1. Sri Lanka’s China-backed tax haven clears final hurdle

Top court rejects pleas challenging Port City Bill

A Chinese-funded tax-free enclave billed as Sri Lanka’s answer to Dubai and Singapore cleared the final legal hurdle on Tuesday as the Supreme Court in Colombo ruled it could go ahead with only minor tweaks.

The largest single foreign investment in Sri Lanka is one of several massive Asian infrastructure projects funded by China as Beijing increases its regional footprint.

Sri Lanka’s top court rejected 19 petitions challenging the “Colombo Port City Economic Commission” Bill and approved the $1.4-billion project subject to minor amendments which the government immediately said it accepted. Project officials have said they hope the brand new “Port City”, an area of reclaimed land, will attract billions of dollars for trade, banking and offshore services similar to what is available in Dubai and Singapore, two of its potential competitors.

Named the “Colombo Port City” because of its proximity to Colombo’s main harbour, the sea reclamation — carried out with considerable Chinese labour — completed in 2019 has doubled the size of Colombo’s financial district by adding 269 hectares.

Under the proposed legislation expected to be passed by Parliament, the Port City will be administered by a commission with unprecedented powers to fast track investment approvals. ll transactions within the Port City will be denominated in foreign currency and all salaries earned by any worker will be tax-exempt.

China’s New Project in Sri Lanka

• About the Islands:
  • Delft, the largest of the three islands, is the closest to Rameswaram, Tamil Nadu, which lies to the island’s south west.
    • Between the two is Kachchativu, the tiny island that India ceded to Sri Lanka in 1974.
    • The waters around these islands are an area of contest and rivalry between Tamil Nadu and Jaffna fishers.
    • The matter has been on the bilateral agenda for decades.
    • India and Sri Lanka agreed to set up a Joint Working Group (JWG) on Fisheries in 2016 between the Ministry of Agriculture and Farmers Welfare of India and Ministry of Fisheries and Aquatic Resources Development of Sri Lanka as the mechanism to help find a permanent solution to the fishermen issue.
• Sri Lanka’s Stand:
  • It cannot be blamed for this decision, because the project is backed by the ADB, which has its “own procurement guidelines that should be followed by the borrower”.
• India’s Concern:
  • The project site’s proximity to the Indian coastline.
    • Chinese presence in the vicinity is not welcomed especially when India already has many unresolved issues with China.
    • This deal came at a time when India’s confrontation with China in Ladakh is yet to be resolved.
  • Recently, the Sri Lankan government cancelled the contract with India and Japan for the Eastern Container Terminal (ECT).
    • The tripartite agreement, signed by India, Sri Lanka and Japan, proposed to develop the ECT, which is located at the newly expanded southern part of the Colombo Port.
    • For India, the ECT deal was important as around 70% of transhipment that takes place through it is India-linked. The ECT is also considered more strategic than any other in Colombo Port.
• India’s Stand:
  • India had lodged a strong protest with the Sri Lankan government on the contract to the Chinese company.
    • In 2018, India voiced concern over China’s USD 300 million housing project for war-affected areas, accusing the Resettlement Ministry [of the former government] of holding an “opaque” bidding process.
      • The project was eventually dropped.

China’s Rising Influence in South Asia

• Recent Initiative:
  • In January 2021 China held its third multilateral dialogue virtually with countries from South Asia to take forward closer cooperation on fighting Covid-19 and coordinating their economic agendas, reflecting a new approach in Beijing’s outreach to the region.
• Other Initiatives:
  • According to the American Enterprise Institute’s China Global Investment Tracker, China has committed around 100 billion USD in the economies of Afghanistan, Bangladesh, the Maldives, Pakistan, Nepal and Sri Lanka.
    • China is now the largest overseas investor in the Maldives, Pakistan, and Sri Lanka.
• Concerns for India:
  • Security Concerns:
    • Growing cooperation between Pakistan and China.
    • Increasing nexus between Nepal and China.
    • Acceptance to China-Pakistan Economic Corridor by south asian countries.
  • Leadership Roles in South Asia:
    • It shows increasing chinese presence in south asia and its acceptance by the countries as a torch bearer for the region which India wants for itself.
  • Economic Concerns:
    • Over the past decade, China has replaced India as the major trading partner of several South Asian countries.
    • For instance, the share of India’s trade with Maldives was 3.4 times that of China’s in 2008. But by 2018, China’s total trade with Maldives slightly exceeded that of India.
  • China’s trade with Bangladesh is now about twice that of India. China’s trade with Nepal and Sri Lanka still lags India’s trade with those countries but the gap has shrunk.

2. ‘U.S. against militarisation of the Artic’

U.S. Secretary of State Antony Blinken said on Tuesday that Washington wanted to avoid a military build-up in the Arctic, a day after Russia defended its military activities in the strategic region.

“We have concerns about some of the increased military activities in the Arctic. That increases the dangers or prospects of accidents… and undermines the shared goal of a peaceful and sustainable future for the region,” Mr. Blinken told a press conference in Reykjavik.

