1. SC urged to stop illegal adoption

Details of children orphaned by the COVID-19

The Supreme Court on Monday agreed to intervene after the National Commission for Protection of Child Rights (NCPCR) sounded the alarm on a spate of complaints about illegal adoption of COVID orphans through private individuals and organisations.

The NCPCR informed a Bench led by Justices L. Nageswara Rao and Aniruddha Bose that it had received many complaints in May that private individuals and organisations have been actively collecting data on these children while claiming that they want to assist families and children in adoption.

‘Violates JJ Act’

“Social media posts are circulating that children are up for adoption. This is plainly illegal and violates the Juvenile Justice Act,” advocate Shobha Gupta, for an intervenor, made an impassioned plea.

“The adoption of orphaned/abandoned/ surrendered children is lawful only after the adoption procedure as given under the Juvenile Justice Act, 2015 is followed and the final adoption order is passed by the prescribed authority,” Additional Solicitor General K.M. Nataraj, for NCPCR, submitted.

NCPCR statistics shows that 3,621 children were orphaned, 26,176 children lost either parent and 274 children were abandoned between April 1, 2021 to June 5, 2021. The second wave of the pandemic was at its worst form during this period, leaving a trail of death across the country.

Justice Rao said the court would pass the necessary orders on the issue of illegal adoptions.

The national child rights body said information about these children, including their personal details, are being leaked from within government sources to private bodies, which circulate them.

“The Commission is receiving intimation regarding disclosure of children’s identity/information by government authorities to private NGOs and organizations. Care must be taken by the authorities to ensure that their action is not in violation of Section 74 of the Juvenile Justice Act,” the NCPCR affidavit said.

The provision prohibits the disclosure of identity of children with regard to the name, school, age, address or any information which would reveal the essential details of the child.

Susceptible to trafficking

NCPCR urged the court to direct the States and Union Territories to not place any confidential information about children in the public domain which would make them susceptible to trafficking,

“The Commission is also concerned to note that several NGOs are seeking monetary support in the name of children impacted by COVID. However, there is no disclosure to authorities regarding actual beneficiaries, as mandated under the JJ Act, 2015,” the NCPCR said.

The Commission asked the court to direct the States and UTs to create State Juvenile Justice Funds to enable the credit of donations/ contributions/ subscriptions directly in the notified account.

National Commission for Protection of Child Rights (NCPCR)

 Set up in March 2007 under the Commission for Protection of Child Rights Act, 2005.

It works under the administrative control of the Ministry of Women & Child Development.

Definition: The Child is defined as a person in the 0 to 18 years age group.

The Commission’s Mandate is to ensure that all Laws, Policies, Programmes, and Administrative Mechanisms are in consonance with the Child Rights perspective as enshrined in the Constitution of India and also the UN Convention on the Rights of the Child.

Under the RTE Act, 2009, the NCPCR can:

1. Inquire into complaints about violation of the law.
2. Summon an individual and demand evidence.
3. Seek a magisterial enquiry.
4. File a writ petition in the High Court or Supreme Court.
5. Approach the government concerned for prosecution of the offender.
6. Recommend interim relief to those affected.

Composition:

This commission has a chairperson and six members of which at least two should be women.

1. All of them are appointed by Central Government for three years.
2. The maximum age to serve in commission is 65 years for Chairman and 60 years for members.

About Child Welfare Committees:

As per the Section 27(1) of Juvenile Justice (Care and Protection of Children) Act, 2015 (JJ Act), Child Welfare Committees (CWCs) are to be constituted by State Government for every district, for exercising the powers and to discharge the duties conferred on such Committees in relation to children in need of care and protection under JJ Act, 2015.

Composition of the committees:

The Committee shall consist of a Chairperson, and four other members as the State Government may think fit to appoint, of whom atleast one shall be a woman and another, an expert on the matters concerning children.

Eligibility conditions:

Chairperson and the members shall be above the age of thirty-five years and shall have a minimum of seven years of experience of working with children in the field of education, health, or welfare activities, or should be a practicing professional with a degree in child psychology or psychiatry or social work or sociology or human development or in the field of law or a retired judicial officer.

2. China hosts ASEAN Foreign Ministers

It seeks closer economic cooperation with Southeast Asian nations while pushing back against Quad

China is hosting Foreign Ministers from the 10 ASEAN countries on Monday and Tuesday, with Beijing pushing for closer economic cooperation and aligning COVID-19 recovery efforts even as it looks to push back against the recent regional outreach of the Quad grouping.

