By Dr Arun Mitra
The G20 Presidency to India has given ample opportunities to highlight the health problems facing the developing world in general and India in particular. This is also time to set the direction for global equity in health care. The Third Health Working Group (HWG) meeting of the G20 was held in Hyderabad in the first week of June 2023. Dr Ranga Reddy, President Infection Control Academy and Honorary Professor University of Hyderabad who was deeply involved in organizing this meeting pointed out that the Third HWG (Health Working Group) meeting had its focus on Health Emergencies, Prevention, Preparedness and Response. Also under serious debate is strengthening cooperation in the Pharmaceutical sector with focus on Access and Availability to Safe, Effective, Quality and Affordable Medical Countermeasures.
Smt S Aparna, Secretary, Department of Pharmaceuticals, addressing the HWG highlighted the role of initiatives like the Global R&D Network that we can collectively build a future where no one is left behind and access to life-saving medical countermeasures becomes a universal reality. She also talked about collaboration among nations, institutions, and stakeholders through a global R&D network that fosters innovation and accelerates research.
This is important because the world witnessed serious inequities and pressures during the Pandemic. As per the WHO we witnessed 6,943,390 deaths globally till 14th June 2023. Unofficial figures could be even higher! The problem of unavailability of drugs, equipment and vaccines has been very acute. Smaller countries which lacked resources and knowhow to make vaccines or drugs suffered the most. Vaccine producing companies made huge profits during this period. There are reports of blackmail of small countries by these companies.
Many of the contracts between the companies and governments of these countries had confidentiality clauses according to which the company was exempted “from any civil liability for serious side effects arising from the use of the vaccine, indefinitely”. The affected countries had to accept several clauses which would favour only the vaccine manufacturer, to the extent that the properties of the countries including their embassy buildings and cultural centres were mortgaged to these companies as a guarantee.
Developing countries which have so far been faced with the burden of communicable diseases, are now feeling the burden of the non-communicable diseases as well. India is hub to both communicable and non-communicable diseases.
At a rank of 107 out of 120 countries in the Hunger Index it is easy to understand the health situation of our people. India is the largest contributor of undernourished people in the world (Worldometer), with around 194.4 Million people, or 14.37% of its population not receiving enough nutrition. India has one of the worst rates of child malnutrition in the world, with one third of malnourished children globally being Indian. As per the Government of India's National Family Health Survey 5 (NFHS 5), ‘36% of children under age five years are stunted; 19% are wasted; 32% are underweight; and 3% are overweight'.
Anaemia, also referred to as low Haemoglobin; a condition that can make you feel tired and weak as you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues, affects a staggering 67% of children below the age of 5 years, higher than the 59% in the NFHS 4 survey.
As per the International Vaccine Access Center at John Hopkins Bloomberg School of Public Health Pneumonia & Diarrhea Progress Report 2022, under-5 pneumonia & diarrhoea burden number of deaths in India is 146,558.
Unclean drinking water is the main cause for this. A new WHO report published in the media on 10 June 2023 says that in 2018, women in India spent an average of 45.5 minutes daily collecting water to meet household needs. Overall, households without on-premises water spent a staggering 666 lakh hours each day collecting water, with the majority 558 lakh hours occurring in rural areas. The report has estimated that India's on-going ‘HarGhar Jal' (water in every home) can avert nearly 400,000 diarrhoeal deaths and prevent loss of productive days caused due to unclean drinking water. “This achievement alone would result in estimated cost savings of up to $101 billion”.
Tuberculosis, as a communicable disease, is an on-going global epidemic that accounts for the high burden of global mortality and morbidity. Globally, with an estimated 10 million new cases and around 1.4 million deaths, TB has emerged as one of the top 10 causes of morbidity and mortality in 2019. India accounts for 28% of all TB cases in the world, according to the Global TB Report 2022. There were 21.3 lakh cases detected in 2021 despite an increase in the budget to tackle Tuberculosis (TB), the interim estimated number of deaths due to the infectious disease in India rose by 10 per cent, from 500,000 in 2020 to 505,000 in 2021, noted the Global TB Report 2022 released by the World Health Organisation (WHO). This comes to 1383 deaths due to TB per day.
The Non Communicable Diseases (NCD) too are on the rise in our country to alarming levels and their rate of increase is very high.
The Indian Council of Medical Research–India, Diabetes (ICMR-INDIAB) study, found prevalence of diabetes among 11.4 per cent population, which comes to 101 million. This is 1.68 times higher than the previously estimated 60 million diabetics in India and a previously known 7.84 per cent national prevalence rate of diabetes.
The new study published in The Lancet puts the prevalence of hypertension at 35.5 per cent; general obesity at 39.5 percent and dyslipidemia (lipid imbalance which can cause heart diseases) at 81.2 per cent. One in every three Indians has hypertension and two in five are obese.
Based on the above points, it is important to envisage the steps required to bring down the disease burden particularly among the lower strata. It is important that each citizen of the country gets nutritious food which will help in developing immunity to fight back the disease. Most important is to ensure a nutritious diet for pregnant women. ‘Progress towards universal maternity benefits, sluggish as it was in the first place, has gone into reverse gear in the last few years' point out Jeane Drez and Ritika Khera in an article published on 14th June 2023 in The India Forum. They further point out that the National Food Security Act passed 10 years back gave all pregnant women a right to maternity benefits.
Initially the benefits were Rs.6000/- per child. Had the benefits been raised in tandem with nominal GDP, Indian women today would be receiving cash benefits of about Rs 20,000 in the event of pregnancy, as they do in Tamil Nadu. This would help to ensure that they are not deprived of adequate nutrition, rest and healthcare at this difficult time. According to them ‘the root of this fiasco is that pregnant women count for very little in public policy and electoral politics'. Situation of food security is so pathetic that 80 Crore people were given 5 Kg of grain and one kilo of daal to fill their stomach.
It is important to design disease prevention and control programmes based on the needs of lower strata of the society. The state should directly own the responsibility for heath of the citizens. The PPP (Public Private Partnership) model amounts to passing on the benefits to the private sector from the public exchequer.
It is important to develop policies for inclusive growth which ensure jobs with proper remuneration and means of livelihood to all. This will help citizens to purchase food and not depend on the state for freebies. Clean drinking water, sanitation services and housing are available to all.
There is a need to revive the manufacture of drugs, vaccines and medical equipment in the public sector to produce them at lower cost. It would be pertinent to remember the statement by our First Prime Minister Shri Jawaharlal Nehru while inaugurating the Indian Drugs and Pharmaceuticals Ltd. (IDPL) in 1961. He had said “the drug industry must be in the public sector….. I think an industry of the nature of the drug industry should not be in the private sector anyhow. There is far too much exploitation of the public in this industry”.
To end the exploitation of the developing countries under the garb of various clauses of the World Trade Organisation (WTO) it is important to make necessary changes in the WTO. The intellectual Property Rights and the Patent laws under the WTO at present benefit the big companies. This has to be changed. The founder of ORS, Dr Dilip Mahalanabis never patented his product saying that this is for public good and not for making profits. Will the companies and the governments follow suit?
Finance allocation to health has to be substantially increased. It has been hovering around 1.2% of the GDP. It should be increased to a minimum of 5% of the GDP. Likewise allocation to R&D in health has to be increased.
Even though the G20 is dominated by the developed countries and the corporate sector, a forceful voice by India together with others can help change the situation. The outcome of the G20 meet on health has to be seen in that background. India can play a big role if our approach is not limited to mere electoral gimmickry.
(IPA Service)
