Tag: health minister harsh vardhan

Kumbh Mela Shahi Snans Biggest Super-Spreaders in Pandemic’s History: Dr Ashish Jha

The Modi government’s refusal to accept advice from its own scientists and to be guided by indisputable data is one of the main causes of the COVID-19 crisis, the global health expert said.

One of the world’s most highly regarded experts on global health has said the Modi government’s refusal to accept advice from its own scientists as well as its refusal to be guided by indisputable data is one of the main causes of the present COVID-19 crisis in India.

Professor Ashish Jha has also said the Kumbh Mela shahi snans, held in March and April, when two and three million people gathered together without masks and social distancing, would be the biggest super-spreaders in this pandemic’s history. However, Jha also said he can see some signs of the present surge in COVID-19 cases plateauing but added the dark ominous cloud surrounding this silver lining is the fact they are plateauing at levels of 3.5 lakh cases a day, which is higher than any other country in the world.

In a 35-minute interview to Karan Thapar for The Wire, Jha, who is Dean of Brown University’s School of Public Health, said the Modi government’s “failure to respond to data is very concerning”. He said it must be explained by “the people in power”. He said India is owed “an explanation” by the government.

Jha said by early or, latest, middle March it was clear from the data that India was heading toward trouble and yet the government failed to respond “in any serious way”.

Jha added the Kumbh Mela shahi snans, in March and April, when 2 or 3 million people gathered without masks or social distancing, could be counted as “the biggest super-spreaders in the history of this pandemic”.

Instead of acting when its own INSACOG scientists were expressing “high concern” about how new and contagious variants could cause an exponential rise in cases – this was in early March – the Health Minister on March 7 claimed India was in the “endgame” of the fight against the virus. Earlier, in February, a BJP resolution claimed India had “defeated” COVID-19. In January, at the World Economic Forum, the Prime Minister boasted India had succeeded in “containing corona effectively”.

Jha told The Wire that though the official daily increase in cases was 412,000 (as per May 5), he believes its likely to be between 15-20 lakhs a day if you include the undetected infections.

However, Jha said he can see some early signs that the daily increase in COVID-19 cases is plateauing. He said that seems to be particularly true of Maharashtra and Delhi. However, he added two notes of caution. First, he said testing is not happening as widely and consistently as it needs to and so we need to be careful in concluding cases are plateauing. It could also be an outcome of testing levels dipping.

More importantly, Jha said even if cases are plateauing they are doing so at levels of 3.5 lakh a day, the highest anywhere in the world. This means we will continue to see a worryingly high level of serious illness and deaths.

Jha also pointed out the assumption that because cases rose sharply they will also decline equally dramatically may not be correct. He fears cases may only slowly meander down. In that event it could entail a period of prolonged suffering. In fact, he told The Wire he was very worried about the next month or six weeks.

However, questioned about Principal Scientific Advisor K. Vijay Raghavan’s warning that a third wave is inevitable, Jha first said “It’s really good to see acceptance (from the government) India is not unique”. India’s earlier refusal to accept there would be a second wave was, it seems, predicated on the assumption India, unlike any other country, had defeated the virus.

But Jha went on to say that India could avoid a third wave if it steps up vaccination. To do so, India would need to vaccinate a further 500 million people on top of the 160 million it has already vaccinated with one jab. He said this cohort do not need to be given both doses. One would do. He also said India should now follow British practice and WHO guidance and increase the gap between both doses from the present 6-8 weeks to 10-12 weeks.

However, Jha does not believe a prolonged nationwide lockdown is necessary. What is essential is to ensure that people who are not part of the same household do not gather together indoors.

Watch the full interview here.

In ‘Response’ to Manmohan’s Letter on COVID-19 Crisis, Vardhan Attacks Congress

The Union health minister chose to place the blame for India’s second wave on Congress-ruled states, ignoring two crucial suggestions made by the former prime minister.

New Delhi: In a starkly political response to a list of suggestions that former prime minister Manmohan Singh made in a letter to his successor Narendra Modi on combating the alarming rise in COVID-19 cases in the country, Union health minister Harsh Vardhan on Monday attacked the Congress party for apparently attempting to derail India’s vaccination drive.

On Sunday, Singh’s letter said that ramping up the vaccination drive is key to battling the pandemic, asking the government to “resist the temptation to look at the absolute numbers being vaccinated, and focus instead on the percentage of the population vaccinated”.

He added that India currently has vaccinated only a small fraction of its population, adding that with the right policy design, “We can do much better and very quickly.”

Vardhan acknowledged that Singh’s emphasis on vaccination was shared by the government – and then launched into a boastful tirade. He highlighted that the “world’s biggest vaccination drive” has become the fastest to reach the milestones of 10, 11 and 12 crore administered doses.

But Bhramar Mukherjee, a biostatistician at the University of Michigan, told the BBC that India’s current pace of vaccination – which is around 3 million doses a day – is ‘complacent’ and the country should aim to vaccinate at least 10 million people every day.

This may not be possible in the immediate future as India is facing a debilitating vaccine shortage. After hitting a record high of more than 43 lakh doses administered on April 5, India has not been able to match this number since. In fact, in the last week, the average doses per day was only 2.76 million, according to covid19india.org.

In his reply, Vardhan said junior members of the Congress party must also follow Singh’s advice. “Quite obviously, it cannot be said that the discussion on total cases, active cases or mortality is based on absolute numbers, which the Congress party often tries to do,” the health minister said.

Vardhan continued to attack the Congress party, saying that members of the party and state governments formed by it “do not seem to share” Singh’s views. “It is shocking that senior members of the Congress party are yet to utter a single word of gratitude towards our scientist community and vaccine manufacturers for innovating under trying circumstances and empowering the world with vaccines,” the health minister added.

