- The commitment to end the AIDS pandemic by 2030 needs strong and fearless leadership
Relevance: mains: G.S paper III: Health
The Joint UN programme on AIDS, commonly known as UNAIDS, is facing one of the worst challenges afflicting the global AIDS response — this time an existential threat questioning its very relevance. The UN Secretary-General, António Guterres, is expected to appoint a new executive director after the departure of Michel Sidibé in May 2019 on the recommendation of the programme coordinating board which manages the organisation. There are strong contenders from Africa and the U.S. in the reckoning among those who have been shortlisted.
A pivotal role
At such a crucial time, it is disturbing to hear voices again questioning the relevance of UNAIDS for the global response.
There are suggestions that AIDS should go back to the World Health Organisation (WHO) where it originally belonged to some 25 years ago. And that the new executive director should be equipped with an exit strategy to wind up the organisation.
Since its establishment in 1994, UNAIDS has been able to successfully mobilise world opinion to mount an exceptional response to an epidemic which has consumed over 20 million lives with still no effective treatment or cure. The UN General Assembly Special Session (UNGASS) 2001 was a game changer with the adoption of a political resolution that itself was exceptional in many ways. The creation of a Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and the slashing of prices of AIDS drugs by Indian generics have brought treatment within the reach of many countries. Today some 22 million people are under antiretroviral therapy (ART) and preventing mother-to-child transmission of HIV has become an achievable goal by 2020. The organisation has provided leadership to many countries which in 10 years (2001-2010) could halt the epidemic and reverse the trend.
The epidemic is still alive
However, at a time when it should be leading the global response to end AIDS as a public health threat, the organisation has started to falter in its strategy. First came the extremely optimistic messaging blitz that the world was going to see the end of AIDS very soon. This is far from true. Regions such as eastern Europe and Central Asia and West Asia are nowhere near reaching that goal, with many countries such as Russia witnessing a raging epidemic among drug users and men who have sex with men (MSM) communities. With the top leadership in UNAIDS exhorting countries to bring AIDS “out of isolation” and integrate with health systems, the political leadership in many countries have thought that AIDS is no more a challenge.
Second has been the thinking that the AIDS epidemic can simply be treated away by saturating anti retroviral (ARV) coverage. Nothing could be farther from the truth. It is forgotten that AIDS affects the poor, the marginalised and criminalised communities disproportionately as they face challenges in accessing the ‘test and treat’ programmes. The ever increasing number of young people who are joining the ranks of vulnerable populations do not get prevention messages like in the past. National programmes do not any more consider condoms, sexual education and drug harm reduction as central to the prevention of HIV transmission that results from unprotected sex and drug use. Funding for non-governmental organisations and community-based organisations working on prevention has virtually dried up.
Third has been the weakening of country leadership of UNAIDS in many high-prevalence countries. Senior country-level positions are, in many instances, held by people who do not possess the core competence to constructively engage political leadership to undertake legal reforms and provide access to services to marginalised populations.
Weakening activism
But the biggest setback has been the lost voice of vulnerable communities which was the main driving force of AIDS response in the decade after UNGASS. Activism surrounding AIDS has suddenly fizzled out emboldening many countries, especially in Africa, to further stigmatise and discriminate by enacting new laws that criminalise vulnerable sections of society.
To add to its woes, the charges against one of the senior most staff and his exit from the organisation have seriously compromised UNAIDS at a time when the global response needs its leadership the most. The new executive director will have an unenviable task of not just restoring the credibility and relevance of the organisation but strengthening its presence at country level and making it more meaningful to the communities which look to it for leadership. The new executive director has to work relentlessly to place prevention of the epidemic and empowering communities at the centre of global response.
With 1.7 million new infections and one million deaths occurring every year, we can’t afford to drop the ball half way. The commitment to end AIDS by 2030 is ambitious but not impossible to achieve. What we need is a re-energised UNAIDS with a strong and fearless leadership from a person of high integrity and commitment along with a sincere effort to remove the deadwood from the organisation. Any thought of winding it up or giving the mandate back to WHO would be suicidal at this moment.
(Source: The Hindu)
- The country’s new DNA law raises privacy concerns:
Relevance: mains: G.S Paper II: policy and schemes
Parliament is set to pass a law to regulate the use of DNA technology. Since the DNA of a person is unique, it can be used to accurately identify a person’s identity. Globally, DNA technology is used to help enforcement agencies identify both perpetrators and victims in criminal cases. In medicine, DNA is used to identify the susceptibility of a person to diseases such as cancer and Alzheimer’s. In civilian life, DNA can be used to establish parentage of children or sibling relationships.