“What we need to avoid is a militarisation of the region,” Mr. Blinken said on the eve of an Arctic Council meeting of Foreign Ministers on Wednesday and Thursday where he will meet his Russian counterpart Sergei Lavrov.

New Maritime route through Arctic Ice

AP Moller-Maersk, the world’s largest container shipping groups cargo vessels, had navigated through the Russian Arctic on a trial journey.

• The ship arrived in St Petersburg on the Gulf of Finland after leaving Vladivostok on the North Pacific on August 22.
• The route can become the new maritime highway between Asia and Europe.
• The Northern Sea Route (along Russia’s northern extremity) could potentially cut the travel distance between East Asia and Western Europe (currently via the Malacca Strait, Indian Ocean, Gulf of Aden and Suez Canal) from 21,000 km to just 12,800 km, and the journey time by 10-15 days.

The Vanishing Ice

• Years of melting ice have made it easier for ships to ply these frigid waters.
• The extent of sea ice covering the Arctic Ocean has declined in every decade since the 1980s, measurements which were taken every September show.
• As climate change is resulting in parts of the Arctic warming up to 100% faster than elsewhere, there is evidence that ancient, thick ice is disappearing as well.

The New Shipping Route

• As the seas warm, it is conceivable that ships, by the middle of this century, will be able to pass directly over the North Pole from the north of Russia to the north of Canada, at least for some weeks in the summer.
• The shipping activity in the region is likely to increase significantly over the next decade, also because Russia is likely to develop oil and gas fields in Siberia.

Issues with Arctic Sea Route

• Costs
  • High costs and varying conditions of Arctic ice can discourage the shippers who have to follow strict schedules.
• Safety
  • Increased insurance costs and safety considerations are other concerns.
• Environment
  • The noise and environmental pollution done by ships can severely impact the environment as well as the wildlife in the otherwise remote part of the world.

3. GST Council to mull COVID relief: Govt.

Finance Ministry tells court it is receptive to citizens’ needs, has already offered significant duty relief

Requests for relief from the Goods and Services Tax (GST) on critical COVID-19 materials will be placed before the GST Council at its May 28 meeting, the Centre told the Delhi High Court, which had asked it to consider exempting the GST levied on oxygen concentrators imported for personal use.

Stating it had an ‘open mind’ on all tax relief requests, the Finance Ministry, in a counter affidavit filed before the Bench of Justices Rajiv Shakdher and Talwant Singh on Tuesday, argued that merely levying a reasonable GST rate on oxygen concentrators cannot be considered a violation of the Right to Life under Article 21 of the Constitution.

“If the argument of the petitioner is accepted, then it will lead to absurd consequences and interpretations, wherein citizens will be seeking exemption from property tax, since housing is an essential facet of Right of Life… or exemption from taxes on several food items since Right to Food has been held by the Supreme Court to be a part of Right of Life under Article 21,” the Ministry submitted to the court.

Judgment reserved

The Court, which reserved its judgment following Tuesday’s proceedings assisted by Amicus Curiae Arvind Datar, had asked the Centre to drop the GST levy temporarily till the pandemic subsides. The petitioner in the case, a senior citizen getting a concentrator as a gift from a nephew abroad, had invoked Article 21 to challenge a May 1 notification that levied 12% GST on such imports from 28% earlier.

‘Parity to deter misuse’

“Significant relief has already been provided on personal imports of oxygen concentrators with reduction of duty incidence from 77% to 12%,” the Ministry said, adding that tax parity between commercial and personal imports would prevent misuse of the latter route.

“It is felt that any person importing concentrator for personal use or has sources for receiving such supplies in gifts would be in better position to afford the nominal 12% GST as compared to others who source it through commercial channels,” the Ministry said, urging the Court to dismiss the petition. Since GST rates and general exemptions are prescribed on the recommendation of the GST Council, all the representations seeking GST relief shall be placed before the Council at its next meeting, the Ministry said.

“The government is receptive to the needs of the citizens… The government has an open mind to all these requests (for tax relief and exemptions) and it would intervene for further concession, as necessary, in the present unprecedented and very dynamic situation to provide relief to the public, particularly those who are not in a position by themselves to afford the COVID relief supply,” the Ministry added.

4. New naming system for virus variants

The initiative, similar to how hurricanes are labelled, seeks to remove stigma

The World Health Organization (WHO) would unveil a system of naming of coronavirus variants drawn from the way tropical storms are named, WHO Chief Scientist Soumya Swaminathan says.

“The new naming system should go live soon — yes, it will be names like hurricanes. This is so as not to stigmatise and deincentivise countries from making their sequencing results public. It will also be easier for the lay public to remember rather than these complicated lineage numbers,” she said in an email to The Hindu.

The WHO and health and science agencies across the world, for instance the Indian Council of Medical Research, the United States’ Centres for Disease Control and the Public Health England refer to viruses and their variants by formal lineage names, which are a combination of letters and names that point to the relationships between different variants.

To the trained eye, variants such as B.1.1.7 and B.1.617 suggest that they have certain mutations in common and as well clues to their evolutionary history.

Geographical tag

However, because virus names and their associated diseases have frequently been named after geographical places where outbreaks were first reported or samples first isolated — such as the West Nile virus or Ebola.

