supporters was often quite lax during the long campaign. The Madras High Court’s remark to the effect that ECI officials should bear a great responsibility for the horrific spike in infections, illness, hospitalisation and deaths will resonate with the public. While it was quite in order that the court voiced its displeasure with the ECI for failing to make all parties adhere to its norms, the suggestion by the Bench that ECI officials should bear sole responsibility for the situation was avoidable, bordering on the intemperate. However, the court’s caution that the counting process should not become a catalyst for a new surge has undoubtedly helped and led to new norms for counting day activities.

As the election draws to a close, the time may have come for the ECI to reconsider its resort to multi-phase polling as a permanent practice. Granted, some States are prone to violence, but should it not reconsider the practice, taking into account the strides made in communications and logistics? Multi-phase voting has been defended for the last three decades as something necessary because of the time needed to move central forces to different parts of the country; security and sensitivity in select constituencies are also considerations. However, in the present round, the first three phases of the West Bengal elections were held alongside those of Assam, and polling in the three other States and Puducherry was completed on April 6. With only one State left, there was a good case for fulfilling logistical requirements within a week or so and getting the remaining polling work done in one or two phases by April 15. A prolonged campaign contributes to build-up of tension. Covering an entire State in as few phases as possible will help localise the potential for violence, prevent the spread of tension due to the virulence of the campaign, besides reducing the fatigue of forces deployed throughout the campaign, up to the day of counting. A shorter election may be a safer one too.

The theatre, it will generally be admitted, is an institution with great potentialities for the advancement of Nationalism in a country. The Drama, in times of healthy literary progress, tends to truly reflect the varied aspects of national life — political, social, religious and cultural — and in the hands of patriotic playwrights and actors can well be utilised to present before the masses the ancient ideals of National greatness in a popular and impressive form. It provides ample scope for a happy synthesis of all the fine arts and makes an almost irresistible appeal alike to the literate and illiterate mind. Hence the necessity, especially in critical times of National renascence like the present, to pay proper attention to the development of the theatre and exploit it effectively for purposes of patriotic inspiration and National education among the people. The value of the theatre particularly in the education of children is, it is happy to note, gradually coming to be realised in modern times.

India to-day [April 28] protested strongly against the persistent Pakistani violations of the country’s border with East Bengal and repeated intrusions into Indian territory resulting in the death of or injury to nearly 40 Indian nationals and warned the Yahya Khan regime of serious consequences if it continued to indulge in such provocations. The External Affairs Ministry released three protest notes which have been handed over to the Pakistan High Commission here [New Delhi] listing several instances of Pakistani aggressive activities across the Indian border in constant violation of the ground rules governing the disposition of troop deployments on either side. These protest notes drew the Pakistan Government’s attention to specific instances of border violations by the Pakistan Army in the last few days with the deliberate intention of provoking a conflict. On the night oi April 26 the Pakistan Army came right up to the Indian border at Barnapara near Jalpaiguri and opened fire into Indian territory killing two Indian villagers. The next day there was a further Pakistani incursion in the Boira area north of Bongaon which resulted in the death of five Indians including a minor girl and injuries to three other persons.