Content:
- India’s winding road to ‘#EndTB’
- Rumour has it
- WHO is right
India’s winding road to ‘#EndTB’
Context :
- Tuberculosis (TB) remains the leading infectious disease killer globally as per the 2024 WHO report.
- India accounts for 26% of the global TB burden, with high cases of drug-resistant TB (DR-TB) and TB-related deaths.
- India pledged to achieve the “End TB” targets by 2025, but the COVID-19 pandemic severely disrupted efforts.
Relevance : GS 2(Health)
Practice Question : Critically analyze the challenges and opportunities in achieving India’s ‘End TB’ targets by 2025. (250 Words)
End TB Targets
- 90% reduction in TB deaths.
- 80% reduction in new cases.
- Zero TB-affected families facing catastrophic health expenses by 2030.
- Current progress: Decline in TB deaths by 24% (2015–2023), but targets are far from reach.
Challenges in TB Elimination in India
a) Vulnerable Groups
- Defined high-risk groups: miners, stone carvers, undernourished individuals, and those with co-morbidities (e.g., diabetes).
- Migrant workers: Poor access to healthcare and lack of continuity in treatment due to mobility.
b) Undernutrition and Socioeconomic Factors
- Undernutrition, silicosis, and overcrowded living conditions increase vulnerability.
- Addressing these issues requires multi-sectoral action beyond healthcare policies.
c) Supply Chain Gaps
- Despite a 95% treatment initiation rate, 2023 witnessed disruptions in the drug supply chain.
- Shortages of key drugs forced patients to buy medicines, leading to catastrophic healthcare costs and risk of antibiotic resistance.
d) Extrapulmonary TB (EP-TB)
- Comprises 24% of notified cases, often underdiagnosed due to vague symptoms.
- Lack of training for general practitioners and frontline workers delays early diagnosis and treatment.
e) Diagnostic Challenges
- Molecular diagnostic tools (e.g., CBNAAT, Truenat) are inaccessible in rural areas.
- Shortage of trained staff and supply issues hinder timely diagnosis and increase patient expenses.
- High reliance on specialists and private practitioners delays notification and treatment.
Administrative and Programmatic Gaps
- Frequent guideline updates are not matched by adequately trained human resources.
- Local ownership of TB programmes is lacking in many regions.
- Best practices, such as Idukki’s collaboration with Kudumbashree, show the importance of community participation and advocacy.
International Case Study
- Vietnam successfully implemented active case finding for TB among high-risk groups, yielding better outcomes.
- India could adopt similar strategies to restructure its frameworks.
Progress and Opportunities
- Case notification in India reached the highest level, showcasing increased detection.
- Decline in TB deaths indicates potential for improvement with strategic interventions.
Rumour has it
Background : Rumour-Induced Panic
- A rumour of a fire caused panic among passengers of the Pushpak Express, leading to the pulling of the alarm chain.
- Passengers deboarded near Pachora station on the side of an adjacent track, unaware of the danger posed by an oncoming train, the Karnataka Express.
Relevance : GS 3(Disaster Management)
Practice Question : Recent railway accidents in India underscore deeper systemic issues. Discuss the causes and suggest measures to enhance railway safety, with reference to the Pushpak Express accident.(250 Words)
Systemic and Technical Shortcomings
- Design Issues:Absence of auto-locking doors in general compartments made it easy for passengers to deboard unsafely.A curve in the track reduced visibility for the driver of the Karnataka Express, adding to the accident’s inevitability.
- Brake Binding and Hot Axle Issues:Brake binding (poor maintenance) may have led to sparks and smoke, further fueling panic.
- Inadequate Emergency Response:Lack of awareness and protocol for safe evacuation in emergencies contributed to the fatalities.
Psychological and Behavioral Factors
- Panic and confusion during emergencies are common in India, as seen in stampedes like the Elphinstone Road tragedy (2017).
- Passengers’ reactions are often influenced by recent events and heightened fear of accidents.
Larger Issues in Railway Safety
- Infrastructure Deficiencies:General coaches lack modern safety features like automatic doors.
- Maintenance Failures:Brake binding reflects poor upkeep of rolling stock.
