1. 21.4 lakh TB cases notified in India in 2021: Health Ministry

India’s TB incidence for the year 2021 is 210 per 100,000 population – compared to the baseline year of 2015 (incidence was 256 per lakh population in India) and there has been an 18% decline which is 7 percentage points better than the global average of 11%, said the Health Ministry on Friday, while reacting to the World Health Organization (WHO) Global TB Report 2022, released on October 27.

Stating that India had done better in major metrics as compared to other countries over time, the Ministry said the figures placed India at the 36th position in terms of incidence rates (from the largest to the smallest incidence numbers).

According to the WHO report, an estimated 10.6 million people fell ill with tuberculosis (TB) in 2021, an increase of 4.5% from 2020, and 1.6 million people died from TB (including 187 000 among HIV positive people).

“While the COVID-19 pandemic impacted TB Programmes across the world, India was able to successfully offset the disruptions caused, through the introduction of critical interventions in 2020 and 2021 – this led to the National TB Elimination Programme notifying over 21.4 lakh TB cases – 18% higher than 2020,’’ said the Ministry.

Tuberculosis (TB)

Tuberculosis (TB) is generally defined as a dangerous bacterial infectious disease caused by Mycobacterium tuberculosis, which most often affects the lungs and later might spread to different parts of the body.

Types of Tuberculosis (TB)

• Pulmonary Tuberculosis.
• Extrapulmonary Tuberculosis.

Causes of Tuberculosis

• Tuberculosis is a contagious airborne disease, which can be acquired from close contact with an infected person.
• Mycobacterium Tuberculosis is one of the main causes of this dreadful infectious disease.
• Infants and aged people are at a greater risk of catching TB infections.
• Individuals with a weak immune system due to HIV, diabetes are quickly exposed to this infectious disease.
• Mycobacterium Tuberculosis is a pathogenic bacterial species and mainly comprises of four other types of TB-causing bacteria namely:
  • Mycobacterium Bovis
  • Mycobacterium Canetti
  • Mycobacterium Microti
  • Mycobacterium Africanum

Diagnosis of Tuberculosis

Apart from all the physical tests, other tests are available to diagnose the presence of the infectious bacteria. These tests include certain body fluids test – blood and sputum, skin test and chest X-rays.

• Blood Test: In this procedure, blood samples are collected and are tested in the laboratories for the presence or absence of TB germs in the blood cells.
• Skin Test: It is the most common type of test. In this procedure, a small sample of Tuberculin – a purified protein is injected under the patient’s skin. If the skin around the site of the injection gets swollen more than five millimetres then it is a clear indication of TB infection. This test is called the Mantoux tuberculin skin test (TST).

Symptoms of Tuberculosis

TB bacteria or Mycobacterium tuberculosis most commonly grow in the lungs and can cause severe symptoms such as:

• Coughing with blood
• Bad cough for more than 3 weeks
• Fatigue & weakness
• Night sweats   
• Chest pain      
• Weight loss
• Loss of appetite        
• Sudden and random c hills
• Fever

Treatment for Tuberculosis

1. Drug treatment is one of the most efficient ways to treat this infectious disease.
2. For patients with Latent TB infections, doctors generally prescribe an antibiotic called isoniazid for preventing the latent infection from becoming active.
3. Active TB Diseases will be deadly if it is left untreated.
4. The procedure involves taking a combination of ethambutol, INH, priftin and pyrazinamide for a term of three months followed by a mix of INH and pyrazinamide for 12 months.

Drug-Resistant TB

There is a global concern about the Multi-Drug Resistant TB (MDR-TB) which emerges in the host body due to lack of treatment drug; and the bacteria is not eradicated completely from the body due to interrupted course of antibiotic medicine. 

• Since the bacteria are resistant to the first-line anti-TB drugs, the host is treated with second-line anti-TB drugs. 

There exists an Extensively Drug resistance TB (XDR-TB) which is developed in the host body due to the high concentration of TB in an area making it very difficult to control. The XDR-TB bacteria strain is resistant to one or two medicines in the second-line antibiotic treatment.