B.1.1.7 started to be known as the ‘U.K. variant’ and B.1.351 as the ‘South African’ variant.

India’s Health Ministry, in the aftermath of B.1.617 that was popularly called the ‘Indian variant’, issued a press release decrying the media’s use of the name.

The dilemma of having names that don’t stigmatise places but also are amenable to popular use has to an extent been solved by the system of naming hurricanes, or tropical cyclones. The World Meteorological Organisation leaves it to countries that surround a particular ocean basin to come up with names.

5. 98% of India still at risk, warns Health Ministry

‘The virus hasn’t got tired, so we cannot relax just yet’

Over 98% of India’s population continues to be vulnerable or susceptible to COVID-19, said Lav Agarwal, Joint Secretary, Health Ministry, on Tuesday, adding that so far only 1.8% of the total population of the country had been affected.

“Despite the high number of COVID cases reported so far, we have been able to contain the spread to under 2% of the population. But with the majority still vulnerable, we cannot let our guard down and hence continued focus on containment is critical. The virus hasn’t got tired so we don’t have the option to relax just yet,” he said.

Releasing data, Mr. Agarwal said that from the 17.13% of the total COVID-19 case load reported on May 3, India’s current status stands at a reduced 13.3%

“Currently, eight States have more than 1 lakh active COVID-19 cases and 22 States have more than 15% case positivity. Maharashtra, U.P., Delhi, Bihar, Madhya Pradesh and Chhattisgarh have shown a decline in COVID-19 cases and a decline in positivity. There are 199 districts showing a continued decline in COVID-19 cases and positivity in the last two weeks,” he said.

NITI Aayog, Member (Health) V.K. Paul, who also addressed the conference, said that the COVID-19 curve was stabilising in India.

“We are already looking at the possible vaccine use for children as is being done internationally also, and are carefully tracking any changes in the virus. The basic rules to prevent the spread of the virus don’t change, and together we have to contain and defeat the virus,” he said.

Trials for children

Dr. Paul noted that Covaxin had received approval for Phase II/III clinical trials in the two-to-18 age group. “And I have been told that trials will begin in the next 10-12 days,” he said.

He added that the COVID-19 National Task Force would examine the drug 2-deoxy-D-glucose (‘2-DG’) developed by the Defence Research and Development Organisation (DRDO) for adding it to the COVID-19 treatment protocol.

The drug has received emergency use authorisation from the Drugs Controller General of India (DCGI).

Replying to a question about a COVID-19 virus variant found in Singapore, which could be more harmful to children, Dr. Paul said that it was being looked into.

“We are examining the report about this particular variant. Regarding COVID-19 among children, so far, the knowledge that we have is that most of them are asymptomatic, and it is reassuring that they don’t get serious infections. Meanwhile, we are keeping an eye on variants found in Singapore,” he said.

Public Health System In India

Contrary to the popular notion about India’s Public health systems being inefficient and ineffective, it is performing reasonably well in tackling the Covid-19 pandemic and providing treatment of patients without refusing anyone on financial grounds.

However, the private health sector which accounts for 70% of healthcare services in India, is playing only a supporting role and referring the patients to public hospitals for treatment of any cases relating to Covid-19.

The current pandemic reiterates the importance of Public Health systems. Thus, there is a need to address the constraints and revamp of the public health system in India.

Associated Challenges With Public Health Systems in India

• Lack of Primary Healthcare Services: The existing public primary health care model in the country is limited in scope.
  • Even where there is a well-functioning public primary health centre, only services related to pregnancy care, limited childcare and certain services related to national health programmes are provided.
  • This represents only 15% of all morbidities for which people seek care.
• Supply-Side Deficiencies: Poor health management skills and lack of appropriate training and supportive supervision for health workers prevent delivery of the desired quality of health services.
• Inadequate Funding: Expenditure on public health funding has been consistently low in India (approximately 1.3% of GDP). As per OECD, India’s total out-of-pocket expenditure is around 2.3 % of GDP.
• Overlapping Jurisdiction: There is no single authority responsible for public health that is legally empowered to issue guidelines and enforce compliance of the health standards.
• Sub-optimal Public Health System: Due to this, it is challenging to tackle Non-communicable Diseases, which is all about prevention and early detection.
  • It diminishes preparedness and effective management for new and emerging threats such as pandemic like Covid-19.

