Tuesday, April 5, 2016

More power to the vaccine arsenal

India has made huge strides as far as public health achievements are concerned, made possible by the use of safe and effective vaccines delivered through quality programmes. For example, small pox was eliminated in 1975, polio in 2014 and maternal and neonatal tetanus (MNT) in August 2015.
While India has shown its ability to undertake massive campaigns to improve vaccination coverage, routine immunisation coverage, which stands at 65 per cent when last measured, remains low. Moreover, the immunisation schedule lacks important vaccines that are already in use in most countries. All that is set to change.
In 2014, the Prime Minister’s Office announced the decision to introduce four new vaccines as part of India’s Universal Immunization Programme (UIP). These are vaccines against rotavirus, rubella and polio (injectable) and an adult vaccine against Japanese encephalitis introduced in districts with high levels of the disease. Earlier in 2011, a vaccine against Haemophilus influenza type B (Hib) was introduced as part of the pentavalent vaccine to contain diphtheria, pertussis, tetanus, hepatitis B and Hib. Thus the government has introduced or committed to introduce more vaccines than it has in the last 30 years of the UIP.
These vaccines could collectively prevent at least one lakh infant deaths, deaths of adults in the working age group and up to 10 lakh cases of hospitalisation each year. India’s UIP will now be able to provide free vaccines against 13 life-threatening diseases to 27 million children annually, the largest birth cohort in the world.
The India Newborn Action Plan (INAP) was launched in September 2014 with the aim of reducing preventable newborn deaths and stillbirths and the goal to attain single digit neonatal mortality and stillbirth rate by 2030. The current rate is 38/1,000 live births. To reach this goal, four additional vaccines are being thought of as priority vaccines for introduction in India.
Priority vaccines
The first of them is the Pneumococcal conjugate vaccine. Singularly, bacterial pneumonias kill more children under the age of five than any other disease. India has the world’s highest number of deaths caused by Streptococcus pneumoniae, the bacteria most commonly associated with pneumonias. There are an estimated 5-6 lakh cases of severe episodes of pneumococcal pneumonia and 95,000-1,05,000 deaths in India annually. An effective and safe vaccine for pneumococcus pneumonia is available.
The Human Papillomavirus (HPV) vaccine is next. Cervical cancer is one of the top three cancers affecting women in the world. Worldwide, every fourth new case is an Indian. It is estimated that in India, there are 1.32 lakh new cases every year and about 75,000 deaths reported. Two strains of HPV-16 and -18 are responsible for almost 80 to 85 per cent of cervical cancers. Preventive vaccines are available and are given to adolescents (9-13 years).
The third is the influenza vaccine. Immunising mothers during pregnancy against vaccine-preventable diseases has the potential to improve health outcomes in mothers and their children. This is likely to emerge as a key strategy to address neonatal mortality in particular which accounts for almost half of the under-five mortality. This strategy has been successfully used to eliminate MNT. Clinical trials have shown that influenza vaccination during pregnancy can prevent influenza disease in pregnant women and their newborn children for the first six months of life with no indication of harm to the recipients or their children .
Given the potential impact of maternal influenza immunisation programmes on maternal and child health worldwide, the World Health Organisation Strategic Advisory Group of Experts on Immunization (SAGE) has recommended that pregnant women having influenza vaccine receipt in countries initiating or expanding their influenza vaccine programmes be made a priority. In India, a large number of deaths were reported during the H1N1 outbreak from 2009 onwards. Infection in pregnant women led to deaths in their third trimester. The Maharashtra government has introduced seasonal flu vaccine for high-risk groups including pregnant women. Season flu vaccine, which includes the pandemic H1N1 strain, is a priority vaccine for use in high-risk groups in India including pregnant women.
The last is the cholera vaccine. Though interventions for the prevention and control of cholera (including an oral vaccine produced and licensed in India) are available, cholera remains an important cause of morbidity and mortality. It is estimated that there are about 7-8 lakh cases every year resulting in about 20,000-24,000 deaths. About 400-500 million people are at risk. Outbreaks occur after the monsoon. Though the oral vaccine is available in India, there has been limited use.
Targeting seven diseases
The UIP is now a much strengthened programme, supported by a transparent system of taking decisions to introduce new vaccines, being sensitive to adverse events following immunisation and with the capacity to add additional vaccines. Through Mission Indradhanush [to cover, by 2020, children who are either unvaccinated, or are partially vaccinated against diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B], India aims to be on track to increase routine immunisation coverage to 90 per cent within a few years. The years to come may well be the golden years of immunisation in India.
(Prof. Ramanan Laxminarayan is Distinguished Professor and
Dr. Lalit Kant is Senior Adviser, Infectious Diseases, Public Health Foundation of India, New Delhi.
The views expressed are personal.)

