Headline : World AIDS Day: HIV still a threat, but rate of spread is down
- Since 1988, December 1 every year is observed as World AIDS day.
- Once contracted, Human Immunodeficiency Virus (HIV) has the potential to attack the body’s immune cells called CD4 (which help the body to respond to infection).
- After HIV attacks the CD4 cells, it starts replicating itself and destroys them, weakening the body’s immune system making it more prone to certain “opportunistic infections” that take advantage of the weak immune system. This susceptibility worsens if the syndrome progresses.
- AIDS or Acquired Immunodeficiency Syndrome applies to the advanced stages of the infection caused by the HIV. Typically, the time between HIV transmission and AIDS diagnosis is 10-15 years, although it may occur sooner.
- Without treatment, HIV can progress and, eventually, it will develop into AIDS in the vast majority of cases.
- The virus progresses in the absence of antiretroviral therapy (ART) – a drug therapy that slows or prevents the virus from developing.
- Sexual transmission — it can happen when there is contact with infected sexual fluids (rectal, genital, or oral mucous membranes). This can happen while having sex without a condom, including vaginal, oral, and anal sex, or sharing sex toys with someone who is HIV-positive.
- Perinatal transmission — a mother can transmit HIV to her child during childbirth, pregnancy, and also through breastfeeding.
- Blood transmission — the risk of transmitting HIV through blood transfusion is extremely low in developed countries, thanks to meticulous screening and precautions. However, among people who inject drugs, sharing and reusing syringes contaminated with HIV-infected blood is extremely hazardous.
- As of now, there is no cure for HIV.
- It can be managed by the administration of antiretroviral (ART) drugs that stop the virus from replicating itself. This means that, most people infected with HIV who use ART, do not develop AIDS.
- In 2018, 62 percent of the adults and 54 percent of the children living with HIV were receiving life-long ART.
Improved control of HIV infections:
- Through national and international efforts, between 2000 and 2018, new HIV infections fell by 37 percent.
- HIV related deaths fell by 45 percent, with over 13.6 million lives saved due to ART.
Prevalence of HIV
- According to the World Health Organisation (WHO), there were about 37.9 million affected by HIV by the end of 2018 and 1.7 million were newly infected by it in the same year.
- In 2018, 770,000 people died of HIV related causes and 500,000 new cases and deaths are expected by 2020.
- In India:
- As per NACO’s 14th India-HIV Estimations, 2017, Total number of People Living with HIV in India is 21.4 lakh with about 0.22% adult population (15-49 years) suffering from the disease.
- Nearly 88 thousand people were newly infected with HIV in 2017.
- Maharashtra has the highest prevalence of people living with HIV, with 15 per cent of the cases, followed by Andhra Pradesh, Karnataka, Telangana and Tamil Nadu.
India’s efforts to reduce AIDS
- In 1986, the first known case of HIV was diagnosed and by 1987 , about 135 more cases came to light.
- Soon after the first cases emerged in 1986, the Government of India established the National AIDS Committee within the Ministry of Health and Family Welfare.
- To control the spread of the virus, the Indian government set up the National AIDS Control Programme in 1987 to co-ordinate national responses such as blood screening and health education.
- In 1992, the government set up the National AIDS Control Organisation (NACO) to oversee policies and prevention and control programmes relating to HIV and AIDS and the National AIDS Control Programme (NACP) for HIV prevention.
- In 2009 India established a “National HIV and AIDS Policy and the World of Work“, which sought to end discrimination against workers on the basis of their real or perceived HIV status.
- Government passed the HIV and AIDS act in 2017 to provide for the prevention and control of the spread of HIV and AIDS and for the protection of human rights of persons affected by the said virus and syndrome and for matters connected therewith or incidental thereto.
- Prevention and Care, Support & Treatment (CST) form the two key pillars of all HIV/AIDS control efforts in India.
About National AIDS Control Organisation (NACO):
- NACO was established in 1992 as a division of India’s Ministry of Health and Family Welfare .