Steps To Be Taken

• Enabling Preventive Care: In order to promote preventive care, the Union government has announced the conversion of primary health care centres into Health and Wellness Centers (HWCs).
  • These HWCs will act as the pillar of preventive care and ‘gateway’ for access to secondary and tertiary health services.
  • Thus, there is a need to accelerate the establishment of a network HWCs, for this extra funding through Corporate Social Responsibility (CSR) can be mobilised.
• Bringing Behavioural Change: There is a need to ensure people eat right, sleep right, maintain good hygiene, exercise, and adopt a healthy lifestyle that necessitates concerted interventions at various levels of the system.
  • In order to catalyse people’s participation for healthy India, there is need for Swasth Bharat Jan Andolan on lines of Swach Bharat Abhiyan.
• Cooperative Federalism: Given the major role that States have to play in creating strong health systems across the country, allocations provided by the Finance Commission can become the critical catalyst for transforming the nation’s health.
  • State governments should be incentivized to invest in creating a dedicated cadre for public health at the state, district and block levels.
• More Funding: Public funding on health should be increased to at least 2.5% of GDP as envisaged in the National Health Policy, 2017.
• Decentralisation: There is a need to make nutrition, water, sanitation and hygiene (WASH) part of the core functions of Panchayati raj institutions and municipalities.
• Creating a Nodal Health Agency: There is need to create a designated and autonomous focal agency with the required capacities and linkages to perform the functions of disease surveillance, information gathering on the health impact of policies of key non-health departments, maintenance of national health statistics, enforcement of public health regulations, and dissemination of information to the public.
  • In this pursuit, NITI Aayog’s National Health Stack is a step in the right direction, which needs to be operationalised as soon as possible.

6. Editorial-1: Tracking the pandemic’s rural march

States, especially in the north, are facing the brunt of the second wave, made worse by their poor health infrastructure

When the first wave of the novel coronavirus pandemic hit the country, the central government imposed the strictest lockdown for almost two months. For most of the migrants stuck in urban areas without incomes, jobs and food to survive, the only escape was to walk back to the rural areas where they came from. Migrants walked back thousands of kilometres to return to rural areas not because the villages were best equipped to deal with the pandemic but primarily because it provided them protection from hunger and starvation. During the second wave now, it is the rural areas which are bearing the brunt of the pandemic with most cases being reported from rural areas. And, unlike last time, there is nowhere to go.

Estimates versus the reality

The second wave was expected at least based on past experience of other countries and of earlier pandemics but also because most scientists predicted it given the changing nature of the virus and the pandemic. However, unlike the last time when it was largely in urban areas, this time it has spread to villages. Also, in contrast to the previous episode, it has spread this time to the rural areas in Bihar, Uttar Pradesh, West Bengal, Jharkhand and Odisha — States which remained largely unaffected by the spread of the pandemic during the first wave. Most of these States are those with a low availability of health professionals and a lower level of health infrastructure. The result has been a much higher level of infections and deaths. Stories of bodies floating in rivers or left buried on the banks are being reported from both Uttar Pradesh and Bihar. While these are stark visuals of the nature of impact that the pandemic has caused on infections and deaths resulting from the infections, these are all estimates; gross underestimates of the actual reality in the rural areas in many of these States.

Neglect of primary care

The scale of the misery inflicted by the pandemic was expected in most of these States, where the existing health infrastructure has been found lacking. But what made it worse was also complete apathy and a lack of governance in improving the health infrastructure despite knowledge of the second wave of the epidemic.

As in the latest report of the Rural Health Statistics 2019-20 released by the Ministry of Health and Family Welfare (MOHFW), not only are these States which figure among the States with the worst health infrastructure but are also ones where the situation has worsened over the years. Compared to 10,337 functioning subcentres in rural Bihar in 2005, only 9,112 subcentres were functioning in 2020. The number of community health centres declined during the same period from 101 in 2005 to only 57 in 2020. Despite population growth, during the same period, the number of primary health care centres increased marginally to 1,702 in 2020 compared to 1,648 in 2005.

The situation in Uttar Pradesh, another large State, is no different with the number of primary health centres declining from 3,660 in 2005 to 2,880 in 2020. While the number of community health centres increased from 386 to 711 during the same period, sub-centres increased only marginally, from 20,521 in 2005 to 20,778 in 2020. The situation with regard to the availability of health professionals is not very different, with most States witnessing a worsening situation. For example, only 29% of specialists were in place in the community health centres in Uttar Pradesh as against the requirement based on official norms. Compared to the norm, Bihar reported the highest shortfall in availability of subcentres, at 58%, followed by Jharkhand, at 44%, and Uttar Pradesh, at 41%, as on July 1, 2020. Similar numbers in the case of primary health care centres were 73% for Jharkhand, 58% for West Bengal, 53% for Bihar and 51% for Uttar Pradesh.

Avoidable events

Given the state of the rural health infrastructure, it was obvious that the pandemic would lead to catastrophic outcomes once the rural population was exposed to the virus. The lack of governance in this case is not the state of health infrastructure that the State governments inherited but the failure to contain the spread of the pandemic despite the knowledge of the state of rural health infrastructure. This failure to estimate the scale of the havoc created by the pandemic was obvious in the case of the central government — steps were not taken to contain the spread along with augmenting the rural health infrastructure and there were decisions such as prolonged electioneering in some of the States. West Bengal, which has seen the fastest rise in cases, was witness to the longest period of electioneering this time, with no precautions such as social distancing in place. Similar adventurism in the case of Uttar Pradesh saw hundreds of polling officials getting infected and passing away due to the pandemic during the conduct of local body elections in the State. The Maha Kumbh organised in the middle of the pandemic, with millions of devotees participating, further added to the spread of the infection with devotees returning to rural areas in different States. All of these were eminently avoidable, with the resources used to augment and strengthen the rural health infrastructure.