Dr Manmohan Singh. Photo: Twitter

Scientists and healthcare workers have previously said that more than expressions of gratitude, they need the freedom to determine and then the resources to execute their research agendas without interference from the government.

Recently, Vardhan – who is also the science minister – had chastised representatives of various ministries for the delay in approving and funding research projects primed to scientifically validate the “uniqueness of indigenous cows and its products”. The government’s promotion of the so-called ‘cow science’ has been criticised by the scientific community. Vardhan was also called out by the Indian Medical Association for his presence at an event in February 2021, during which Baba Ramdev claimed that Patanjali’s ‘medicine’ Coronil would ‘treat’ COVID-19, without any evidence to support the claim.

Vardhan also accused the party’s governments of “spreading falsehoods” regarding the efficacy of the vaccines candidates that India is administering, “thereby fuelling vaccine hesitancy, and playing with the lives of our countrymen”. He said a Congress party chief minister had incited people against taking Covaxin, India’s indigenous COVID-19 vaccine candidate.

While Vardhan didn’t mention who he was referring to, media reports show that several Congress leaders had expressed alarm at the government’s decision to approve Covaxin for use even before data from its phase 3 clinical trials had become available. They were not alone in doing this, as many health and medical experts had also questioned the move. These experts were of the opinion that while the vaccine candidate may prove to be safe, it should not have been approved before having access to data that demonstrated safety and efficacy.

Punjab chief minister Amarinder Singh had said in early March that the allegation by BJP spokesperson Sambit Patra that his state government, along with other opposition-ruled states, had expressed “doubts and refused to accept” Covaxin. “It was not at all true,” Amarinder Singh said, describing it as a “complete lie” that was part of the ruling party’s “false and politically motivated propaganda”.

Vardhan then placed the blame for India’s second wave of COVID-19 on Congress-ruled states. “The test positivity ratio in these [Congress-ruled] states during the second wave is alarmingly high and they too could benefit from your counsel and wisdom.”

Vardhan then told Singh that those who advised him in drafting the letter have “done a great disservice” to him by “misleading” the former PM on material that is already in the public domain. He says that on April 11, the Centre had already decided to allow the import of vaccine candidates that have been approved in other countries, a suggestion that Singh had made in his letter.

While this is true, by April 11, many state governments were already complaining about a shortage in available vaccine doses.

The health minister said that the Centre had also acted on another suggestion made by Singh, that funds and other concessions should be made to companies that are involved in the process of manufacturing vaccines.

Vardhan’s ‘response’ ignored two crucial suggestions made by Singh – that the Centre should publicise how many orders it has placed with different vaccine manufacturers, so that state governments can plan for the vaccination drive based on a ‘transparent formula’. The former PM had also said that states should be given leeway in defining frontline workers, saying that some governments may want to vaccinate school teachers, bus drivers or taxi drivers. The health minister did not indicate whether such a move would be approved by the Centre.

COVID-19: In PM Modi’s CMs Meet, Vaccine Shortage Takes Centre Stage

As some states complained of centres shutting down for lack of doses, health minister Harsh Vardhan called for an end to ‘fear mongering’.

Prime Minister Narendra Modi addresses a gathering in Ahmedabad, March 12, 2021. Photo: Reuters/Amit Dave/File Photo

New Delhi: Prime Minister Narendra Modi on Thursday said states should observe a ‘vaccine festival’ between April 11 and 14 to inoculate the maximum number of eligible beneficiaries against COVID-19 even as Union health minister Harsh Vardhan called for an end to “fear mongering” about shortage of vaccines after some states complained of lack of supplies.

The calls by Modi, at yet another interaction with chief ministers, where they were urged to strengthen efforts for the next 2-3 weeks to check the spread of the virus on a “war-footing”, and Vardhan came on a day when the daily count of new COVID-19 cases hit a record high, of over 1.26 lakh. The prime minister also said that administration was appearing lax in many states.

Modi asked the chief ministers to focus on micro-containment zones and reiterated his call to work on the mantra of ‘test, track, treat’ besides pushing COVID-19-appropriate behaviour and management. He asked states to not bother much about positive cases and focus on more testing.

“Our efforts should be to inoculate the maximum eligible people during the ‘Tika utsav’ (vaccination festival) between April 11 and 14,” he said, asking youngsters to help those above 45 years of age to get the jab. April 11 is the birth anniversary of noted social reformer Jyotirao Phule, he noted.

Vardhan took to Twitter to say that 9.1 crore vaccine doses had been utilised, while 2.4 crore are in stock and 1.9 crore vaccines are in the pipeline, indicating there are sufficient doses available for all states.

Ten states – Maharashtra, Chhattisgarh, Karnataka, Uttar Pradesh, Delhi, Madhya Pradesh, Tamil Nadu, Gujarat, Kerala and Punjab – have reported a steep rise in the daily tally of COVID-19 cases, accounting for 84.21% of the 1,26,789 new infections, the Union health ministry said.

The national weekly COVID-19 positivity rate has increased by 6.21% cent – from 2.19% to 8.40% – in the first seven days of March and April, it added.

As more states like Uttar Pradesh and Karnataka and the union territory of Jammu and Kashmir imposed night curfew in several districts up to the end of this month, Modi defended this measure saying it has been an experiment globally to contain the COVID-19 spread, and proposed to call the night restriction a “corona curfew” to maintain public awareness about the pandemic.

Prime Minister Narendra Modi during an interaction with chief ministers during to discuss the COVID-19 situation on April 8, 2020. Photo: pmindia.gov.in

Taking a cue from Modi, Karnataka chief minister B.S. Yediyurappa used the term “night corona curfew” while announcing this restriction between 10 pm to 5 am in seven district centres, including Bengaluru.