Towards restorative criminal justice | N.R. MADHAVA MENON

The way criminal justice is designed and administered today hardly serves any of the purposes for which it is set up: towards securing life and property. It does not deter criminals because of the delay and uncertainties involved in its processes and ridiculously ineffective punishments it imposes on those few who get convicted. It provides wide discretion to the police and the prosecution, rendering the system vulnerable to corruption and manipulation and endangering basic rights of innocent citizens. It ignores the real victim, often compelling him/her to find extralegal methods of getting justice. Above all, it puts heavy economic costs on the state for its maintenance without commensurate benefits in return. With nearly 30 million criminal cases pending in the system (the annual capacity of which is only half that number), and with another 10 million or more cases being added every year, whatever is left of the system is bound to collapse completely unless some radical alternatives are adopted urgently.

Faced with a similar situation, the U.S. adopted plea bargaining and diversion to administrative and quasi-judicial institutions in a big way several years ago with the result that less than a third of criminal cases are allowed to go for trial. Diversion is followed in the U.K. as well. Recently, it reformed its criminal justice system giving a central role to the victims to direct their cases in the system. In Russia, Australia and several other countries, the victim is brought centre stage through what is called “restorative justice” to replace unproductive aspects of conventional criminal processes. On the recommendation of the Committee on Reforms of Criminal Justice System (2003), India also adopted “plea bargaining” under Chapter XXI-A of the the Code of Criminal Procedure to take out from the system cases punishable up to seven years of imprisonment for negotiated settlement without trial. However, the Bar and the Bench seem to be allergic to plea-bargained settlement, with the result that even after a decade of its introduction, it remains a dead letter not invoked by those caught in the system.
Differentiated penal codes
The committee on criminal justice reforms recommended a threefold strategy to arrest the drift and to prevent total disaster. First, the law, substantive and procedural, requires a fresh comprehensive look based on changes in society and economy as well as priorities in governance. The guiding principle in the reform process should be decriminalisation wherever possible and diversion, reserving the criminal justice system mainly to deal with real “hard” crimes. A suggestion was made to divide the Penal Code into four different codes — a “Social Offences Code” consisting of matters which are essentially of a civil nature and can be settled or compounded through administrative processes without police intervention and prison terms; a “Correctional Offences Code” containing offences punishable up to three years’ imprisonment where parole, probation and conditional sentences can be imposed in lieu of prison terms and can be handled under summary/summons procedure where plea bargaining can be liberally invoked without the stigma of conviction; an “Economic Offences Code” where property offences which affect the financial stability of the country are dealt with by a combination of criminal and administrative strategies including plea bargaining (both on charge as well as on punishment) with a view to making crimes economically non-viable; and an “Indian Penal Code” which will have only major crimes which warrant 10 years’ imprisonment or more or death and deserve a full-fledged warrant trial with all safeguards of a criminal trial. The police and prosecution systems will accordingly be reorganised making them more specialised, efficient and accountable.
The second strategy proposed by the committee was institutional reform of police processes, including investigation of crimes, professionalisation and rationalisation of court systems with induction of technology and limiting appeal procedures to the minimum required. It is here the committee sought to bring in a bigger and responsible role to victims of crime in the whole proceedings. The Code of Criminal Procedure (Amendment) Act of 2006 adopted a small part of the recommendation on victims and left the rest for future consideration. This did not help in changing the system to a victim-centric one; nor did it support a restorative approach necessary to make the system serve its reformatory and deterrent functions meaningfully.
Victim-oriented criminal justice
What does “victim-centric” mean in the criminal justice system? It means restoring the confidence of victims in the system and achieving the goal of justice in whichever sense the idea is conceived. Toward this end, the system must confer certain rights on victims to enable them to participate in the proceedings, including the right to be impleaded and to engage an advocate in serious offences, the right to track the progress of the proceedings, the right to be heard on critical issues and to assist the court in the pursuit of truth. Second, victims have the right to seek and receive compensation for injuries suffered including appropriate interim relief irrespective of the fate of the proceedings. Victims may also submit a victim impact statement to the courts setting out the effect of the crime on their lives.
Today, a victim-centric approach in criminal justice can also mean healing the wounds through reconciliation and restorative means of justice rather than letting it get prolonged in the system, leading to frustration and more wrongs. Restorative justice is more akin to indigenous systems of quick, simple systems of resolution of wrongs which enjoy community support, victim satisfaction and offender acknowledgement of obligations. Thus perceived, restorative justice takes on board all three parties — the offender, the victim and the community — in a harmonious resolution of the injury, maximising the sense of justice and restoring peace and harmony in the community.
Restorative justice is distinct from mediation though it involves meetings and dialogues to fix responsibility for wrongdoing and to find a solution acceptable to all three parties. More importantly, it directly addresses victim needs and therefore emphasises the private dimensions of a public wrong. It is not a substitute to the formal criminal justice system, but a good backup to reduce its workload and to increase the sense of justice in the system as a whole. In a sense, the concept of “plea bargain” is closer to the idea and processes of restorative justice and therefore nothing new to criminal proceedings.
A distinctive feature of restorative justice is that it looks at the needs of crime victims which are today outside criminal justice concerns, leading to frustration and alienation of victims from the system itself. The victim is deprived of information on why he should suffer the injury and how it is going to be repaired. He would perhaps feel vindicated if the offender were to make an effort to right the harm, even if partially, by restitution. The victim would respect the system if it could make the offender assume responsibility and persuade him to transform himself. Restorative justice therefore aims to respond to the needs of the victim and help sustain interpersonal relationships while reinforcing offender obligations. Justice, in other words, should engage with victims, offenders and the right-thinking members of the community in an effort of reconciliation and repairing of harm. This approach begins with a concern for victims and their needs even when no offender has been identified or apprehended.
Limiting the adversarial model
Several countries across the world are now replacing the adversarial model of criminal justice partly or wholly with different models of restorative justice, yielding promising results in crime control. The process is more collaborative, consensual and inclusive, that is characteristic of indigenous systems of justice. The role of the state is reduced and the participation of communities encouraged. This is not to be confused with the khap panchayat model of arbitrary decision-making by a few elders of the locality. Due process requirements are followed in restorative justice while participation is enlarged and made transparent, inclusive and accountable. While doing so, the system respects diversity as a social fact, interrelatedness as a virtue and correcting/healing the harm as a major objective.
Crime and violence constitute a major impediment for development and social integration for a plural society like India. The adversarial model of criminal justice, with punishing the offender as its only aim, has proved costly and counterproductive. Communities have to be involved and victims given rights in finding ways to correct the wrong. While keeping the adversarial system for certain serious and complex offences, India needs to experiment with more democratic models aimed at reconciliation and restoration of relationships. Restorative justice is a welcome idea particularly in the matter of juvenile justice, property offences, communal conflicts, family disputes, etc. What is needed is a change of mindset, willingness to bring victims to the centre stage of criminal proceedings and to acknowledge that restoring relationships and correcting the harm are important elements of the criminal justice system.