- It is the nodal organisation for formulation of policy and implementation of programs for prevention and control of HIV/AIDS in India.
- NACO also undertakes HIV estimations biennially(every 2 year) in collaboration with the Indian Council of Medical Research (ICMR) and National Institute of Medical Statistics (NIMS).
- The first round of HIV estimation in India was done in 1998, while the last round was done in 2017.
National AIDS Control Programme:
- The National AIDS Control Programme (NACP), launched in 1992, is being implemented as a comprehensive programme for prevention and control of HIV/AIDS in India.
- It is a 100% centrally sponsored scheme.
- Launched in 1992, it was followed by NACP-II in 1999, NACP-III in 2007 and NACP-IV in 2012 (which was later extended from April 2017 to March 2020)
- NACP-I (1992):
- Objective: Slowing down the spread of HIV infections so as to reduce morbidity, mortality and impact of AIDS in the country.
- National AIDS Control Board (NACB) was constituted and an autonomous National AIDS Control Organization (NACO) was set up to implement the project.
- Focus areas:
- Setting up surveillance system for monitoring HIV epidemic
- Measures to ensure access to safe blood
- Preventive services for high risk group populations.
- NACP-II (1999):
- Two key objectives of NACP II:
- to reduce the spread of HIV infection in India
- to increase India’s capacity to respond to HIV/AIDS on a long-term basis.
- NACP- III (2007):
- Goal: Halting and Reversing the Epidemic over its five-year period.
- NACP-IV (2012):
- Aim: To accelerate the process of reversal and further strengthen the epidemic response in India through a cautious and well defined integration process.
- Achieving the seventy five percent (75%) reduction in new HIV infections
- 90-90-90 strategy
- It refers to the UNAIDS’ ambitious treatment target to help end the AIDS epidemic.
- It targets that 90% of those who are HIV positive in the country know their status and that 90% of those who know their status are on treatment and 90% of those who are on treatment experience effective viral load suppression).
- NACO is even trying to achieve 95-95-95 in this regard.
- Elimination of mother-to-child transmission of HIV and syphilis and elimination of discrimination and stigmatization of people living with HIV
- The programme has succeeded in reducing the estimated number of annual new HIV infections in adults by 57% during the last decade through scaled up prevention activities.
Headline : Price controls can do more harm than good Editorial 3rd Sep’19 Livemint
Logic behind pricing of pharmaceutical products:
- Many healthcare products such as pharmaceutical drugs require years of research and millions of dollars to develop.
- Even after that, there is always the risk of a new medicine failing to pass human trials.
- As an incentive for research and risks, such firms are granted patents for their formulations that let them charge high “monopoly” prices if and when they are launched.
- The actual cost of making drugs, however, is typically only a tiny fraction of the retail price. So, once the initials costs have been recovered over the span of some years, these tend to yield bumper profits.
Government caps life-saving drugs:
- In case of life-saving drugs, a government would be justified in capping their prices in the public interest.
- Ensuring the cheap availability of old but essential drugs is easily done without any adverse consequences for public health.
- So long as their cost of production is lower than the price caps—which is usually the case—companies would keep selling them.
Proposed government price control on a new list of hygiene products:
- The government is considering bringing essential products such as sanitary napkins and hand wash agents under its price control regime.
Correct objective but wrong method:
- The objective is to make such products affordable to people at large, so that basic hygiene standards are upheld and nobody’s health suffers.
- This is a noble cause, but the method that has been suggested to achieve the aim is not appropriate.
Companies should be able to price their products:
- If the role of pricing products is taken away from companies in markets with vastly differing dynamics, the results could be poor.
Market will ensure correct pricing of products:
- For example, sanitary pads sell in varying grades of quality, offering women with varied budgets a range of options.
- The market for these products is not short of competition.
- The competition between companies to increase sales is enough to guarantee that no single brand can get away with charging too much.