Poor management at this state may lead to further mutation in bacteria leading to complete drug resistance known as Total Drug Resistance TB (TD

India and Tuberculosis

1. India stands at the top when it comes to TB, with more than 2 million cases reported in 2018.
2. The Indian Government encourages new tools that will aid TB Research and Development (R&D) and discards the ones that won’t benefit the system.
3. The Government of India intends to come up with plans in collaboration with the Ministry of Science and Technology, Ministry of Health and other research-oriented pharmaceutical companies in order to reach targets of TB elimination in the country. 
4. Case-finding campaigns have been taken into consideration to avoid delay in the detection of TB.

Government Schemes for Tuberculosis

The Government of India has set a target of Zero-Tuberculosis deaths by the year 2025. In order to commit to that, the Ministry of Health and Family Welfare has formulated the National Strategic Plan (NSP) for TB Elimination in 2017.  The National Strategic Plan will guide the development of the national project implementation plan (PIP) and state PIPs, as well as district health action plans (DHAP) under the National Health Mission (NHM).

National Strategic Plan (NSP) for TB Elimination

It is a framework to guide all the activities of all stakeholders including the national and the state governments, developmental partners, civil society organizations, international agencies, research institutions, the private sector and the other stakeholders whose work is relevant to the elimination of TB in India. This program works on four strategic pillars, as mentioned below, DTPB.

VISION: TB-Free India with zero deaths, disease and poverty due to tuberculosis.

GOAL: To achieve a rapid decline in the burden of TB, morbidity and mortality while working towards the elimination of TB in India by 2025. 

Pillars of NSP for TB Elimination: Detect – Treat – Prevent – Build [DTPB]

Features of the National Strategic Plan for

 TB Elimination

1. Complete detection of TB cases by 2020 followed by 100% elimination of TB by 2025.
2. The Conditional Access Program (CAP) has introduced an Anti-TB Drug named Bedaqualine
3. Under the Make in India program, development of a first-line anti-TB drug was proposed in the public sector. 
4. A corpus fund for TB to be maintained under the Bharat Kshay Niyantran Pratishthan (BKNP) which is also known as the India TB control F
   foundation, is one of the visions of this NSP.
5. It aims at creating synergy through a shift from a regulatory approach to a partnership approach to streamline the services in the largely unorganized and unregulated private sector.
6. Technological implementation by creating a user-friendly online platform E-Nikshay to let doctors notify the cases as soon as they come across the infected patient.
7. Awareness about TB and its prevention among masses is important. Media campaigns are planned under this program to promote TB Preventive measures. Swasth E- Gurukul is one such initiative of the World Health Organization.

The overwhelming challenge facing TB control in India remains delayed diagnosis and inadequate treatment, particularly among patients seeking care from private providers. The plan aims to detect and treat 100% of the TB cases and at the same time prevent further spread of the disease by building & strengthening the policies in this direction.

2. Editorial-1: The death penalty and humanising criminal justice

As a conservative agency of the state, the Supreme Court of India is ordinarily expected to tread the path laid out by the written text of law and the binding precedents. But there do come some exceptional moments when, either because of inspired leadership or the burden of anomalous operations of criminal justice, the agencies feel free to break the shackles that force it to the conservative frame. It must go to the credit of the Chief Justice of India (CJI), Justice U.U. Lalit that as the 49th CJI of India, he has ushered in that rare moment by taking several bold initiatives to correct certain grave anomalies that have persisted in operation of the death penalty law. Even before taking up the office of the CJI, Justice Lalit had displayed unique sensitivity to the plight of the condemned ‘death-row prisoners’ in Anokhilal vs State of M.P. (2019), Irfan vs State of M.P., Manoj and Ors vs State of M.P. (May 2022), and impart corrections in the form of creative directions/guidelines. Such a corrective line of judicial decisions under the CJI’s leadership has continued in the Prakash Vishwanath and review petition order in the Mohd. Firoz cases.

The empirical evidence and research findings contained in the Death Penalty India Report (2016) and the ‘Deathworthy’ report (Project 39A of the National Law University Delhi) came in handy to buttress the exceptional sensitivities of Justice Lalit. It is a happy augury that the CJI had the unique opportunity of teaming up with like-minded judges such as Justices P.S. Narasimha, S. Ravindra Bhat, Bela M. Trivedi, and Sudhanshu Dhulia.

On policies and uniformity

The focus here is on reframing ‘Framing Guidelines Regarding Potential Mitigating Circumstances to be Considered While Imposing Death Sentences’, a decision authored by the three judge Bench (the current CJI and Justices Ravindra Bhat and Sudhanshu Dhulia, September 19, 2022).