N.R. Madhava Menon is former Vice-Chancellor of the National Law Universities in Bengaluru and Kolkata, Director of National Judicial Academy in Bhopal and presently Honorary Director of the M.K.N. Academy of Continuing Legal Education in Kochi.

India- Saudi Arabia

The real question, however, is whether the joint statements will be translated into actual policies. Despite some tensions, there is nothing substantial to suggest that the Pakistani-Saudi alliance is getting any worse. Even though the joint statement denounces all kinds of terrorism, the Saudis are accused of funding extremist groups in West Asia, particularly in war-torn Syria. Besides, there are some fundamental weak spots in India-Saudi ties, ranging from concerns about Indian workers in the kingdom to its funding of Wahhabi groups elsewhere, including in India. Another obvious concern is the drastic change under way in West Asia, and the aggressive role Riyadh is playing in regional geopolitics. During the visit Mr. Modi may have focussed on the positive factors of the relationship to improve ties, and rightly so. But India cannot afford to miss the big picture while finessing policies. There have to be mechanisms to address the flaws as well, without which the grand diplomatic overtures may not bear fruit. Also, India would be wary of appearing partisan at a time when the rivalry between Iran and Saudi Arabia is at its peak. The best way forward is to continue the multi-directional West Asia policy with more vigour, but maintaining its equilibrium.