- When there is demand for cheaper variants, a new entrant would fulfil it, which would push existing brands to contain costs and reduce prices.
Price caps lead to products going out of market:
- A price cap imposed on a product can make it unremunerative for its manufacturers to sell, leaving them with no choice but to pull out of the market.
- Seen in the case of coronary stents:
- An example of this is visible in the Indian market for coronary stents used in heart surgeries.
- Some makers of specialized and other premium stents have withdrawn their stents from Indian market in response to a state-ordered price ceiling.
- Selling these at lower rates, they say, does not make commercial sense for them.
- As a result, according to various surgeons, patients in need of superior stents are forced to make do with cheaper alternatives that risk exposing them to health complications.
Government intervention will discourage innovation:
- In contrast to the market determination of prices, an arbitrary maximum retail price set by the government would distort the market by turning innovative products (that use expensive input materials) unprofitable.
- If choice of premium products is not available, it would spell a net welfare loss for Indians.
Government can intervene by subsidizing customers:
- As for the poor cannot afford even the cheapest available sanitary pads unaffordable, the government could intervene in other ways.
- For example, it could use public funds to subsidize low-cost napkins for mass distribution.
- In general, it is best to rely on market forces to have people’s needs met.
- The government’s heart may be in the right place, but price caps in open markets are likely to do more harm than good.
GS Paper III: EconomySection : Editorial Analysis
Headline : Telangana government stalls deworming drive for children
- The deworming drive aimed at distribution of Albendazole tablets to around 6.68 lakh children in both some districts of Telangana as part of the National Deworming Programme (NDP) could not be held as per schedule.
- The drive has been put off after two batches of the anti-worm tablets supplied to both the districts were found to be ‘Not of Standard Quality’ (NSQ).
In Focus: National Deworming Initiative
- According to World Health Organization, 241 million children between the ages of 1 and 14 years are at risk of parasitic intestinal worms in India, also known as Soil-Transmitted Helminths (STH).
- More than 1.5 billion people, or 24% of the world’s population, are infected with soil-transmitted helminth infections worldwide.
- As per WHO, 64% of the Indian population less than 14 years are at risk of STH infections.
- Helminths (worms) which are transmitted through soil contaminated with faecal matter are called soil-transmitted helminths (Intestinal parasitic worms).
- Roundworm, whipworm and hookworms are worms that infect people.
- They are transmitted by eggs present in human faeces which in turn contaminate soil in areas where sanitation is poor.
Effects of STH infections:
- STH infections can lead to anemia, malnutrition, impaired mental and physical & cognitive development, and reduced school participation.
About: National Deworming Day
- It is a single fixed-day approach to treating intestinal worm infections in all children aged 1- 19 years, and is held on 10 February and 10 August each year.
- Note: This year the NDD was being conducted on 8th February and mop up day on the 14th February.
- National Deworming Day program initiative is implemented with an objective to reduce the prevalence of Soil Transmitted Helminths (STH) or parasitic intestinal worms so that they are no longer a public health problem.
- The programme was first launched in 2015 and was implemented in 11 States/UTs across all Government and Government-aided schools and Anganwadi centres targeting children aged 1 to 19 years.
- After conducting five rounds of National Deworming Day since 2015, the program has been scaled up throughout the country.
- Albendazole tablets given: The NDD program is a cost-effective program at scale that continues to reach crores of children and adolescents with deworming benefits through a safe medicine Albendazole.
- To deworm all preschool and school-age children (enrolled and non-enrolled) between theages of 1-19 years through the platform of schools and Anganwadi Centers in order to improve their overall health, nutritional status, access to education and quality of life.
- To increase programme outreach to private schools and maximize deworming benefits for large number of children various awareness activities (media mix) are involved under the programme.
- Campaigns are conducted to spread awareness about importance and benefits of dewarming, as well as prevention strategies related to improved behaviors and practices for hygiene and sanitation.