However, the use of DNA technology also raises major concerns relating to consent (i.e. the right to refuse to provide a bodily substance), privacy and data security. Hence, countries the world over have felt the need to strictly regulate the use of DNA. One hopes that the new law would fill a major gap, as the use of DNA technology in India has been left unregulated. Unfortunately, there are major lacunae in the way the new law addresses core issues such as privacy and fundamental rights.
In criminal cases, the law specifies the requirement of written consent before DNA samples are collected for testing from criminal suspects or under trials, offenders, victims of a crime, and missing or unidentified deceased persons.
Once these samples are analysed by a DNA laboratory, they will be stored in a national DNA data bank under various categories depending on whether the DNA has been collected from a crime scene, suspects or offenders, or unidentified deceased persons. For such criminal cases, safeguards are specified on limiting access to the DNA data bank and conditions under which DNA information can be deleted.
However, the new law goes well beyond criminal matters and regulates civilian and medical use of DNA. This is where major concerns arise and affect issues as diverse as parentage disputes, medical negligence, and any matter related to establishing an individual’s identity. On these issues, the new law does not prescribe any safeguards.
For example, the law does not require the consent of an individual while giving DNA samples in civil matters such as a paternity suit. The ethic behind the need for consent is that a person’s bodily substances include DNA, which not only identifies the person, but also reveals her genetic information such as physical and medical traits. Such information may affect her privacy, and so consent offers a safeguard against DNA misuse.
Or consider the provision related to the national DNA database that is being created under the law. As the name suggests, the database is a central repository of DNA information of individuals covered by the law. While the database will have information related to criminal offences, the law is unclear on whether DNA collected for civil cases will be stored in this database.
This is because the law requires all DNA laboratories to share DNA test results with the data bank. Therefore, were a DNA laboratory to analyse a DNA sample in the course of a private dispute between parties (say, an in vitro fertilization clinic and a pregnant woman), would it share this information with the data bank?
The Bill in question does not state that DNA information related to civil matters will not be stored in it. Note that the Combined DNA Index System (CODIS) in the US and the National Criminal Intelligence DNA Database in the UK are national DNA data banks with information related only to criminal investigations.
Further, if DNA information related to civil matters is stored in the data bank, it may violate the fundamental right to privacy as laid down by the Supreme Court. The Court has stated that the right to privacy may be infringed only through the enactment of a law, and that law must achieve a public purpose that’s proportionate to the infringement of privacy. Since the storage of DNA profiles for civil matters (such as paternity suits and medical diagnoses) may not serve a public purpose, it may violate the right to privacy.
A more fundamental issue is ambiguity on whether the law intends to regulate DNA tests conducted in medical and diagnostic settings. For instance, many laboratories across the country offer such tests to determine a person’s predisposition to cancer, diabetes and other diseases.
Such testing can also be used to identify an individual. For example, breast cancer can be diagnosed by analysing mutations in the BRCA1 gene, which involve analysis of large parts of an individual’s DNA, which could provide enough information to identify an individual. The law does not address how this DNA data will be stored, for how long, whom it will be shared with (such as a person’s health insurer), and when it will be deleted.
In fact, the gaps in the new DNA law dovetail into the larger issue of the lack of a data privacy law, which was raised by several Members of Parliament opposed to the law. While introducing it, Union minister Dr. Harsh Vardhan stated that the law intends to regulate DNA testing for identifying criminals, victims, missing, and deceased persons.
Clearly, the law goes beyond this objective. It needs rigorous scrutiny by a cross-section of experts and wider consultations. This can be achieved if the Bill is referred to a parliamentary committee. Otherwise, it could be a missed opportunity to effectively regulate the use of DNA technology.
(Source: Livemint)
- New rules for medical education:
Relevance: mains: G.S paper II: government policies and interventions:
In a nation of billion-plus people with woefully inadequate access to healthcare and an acute shortage of qualified doctors, getting a seat at a medical college is often seen as a sure-fire way to prosperity. Owners of private medical colleges have for years sought to exploit this heavy demand by charging exorbitant fees, often with the blessings of the Medical Council of India (MCI). The Council, the country’s regulator for medical education and practice, has been accused of corruption in granting recognition to medical colleges. All this would change, or so the government hopes, once the National Medical Commission (NMC) Bill, introduced on Monday in the Lok Sabha, replaces the 63-year-old MCI with a new oversight body.