Hydrocarbon Exploration Licensing Policy (HELP)

Hydrocarbon Exploration Licensing Policy (HELP) has been introduced with a view to realize the Hydrocarbon vision 2005 that seeks to explore potential oil and gas reserves by 2025. The new policy will have the following impacts-
#On Consumers-
1)Impetus to exploration in deep water and ultra deep water exploration through concessions would improve availability
2)Moving towards revenue sharing contracts (RSCs) ensures that revenue is shared with government from first batch of production. Improved revenues can be used for consumer welfare
3)Market linked pricing disincentivizes hoarding by producers and provide oil and gas at a better price
#On Producers-
1)Open acreage policy allows the producer to acquire a hydrocarbon field at an early stage through bidding
2)Single and unified license for all hydrocarbons promotes ease of doing business because no need to acquire new license for every single hydrocarbon
3)Concessional royalty for difficult terrains allow producer to take exploration and improve profits
1)Move towards RSCs can reduce investment by producers as they do not feel confident about their recoveries
2)Imposing price cap on new gas produced from deep water and ultra deep water fields can hamper investment in gas production
The move is well intended an in line with Rangarajan committee's recommendation of moving towards RSCs to avoid production hassles as in case of KG-D6 basin.

India’s new federal polity takes root

In the past six weeks or so, beginning from just before the presentation of the Union budget on 29 February, several state governments have been, almost unnoticed by the national media, presenting their own budgets. Treating it as business as usual means we are missing a key moment in the evolution of India’s new federal polity.
This is because these state budgets are now beginning to reflect the radical makeover in fiscal relations between the Union government and the states that were put in place by the implementation of the recommendations of the 14th Finance Commission (FFC) chaired by former Reserve Bank of India governor Y.V. Reddy.
At its core, the FFC championed the idea that one size cannot fit all; particularly relevant in such a large country like India, which is culturally, topographically and economically so diverse. To be sure, this shift has been in the making, incrementally albeit, for the past two decades beginning with the 10th Finance Commission; what the FFC has done is to accelerate this pace dramatically.
The FFC abandoned the idea of tied aid—in the form of centrally sponsored programmes and grants—and instead trusted states to manage their own fiscal future. Not only did the states get the freedom to prioritize spending, the new formula sharply increased the share—from 32% to 42% of net Union tax receipts—of fiscal resources accruing to states. It further allowed states committing to greater fiscal discipline greater leeway to borrow from the market to fund their development priorities.
Effectively, the FFC had sowed the seeds of cooperative federalism as states have been accorded unprecedented fiscal freedom. For the first time, public expenditure is now decisively in the jurisdiction of states. Consequently, states are now greater stakeholders and the implementation of the single goods and services tax—pending before Parliament for the past 10 years and more—will only bind this relationship further.
The states took some time in absorbing this tectonic shift in fiscal federal relations and it is only from this year that they have begun to truly reflect in state budgets. Given that states prefer to use regional languages and do not often provide an English version, it is a struggle to follow these budgets. (The empowered group of state finance ministers should address this in haste; surely it can’t be difficult to come up with a bilingual version. After all, it is not just curious journalists, even foreign investors now closely scrutinizing states are a target group that should not be overlooked.)
The good news though is that PRS Legislative Research, a New Delhi-based independent research initiative to make the legislative process more transparent and accountable, is systematically tracking them down in a standard format. A cursory glance tells us how states have begun to prioritize their spending—natural, given that the socioeconomic needs cannot be the same across the country. For instance, Bihar has focused its resource allocation on the sectors of health, energy and panchayats, while in the case of Madhya Pradesh and Rajasthan, it is the social sector and energy.
Alongside, the Union government also launched an unprecedented clean-up of the power sector—mired in accumulated debt of nearly Rs.4 trillion, which was not only impeding fresh investments, but also threatening to snowball into a balance sheet crisis for banks that had loaned funds to state power utilities.
The Ujwal Discom Assurance Yojana or UDAY, launched last November, drew up a contract between the Union government and volunteering state governments (Nine, including Uttar Pradesh ruled by an opposition party, have inked this deal and have already begun implementing it) wherein the discom debt was transferred to the state government—who, in turn, would float bonds to fund it. Further, the discoms were required to adopt transparent pricing rules and also overhaul the creaking power infrastructure in their state—with the end objective of providing 24x7 power.
Taking the two developments together—a new formula to share fiscal resources and a structural fix to the power sector—means the Union and state governments together have hit the reset button on the federal polity. While one would resolve a key infrastructure bottleneck (even while it addresses a mindset about public utilities being required to bear the burden of political populism), the other provides unprecedented fiscal room to states.
Effectively, it confirms a new federal compact: an India where the sum of the parts will be greater than the whole.
Anil Padmanabhan is deputy managing editor of Mint and writes every week on the intersection of politics and economics.


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