Judiciary and the state

While all these created the perfect breeding ground for the pandemic to spread to rural areas, the severity of the infections was also a result of the misgovernance of State governments. This bordered on ignorance of the level of severity to outright denial and complete apathy of the health and humanitarian crisis unfolding in the respective States. In most cases, the judiciary at the level of High Courts has stepped in to fill the vacuum created by an absent state. The judicial intervention of the Allahabad High Court last month directing the State government to impose lockdowns in Uttar Pradesh was in turn challenged by the State government in the Supreme Court. Attempts to voice concern over the state of health infrastructure and the spread of the pandemic by helpless citizens was countered with threats of legal action by the Uttar Pradesh government until the Supreme Court stepped in.

Instead of expanding testing and contact tracing, attempts were made to restrict testing and report a lower number of infections, leading to a sense of complacency within the State administration. The reality in rural areas of most of these States is worse than what is being released to the public through official estimates. This is true for the number of deaths which by all measures appears to be much higher than official statistics. The absence of testing and treatment infrastructure has left the rural population at the mercy of private health providers; a large majority of the population has been left unable to avail the services of private health-care providers. The slow pace of vaccinations in rural areas despite the vulnerabilities has only contributed to the rise in infections and thousands of deaths which could have been easily prevented.

Aggravating rural distress

Rural areas provided refuge to the majority of the migrant population which had lost jobs and incomes during the first phase. It also helped the economy revive given that rural areas were largely unaffected. However, this time round it is the rural areas which are facing the worst of the pandemic as well as economic distress. Rural wage data as well as data on rural non-farm income available from official and private surveys point to a dismal economic scenario. While many have lost their primaryincome earner, even for those who managed to recover, it has come at the cost of huge private health expenditure. Many are likely to fall into a debt trap with the usurious rate of interest from the private money lenders pushing them into chronic poverty. For the rest, the loss of jobs and income has come at the cost of depleted savings. Rural areas are not just staring at the worst of the pandemic but also at prolonged economic distress.

While the pandemic with its uncertain nature is certainly responsible for it, the blame must equally lie with the government, both at the State as well as central levels, for its failure to anticipate and prevent the thousands of deaths.

7. Editorial-2: The czar of brinkmanship must seek peace

Russia and the other players in the Ukrainian crisis need to be prudent enough to resolve chronic tensions

The recent stand-off between Russia and Ukraine has again captured headlines in the international news media. This geopolitical situation appears to be complex due to the indirect involvement of its multiple stakeholders, including the United States, Turkey and the North Atlantic Treaty Organization (NATO).

Increased tensions between Ukraine and Russia can be viewed as a continuation of the unresolved conflict of 2014. Since then, the ‘illegal annexation of Crimea’ has become a buzzword in international politics, and Russia has been constantly painted as an aggressor and a hostile power. In addition to this, the country has been criticised for its involvement in the Donetsk and Luhansk regions in eastern Ukraine, where Russian-backed separatists have been fighting with Ukrainian troops.

From the beginning of April 2021, Moscow has allegedly deployed thousands of troops as well as tanks and artillery near Ukraine’s eastern border. It has also mobilised troops in the annexed Black Sea region of Crimea. This was enough to send a shock wave among the political elite in Ukraine, forcing them to appeal to the U.S. and NATO and ask for an intervention, if needed.

How dangerous can this become in the short term, and to which extent is the fear-mongering of the Ukrainian administration justified by the real situation on the ground?

NATO, U.S. response

On April 13, 2021, NATO Secretary General Jens Stoltenberg invited Ukrainian Foreign Minister Dmytro Kuleba to the NATO headquarters for a meeting of the NATO-Ukraine Commission on the security situation in Ukraine. Mr. Stoltenberg said, ‘Russia’s considerable military build-up is unjustified, unexplained, and deeply concerning.’ He underlined that NATO would continue to provide significant political and practical support to Ukraine. In turn, Mr. Kuleba made a strong statement that ‘the mistakes of 2014 must be avoided this time, so that Russia cannot catch anyone by surprise’.

Besides powerful rhetoric from NATO, Ukraine seems to be desperate to receive more commitments and concrete actions. Dealing with Russia, a powerful and unpredictable neighbour, forces Kiev to rely on NATO/U.S. military support if Russia is to continue with its provocations. The question though is how far the NATO alliance can go in its support, given that Ukraine has not yet obtained membership. In June 2020, NATO recognised Ukraine as an Enhanced Opportunities Partner, along with Australia, Finland, Georgia, Jordan, and Sweden. This partnership aims to maintain and deepen cooperation between countries that have made significant contributions to the NATO-led missions and operations.

The Ukrainian President Volodymyr Zelensky has also used the current tension as an opportunity to push for NATO membership, arguing that ‘this is the only way to end the war in Donbas’.

Notably, the U.S., under the new administration, has taken a more resolute stance towards this conflict, unlike the predecessors of the U.S. President, Joe Biden. Mr. Biden seems to be less apprehensive about provoking Russia and is ready to support Ukraine militarily, if the need arises. The recent visit of the U.S. Secretary of State, Antony J. Blinken, to Kiev indicates the U.S.’s foreign policy priorities. The underlying rhetoric of this visit was to support the ‘independence, sovereignty, and territorial integrity of Ukraine’.