- Reaching out to Private Schools and Out-of-School children:
- In addition to including government and government-aided schools and anganwadis, all states makes special efforts to reach out-of-school children, who are most vulnerable to worm infections.
- Private schools across the country, since they have high enrolment of children, have also enthusiastically joined the program, so that children in these schools, too, get deworming treatment and contribute to overall reduction in worm prevalence in communities.
Significance of Deworming Programme:
- reduce absenteeism in schools;
- improve health, nutritional, and learning outcomes; and
- increase the likelihood of higher-wage jobs later in life.
- Apart from being dewormed, maintaining healthy and hygienic practices will help children and communities remain safe from worm infections.
- The MoHFW envisions an open-defecation-free India which holds the capacity to reduce the overall worm burden in a community.
Headline : Global measles cases up 300 per cent year-on-year, WHO
- According to WHO, the number of cases of measles world over has seen an increase by 300% in the first 3 months of 2019 compared to same period in 2018.
- The increase in measles cases around the world is attributed to anti-vaccination stigma. According to WHO data, the global vaccination rates have decreased.
- According to WHO, total number of measles cases reported globally is 112,163 between January and March 2019.
- Africa with low vaccination coverage has witnessed a spike in 700% in measles cases reported.
- Israel, Thailand and Tunisia have also experienced alarming outbreaks among unvaccinated groups.
- Philippines and Brazil saw the biggest increase in 2018.
About Anti-vaccine campaign
- Anti-vax campaigns are campaigns against the use of MMR vaccine against measles, mumps and rubella.
- The main reason attributed to spike in measles cases is decreasing global vaccination rates.
- Global vaccination rates are decreasing due to growing vaccine hesitancy.
- Vaccine hesitancy for measles has been growing world over as result of anti-vaccination stigma.
Anti-vax campaign: Reasons
- Link with autism:The campaigns are spreading misinformation that MMR vaccine is linked with autism in children.
- Religious reason: Besides some ultra-orthodox communities are resisting MMR vaccines for religious reasons like a particular Jew community in New York.
- Social media: Besides social media has accelerated the speed at which the misinformation in spread across the world.
- Populist measure: In countries like Italy and France, politicians have supported the anti-vaccination campaign as a populist measure.
- It is a contagious air-borne infection of the respiratory tract.
- It is caused by a virus in the paramyxovirus family.
- It can spread through direct contact or coughing, sneezing etc.
- It affects mostly children under the age of 5 years.
- Unvaccinated groups including children, pregnant women.
- People with weak immune system.
- High fever
- Runny nose and cough
- Red and watery eyes,
- Small white spots inside the cheeks
- Rashes in face, upper neck, hands and feet
- Severe respiratory infections such as pneumonia.
- Serious complications include blindness, encephalitis (brain swelling), and diarrhea.
Headline : Five actions to turbocharge India’s public healthcare Editorial 7th Apr’19 IndianExpress
India’s rising population has great health services need:
- India has the world’s second largest population which went from 760 million in 1985 and doubled in size by 2015.
- This rapid rise in population has not seen an appropriate increase in health services for the population.
But Budgetary allocation for health insufficient:
- Budgetary allocation to public health is only 1.2 per cent of the total health expenditure which is far lower than the WHO recommendation of 5 per cent.
- This lack of funds hits public healthcare infrastructure, lack of experienced medical staff to manage the burgeoning population.
- Government statistics show that community healthcare centres are falling short of specialists and 63 per cent of hospital beds belong to private sector.
- This gap is sharper when you look at the rural sector which has a higher percentage of the population and are financially weaker.
Technology and Innovation to tackle healthcare challenges:
- India is experiencing a fast-paced growth on the back of technological disruption and innovative thinking.
- This provides an opportunity to bring the same to solve the public healthcare challenge.
Five urgent actions that can be taken on healthcare:
1. Tracking health outcomes
- Tracking the healthcare outcomes on a real-time basis will allow for a clearer picture for the authorities to deploy funds and resources in the most appropriate manner.