The decision stands out because of the thrust on the trial court’s death sentencing policies and the practice and desire to elicit, from a larger Bench, directions to ensure some kind of uniformity in the matter. Such a reference to a larger Bench would constitute yet another step in the direction of death penalty sentencing justice reform such as the legislative limitation flowing from Section 354(3) in the Code of Criminal Procedure; judicial limitation flowing from the ‘rarest of rare’ case; and ‘oral hearing’ after all the remedies to the condemned are exhausted.

Justice Ravindra Bhat’s decision (concurred by the CJI and Justice Dhulia) has summed up the core issue that displays a special concern for the legislative mandate under Section 235(2) conferring a right to pre-sentence hearing after conviction and its endorsement by the full Bench ruling in Bachan Singh; the trial courts and the appellate court’s display of a conflicting patterns of compliances. As an ardent follower of the theory of binding precedents for a cause, Justice Ravindra Bhat did not stop at paying lip service to ‘rarest of rare’ case limitation, but also required the sentencing court to take the trouble of balancing the aggravating factors and mitigating factors, as per the full Bench ruling.

Sentencing incongruities

With this foundational background and the context of the wide-spread discrepancies in the interpretation of the law, the following observations of the Court are significant: “It is also a fact that in all cases where imposition of capital sentence is a choice of sentence, aggravating circumstances would always be on record, and would be part of [the] prosecutor’s evidence, leading to conviction, whereas the accused can scarcely be expected to place mitigating circumstances on the record, for the reason that the stage for doing so is after conviction. This places the convict at a hopeless disadvantage, tilting the scales heavily against him.” (emphasis supplied). The three-judge Bench decision seems to have gone beyond sentencing incongruities when it observes: “This court is of the opinion that it is necessary to have clarity in the matter to ensure a uniform approach on the question of granting real and meaningful opportunity, as opposed to formal hearing to the accused/convict on the issue of sentence.” (emphasis supplied).

How is a real and meaningful opportunity to be transformed into reality? What would be the implications of such a ‘real hearing’ limited only to the matters of sentence?

Such questions need answers that must be given by future society. It is significant that the sentencing lacunae pointed out by the three judge Bench have received a positive response from academics and the media. For instance, an editorial in this daily (September 20, 2022) said: “The Constitution Bench may come up with new guidelines under which the trial courts themselves can hold a comprehensive investigation into factors related to upbringing, education and socio-economic conditions of an offender before deciding the punishment…” Another leading daily, elaborating further on the subjective factors identified in Manoj and Ors. vs State of M.P., said: “trial court must take into account the social milieu, the educational levels, whether the accused had faced trauma earlier in life, family circumstances, psychological evaluation of a convict and post-conviction conduct, were relevant factors at the time of considering whether the death penalty ought to be imposed upon the accused”.

‘Quality’ of guilt

The euphoria and appreciation generated by the bold initiative of the three judge Bench under the leadership of the CJI might have made a positive mark, but the future shape of the mission to humanise criminal justice will ultimately depend upon two things. The first is the composition of the larger Bench and the inclination of the judiciary to continue in its onward creative path, as the CJI retires on November 8. Second, the extent to which society is prepared to broaden the horizons of meaningful hearing, even to the earlier guilt determination stage. Hitherto, criminal liability is a product of the component of culpability/guilt and sanction/punishment. The consideration of these two components in isolation leads to a disconnect between the wrongdoer and his punishment or sentence. Should the ‘mitigating factors’ influence only the sentence, and not alter the nature and quality of the guilty mind, or the ‘guilt’ that constitutes the stock justification for punishment? How long and at what cost should we continue to ignore the ‘quality’ of the guilty mind of the ‘death row prisoners’ who suffer from severe to mild psychiatric disorders before and after crime (according to empirical evidence in chapter IV of the Deathworthy report?

Perhaps, there will be some answers from leads given by western critical criminal law scholars who have already begun making a distinction between ‘early guilt’ that is regressive, prosecutory and punitive, and ‘mature guilt’ that is developmental and progressive. A recent article by Professor Alan Norrie, “Taking Guilt Seriously – Towards a Mature Retributivism” (On Crime, Society, and Responsibility in The Work of Nicola Lacey) has covered the trajectory of criminal justice humanisation succinctly.