Chinese officials have in recent weeks stepped up criticism of the Quad — the informal India, Australia, Japan and the United States grouping — and of Washington in particular. During recent visits to Sri Lanka and Bangladesh, China’s Defence Minister called on both countries to reject “military alliances” — a term that some Beijing are using to describe the Quad, but a label that the group rejects.

China’s Foreign Ministry spokesperson Wang Wenbin said in a statement the China-ASEAN Foreign Ministers meeting, in the city of Chongqing, would mark the 30-year anniversary of relations and also “focus on combating COVID-19, promoting economic recovery, [and] better dovetail[ing] strategic plans.” A vaccine passport connecting China and ASEAN countries is also being discussed.

China’s Foreign Minister Wang Yi will hold bilateral meetings with all the visiting Ministers, and also chair a meeting of the Lancang-Mekong Cooperation (LMC) with Cambodia, Laos, Myanmar, Thailand and Vietnam.

Economic cooperation

Deepening economic cooperation, particularly following the signing of the Regional Comprehensive Economic Partnership (RCEP) trade deal, would be China’s focus, analysts in Beijing said, even as it grapples with disputes over the South China Sea. Recently, China and the Philippines have clashed over the presence of Chinese vessels near a disputed reef, while Malaysia alleged the intrusion of 16 Chinese aircraft into its airspace.

The Communist Party-run Global Times on Monday blamed the U.S. for those tensions rather than China’s moves that prompted the protests from the Philippines and Malaysia. Countries “see clearly that quarrels on South China Sea are not the biggest threat to regional stability; it is the U.S., whose warships frequently sail through the sensitive waters and try to force ASEAN countries take sides to confront China,” the newspaper wrote.

After the first Quad leaders’ summit held in March and the announcement of a regional vaccine initiative, many Chinese analysts framed ASEAN as a key space where Chinese and Quad initiatives may rub up against each other.

China “cannot rule out the possibilities that Quad members will further rope in ASEAN members to counter China as Southeast Asia is of great significance to the U.S.’ Indo-Pacific Strategy,” wrote Yuan Zheng, senior fellow of the Institute of American Studies at the Chinese Academy of Social Sciences. “Yet ASEAN will not easily take sides.”

The framing of the Quad as “an Asian NATO” by Beijing has been criticised by the group’s members. India’s External Affairs Minister S. Jaishankar in April described the using of words such as “Asian NATO” as “a mind game which people are playing”.

Lancang-Mekong Cooperation (LMC) initiative

• An alternative to the lower-basin states’ Mekong River Commission
• Designed to overshadow the US-sponsored Lower Mekong Initiative, which seeks to overcome Chinese opposition to the Mekong treaty by promoting integrated cooperation among Cambodia, Laos, Thailand and Vietnam
• China— A dialogue partner but not a member of the commission (stay clued in on the discussions, without having to take on any legal obligations— had refused to join the Mekong Treaty in 1995)

Rivers dammed by China

The Mekong (Southeast Asia’s lifeline that is running at a record low since late last year), the Brahmaputra, the Arun, the Indus, the Sutlej, the Irtysh, the Illy, the Amur and the Salween

Fundamental Change in Asia’s Water Map

Before the communists seized power— China had only 22 dams of any significant size (Today: China surpasses 90,000)

After the communists took power in China in 1949—

• Guns establishing China’s chokehold on almost every major transnational river system in Asia
• By forcibly absorbing the Tibetan plateau (the giant incubator of Asia’s main river systems) and Xinjiang (the starting point of the Irtysh and the Illy), China became the source of transboundary river flows to the largest number of countries in the world, extending from the Indo-China peninsula and South Asia to Kazakhstan and Russia.

China’s dam frenzy—

• Dam builders are presently shifting their focus from the dam-saturated internal rivers (some of which, like the Yellow, are dying) to the international rivers— raising fears that the degradation haunting China’s internal rivers could be replicated in the international rivers.
• Started erecting mega-dams— Latest dams on the Mekong:
  • the 4,200-megawatt Xiaowan (taller than the Eiffel Tower in Paris)
  • the 5,850-megawatt Nuozhadu, with a 190 sq. km reservoir

Water sharing:

China has simply ignored the idea of a water-sharing treaty with any neighbour, thus, sparking concern, growing among downstream neighbours over China- seeking to turn water into a potential political weapon (China has much leverage over its neighbours who are reeling under very low freshwater availability)

Mekong basin:

• China has denied that it is stealing shared waters or that its existing dams have contributed to river depletion and recurrent drought in the downstream region.
• By ramping up construction of additional giant dams, it has virtually ensured long-term adverse impacts on the critical river system
• Landlocked Laos also plans to build more Mekong dams in order to make hydropower exports, especially to China—the mainstay of its economy (with Chinese assistance)

3. Maldives wins UNGA election, India seeks close cooperation

‘Talks are on to bring in Indian diplomat as Chef de Cabinet’

In a first for the Maldives, Foreign Minister Abdulla Shahid was elected the President of the UN General Assembly for 2021-22, winning 143 votes or nearly three-fourths of the 191 countries that voted in the annual election, while his rival, former Afghanistan Foreign Minister Zalmai Rassoul, won 48.

Mr. Shahid’s win was welcomed in particular in New Delhi, where Indian diplomats had been active behind the scenes in helping the Maldives canvass for him, after Maldives announced its candidate for the 76th General Assembly Presidency a year ago. Sources confirmed that given the close cooperation between both countries, Maldives is in discussions with the Indian mission for India’s deputy Permanent Representative at the UN Nagaraj Naidu to officiate as Mr. Shahid’s Chef de Cabinet.

Maldives President Ibrahim Solih called the election win “resounding” and a “great honour for the Maldives”, while former President and Maldives speaker Mohammad Nasheed said it was a “great day” for small island states and for “climate vulnerable countries everywhere”.

“This is a testimony as much to [Mr. Shahid’s] own stature as to the standing of Maldives. We look forward to working with him to strengthen multilateralism and its much-needed reforms,” said External Affairs Minister S. Jaishankar.

As The Hindu had reported last week, India had made it clear to Afghanistan’s government that it would be unable to support Mr. Rassoul as it had declared its support for Maldives publicly in November, long before Afghanistan announced its candidature in January this year. The announcement had caused an awkward tussle within the Asia Pacific group, whose turn it is to take the Presidency of the General Assembly, and especially for India, which has close ties with both countries.

Surprising development

Sources said the announcement was a “surprising development”, and that it was important for Maldives to take the position that it has, unlike Afghanistan, never held before.

“Both Maldives and Afghanistan have excellent ties with India and both candidates are friends of India. However, since India had already committed its support to Maldives at a time when no other candidate was in the fray, India voted in favour of Maldives,” the sources said.

United Nations General Assembly (UNGA)

The United Nations General Assembly (UNGA) is one of the six principal organs of the United Nations.

United Nations General Assembly (UNGA)

The UNGA is a principal component of the United Nations. It is the main governing body of the organisation and is also the most representative body in the UN. 

• All the members of the UN are represented in the UNGA, which is sometimes referred to as simply the GA. Hence, it has 193 members (all the UN member countries).
• It meets annually in its headquarters in New York City, generally in the month of September. It can also meet at other times according to the need.
• The UNGA is headed by its President, who is elected for a term of one year.
• It is sometimes called the parliament of the world.
• The UNGA deliberates and decides on important matters such as peace and security, and other international issues.
• It also decides on the admission of new members.
• Decisions are taken by voting. Generally, a simple majority is considered but in case of important decisions, a two-thirds majority is considered. Each member has one vote.
• Unlike the Security Council, there is no veto power bestowed to anyone.
• In 1953, Vijaya Lakshmi Pandit became the eight President of the UNGA, the only Indian GA President to date.

Functions and Powers of UNGA

The functions and powers of the UNGA are described below:

• Considering and approving the UN budget and establishing the financial assessments of member countries.
• Considering and making recommendations on the general principles of cooperation to maintain global peace & security, including disarmament.
• Electing the non-permanent members of the UNSC and the members of other UN councils and organs and, appointing the Secretary-General, as per the UNSC’s recommendations.
• Discussing questions concerning international peace & security and making recommendations on it (unless the matter is currently being discussed by the Security Council).
• Initiating studies and making recommendations to boost international political cooperation, developing and codifying international law, realizing fundamental freedoms and human rights, and creating global collaboration in the social, economic, humanitarian, educational, cultural and health domains.
• Making recommendations for the peaceful settlement of any situation that could hamper friendly relations among nations.
• The UNGA also considers reports from the UNSC and other organs of the UN.
• In case of threats to peace, and where the UNSC has failed to take action because of the negative vote (veto) of a permanent member, the GA can consider the matter and recommend actions to its members.

UNGA Subsidiary Organs

The UNGA has many subsidiary organs, in the form of commissions, committees, boards, councils and working groups.