- Judging the health care providers performance on outcomes would introduce a clear target that rewards innovation.
- To ensure this, the policy makers should introduce a standardized collection and reporting methodology.
2. Maintaining digital health records
- India needs a universal system of tracking health records. The system would contain every patient’s complete medical history and would be available to any healthcare provider while still ensuring the privacy and security of the patient information.
- Budgetary allocation while the data collected can also be leveraged to understand the efficacy of the processes and protocols being implemented.
- The larger analysis of this data can help keep a track of healthcare trends, track disease, understand policy impact and anticipate demand for drugs / care.
- This information would be vital to better divert funds to specific resources that are required at the point in time.
3. Government health insurance
- Most people are vulnerable to financial distress related to critical medical procedures and require the national health insurance system for economically viable health coverage.
- Through the use of artificial intelligence and the use of digital health, records actuaries (like insurance analysts) would be able to detect any claim anomalies to prevent fraud.
4. Leveraging a connected India
- Over 60 per cent of the population live in rural areas in India that are in remote locations without easy access to the primary health centres.
- These people avoid treatment for minor injuries and ailments that exacerbate due to non-treatment or incorrect home remedies.
- Mobility and digital technology platforms have the potential of bridging this deficit by allowing doctors to remotely treat patients in under-resourced areas efficiently and economically.
5. Mobile resources for last mile delivery
- Healthcare service professionals who are delivering at the last mile must be empowered with mobile-enabled resources to provide lifesaving care to the doorstep of those living in remote areas.
- These resources can enable mobile diagnostics, improve collection of data and real-time consultation with doctors that are available through Telemedicine solutions.
GS Paper II: Social Issues
Section : Editorial Analysis
Headline : A Rare Opportunity Editorial 11th Apr’19 IndianExpress
- A rare disease affects a small percentage of people.
- Most rare diseases are chronic and severe, leading to death or disability.
Problems in diagnosis, understanding and treatment:
- Since these diseases are not found commonly, doctors are typically unaware about them and therefore either misdiagnose or do not diagnose them.
- This further decreases recorded incidence of the disease, which in turn diminishes interest in understanding the disease and finding treatments for it.
Needs support of government:
- The issues related to rare diseases can only be overcome by strong support from the government.
National Policy for the Treatment of Rare Diseases suspended in 2018:
- However, in 2018, the Union government suspended the National Policy for the Treatment of Rare Diseases.
- This came as a shock to those patients who were relying on the money allotted through the policy for life-saving treatments.
- The Centre said that the current policy for rare diseases needed to be reframed due to challenges in implementation and costs.
- The Union Health Ministry termed the policy “untenable” as the implementation of the policy was moved out of the Public Health Division to the National Health Mission (NHM).
Low public health expenditure necessitated this decision:
- India’s meagre 1.15 per cent of GDP allocation to healthcare means government has to make a decision of “balancing” disease incidence.
- In this, rare diseases lose out due to the high cost of treating them.
But patients with rare disease should not be discriminated against due to costs:
- A utilitarian calculation is not the right basis for public policy because it perpetuates marginalisation and subverts the state’s duty to treat its citizens equally.
- The Delhi High Court recognised the rights of rare disease patients, and said that low disease incidence cannot be the state’s basis for denying someone the right to life enshrined under Article 21 of the Constitution.
Need a new rare disease policy:
- The Delhi HC has also demanded that the government promptly frame a new rare disease policy that incorporates global best practices.
- To respect the HC’s directions, a new policy must be founded on non-discriminatory ideals.
- Policymakers will have to address fiscal constraints without devaluing lives of patients with rare diseases.
The new policy should be different from the earlier policy:
- The government should create a new policy that is based on different fundamentals.
- Attention should be on all rare diseases: The earlier policy had a narrow focus on allocating funds to treat a select few rare diseases that could be treated, while it excluded untreatable diseases. This is problematic as only 5 per cent of all rare diseases are treatable, and thus effectively excludes 95 per cent of rare diseases from its purview. The new policy should deal with this.