Support from Turkey

On April 11, 2021, Mr. Zelensky visited Istanbul to mark the 10th anniversary of Ukraine’s strategic partnership with Turkey. This was also an opportunity for him to be reassured by Turkish President Recep Tayyip Erdoğan, that Turkey stands by Ukraine amidst the current tensions with Russia. Both leaders discussed the security issues in the Black Sea region. During the bilateral meeting, Mr. Zelensky emphasised that ‘the visions of both countries regarding geopolitical threats coincide with each other’. In other words, the visit was a diplomatic success for Ukraine as it had obtained the necessary guarantees from Turkey should tensions with Russia escalate.

It is worth recalling that Turkey has not acted in synchrony with Russia during several conflicts, e.g., in Syria, Libya, and, most recently, in Nagorno-Karabakh.

Russia’s moves

So what is Russia’s end goal? Arguably, the cornerstone of the Russia-Ukraine conflict is insufficient communication, especially on the part of Vladimir Putin’s Russia. It is very difficult, if not impossible, to speculate on the overarching rationale behind Russia’s tactical decisions towards Ukraine. There are more questions than answers regarding the strategic calculus of the Russian administration. A deficit of explicit messages from Moscow creates room for misinterpretations and exaggerations on the part of Ukraine and its western supporters. This misunderstanding can be best illustrated by the Russian explanation of its recent ‘military build-up’ in western Russia. According to the Russian Defence Minister, Sergei Shoigu, it was just a ‘three-week drill’ meant to test combat readiness to respond to NATO’s threats.

Russian President Vladmir Putin has been known for his geopolitical adventures, especially in West Asia. In the case of the eastern Ukraine, it is highly unlikely that he would be willing to make further territorial gains this time around. He possesses enough diplomatic (and pragmatic) skills not to indulge in yet another geopolitical endeavour, that might entail serious repercussions from the international community. Mr. Putin is aware of the ‘red line’ that should not be crossed. Hence, from the Russian perspective, the current ‘military build-up’ can be viewed as another round of muscle flexing and an attempt to perpetuate the narrative of a powerful and capable Russia.

For a peaceful resolution

All the stakeholders in the ongoing crisis should focus on establishing a constructive dialogue among themselves using clear and unambiguous language. The only way forward is to seek a peaceful resolution to the Russia-Ukraine conflict rather than exacerbating the reality and using quid pro quo tactics. Both countries do need support from the global community, but not in a military form. There is a need for a platform (similarly to the Minsk Agreements) that will facilitate negotiation, mutual consensus and possible compromises, as well as engagement with mediators.

The long-term solution should be sought out in order to break the vicious cycle of animosity and misunderstanding.

8. Editorial-3: Stormy start

Accurate forecasts and resilience-building hold the key to handling severe cyclones

Millions of people wearied by the onslaught of the coronavirus have had to contend with a furious tropical cyclone that has left a trail of death and destruction before making landfall in Gujarat. Cyclone Tauktae swelled into an extremely severe cyclonic storm, dumping enormous volumes of water all along the west coast, and caused loss of life in Kerala, Karnataka, Goa, Maharashtra and Gujarat, before weakening overland. To thousands who had to be evacuated to safe locations, this year’s pre-monsoon season presented a double jeopardy, caught as they were between a fast-spreading virus variant and an unrelenting storm. Many coastal residents would have felt a sense of déjà vu, having gone through a similar experience last year, when the severe cyclonic storm, Nisarga, barrelled landwards from the Arabian Sea, pounding Alibaug in Maharashtra as it came ashore. The cyclones in both years spared densely populated Mumbai. The twin crises have, however, strained the capacities of multiple States, especially the coastal ones, although the impact of the storm was considerably mitigated by disaster response forces. Once again, the value of creating a trained cadre, supported by the defence forces in rescue and relief work, is seen. The heralding of the 2021 monsoon season by a cyclone comes as another reminder that the subcontinent is at the confluence of more frequent, extreme weather events originating in the Bay of Bengal and the Arabian Sea every year.

How well India is prepared to handle cyclones depends on developing greater expertise in forecasting and disaster mitigation, and crafting policies to increase resilience among communities. Last year, the India Meteorological Department (IMD) launched an impact-based cyclone warning system from the October-December season designed to reduce economic losses by focusing on districts and specific locations, and incorporating such factors as population, infrastructure, land use and settlements. The IMD also claimed that its accuracy of forecasts, for instance, in plotting landfall location, is now better. Together with ground mapping of vulnerabilities, this is a promising approach to avoid loss of life and destruction of property. The importance of precise early warnings cannot be overemphasised, considering that the Arabian Sea has emerged as a major source of severe cyclones, and their intensity is aggravated by long-term rise in sea surface temperatures linked to pollution over South Asia and its neighbourhood. Climate-proofing lives and dwellings is a high priority now, a task that warrants a multi-sectoral approach: to build sturdy homes of suitable design, create adequate storm shelters, provide accurate early warnings, and ensure financial protection against calamities through insurance for property and assets. Governments must rise up to the challenge.