The commissions of the UNGA are:

• Disarmament Commission
• International Law Commission
• International Civil Service Commission
• United Nations Conciliation Commission for Palestine
• United Nations Commission on International Trade Law (UNCITRAL)
• United Nations Peacebuilding Commission

4. ‘Second wave may delay resolutions, increase haircuts’

FY22 realisation under IBC rests on 8-9 large accounts: ICRA

The second wave of the COVID-19 pandemic may again delay resolutions under the Insolvency & Bankruptcy Code (IBC) and increase haircuts for lenders, though realisations for financial creditors is likely to improve under the Code in FY22, ICRA said in a report.

Stating that realisation for financial creditors from the resolution under the IBC fell to ₹26,000 crore in FY21 — almost a quarter of the realisations in FY20 — it said financial creditors may realise about ₹55,000-60,000 crore in FY22, largely driven by the expected resolution of a large housing finance firm. This is likely to be DHFL.

“The pandemic has increased operational challenges for the various parties involved in a corporate insolvency resolution process, which resulted in limited cases yielding a resolution plan,” ICRA said. “Further, the suspension of new proceedings under the IBC for the entire fiscal resulted in a sharp slowdown in the resolution process,” it added.

“The increase in the resolution amount in FY22 would depend on the expected resolution of a large housing finance company which is awaiting the NCLT’s approval but is also under litigation in the higher courts,” said Abhishek Dafria, VP and group head, Structured Finance, ICRA.

In FY22, realisations would depend on successful resolution of 8-9 big-ticket accounts, ICRA said.

5. Heightened stress could delay bank privatisation: Fitch

‘Investor interest needed for success’

The Centre’s plan to privatise two public sector banks this year could face delays on account of higher stress levels in banks’ balance sheets due to COVID-19, as well as political hurdles in effecting necessary legislative changes, Fitch Ratings said on Monday.

The government has announced an ambitious disinvestment target of ₹1.75 lakh crore for 2021-22, which includes the sale of two banks, yet to be officially identified from the dozen public sector entities in the sector.

“The bold move to privatise state-run banks faces risk from political opposition and structural challenges including heightened balance-sheet stress due to the pandemic, which is likely to keep bank performance subdued for the next 2-3 years,” Fitch said in a note.

Arguing that investors’ appetite for government-owned banks is muted due to ‘structurally weak governance frameworks’ and ‘persistently weak performance, reflected in significant asset-quality problems’, the ratings agency said that larger banks have generally ‘compromised’ financials.

‘Resistance from unions’

Investor interest might be especially muted in banks prohibited by the central bank from pursuing fresh loans and new branches under the prompt corrective action framework.

“There could also be more resistance from the trade unions this time around, who will be against the safety-net withdrawal of state ownership. Success of the plan would also require sufficient interest from investor(s) willing to acquire large stake(s) in state-owned banks and run them,” it added.

State-owned banks have been more active in extending relief and forbearance measures announced by the authorities than their private peers, Fitch noted, stressing this would make it more difficult to assess stress levels at these banks.

Work culture differences and more ‘bureaucratic’ organisational practices at public sector banks also pose a challenge.

“Similar challenges and the absence of meaningful investor interest resulted in the state ultimately having to sell its majority stake in IDBI Bank to LIC in 2019, which has somewhat been privatisation in letter but not in spirit.

“However, this could change in 2021 if both government and LIC are able to divest a majority stake in the bank to an external investor, as it may be indicative of broader investor appetite in state banks with adequate loan-loss reserves,” it concluded.

6. Banks to shift ₹89,000-crore NPAs to NARCL

Banks have identified about 22 bad loans worth ₹89,000 crore to be transferred to the National Asset Reconstruction Company Ltd. (NARCL) in the initial phase, according to Union Bank of India MD and CEO Rajkiran Rai G.

“The Indian Banks’ Association (IBA) has asked lead banks to call for meetings and keep an approval ready so that as soon as the ARC is formed, they can start the process,” Mr. Rai, who is also the chairman of IBA, told reporters.

“I think the assessment in the first phase was of 22 accounts of about ₹89,000 crore for the system.”

National Asset Reconstruction Company Ltd. (NARCL)

1. Setting up of NARCL, the proposed bad bank for taking over stressed assets of lenders, was announced in the Budget for 2021-22.
2. The plan is to create a bad bank to house bad loans of ₹500 crore and above, in a structure that will contain an asset reconstruction company (ARC) and an asset management company (AMC) to manage and recover dud assets.
3. The new entity is being created in collaboration with both public and private sector banks.