In his virtual interaction with chief ministers to discuss the pandemic situation and the ongoing vaccination drive, Modi strongly defended the current eligibility criteria for the vaccination amid demand by some states to make the shot open for everyone older than 18 years.

India’s criteria is no different from the most prosperous countries in the world, and it will have to prioritise the vaccination, he said. As of now, those above 45 years are eligible for the jabs.

With the debate assuming political overtones in some cases, Modi said wryly that those doing politics over the matter may do so but he will not join issue and asked chief ministers to work together with the Centre to prevail over the pandemic.

Maharashtra Chief Minister Uddhav Thackeray told the prime minister that the state was not lagging behind in the fight against COVID-19, and urged him to affirm there should be no politics in this effort.

A statement issued by the chief minister’s office in Mumbai said Thackeray requested the prime minister to address the leaders of all political parties, asking them to refrain from indulging in politics on the issue.

Delhi health minister Satyendar Jain said the fight against coronavirus is not a Centre-versus-state issue and that it should not be politicised.

Some senior functionaries of the Maharashtra government had recently hit out at the Centre over the allegedly low availability of vaccines in their state, inviting a sharp rebuke from Vardhan.

Vardhan on Wednesday accused Maharashtra and some other states of doing politics over the vaccine issue by trying to cover their “failures” and spreading panic among people by demanding vaccination of all without inoculating enough eligible beneficiaries.

Stating that the country had brought down its active cases to 1.25 lakh from 10 lakh earlier with a similar approach, Modi expressed confidence that the nation will win over the crisis as it now has better resources, more experience besides vaccines.

Modi said the situation is more worrisome in some states with people becoming much more casual in their behaviour and administration appearing lax in many states. This sudden surge had created difficulties, he acknowledged.

“There is a need to improve the governance system. I understand that because of the one-year battle, the system can experience tiredness and there can be laxity, but we must tighten it for 2-3 weeks and strengthen the governance… To stop the spread of the virus, there is a need to work on a war-footing,” he added.

Also read: Are the New Variants Driving India’s Second COVID-19 Wave?

In his address, Modi underlined that the case load has surged past the peak during the first wave, that their growth is also higher, and that Maharashtra, Chhattisgarh, Punjab, Madhya Pradesh and Gujarat are now reporting more cases than they did in the last year.

“Some other states are also moving in that direction. This is a matter of worry.”

Minister Vardhan dismissed as a “farce” the “hue and cry” by certain states about partisanship by the Centre and called it an attempt to hide their own incompetence, saying non-BJP ruled Maharashtra and Rajasthan figured among the top three states based on allocation of vaccines.

Releasing the figures, he said in another tweet, “Let’s put an end to fear mongering now! #COVID19 vaccine doses: total administered: 9 cr+ In stock/nearing delivery to states: 4.3 cr+ Where does question of shortages arise? We’re continuously monitoring and enhancing supply.”

Maharashtra health minister Rajesh Tope had sought to know why the state was getting fewer COVID-19 vaccine doses as compared to some other states, including Gujarat and Madhya Pradesh, even as it led the vaccination drive and had the highest number of active cases in the country.

The ongoing COVID-19 vaccination drive in Mumbai will come to a halt from Friday as the stock of vaccine doses in the city is about to end, Mayor Kishori Pednekar said.

Reuters reported that vaccine centres in several states, including Maharashtra, have been shutting early and turning people away as supplies run out.

Healthcare workers outside a government hospital in Mumbai city were seen turning people seeking vaccinations away, asking them to call a helpline number set up by the municipal authorities. It was not immediately possible to confirm whether those seeking the shots were in the priority groups.

“We don’t know when the vaccine will be back in stock. It could be available later today or maybe tomorrow,” one said. Notices saying “vaccine out of stock” were plastered outside a centre in a neighbouring suburb, along with helpline numbers. In two other districts in Maharashtra, local officials said inoculation efforts had been stopped and centres were closed.

Odisha state said it had closed half its vaccination sites.

Punjab Chief Minister Amarinder Singh urged the Centre to give flexibility to states to devise local strategies for COVID-19 vaccination within the broad parameters of the central government’s approach. In a letter to the prime minister, he also sought a review of norms in order to allow all adults in high-risk areas to be immunised, along with people below the age of 45 suffering from liver and kidney diseases.

Chhattisgarh chief minister Bhupesh Baghel requested the prime minister to allow all people above 18 years to get vaccinated against COVID-19.

However, Modi rejected these calls. “It’s not that you can set up these big vaccine factories overnight,” Modi said in his address to chief ministers. “Whatever production we have got, we will have to prioritise.” He added, “In our cities, a huge segment is poor or elderly… we should take them for vaccination and prioritise it.”

Opposition parties have blamed Modi’s government for exporting 64.5 million vaccine doses while itself covering only a fraction of India‘s 1.35 billion people. “Why was there no strategy or planning put into the logistics of the vaccine programme?” the main opposition Congress party said on Twitter. “Why is there both extremely high wastage and an acute shortage of vaccines?”

New Zealand on Thursday suspended entry for all travellers from India, including its own citizens, for about two weeks.

(With inputs from Reuters and PTI)

Parliament Passes Bill To Punish Those Who Attack Healthcare Workers

The government had brought the ordinance on April 22, to amend the Epidemic Diseases Act, 1897, to make incidents of violence on health workers treating COVID-19 patients a non-bailable offence.

New Delhi: The Lok Sabha on Monday passed legislation that provides for up to seven years in jail for those attacking healthcare workers fighting the coronavirus or during any situation akin to the current pandemic.

The Epidemic Diseases (Amendment) Bill, 2020, will replace an ordinance issued in April by the government. The Rajya Sabha has already passed the bill on Saturday.