The bill seeks to establish uniform standards for medical education by proposing that the final year of MBBS exam be treated as an entrance test for post-graduate courses and a screening test for those who obtained a degree in medicine from abroad. This exam will be called the National Exit Test (NEXT). While some medical professionals have raised concerns over a possible dilution of standards this way, students at large appear to have welcomed the shift.
Perhaps the stand-out provision of the bill is its intent to cap fees on 50% of seats in MBBS and PG courses at private medical colleges. This seems to be a good interim measure, given the state-created squeeze on seat supply. However, price caps should not get institutionalized as a matter of policy. What the government needs to do is set up a large number of new medical colleges. Simultaneously, it must allow private players, as many as possible, to set up colleges with permits granted in an open and transparent manner. An increase in the number of seats, along with scrupulous regulation, would do a better job of solving the sector’s problems than price caps, which are inherently arbitrary and could distort the dynamics of medical education in the long term.
(Source: Livemint)
- An improved monitoring mechanism can play a key role
Relevance: mains: G.S paper III: Science and technology
The advancing monsoon has brought relief to many parts of India, but its progress has been slower than average and the country is still in the midst of a rainfall deficit, with millions facing an acute water shortage. Water is essential for human survival, and for agriculture and industry. It is important that India — which has only 4% of the world’s renewable water resources but about 18% of the world’s population — consumes water more sensibly.
In India’s pursuit of 100% electrification goal, the country’s installed power capacity will need to be doubled. Even with the growth of renewable energy (RE), coal has been projected to be the backbone of the electricity sector till 2030 and beyond. Managing the electricity needs of a country that’s already dealing with water scarcity will be a challenge.
Located in water-scarce areas
Thermal power plants (TPPs) consume significant amounts of water during the electricity generation process. Most of India’s TPPs are located in water-stressed areas, and water shortages have led to electricity-generation disruptions and significant revenue losses to the economy.
In December 2015, the Ministry of Environment, Forest and Climate Change issued a notification setting limits for water consumption by TPPs. However, the amended Environment Protection (EP) Rules codified in June 2018 ended up permitting TPPs to use more water than what was initially specified. There are certain mechanisms that need to be strengthened to make these regulations more effective.
The Central Electricity Authority (CEA) recently released the format for TPPs to report on their annual water consumption. The power plants were asked to specify both metered and un-metered usage, report on the source (like river, canal or sea), and state the percentage of deviation from the water norms, along with the reasons and the corrective measures undertaken.
These guidelines can be strengthened by including other relevant inputs. First, TPPs should disclose the amount of water consumed by them in previous years, so that a baseline for water consumption per TPP can be established, and subsequent reductions in water consumption can be quantified. Second, these reporting requirements — currently in the form of an Excel sheet on the CEA website — must be added to the EP Rules, to accord the disclosure process greater transparency and enforceability. Third, TPPs should also be required to submit verifiable evidence (for example, water bills) to support and substantiate the disclosures. Without these, the self-reporting guidelines will remain weak.
Finally, the data supplied by TPPs should be placed in the public domain, so that the parameters disclosed can be studied in the context of region-specific water shortages, outages in the plants, and future research and analysis in this field.
Specifying penalties
Section 15 of the EP Act provides for a blanket penalty for contravention of any provisions of the Environment Protection Act or EP Rules: up to five years of imprisonment and/or up to ₹1 lakh fine along with additional daily fines for continuing offences. However, the Act does not stipulate specific penalties for specific offences. Perhaps this is an area for review by the government, so that we have a more nuanced framework for enforcement and penalties.
Further, the relevant officials in charge of enforcement, across the Ministry and the CEA, should be identified, and their roles clearly defined. The implementation of these norms should include milestones and time-based targets, and periodic monitoring of the progress of TPPs in making improvements.
In addition to reducing the stress caused by TPPs, shifting to a more aggressive RE pathway will help India achieve its global climate targets. However, this will need further work — particularly to regulate water consumption by specific RE technologies. The Ministry of New and Renewable Energy has taken a first step by issuing a notice to State governments on reducing water use for cleaning solar panels and to explore alternative mechanisms to ensure that solar panels remain efficient.
India will need to balance the needs of its growing economy with its heightening water stress. Stringent implementation of standards for judicious water use by TPPs, combined with the promotion of RE and energy efficiency, will offer pathways for achieving these goals.