How is NARCL different from existing ARCs? How can it operate differently?

1. The proposed bad bank will have a public sector character since the idea is mooted by the government and majority ownership is likely to rest with state-owned banks.
2. At present, ARCs typically seek a steep discount on loans. With the proposed bad bank being set up, the valuation issue is unlikely to come up since this is a government initiative.
3. The government-backed ARC will have deep pockets to buy out big accounts and thus free up banks from carrying these accounts on their books.

What is an Asset Reconstruction Company (ARC)?

It is a specialized financial institution that buys the Non-Performing Assets (NPAs) from banks and financial institutions so that they can clean up their balance sheets. This helps banks to concentrate on normal banking activities.

The asset reconstruction companies or ARCs are registered under the RBI.

Legal Basis:

The Securitization and Reconstruction of Financial Assets and Enforcement of Security Interest (SARFAESI) Act, 2002 provides the legal basis for the setting up of ARCs in India.

Capital Needs for ARCs:

1. As per amendment made in the SARFAESI Act in 2016, an ARC should have a minimum net owned fund of Rs. 2 crores. The RBI raised this amount to Rs. 100 crores in 2017.
2. The ARCs also have to maintain a capital adequacy ratio of 15% of its risk-weighted assets.

Need for:

The total stress in the banking system would be in excess of Rs 15 lakh crore. The banks burdened with stressed assets and limited capital will find it difficult to manage the NPAs. There is also limited capital that the government can provide. This is where the bad bank model would step in and help both the government and banks.

7. FDA conditionally approves controversial Alzheimer’s drug

The drug, Aduhelm, has been granted ‘accelerated approval’

The U.S.’s pharma regulator, the Food and Drug Administration (FDA), made a much anticipated ruling on Monday, in conditionally approving the use of an Alzheimer’s drug, called aducanumab, the first such approval since 2003. The drug, which goes by the brand name Aduhelm, has been granted ‘accelerated approval’, meaning it will need to verify expected clinical benefits in a new trial.

The drug’s approval had become controversial, with growing pressure from those impacted by the debilitating degenerative brain disease on one hand and opposition from many in the scientific community who were not convinced that the drug had demonstrated efficacy in trials, on the other. The FDA’s conditional approval on Monday took account of this.

On Monday, Patrizia Cavazzoni, director of the FDA’s Center for Drug Evaluation and Research, wrote on the organisation’s website that “the data included in the applicant’s submission were highly complex and left residual uncertainties regarding clinical benefit.”

Aducanumab is based on the amyloid hypothesis of the disease — that plaques made of beta amyloid peptide (a type of protein) form in the patients brain leading to cognitive decline and problems with thinking. The drug supposedly binds to beta amyloid molecules and removes them. The drug, a monoclonal antibody, is given monthly via injection to patients who suffer from early stages of Alzheimer’s.

‘No strong evidence’

The drug, developed by Biogen, a Cambridge (Massachusetts)-based company and Eisai Co., a Japanese company, was pulled out of two trials in 2019 after it was thought not to be working. In October of last year, Biogen said a high dose of the drug slightly slowed cognitive decline.

A panel of experts — not part of the FDA — had ruled last November that the drug did not show “strong evidence” of working. Their decision was non-binding on the FDA. Other scientists and a think tank had said safety concerns around the drug did not outweigh any possible benefits, the New York Times reported.

“The late-stage development program for Aduhelm consisted of two phase 3 clinical trials. One study met the primary endpoint, showing reduction in clinical decline. The second trial did not meet the primary endpoint. In all studies in which it was evaluated, however, Aduhelm consistently and very convincingly reduced the level of amyloid plaques in the brain in a dose- and time-dependent fashion. It is expected that the reduction in amyloid plaque will result in a reduction in clinical decline,” Ms. Cavazzoni wrote on Monday.

Alzheimer

Alzheimer’s disease is the most prevalent neurodegenerative disorder and accounts for more than 70% of all dementia. The multifactorial nature of the disease attributed to multifaceted toxicity has made it difficult for researchers to develop effective medication.

Protein aggregation and amyloid toxicity predominantly contribute to multifaceted toxicity observed in neuronal cells, including generation of reactive oxygen species (ROS), mitochondrial dysfunction, interfering with synaptic signaling, and activation of premature cell death.

What is Alzheimer’s?

It is a progressive brain disorder that typically affects people older than 65. When it affects younger individuals, it is considered early onset.