With the Lok Sabha giving its nod, it will soon become an act, which is going to amend 123-year-old legislation.

The government had brought the ordinance on April 22, 2020, to amend the Epidemic Diseases Act, 1897, to make incidents of violence on health workers treating COVID-19 patients a non-bailable offence, with provisions of a penalty and a jail term of up to seven years.

The bill intends to ensure that during any situation akin to the current pandemic, there is zero-tolerance to any form of violence against healthcare personnel and damage to property.

Under the proposed act, the commission or abetment of such violence will be punishable with imprisonment for a term of three months to five years and with a fine of Rs 50,000 to Rs 2,00,000.

In case of causing grievous hurt, the imprisonment shall be for a term of six months to seven years and with a fine of Rs One-Five lakh.

Replying to a debate on the bill in the Lower House, Health Minister Harsh Vardhan said this was empowering legislation and states could make additions to the act.

Also read: Cabinet Clears Ordinance to Punish Violence Against Health Workers, IMA Withdraws Protest

The ordinance has given a very strong message to perpetrators of violence against medical professionals and health workers during the pandemic, Vardhan said.

“We have all noticed that there has been a dramatic decline in the incidents of violence against health workers all over the country,” he said.

Vardhan explained that the ordinance had to be brought as incidents of harassment and violence against health workers were rising amid a lack of awareness about coronavirus.

“Everyone was feeling sad and bad. That was the time the Government thought of taking a proactive step. When the Government reviewed, it found there were minimal laws and powers in some states. There was a need to have a central law to put in place a prohibitory mechanism to stop such activities,” Vardhan said.

With regard to certain objections raised by members from opposition parties regarding some legal flaws in the Bill, he said the bill had been drafted after taking legal opinion.

Adhir Chowdhury of the Congress said it seemed that the Government had brought the Bill in haste as certain provisions were an area of concern.

As the saying goes, “haste makes waste”, he said, adding: “I would request the Government to send the bill to the standing committee and comprehensive legislation should be brought in.”

Under the bill, there is a provision that says the offender would be presumed to be guilty of the offence unless proved otherwise by the accused defender, Chowdhury said, adding that this was an incomplete deviation from the principles of the country’s criminal law.

Bhartruhari Mahtab of the BJD and Kalyan Banerjee of the TMC also raised legal lacuna in the bill and wanted the government to consider changes.

The Health Minister said, “our government from the last 3-4 years is working on a National Public Health Act to comprehensively deal with issues related to biological emergencies”.

Subhash Bhamre of the BJP said healthcare workers should be allowed to work in an environment free of abuse. He said 68,000 healthcare workers had tested positive for coronavirus so far and 500 doctors had lost their lives due to the infection.

Bhamre said when doctors were working round the clock, donning PPEs, which makes it difficult to work, and without caring for their lives, the healthcare workers should get the respect they deserve.

T Sumathy Thangapandian of the DMK said the bill talked about violence against healthcare personnel during the pandemic, asking what would be the case after the pandemic ended.

Kalyan Banerjee said West Bengal already had legislation that provides protection to healthcare workers. He said the states should be authorised to take a decision on the punishment.

K Suresh of the Congress cited various instances when healthcare workers and doctors were attacked during the pandemic.

LS Members Come to Blows as Harsh Vardhan Condemns Rahul Gandhi’s Remarks on PM

“In a recent speech, he (Rahul) used words like 6 mahina baad, iss desh ka yuva, Narendra Modi ko dande maar maar ke desh se bahar karenge,” Vardhan said.

New Delhi: Treasury and opposition members nearly came to blows in Lok Sabha on Friday when Union health minister Harsh Vardhan condemned in “no uncertain words” the “outlandish” remarks made by Congress leader Rahul Gandhi against Prime Minister Narendra Modi.

During Question Hour, when Rahul asked a question related to the establishment of medical colleges, Vardhan said before giving the answer, he would like to make a statement on the Congress leader’s recent comment on the prime minister.

Vardhan said he “condemns in no uncertain words” the “outlandish” remarks made by Rahul.

“Sir, please excuse me. Before I begin answering this question of dear Shri Rahul Gandhi ji. I want to condemn in no uncertain words the outlandish language that he has used against the prime minister of the country,” he said.

Speaker Om Birla asked the minister to stick to his answer.

Also read: In Parliament, Modi Targets Omar Abdullah by Quoting Satirical Website ‘Faking News’

As Vardhan continued reading out the statement, Congress MPs strongly protested the minister’s move.

One of the Congress members from Tamil Nadu, Manickam Tagore, came to the treasury benches and attempted to aggressively reach Vardhan, who was sitting in the second row.

Immediately, BJP member from Uttar Pradesh, Brij Bhushan Sharan Singh, held Tagore by his arm to prevent him from reaching the union minister.

Congress MP from Kerala Hibi Eden tried to intervene. Several MPs from both sides and union ministers, including Smriti Irani, prevented them from coming to blows. “Guys, what are you doing. What is going on,” Irani was heard saying.

Unnerved by the commotion, Vardhan continued reading his statement.

“In a recent speech, he (Rahul) used words like 6 mahina baad, iss desh ka yuva, Narendra Modi ko dande maar maar ke desh se bahar karenge. (After six months, youth of the country would beat Modi with sticks and throw him out),” Vardhan said.

The minister said, “I don’t think in the worst of cases our party leaders have made such outlandish personal remarks against him threatening to beat him with dandas (sticks) and throwing him out of the country”.

“The entire House present here must in unequivocal terms condemn his remarks against our prime minister. We demand…,” he said.

The speaker immediately adjourned the House till 1 pm.