- Safety Culture:A reactive rather than preventive approach to railway safety results in recurring incidents.
Possible Mitigations:
- Install auto-locking doors in general compartments to prevent unsafe deboarding.
- Conduct regular maintenance to address issues like brake binding.
- Train passengers in emergency protocols through regular awareness campaigns.
- Use advanced signaling and monitoring systems to reduce risks on curved tracks.
Recommendations:
Technical Upgrades:
- Retrofittinggeneraltrains with auto-locking doors.
- Modernizing braking systems to prevent binding.
- Enhancing track infrastructure for better visibility on curves.
Passenger Awareness and Training:
- Periodicdrills and campaigns on safety protocols during emergencies.
- Multilingual communication systems to avoid misunderstandings.
Organizational Reforms:
- Strengthen the CommissionerofRailwaySafety’sautonomy and capacity.
- Foster a preventive safety culture through audits and real-time monitoring.
Emergency Response Systems:
- Install sensors to detectsmoke or sparks early, minimizing false alarms.
- Equip trains with AI-powered systems to assist in emergency braking and signaling.
WHO is right
Context and Background
- U.S. and WHO: The United States has been a founding member and the largest contributor to the World Health Organization (WHO), providing approximately 18% of its funding.
- Decision to Withdraw: Former President Donald Trump announced the U.S.’s withdrawal in 2020, accusing WHO of mishandling the COVID-19 pandemic and alleged bias towards China.
- Impact Timeline: The decision required a 12-month notice period, during which funding commitments were to cease.
Relevance : GS 2(International Relations)
Practice Question : The U.S.’s decision to withdraw from the World Health Organization (WHO) has significant implications for global health governance. Discuss the consequences of such a move and suggest measures to strengthen WHO’s role in addressing global health challenges.(250 Words)
Significance of U.S. Contributions to WHO
- Financial Dependency: U.S. funding supports critical global health programs, including:
- HIV/AIDS Interventions: Providing antiretroviral therapy and preventive measures.
- Tuberculosis Control: Detection, treatment, and eradication strategies.
- Disease Eradication Campaigns: Efforts to eliminate polio and other infectious diseases.
- Equity in Healthcare: WHO ensures global access to life-saving drugs and vaccines, particularly in low-income countries.
- Global Disease Surveillance: U.S. funding aids WHO’s capacity to monitor and prevent disease outbreaks globally.
Consequences of U.S. Withdrawal
- Global Health Programs: A funding vacuum risks halting or delaying vital healthcare initiatives, especially in vulnerable regions.
- Pandemic Preparedness: Collaborative efforts to tackle pandemics, such as COVID-19, may weaken without U.S. leadership.
- Research and Innovation: U.S. withdrawal could undermine WHO’s efforts in global research collaboration for vaccines and treatments.
- Geopolitical Influence: Loss of U.S. influence in WHO decisions could pave the way for other nations, like China, to assume leadership roles, altering the balance of power in global health governance.
Rationale Against Withdrawal
- Interdependence in Global Health: Pathogens do not recognize borders, and pandemic containment requires cooperation among nations.
- COVID-19 Lessons: The pandemic underscored the need for shared data, resources, and coordinated response mechanisms.
- Damage to U.S. Leadership: Abandoning WHO undermines U.S. credibility and leadership in addressing global challenges.
Counterarguments and Criticism of WHO
- Allegations of Bias: Critics, including Mr. Trump, argue WHO was slow in responding to COVID-19 and allegedly too lenient on China.
- Reform Needs: While WHO has acknowledged certain gaps, internal reforms to improve responsiveness and transparency are critical.
- Funding Structure: Over-reliance on voluntary contributions from a few nations (like the U.S.) creates vulnerabilities in its financial model.
Broader Implications
- Global Solidarity vs. Isolationism: U.S. withdrawal signals a move away from multilateralism, impacting global efforts to tackle health crises.
- Economic Costs: Pandemic mismanagement due to weakened global collaboration can have cascading economic consequences for all nations.
- Butterfly Effect: The decision risks triggering a chain of unpredictable global consequences, such as fragmented disease response systems.