9. Editorial-4: Delete and control

The ICMR must assess evidence and be very specific with recommendations on treatment

The Indian Council of Medical Research (ICMR) has finally dropped its espousal of convalescent plasma therapy (CPT) as treatment for moderate COVID-19 in its latest guidelines. In its guidelines of April 22, CPT was already on its last legs, with the advisory recommending that it is advisable only in early moderate disease, or within seven days of symptoms. These updates flow from periodic reviews of medicines and treatment protocol by a task force of doctors and experts of the ICMR. Practising doctors are not legally bound to follow these recommendations to the T but are expected to circumscribe their treatments within the guidelines. Last year, the ICMR, in one of the definitive clinical trials in the world, demonstrated that CPT neither saved lives nor improved patient outcomes but was equivocal about it in public. This gave leeway to some States, particularly the Delhi government, which openly disavowed the ICMR’s findings, encouraging several doctors to put the onus on hapless caregivers to source such plasma from those who had recovered from the illness. The clamour for plasma had birthed its own kind of ecosystem. There were apps designed to connect donors to recipients, an inevitable black market, and, if the plasma did not seem to be working, the tendency was to blame the quality of plasma rather than recognise the futility of the treatment.

Last week, it took a letter by a clutch of concerned public health professionals to India’s Principal Scientific Adviser as well as results from a trial, published in The Lancet, spanning around 11,000 patients — that again found no benefit — to demote CPT. Further evidence is emerging that CPT may be contributing to the evolution of coronavirus mutations that, together, may have been the final nail in the coffin. However, this is not the end of the road for treatments with limited scientific basis finding a mention in the ICMR guidelines. Hydroxychloroquine and the anti-parasitic drug, ivermectin, continue to find a place for the treatment of mild disease despite a specific mention of “low certainty of evidence”. There is an argument that doctors, battling a disease that has so far defied a predictable treatment regime, cannot always observe the necessary clinical equipoise. Unlike doctors on the frontline, a collective of experts such as the ICMR taskforce, has the comfort and the distance to dispassionately assess evidence and be very specific with its recommendations. Publicising these at regular intervals serves to educate the public about the evolving nature of treatment and be better prepared as future patients and caregivers. This will work better towards easing the pressure on doctors as well as in improving trust in systems that are designed to offer the best possible expertise.

10. Editorial-5: Planning for future waves of the pandemic

India needs to enhance the surveillance system, vaccinate quickly, and reprioritise healthcare services

The failure to plan and prepare for multiple waves of COVID-19 in India has resulted in the despair and helplessness we are seeing today. Since more waves are expected, what lessons can we learn from the present in order to plan for the long term? This article speaks of the challenges and the road ahead.

Surveillance strategy

First, while it is easy to blame modellers for failing to predict waves, the reason why they are not able to do so is that clear data are unavailable. There is unreliable testing and under-reporting of cases and deaths even now. This does not instil confidence in any of the modellers to come up with realistic estimates. Under-reporting and manipulated data inputs can only provide faulty projections. The Central and State government should use real-time data by encouraging reliable reporting and initiating standardised definitions. This is the time to have a standardised definition of how many cases are expected per million population. Instead of admiring the efforts of administrations in the areas that have fewer cases, efforts should be made to detect the minimum number of cases, to instil confidence in people that the surveillance system works in the state. This can only be done through the syndromic approach of identifying suspect cases and through a reliable testing strategy which does not change when there is a surge in cases.

The COVID-19 trajectory in other countries shows that there will be multiple waves in India. In Japan, the health system is crumbling during the fourth wave. Identifying impending waves is very important in mitigating a catastrophe. India missed building containment and mitigation measures while Maharashtra was seeing a surge in cases during the second wave. This lesson should be incorporated into plans for future waves. A strong surveillance system reporting the minimum number of cases will thus provide reliable early markers of an impending wave. Review mechanisms should be strengthened to detect the outbreak in the initial stages and extinguish it before the pandemic spreads to other areas.

Concurrent genomic sequencing in real-time in the fixed proportion of samples will give us an idea of the likelihood of the variants causing several outbreaks. If the outbreaks in Kerala, Punjab, and Maharashtra were noticed from the results of genomic sequencing, India could have advocated for local lockdowns in high-burden areas and imposed severe restrictions to stop the wide spread of the second wave. We can prevent the adversities of future waves by relying and acting on the inputs of a strong surveillance system.

Vaccinating the population

Next, through vaccination, we can turn the story around. India can emerge as the world’s biggest exporter of vaccines in addition to helping citizens in the country. The Central government should proactively reach out to all the vaccine manufacturing firms in the west and invite them to collaborate with Indian firms under the ‘Make in India’ programme. India needs to fast-track the manufacturing of all vaccines which have been approved for use by various regulatory authorities through a single-window clearance. India can become a soft superpower if it facilitates faster manufacturing by helping the Indian industry. This is not an unrealistic ambition as the country has already proved how it can scale up testing facilities within a short period of time. At this stage, there needs to be greater impetus in stepping up manufacturing and coverage of vaccines. Not many countries in the world have the wherewithal to manufacture their own vaccines if India cannot cater to the vaccination needs of its own citizens and that of the world.