After the House was adjourned, several MPs of the ruling BJP demanded expulsion of Tagore from the House.

“Sadan se bahar karo. Mafi mango (Expel him from the House. Seek apology),” BJP members were heard saying.

Another member was heard saying, “Rahul Gandhi mafi mango (Rahul should tender apology).

Also read: Defending CAA, Did Modi Cite Same Nehru-Bordoloi Letter Which BJP Used to Slam Congress With?

Rahul made the remarks during a rally for the Delhi Assembly polls.

On Thursday the prime minister took a dig at Rahul for his remarks, saying he would increase the number of Surya Namaskars (a yoga exercise) so that his back can bear the attack.

As soon as the House reassembled at 1 pm, Kirit Solanki, who was in the chair, adjourned proceedings till 2 pm.

“It is highly uncalled for. If anything is wrongly spoken then it is up to the Speaker to take a call but trying to attack the Minister is condemnable,” Joshi said as the House reassembled.

As Congress members too were on their feet, A. Raja, who was chairing the proceedings of the House, adjourned it for the day.

Will Our New Community Health Provider Please Stand Up?

The baffling secrecy around the government’s plans of ‘community health providers’ in the NMC Act passed by parliament in July.

Medicine and public health are not the same, even if they are most often confused and idealised as one. The medicine course has a clinical focus, and medical students in India often dream of a prosperous life in the US or Europe. The idea of public health comes with an inherent duty to serve the poorest in the country, no matter what the working conditions are.

The aspiration of a doctor-to-be and the reality of public health needs in India today couldn’t be more divergent.

The Modi 2.0 government has mooted a separate cadre called ‘community health providers’ in a fresh law that attempts to bridge the gap between the two. Ironically, it finds itself in the same soup as the Ajit Jogi-led Congress government found itself in 2001-03 when it launched a dedicated public health cadre to address exactly the same end – letting the state’s rural population access mainstream healthcare services.

Also read: ‘Health for All’ as a Political Question

Doctors’ groupings have been strongly protesting, saying the move will dilute the discipline of medicine by creating a parallel insufficiently qualified medical cadre with prescribing power, and in that sense ‘legalise quackery’.  

They are not completely wrong in their claims but by letting status-quo prevail for decades, India today is in a situation where illegal ‘quacks’ are practically running the medical show in villages. An alarming 57% of allopathic practitioners are without medical qualification, reckoned the WHO in 2016. In villages, this number shoots up to 80%. Various estimates including one of Indian Medical Association’s own peg the number of ‘quacks’ at somewhere between 1-2.5 million.

These ‘quacks’ have thrived because no amount of pull factors – offering extra money or extra marks to enter difficult to crack PG courses or push factors – forcing doctors to sign bonds to serve a few fixed years in rural settings have historically made it palatable for a critical mass of doctors to serve in the country’s hinterland. Ramping up doctors’ cadre will take time, and even if their numbers swell, there is no guarantee that their aspirations will change and they would willingly serve in the countryside.

In that context, a new cadre of ‘community health providers’ proposed in the National Medical Commission Act is probably the only plausible short to medium-term  solution on the horizon to experiment with and evaluate. But even those who wish to support the concept find themselves tongue-tied because no one knows who these ‘community health providers’ will be and how they would be trained.

Also read: Who Is Paying for India’s Healthcare?

This is one of doctors’ cribs as well, and a legitimate one. A member of the parliamentary panel that discussed the bill at length has come out charging that this bit was not part of the proposed law they deliberated upon, hence they don’t have the faintest idea about what’s on the government’s mind.

There isn’t a way to hack the health minister Harsh Vardhan’s thoughts. But applying logic, the plan to build a community health cadre could involve training either one or more of these four categories—the nurses, and/or grass-root level health workers such as ASHAs and Auxilary Nurse Midwives, the practitioners of alternative medicines – known collectively as AYUSH doctors, a freshly trained public health cadre or the very controversial million plus ‘quacks’.

Of the lot, training a set of senior experienced nurses and allowing them to prescribe medicines in primary healthcare may prove the least controversial. Partly because this model has been tried and tested in parts of the US, the UK and Canada for years now with encouraging results. But India’s shortage of fully trained nurses, at around two million is more acute than its shortage of doctors pegged at around six lakh. And diverting existing nurses to take on doctors’ parts in rural healthcare practices could mean a full blown crisis in availability of nursing staff. Even then, readying a nurse cadre is cheaper, less time consuming, and less resource guzzling than preparing new doctors.

Also read: Regulatory Vacuum in Healthcare Is Aiding Exploitation by Private Hospitals

In the case of AYUSH doctors, Maharashtra has already begun allowing them limited range of prescription through a six months bridge course. But many experts warn against it for two reasons – a few months bridge course is too short to equip the healthcare professional with necessary skills to do abortions, and other minor surgical procedures which are a must if one has to effectively lead healthcare practice in rural settings. This process may also take some of the alternative medicine practitioners farther away from their original root healing systems which warrant rigour and discipline of a different order.

It’s not clear what would happen to the million plus ‘quack’ population, many of whom are practising in the countryside and enjoy strong community support. Will they be co-opted in some role in the new order or would they be left out as a new set of unemployed? There have been scattered projects in West Bengal (by a non-profit organisation named Liver Foundation) which are trying to bring unqualified medical practitioners into mainstream by offering them some training, and making them promise that they wouldn’t prescribe medicines labelled for restricted use and wouldn’t prefix ‘Dr’ to their names. The government is unlikely to bestow this set with prescribing rights, but if it does, that may open a can of worms. Most doctors and public health experts have been absolutely allergic to the idea.