The disease destroys brain cells and nerves, and disrupts the message-carrying neurotransmitters.

Eventually, a person with Alzheimer’s loses the ability to perform day-to-day activities.

Symptoms include memory loss, difficulty in completing familiar tasks, confusion with time or place, problems in speaking and writing, decreased or poor judgment, and changes in mood and personality. Alzheimer’s disease is also the most common cause of dementia — which is a syndrome and not a disease in itself, and whose symptoms include loss of memory, thinking skills, problems with language, changes in mood and deterioration in behaviour.

Treatment:

There is no cure for Alzheimer’s, because its exact causes are not known. Most drugs being developed try to slow down or stop the progression of the disease.

There is a degree of consensus in the scientific community that Alzheimer’s involves two proteins, called beta amyloids and tau. When levels of either protein reach abnormal levels in the brain, it leads to the formation of plaque, which gets deposited between neurons, damaging and disrupting nerve cells.

8. Editorial-1: Connecting the dots to mitigate a third wave

The acronym ‘DOTS’ is a framework to understand the dynamics of the second wave, thereby helping mitigate the next

After a long and painful month-and-a-half, confirmed cases of COVID-19 in India have been declining steadily for more than a month. Deaths have started to decrease as well. However, it is a long way down from an unprecedented peak of more than 400,000 daily cases, and the suffering will continue for weeks and months to come. It does, however, appear that the second wave of the novel coronavirus is abating.

‘R’ and determinants

A simple epidemiologic concept can be used to better understand the second wave and help plan for a potential third wave. The reproduction number — often referred as R — is the average number of new infections arising from one infected individual. R fluctuates over time during an epidemic. When R is greater than 1, infected individuals infect more than one person on average and we observe increasing cases. When it is less than 1, cases are declining. It is not a perfect statistic, especially when cases are low, but it does provide helpful insights into how an epidemic is changing.

What led R to increase earlier this year resulting in a second wave? R depends on four factors, summarised by the acronym DOTS: the Duration a person is infectious; Opportunities infected individuals have to spread infection to others; the probability Transmission occurs given an opportunity, and the average Susceptibility of a population or subpopulation. Because each factor is required for increasing cases, reducing any of them to 0 would extinguish an epidemic. This is not practical right now anywhere in the world. However, we should work toward decreasing these factors such that R remains as low as possible. It is also critical to consider the effect new variants have had on each of these four factors.

Susceptibility, opportunities

Let us start with S — the proportion of the population susceptible to infection. Susceptible individuals lack immunity derived through prior infection or immunisation. Results from a national seroprevalence survey done in December 2020 and January 2021 indicate that roughly 25% of the population had antibodies to the virus that causes COVID-19. Estimates were slightly different depending on geography. And some surveys showed substantially higher exposure to the virus. Nevertheless, there was still a substantial susceptible population in most parts of the country at the beginning of 2021. Susceptibility can be reduced through immunisation. By the end-March, however, less than 1% of the total population had received two doses of the vaccine. Taken together, the right conditions were set for a potential second wave at the beginning of 2021.

The next factor is the number of opportunities for transmission — or O in the DOTS. By January, there was a sense that India had made it through the worst of COVID-19. Many people were eager to get back to life and work, especially after a very challenging 2020. Social distancing had reduced and markets filled again with people. One salient characteristic of COVID-19 is that the disease is driven largely by superspreading, where many individuals are infected by a small number of individuals. Colleagues and I showed in research from Tamil Nadu and Andhra Pradesh that only 5% of infected individuals accounted for roughly 80% of all secondary infections. With this in mind, increased social mixing and large gatherings that took place in early 2021 also might have helped facilitate a second wave.

Transmission, duration

This brings us to T, or the probability of transmission. Not taking proper precautions can lead to increased transmission. There are no good national statistics on the proportion of people adhering to preventative measures. However, during my travels throughout India for work in early 2021, it was clear that few people were wearing masks while in public. In addition, new variants that are more transmissible have emerged. One new variant called B.1.617.2, or more recently known as the delta variant, is known to be much more transmissible — potentially twice as much — than those circulating in 2020. This is demonstrated by the fact that it is the dominant variant in India and has emerged as the dominant variant in the United Kingdom according to data from there.

Finally, the last factor in the DOTS equation is the duration of infectiousness or D. Emerging evidence suggests that the duration of infectiousness could be slightly longer with some new variants. More research is needed to confirm this. However, this could help explain why some variants are outcompeting others and could have contributed to the increase in R in India earlier this year.

A third wave?