3. Editorial-2: At COP27, move the needle on climate action

India and other developing economies are justifiably worried about the damage to growth from COVID-19, Russia’s war in Ukraine, and the global economy’s downturn. But these troubles pale in comparison with the climate catastrophe already resulting from the current trajectory of greenhouse gas (GHG) emissions, whose effects hit developing economies and the poor hardest. That is why it is imperative that COP27 — the United Nations’ climate summit which opens in Egypt from November 6 — makes real advances to stave off the worst effects of global warming. This means going beyond COP21’s important Paris agreement (2015) on national commitments to cut GHG emissions and COP26’s notable Glasgow agreement (2021) to stem deforestation.

The core issues

Despite nervousness in making bold commitments in these uncertain times, a breakthrough must be made in rectifying decades of lopsided emissions by rich countries. They are still unwilling to offset past excesses by extending the massive financing that developing economies need for climate action. Just as problematic is the continuous and heavy burning of fossil fuels by the top five emitters — China, the United States, India, Russia, and Japan — as well as Southeast Asian countries taken together. What is worse, many of their plans are woefully inadequate for reaching carbon neutrality by 2050 to help keep temperatures rise below 2°C as envisaged in the Paris agreement. COP27 would be a success if progress is made on both these issues. One way would be for the summit to name the countries that are most out of line and ask them to do more.

On the other hand, rich countries have already shown that they can mobilise vast resources to tackle global emergencies. They did this in the 2008–09 global financial crisis and spectacularly so in the $15 trillion committed in 2020 (by one estimate), by the major economies to fight COVID-19. But when it comes to climate change, rich countries are failing dismally in raising the UN-goal of at least $100 billion annually in climate finance for developing countries. COP27 should move the needle on this vital area.

Reaching carbon neutrality by 2050 is the absolute minimum for all major emitters if unthinkable scenarios of global warming are to be averted. The reverberating message from COP27 should be that the price for achieving carbon neutrality is a fraction of the cost of having to adapt to an increasingly unliveable planet. Ahead of COP27, Singapore has announced that it will achieve net zero emissions by 2050, a powerful signal even if coming from a country with only 0.1% of the carbon footprint.

Advance the year for net zero

India’s reliance on fossil fuels is extremely high. High GDP growth, India’s biggest goal, just cannot be achieved in the face of runaway climate change. The country has set a target date of 2070 for net zero. China is the world’s leader in renewable energy, but its share of coal and gas in energy production remains over 70%, with the country continuing to finance massive fossil fuel-based infrastructure. China has announced net zero for 2060. India and China awkwardly weakened the goal of COP26 from a “phase-out” of coal power to a “phase-down”. This, however, is the moment to advance their date for net zero to 2050. Energy is responsible for about three-fourths of GHGs in the air, and low carbon energy needs to lead the decarbonisation of the global economy. India’s plan for decarbonisation, even if very gradual at present, will nevertheless need to see a massive switch to renewable energy. Electric power has made progress in adopting renewables in its energy mix, but a far bigger switch from fossil fuel is needed for domestic heating and cooling. Factors in the way of a more ambitious adoption of renewables such as solar and wind include the variability in their generation due to weather conditions, weak transmission grids, and poor financial conditions of power distribution companies.

Banks can scale up climate projects

COP27 should call for the extensive use of markets to help shift the global economy to a low-carbon path. The summit could back a radical shift in countries adopting carbon pricing, for example, via a significant carbon tax on the source of pollution. It should reiterate the need for all countries to eliminate fossil fuel subsidies. In terms of climate financing, something similar could be done to what was achieved during the COVID-19 pandemic, when rich countries raised vast amounts of financing. Climate projects can be vastly scaled up by multilateral development banks, such as the World Bank and Asian Development Bank, all of which have strong climate-action mandates.

Based on the mixed track record of past summits, expectations may not be high for what COP27 may bring. One way that it could advance the climate agenda is by choosing commitments to be backed by UN-member states that will be seen by governments to be benefiting them — in terms of health and cleaner cities, to name just two examples — and putting their economies on a more environmentally sustainable path that alone can deliver national interests in these tense economic times. India has historically been a hesitant climate actor, not unlike other big emitters. COP27, which will be held at Sharm El Sheikh, Egypt (November 6-18), is a chance for the country to strongly back environmentally sustainable development in its national interest.