If the government has the patience to train for three years a new batch of public health cadre, like Chattisgarh did in early noughties, build a career progression pathway for them, and keep the referral system well-oiled by syncing their work with doctors at a higher lever centres, the idea may prove worthwhile to try out. Initial evidence and anecdotal reports showed that Chhattisgarh model was working quite decently. Assam replicated it even though in Chattisgarh it had to be abandoned under stiff opposition from doctors. But one reason it worked well was that it drew its cadres from local rural people, who wouldn’t leave for greener pastures.

Also read: What Indian Healthcare Has Looked Like Under Five Years of the Modi Govt

 States like Tamil Nadu which have done well on health indicators have a separate public health cadre too, but they draw candidates from the common pool of medical students. However at a time when, medical colleges are already facing faculty shortages, and the country is ambitiously increasing the  number of doctors, finding trainers for these dedicated public health programs may prove challenging. The structure could resemble pre-1956 India, when there were two levels of medical professionals – full MBBS and Licentiate in Medical Practice (LMPs).

The LMPs were abolished by Bhore committee in 1952, as the panel probably hoped that future doctors would turn ‘social physicians’.  Again the confusion between public health and medicine. If done in haste without attention to quality of training and candidates, eventually this two-layered medical ecosystem could face the quintessential human rights question – are poor lives in rural lndia less than equal to not deserve a fully trained doctor’s attention?

Anyone who has experienced the crumbling public health system, and fleecing private healthcare system in India, while caring for a patient knows that change is the only way out. The present government has taken steps to prioritise health, an essential human right that previous governments had given up on, dreading that their interventions would make the mess messier and a preconceived notion that healthcare doesn’t translate into votes. Connecting the dots, it appears that the BJP government probably wants this 3.5 lakh strong community health cadre to man the 1.5 lakh health and wellness centres it promised in its election manifesto.

But any path the Modi 2.0 government takes from here-on will be riddled with challenges and decisions that affect life and death, and therefore the secrecy surrounding its plans is baffling. Only if they lay their cards on table before rolling out their action plan, can they reduce the chances of erring.  After all, doctoring lives, not doctoring numbers is the end-goal.

Soma Das is a business journalist and the author of The Reluctant Billionaire.

Centre Releases New ‘Blueprint’ to Access Health Data ‘Within Five Clicks’

The framework says Aadhaar will be a key document used to identify people.

New Delhi: For years, India’s health ministry has been trying to work out how they plan on incorporating technology into healthcare. The lowest hanging fruit has not been to increase access to healthcare via technology, but to collect massive amounts of health data and figure out how to use technology to harvest it.

One move in this direction is the government’s latest ‘National Digital Health Blueprint’ (NDHB) which is now open for feedback from stakeholders for a period of three weeks.

The government plans on using Aadhaar as a primary identifier here, and wants a citizen to be able to access their data “preferably within 5 clicks.”

Also Read: Govt Exploring Use of Artificial Intelligence in Public Health: Harsh Vardhan

One of the major triggers for this blueprint is the Ayushmaan Bharat health insurance scheme, which routinely generates “enormous amounts of health data” on Indian patients. Over 30 lakh patients have reportedly used the scheme so far, but the government has been reluctant to release any disaggregated anonymised data. The health minister said on Monday that the NDHB will “accelerate our efforts towards universal health coverage,” or the health insurance model.

The other health programmes right now which have been made dependent on technology include some reproductive child healthcare schemes, NIKSHAY for TB patients, the Hospital Information System and the Integrated Disease Surveillance Programme.

The blueprint explains that technology will need to be used to create district-level electronic databases, establish registries for all diseases of public importance, promote the adoption of standards by different players, create a system of personal health records to be accessible based on “citizen consent” and “most significantly”, to develop a linkage across public and private health providers at the state and national-level.

It also plans to establish a ‘National Digital Health Mission.’

Aadhaar is going to be important to the digital health push of the government, with “identification” being listed as one of the building blocks of the blueprint. Aadhaar is the first suggested method for this identification under Section 7 of the Aadhaar Act.

Indian officials writing this report have studied a few global cases before formulating this blueprint, such as the UK’s National Health Services and the South Korean model of healthcare.

Aadhaar has been built in so closely, that even its enrollment is going to happen as a byproduct/simultaneous process, of the health scheme itself. Credit: PTI

Aadhaar is the first suggested method for identification. Photo: PTI

Before the blueprint

This step on the road to “digital health” was recently preceded by the National Health Stack in July 2018, released by NITI Aayog. A committee was constituted to examine it, with officials from the Ministry of Electronics and Information Technology and the Unique Identification Authority of India (UIDAI), which manages Aadhaar. This blueprint is a result of the deliberations of the committee that examined the report.

But just a few months before the NITI Aayog released the blueprint, the health ministry also released a draft of the ‘Digital Information Security in Healthcare Act’ (DISHA), also inviting public comments. The Bill has not made it to parliament yet and no updated draft has been circulated. Its parent legislation, the Personal Data Protection Bill, 2018 has also not been passed yet.

In 2013, the government notified the Electronic Health Record Standards (EHR), updating it in 2016.

Lok Sabha Passes Indian Medical Council (Amendment) Bill

Minister Harsh Vardhan said the National Medical Commission Bill would soon be ushered in to reform the medical education sector.

New Delhi: The government will soon introduce a National Medical Commission (NMC) Bill to usher in comprehensive reforms in the medical education sector, health minister Harsh Vardhan said in the Lok Sabha on Tuesday.

He said this during a debate on the Indian Medical Council (Amendment) Bill, 2019, which was later passed by the house by voice vote. This Bill provides for supersession of Medical Council of India for a period of two years with effect from September 26, 2018. It will replace an ordinance promulgated on February 21.