What does this mean for a potential third wave? First, we need well-designed seroprevalence surveys to understand how much of the population remains susceptible and where they reside. The Government has planned a seroprevalence study in June in the same 70 districts where the first three rounds were conducted. There also remain questions about waning immunity and the potential for reinfections, which would affect how we calculate the proportion of the population that is susceptible. The new variants also complicate this equation, as they are able to partially evade immunity developed through infection or immunisation.

Despite the need for more data, based on the existing evidence and out of an abundance of caution, we should anticipate that there could be a potential third wave.

Luckily, DOTS provides us with a framework for preventing or mitigating a third wave. We need to drive down the factors that contribute to R wherever possible. And we need to work even harder to do this, because the new variants have skewed the equation such that R can more easily be pushed to be greater than 1. Some regions have implemented lockdowns, which substantially reduce opportunities for transmission. These are temporary solutions and should be used to focus on slowing transmission and scaling up other interventions. Mass gatherings have also largely stopped, which should help reduce opportunities for transmission. This is welcome news and should continue after the second wave. We can reduce the susceptible population by substantially increasing immunisation coverage. Currently only 3% of the population has received both doses. The Government is working hard to procure additional doses that are desperately needed.

Mask use, ventilation

Transmission can be reduced through increased use of face masks and improved ventilation. Research from neighbouring Bangladesh indicates that providing free masks together with community monitors can help improve adoption. Last, if the duration of infectiousness is indeed longer, isolation and quarantining guidelines should be revisited to minimise potential exposure to others.

The emergence of new variants means we need to take these interventions even more seriously. Connecting the DOTS, though, can help mitigate a third wave and the tremendous pain and suffering that have become all too common in recent weeks.

9. Editorial-2: Fair wind

A good monsoon will aid agriculture, now one of the few bright spots in the economy

If everything aligns, India could see a third consecutive year of surplus rainfall. The IMD has said that monsoon rains will likely be 101% of the Long Period Average (LPA) of 88 cm. In 2020, it was 109% of the LPA and in 2019, 110%. While the forecast 101% LPA is short of the rainfall received in these years and still within the range of what the IMD considers ‘normal’ rainfall, it is positive news because the current forecast is ‘above normal’ rainfall in the core agricultural zone. This zone includes States where agriculture is significantly rain-fed including Madhya Pradesh, Bihar, Odisha and West Bengal. The IMD’s estimate of the distribution of this rainfall also suggests that except for the Northeast, where rainfall is expected to be ‘below normal’, other regions are expected to get above normal rainfall. A general pattern of the monsoon is that weakened rains over Northeastern India — which has a higher base rainfall than other parts of India — translate into stronger rainfall in Central India. Propitious rain this year is premised on forecasts from Indian and global climate models, veering towards no excess sea-surface temperatures at the Equatorial Pacific conditions. There are also ‘negative’ IOD (Indian Ocean Dipole) conditions over the Indian Ocean during the monsoon season, meaning warmer water and greater precipitation in the eastern Indian Ocean. Put together, they mean that these larger climate factors are, as of now, unlikely to have a significant influence over the prevailing monsoon.

A good monsoon could aid agriculture which has been among the few bright spots in the Indian economy. Two good years of rains have boosted storage in the key reservoirs. However, the flip side of a forecast for a bounteous monsoon is the possibility of flash floods, landslides and disease outbreaks. In the last year and before it, the IMD had not, in June, warned about the exceptionally high rains. While three consecutive years of above normal rain are exceedingly rare, the IMD itself assigns a 22% probability of it occurring, which is just below the 40% probability of ‘normal’ rainfall. India is now moving to a system where medium range forecasts, or expected changes in monsoon or larger weather patterns over two weeks, are better captured by the monsoon models deployed. These inputs must be used by the Government to better prepare infrastructure in the eventuality that excessive rains can wipe out the potential gains for agriculture. It may also be worthwhile to encourage farmers to sow higher-value crops than only rice via the MSP route. The favourable tidings should not be an excuse to abandon caution.

10. Editorial-3: Towards a stronger mental health strategy

More needs to be done in India in the context of COVID-19, which has exacerbated mental illnesses

Mental health issues are a major health challenge in the world today. According to the World Health Organization (WHO), there is a 10-25-year life expectancy reduction in patients with severe mental disorders. About 72% of member states had a standalone policy or plan for mental health in 2017. India introduced the National Mental Health Policy (NMHP) in 2014, and a rights-based Mental Healthcare Act in 2017, which replaced the Mental Healthcare Act of 1987. The NMHP, National Health Mission, National Adolescent Health Programme, and Ayushman Bharat have the necessary components to address the mental health issues of all sections of the population. But more needs to be done in the context of COVID-19, which has exacerbated mental illnesses everywhere.