With newer variants of concern emerging, it is important to update the vaccines depending on how the virus changes. This provides a clear case and a good business opportunity for setting up manufacturing facilities in both the public and private sectors. Vaccines might be the shot in the arm for our economy. Greater financial allocations, stepping up systems to expand vaccination, applied research, enhancing effective communication, and monitoring effectiveness will solidify India’s role in the future for preventing and managing pandemics.

Since 2009, the World Health Organization has declared six public health emergencies of international concern, including COVID-19. In the near future, India has to have a system that can respond to newer pandemics in the making. We cannot build reactive systems for each wave and each pandemic. Nearly 60% of known infectious diseases and up to 75% of new or emerging infectious diseases are zoonotic in origin. Respecting the boundaries of animals and preserving the ecosystem in its natural form is important in order to prevent future pandemics. Therefore, the country needs to adopt the ‘One Health’ agenda in its entirety and ensure that environmental health and animal health are given similar priority as human health.

Robust public health workforce

The rapid spread of SARS-CoV-2 shows us the importance of timely and efficient public health responses. We can only fight better when we have a battle-ready public health workforce. Unfortunately, our health systems are collapsing. Doctors and nurses have to bear the burden mainly because of a depleted or absent public health workforce. It is an essential to hire front-line workers in public health who can engage in surveillance and contract-tracing, and mobilise people for primary healthcare services, including vaccination. The front-line public health workforce is particularly absent in urban areas, while critical care capacity (oxygenated beds, ICUs) is limited in rural areas. Irrespective of the urban-rural divide, the country needs to reconfigure the health systems to ensure that one Accredited Social Health Activist (ASHA) worker is hired for every 1,000 people, an Auxiliary Nurse Midwife (ANM) and nurse practitioner are hired for every 5,000 people and a hospital with at least 100 beds, including beds with emergency and critical care services, caters to a population of 30,000-50,000.

It is time to have plans for pandemics. We need to improve the health system and public health and regularly review plans to ensure that we prevent future disasters. For now, it is important to have enhanced surveillance to detect and contain future waves, expand vaccination, and work towards building a robust pandemic preparedness plan.

11. Editorial-6: Engage with U.S. progressives

India should note that it was the progressives who pushed the U.S. to back the TRIPS waiver

It is tempting to surmise the shift in the U.S.’s approach on providing COVID-19-related aid to India as well as on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) waiver on COVID-19 vaccines, drugs, therapeutics, and related technologies as being driven by the Comprehensive Global Strategic Partnership with New Delhi. But it is more than just that. The development was a result of the determined push by some sections of the political and business class, civil society, and Indian Americans. Besides them, the progressives in the Democratic Party made a big difference.

President Joe Biden called Prime Minister Narendra Modi in late April expressing the U.S.’s determination to be with India in its most difficult hour. To reduce the negative perception over Vice President Kamala Harris’ tepid response to the crisis in India, the administration arranged for her to address a diaspora event where she brought up her Indian roots and lamented over the deteriorating situation in the country.

The responses by these top leaders to assuage the Indians and Indian Americans came at a time when a section was seeking to underscore New Delhi’s past folly of banking on Washington in times of need.

Urging Biden to act

Among the progressives who urged the President to act soon were Congresswoman Pramila Jayapal, Chair of the Congressional Progressive Caucus, and Congressman Rohit ‘Ro’ Khanna, the Democratic vice chair of the Congressional India Caucus.

Incidentally, while Ms. Jayapal’s comments on human rights violations in Jammu and Kashmir annoyed New Delhi earlier, Mr. Khanna urged the Indian government to maintain democratic norms and allow peaceful protests by farmers, at a meeting of the leadership of the India Caucus with Indian Ambassador to the U.S., Taranjit Singh Sandhu. Irrespective of these positions, the progressives saw the aid and TRIPS waiver through a different prism.

To contextualise the role of progressives, days ahead of the May 5 decision of the Biden administration on the TRIPS waiver, 110 members of the U.S. Congress wrote to President Biden urging him to support the waiver. The signatories included Ms. Jayapal, Mr. Khanna, and Congressman Raja Krishnamoorthi who represents Illinois. At the same time, Senator Bernie Sanders and nine other Senators made a similar plea to the White House. Thus, the Biden administration’s decision on the waiver and the vaccines, characterised as courageous by many, was a result of the push by the progressives.

Joining in this effort, the co-chair of the Congressional India Caucus, Brad Sherman, and over 50 colleagues wrote last week to President Biden seeking supply of specific items amid concern that as long the virus persists in India “there is the potential for additional variants that could pose a threat to a vaccinated America”. The overall approach is to work with India in its battle against the second wave and prepare for subsequent ones.

Not to be ignored

The outreach by Mr. Sandhu and his South African counterpart to members of the U.S. Congress on the waiver notwithstanding, it is evident that the progressives have a grip on policymaking. Its members’ pronouncements on other issues that India finds unpalatable could happen again. But India will have to remain engaged with this section instead of offering a cold shoulder as it did in the recent past. As the adage goes, all politics is local.