The minister said the government is working on the NMC Bill and “will soon take it to Union cabinet and then in parliament”. He said the NMC Bill, which was introduced in December 2017, lapsed with the dissolution of the 16th Lok Sabha.

On the Medical Council (Amendment) Bill, the Minister said that the Board of Governors (BoG) which had replaced the MCI has worked well and taken a series of steps to improve medical education in the country.

The BoG has granted accreditation to more number of medical colleges, increased number of seats and reduced procedural hurdles, he said, adding it is manned by doctors of great repute.

“This is just the beginning of our work and you will see radical reforms in the medical education of the country,” he said.

The Indian Medical Council or the Medical Council of India (MCI) was set up under the Medical Council Act 1956, for setting standards for medical professionals, new medical colleges and revision of curriculum, among others.

Participating in the debate on the Bill, Congress leader Adhir Ranjan Chowdhury opposed the ordinance route taken by the government to supersede the Indian Medical Council, saying it was unhealthy for democracy.

Chowdhury said the ordinance was promulgated twice by the government, despite elections being round the corner. “MCI had become a scam tainted authority,” he said.

Introducing the Bill, Vardhan said in the last two decades, a perception was built that MCI has been unsuccesful in discharging its duties and that corrupt practices are prevalent in the regulatory body.

“Although the National Medical Commission Bill could be introduced in the near future, but to have legal continuity every ordinance has to be converted into a law,” he stressed.

The Bill also proposes to increase the number of members in the BoG to 12 from the existing 7.

The health ministry had come across certain arbitrary action by the MCI in disregard to the provision of IMC Act and regulations.

Further, the oversight committee constituted by the Supreme Court to oversee the functioning of MCI had also cited instances of non-compliance of their instructions. Subsequently, all its members tendered their resignation.

In view of these developments and to put an alternative mechanism in place of MCI so as to bring transparency, accountability and quality in the governance of medical education in the country, it was decided to supersede the MCI through the Indian Medical Council (Amendment) Ordinance, 2018, promulgated on September 26 and entrust its affairs to a board of governors consisting of eminent doctors.

Subsequently, the Indian Medical Council (Amendment) Bill, 2018, was introduced in the Lok Sabha on December 14, 2018, and passed by the house on December 31.

However, the Bill could not be taken up for consideration in the Rajya Sabha.

Accordingly, it was decided to promulgate a fresh Ordinance namely the Indian Medical Council (Amendment) Ordinance, 2019, to allow the board of governors appointed in view of supersession of MCI to continue to exercise powers of the MCI.

As SC Sees No Urgency in Hearing Petition Seeking Doctors’ Safety, IMA Urges Reforms

A vacation bench said it first needed to ascertain if there are sufficient police personnel to provide security to doctors.

The Supreme Court’s vacation bench comprising Justices Deepak Gupta and Justice Surya Kant, on Tuesday, found no urgency in taking up the petition seeking greater security for doctors, as the strike by the medical fraternity in West Bengal and in some other States has been called off.

“List the matter after summer vacation, before appropriate Bench”, the Judges said in their order. As the petitioner, Alakh Alok Srivastava, who argued in person, sought to persuade the bench not to wait for another incident to happen,  the bench observed: “Let it happen. We can’t pass an order that nobody should be murdered.”

Read: After Mamata Meeting, West Bengal Doctors Agree to Call off Strike

The bench asked how it could direct the police to provide security to doctors without ascertaining what is its strength in the respective states, and whether it is feasible if the strength is inadequate. “We can’t put other citizens to risk for the sake of protecting the doctors. We are not against your prayer, but we can’t pass an order without knowing what is the security required, and who will provide that security”, the bench told the petitioner.

A view of Supreme Court of India in New Delhi. Credit: PTI

A view of Supreme Court of India in New Delhi. Credit: PTI

IMA expresses inclination to intervene

The Indian Medical Association (IMA), through its senior counsel, Suryanarayana Singh and Nitesh Jain, expressed its inclination to intervene in the matter in the form of an Interlocutory Application (IA). The IMA has since 2015 urged the Centre to enact a law to ensure protection of doctors from violence. It submitted a draft Bill, “The Protection of Medical Service Persons and Medical Service Institutions (Prevention of Violence and Damage or Loss of Property) Act, 2015” for the Centre’s consideration. The IMA is the national association of more than 3 lakh modern medicine doctors with 1,700 branches.

On June 15, the Union health minister, Harsh Vardhan asked states to consider enacting specific legislation on the model of the IMA’s draft Bill. Since “police” and “public order” are state subjects, it appears, the Centre is reluctant to enact a law on the subject, as recommended by a 14-member inter-ministerial committee in 2016. This committee, constituted under the chairmanship of additional secretary (health) Dr Arun Kumar Panda, to examine the issues raised by IMA, finalised its report on March 30, 2016. It held another meeting to clarify the IMA’s concerns on December 23, 2016.

The Centre was of the view that the Indian Penal Code (IPC) does not provide punishment for offences committed against any specific category of professionals. The committee, however, recommended that the Union Ministry of Health and Family Welfare should write to all state governments to strictly enforce the provisions of special legislation wherever they exist and/or enforce the IPC/Cr.P.C. provisions with vigour.

“In addition, the Ministry of Health and Family Welfare shall explore the possibility to initiate the process to bring a Central Act on the said issue in line with those in vogue in other States”, the committee recommended.

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Health minister Harsh Vardhan. Photo: Facebook/ drharshvardhanofficial

19 states have already passed legislation

According to the IMA, 19 states have already passed legislations in this regard. “Hospitals should be declared as ‘safe zones’. Structured safety measures including 3-layer security, CCTVs and restriction of entry of visitors should be well-defined and enforced uniformly across the country in all sectors”, Dr R.V. Asokan, honorary secretary general of the IMA, wrote to home minister Amit Shah on June 17.