Mental health indicators

Studies in The Lancet Public Health (2019) revealed that median mental health spending across the world was around 2% of the total government health expenditure in 2015. In the case of low-income countries, it was around 0.5% of their health budget; for lower-middle-income countries, it was 1.9%; for upper-middle-income countries, 2.4%; and for high-income countries, 5.1%. There was higher allocation in developed countries than in developing countries. Government expenditure on hospitals dealing with mental health issues as a percentage of total government expenditure on mental health is 1.3% in India; in developed countries, it ranges from 3% to 15%.

In India, the share of mental hospitals per 1,00,000 population is as low as 0.01 in line with developing countries, according to the WHO. This may possibly be due to the lack of focussed attention given to mental health compared to other major diseases in India.

In the distribution of mental health units in general hospitals (per 1,00,000 population) globally, in 2016, India was ranked 114 with just 0.03 units per 1,00,000 population. India was at the 99th position in the distribution of mental health outpatient facilities (per 1,00,000 population), with 0.18 units per 1,00,000 population. India was also at the 64th position in the distribution of mental health day treatment facilities (per 1,00,000 population).

Residential mental health services, particularly community ones, are an important component for good quality mental health care. In most industrialised economies, there has been a growth of community healthcare facilities in line with the increase in patients with mental health issues. Research also shows that long-term patients with mental health issues are usually admitted to residential facilities. The distribution of community residential facilities globally for the median year 2016 showed India at the 58th position, with 0.017 units per 1,00,000 population among the WHO member countries.

The people working in the mental health sector help us understand mental health issues better. Here, India was ranked 107 with 0.292 per 1,00,000 population. Nurses, social workers and psychologists working in the mental health sector (per 1,00,000 population) in India are 0.796, 0.065, and 0.069, respectively. The leading countries in each of these three areas have 150.3, 145.4, and 222.6 per 1,00,000 population. India’s ranking in this context among the WHO member countries was 97, 79 and 104, respectively.

Mental illnesses

Mental illnesses include anxiety disorders, psychotic disorders, mood disorders, substance use disorders, personality disorders and eating disorders. The majority of suicides in the world are related to psychiatric problems or to the illnesses listed above. Death by suicide is a complex phenomenon and not fully reported. Globally, the suicide rate was 10.6 per 1,00,000 population whereas in India, it was 16.3 per 1,00,000 in 2016. The suicide rate was higher among males compared to females.

Mental health may not be the primary concern in developing economies like India as there may be other communicable and non-communicable diseases, which may be more prevalent. There are also challenges regarding funding, delivery of mental health packages, lack of trained staff, etc. However, these challenges need to be considered more seriously in the wake of COVID-19 as mental health issues are widely prevalent among the Indian population due to lockdowns and related issues.

Recent reports published in Lancet revealed that one in seven people in India had a mental disorder ranging from mild to severe in 2017. Also, the proportional contribution of mental disorders to the total disease burden had doubled between 1990 and 2017. Mental disorders include depressive and anxiety disorders, schizophrenia and bipolar disorder. This situation was generally worse in the southern States compared to the northern States due to the nature of development, modernisation, urbanisation and other factors not understood yet. Depressive disorders were more prevalent among females than males, which could be due to sexual abuse, gender discrimination, stress due to antenatal and postnatal issues and other reasons.

Additional measures

In order to further address mental health issues, India could reduce the treatment gap for mental disorders, increase the number of personnel in the mental health sector, work towards reducing discriminatory attitudes, and devise an integrated approach for detecting, treating, and managing patient needs. More counselling facilities, especially in rural areas, with special support for women through the provision of women doctors are needed. More telemedicine, telephone-based helpline numbers, and mental health apps could help. Communities and families have an important role in this regard and so do community-based programmes. School-based programmes on mental health can improve the mental health of children. More fund allocation for treatment of mental health, especially to those States in need of funds, could do wonders. The pandemic may be the best time to explore various policy options including creating online mental health awareness.

There needs to be a road map for mental health awareness. This should include the traditional media, government programmes, the education system, industry, and social media. Media awareness and government involvement is already happening in India but both can improve. It is high time that industry and private sector companies set up counselling facilities. The application of big data and crowd sourcing ideas may help us in informed decision-making.