- Greater resources: A new and inclusive rare disease policy should allocate substantial resources to research for the development of new platform therapies that could commonly treat different rare diseases, while simultaneously bringing down the costs of current treatments.
- More research: More research will also facilitate greater interest in rare diseases in the medical community, increasing rates of diagnosis and improving medical care. Increased focus on research could help develop cheaper treatments.
- Take care of cost of treatment: Giving incentives to pharmaceutical companies to develop treatments for rare diseases has resulted in discovery of treatments but their cost is prohibitively high. In India, where most patients are un-insured and rare diseases fall outside the insurance system, this increases patient dependence on government financing. Ways must be found to incentivize discovery of new treatments while keeping treatment costs affordable.
- Low incidence makes rare diseases “unprofitable” and companies are reluctant to invest in them.
- The government must not abandon the rare disease community to the market mechanism
Headline : AIIMS doctors develop application to help in timely diagnosis of autism
- In the backdrop of the World Autism Awareness Day, doctors at AIIMS have developed a mobile app for early diagnosis of Autism Spectrum Disorders.
- World Autism Awareness Day is observed on April 2 every year.
About the App
- The app developed is called PedNeuroAiimsDiagnostics.
- It is a questionnaire-based app which has 2 sections of questionnaire
- Section A has questions to assess the social interaction and communication skills
- Section B has questions to analyse the response given to questions in section A.
- Based on the response to the questionnaire the app analyses if the child has any of the Autism Spectrum Disorders
- Accordingly the following cases are considered to be suffering with ASD
- A child who cannot babble or point or gesture by 12 months
- Couldn’t say single word by 16 months
- Couldn’t say any two-word spontaneous phrases by 24 months
- Loss of language or social skills at any age.
- The App is easy to use with even a paediatrician can assess the test results.
- The app is very sensitive in that detects 98% of cases.
- It is also very specific in that it predicts specifically which of the ASD in 92% of the cases.
In focus: Autism Spectrum Disorders
- Autism is a developmental disorder associated with the neurological condition of the child.
- It shows signs in the first 3 years of child development.
- Autism is a brain malfunction mainly associated with impairments in 3 main areas
- Communication skills
- Social interactions
- Repetitive and restricted activities
- Autism mainly occurs due to abnormalities in brain structure and function which can occur due to varied reasons.
- As a result Autism is grouped under a spectrum of disorders called Autism Spectrum Disorders.
Common behavior pattern
- In general autistic individual s have different ways of ‘sensing’ their world
- Lack of emotional connection
- Lack of eye contact while communicating
- Not reacting or inconsistently reacting when their name is called out
- Hypersensitivity to noise
- Lost in own thoughts
- Hitting or biting themselves
- Lack of non-verbal communication
- Inability to follow objects visually
- Inability to make friends
- Repetitive body movements
- Repeating their own sentences
- There is no single cause for Autism.
- Different children suffering from Autism are due to different causes.
- Some commonly identified factors include
- Gene mutations: No single gene is associated with Autism.
- Environmental stresses
- Parental age at the time of conception
- Maternal illnesses during pregnancy
- Mother who is a victim of drug and alcohol abuse
- Oxygen deprivation to the child’s brain etc
- However it should be noted that there is no conclusive direct correlation with any of the factors above listed.
- Since no two individual suffer from Autism due to same cause, different conditions are grouped under ASD.
- It can vary between mild learning and social disability, to more complex emotional and physical disabilities.
- Mild form of Autism
- Obsessive interest in a particular object or subject
Pervasive developmental disorder
- This is more severe than Asperger’s syndrome
- No two people suffering from the disease will exhibit the same symptoms
- Common symptoms include
- Poor social interaction
- Impaired language skills
- Most severe form of ASD.
- Multiple impairments
- Mental retardation and seizures
Note: Rett syndrome and Childhood disintegrative disorder are rare ASDs