Saying that healthcare violence has its origin in high expectations, lack of infrastructure and inadequate human resources, the IMA urged the Centre to provide for doctor-patient relationship, effective communication regarding nature of illness and professional counselling.

In its letter to Harsh Vardhan, the IMA has emphasised that limitations of infrastructure and human resources force doctors to spend less time with the patients, and hence the chances of doctor-patient conflicts are very high.

Watch: Doctors’ Strike and the Display of Enmity Through Cricket

Ironically, after rationalising the conflicts, the IMA warned that any form of violence against medical profession and facilities will be counter-productive, demoralising the health providers taking away their confidence and courage, especially in critical situations. “Ultimately, the situation will adversely impact on the patient care and safety”, the IMA told the minister.

The states which have enacted laws to protect doctors include Andhra Pradesh, Assam, Bihar, Chhattisgarh, Delhi, Goa, Gujarat, Haryana, Karnataka, Madhya Pradesh, Maharashtra, Orissa, Puducherry, Punjab, Tamil Nadu, Tripura, Uttar Pradesh and West Bengal.

The West Bengal Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage to Property) Act, 2009 declares any violent act against doctors as cognizable and non-bailable offence, and imposes a punishment of imprisonment which may extend to three years and with a fine up to Rs 50,000 on those found guilty.

While most states have similar punitive provisions, laws in Tamil Nadu and Puducherry seek to impose imprisonment for a minimum term of three years with maximum of ten years.

Members of Joint Doctors Forum march in solidarity with protesting doctors in Kolkata on June 14, 2019. Photo: PTI/Ashok Bhaumik

Effectiveness of legislation

The fact that the IMA called for an all-India strike following an incident in West Bengal – despite the presence of a state legislation to protect doctors enacted way back in 2009 – has called into question the effectiveness of such legislation.

In 2015, the IMA claimed that its survey of doctors – as revealed from 1,739 responses it received from all over India – led to shocking findings. About 45.4% of the doctors feared possible violence; 24.6% feared being sued and 13.5% feared criminal prosecution. Only 16.6% of doctors, the IMA said, reported no stress of any kind in the performance of their duties.

It is debatable whether a National Medical Tribunal comprising experts – as recommended by IMA – in place of the consumer courts, which currently hear grievances of medical negligence, could offer a way out.

Health Ministry to Set up Permanent Multi-Disciplinary Group to Look Into AES Cases

The groups will monitor and formulate measures to be taken in the event of an outbreak of the disease, which has claimed 106 lives in Bihar so far.

New Delhi: As Bihar grapples with Acute Encephalitis Syndrome (AES) that has claimed 106 lives so far, Union health minister Harsh Vardhan on Tuesday decided to constitute a permanent multi-disciplinary group of experts at the Centre to monitor and formulate measures to be taken up in the event of such an outbreak.

The Central group will comprise experts from the All India Institute of Medical Sciences (AIIMS), National Centre for Disease Control (NCDC), Indian Council of Medical Research (ICMR), World Health Organisation (WHO), Ministry of Science and Technology and Ministry of Women and Child Development along with experts of meteorology, nutrition and agricultural science.

Vardhan also chaired a meeting of experts who deliberated upon the factors causing high child mortality in the reported AES/Japanese Encephalitis (JE) cases in Muzaffarpur district of Bihar and the immediate measures to be taken up to prevent them.

“We discussed the socio-economic profile of the households which have reported such cases, their nutrition profiles, ongoing heatwave, reported high percentage of hypoglycemia in children who have died, prevailing health infrastructure in the district and other factors that could significantly be considered in these cases,” the minister said.

Senior officers from the Ministry of Health, Ministry of Women and Child Development, experts from AIIMS, NCDC, ICMR, Indian Academy of Pediatrics (IAP), WHO and the Centers for Disease Control and Prevention (CDC) were present at the meeting.

Measures to further strengthen the health infrastructure, need for an aggressive awareness campaign to prevent these cases and strengthening the research base to provide sound knowledge on the causes of mortality, active collaboration between state and Central governments with experts and researchers were some of the other crucial discussion points.

“In the spirit of collaborative and cooperative federalism, the Centre is actively supporting the Bihar government in immediate measures to contain AES/JE and also to search for long term solutions through evidence generated by sound research.

Also Read: Nitish Kumar Faces Protests During Muzaffarpur Visit to Take Stock of AES Outbreak

“Two central multi-disciplinary teams are already stationed in Bihar and supporting the government presently. Senior officers of the Union Health Ministry are in regular communication with the state government and providing all needed technical and other support,” Vardhan said.

He said the permanent multi-disciplinary expert group will meet regularly during the year to monitor recommendations of the two Central expert teams presently stationed in Muzaffarpur and deliberate upon their findings and suggestions received from other experts in the matter.

“This group shall formulate recommendations for measures to be taken up in case of an outbreak and for immediate control, in addition to a long term understanding about its causes so as to prevent the cases,” he said.

Vardhan had on Sunday visited the families of the children suffering from suspected AES in Bihar and deployed another high-level multi-disciplinary team at the state.

The team will undertake the necessary ground work for setting up state-of-the-art multi-disciplinary research centre at Muzaffarpur, the ministry had said in a statement.

The death toll in AES cases in Bihar has climbed to 106 with both the SKMCH hospital and the privately owned Kejriwal hospital in the state reporting one casualty during the night, officials said.

The symptoms of AES include high fever, convulsions and extremely low level of sugar in the blood. Among the factors said to trigger the syndrome are malnutrition.

Moreover, the litchi grown in Muzaffarpur is said to contain a toxin which can cause a drop in blood sugar levels if consumed by a malnourished child.