11 Nov 2020: UPSC Exam Comprehensive News Analysis

E. Editorials

Category: SCIENCE AND TECHNOLOGY

1. Dose of optimism

Context:

• Multinational Drug Company Pfizer and BioNTech have announced that their vaccine candidate against COVID-19 based on the mRNA technology has achieved success in the first interim analysis from phase 3 study.

Background:

m-RNA technology:

mRNA:

• Messenger ribonucleic acid or mRNA plays a vital role in human biology, specifically in a process known as protein synthesis. mRNA is a single-stranded molecule that carries genetic code from DNA in a cell’s nucleus to ribosomes, the cell’s protein-making machinery.
• Thus mRNA is the set of instructions by which cells make all proteins and send them to various parts of the body.

mRNA medicines:

• Using mRNA as a medicine is a fundamentally different approach in drug therapy.
• Unlike the traditional pharmaceuticals which are small therapeutic molecules or the traditional biologics (recombinant proteins and monoclonal antibodies), mRNA medicines are sets of instructions. These instructions direct cells in the body to make proteins to prevent or fight disease.

Potential:

• mRNA medicines take advantage of normal biological processes to express proteins and create a desired therapeutic effect. This would lead to minimal side effects.
• mRNA medicines can go inside cells to direct protein production, something not possible with other drug approaches. This enables the potential treatment of a broad spectrum of diseases, many of which cannot be addressed with current technologies. This could have a positive effect on improving human health and impacting lives around the world. Using mRNA as a drug opens up a breadth of opportunities to treat and prevent disease.
• mRNA technology has the potential to transform how medicines are discovered, developed and manufactured.

For information on other vaccine development strategies, refer to:

CNA dated April 12, 2020: Two vaccines enter human trials

Details:

• The early results of the phase 3 study have indicated the candidate vaccine being “90% protective” in the nearly 40,000 volunteers involved in the trial.
• The Pfizer vaccine candidate is based on mRNA technology. The Pfizer vaccine candidate uses an infectious particle, such as a portion of the virus, and uses a piece of RNA that is then made into an antigen by the body’s own machinery. This induces the development of antibodies by the body’s immune system.

Significance:

• The mRNA technology-based vaccine reduces the risks of untoward reactions in people who have been administered the vaccine as it does not introduce attenuated or inactivated viruses.
• The mRNA technology-based vaccine also does not need to be cultured in chicken eggs or other mammalian cells, allowing it to be made faster and at a cheaper price.
• The initial success validates the scientists’ basic strategy of developing a vaccine to target the spike protein of the virus. Given that a similar approach is being followed by most vaccine developers, the chances of several encouraging results are high. The mRNA technology-based vaccine marks a new frontier of novel vaccine production methods.

Challenges:

• There are still no commercially available m-RNA based vaccines to accurately predict the efficacy of mRNA technology-based vaccines.
• These mRNA technology-based vaccines need to be refrigerated to nearly minus 70°C and India, with its limited cold chain infrastructure, lacks efficient vaccine storage capacity.

Way forward for India:

• India should try to sign agreements with the major vaccine developers to ensure that it is assured of early access to even a fraction of the vaccine output.
  • In India ‘Covishield’ by the Serum Institute and ‘Covaxin’ by Bharat Biotech Ltd., are undergoing trials.
• India must keep a close watch on the mRNA-based vaccine technology and develop expertise. Additionally, India should also focus on improving its cold chain infrastructure to meet the storage demands on any new COVID-19 vaccine.

For related information, refer to:

CNA dated Nov 8, 2020: Delivery of COVID-19 vaccine poses a huge challenge

Conclusion:

• Though the results are said to be announced by an expert independent committee, they have not yet been announced by the standard procedure of a peer-reviewed journal. There is a need to ascertain whether the results would hold up in a wider population.

For related information on vaccine development, refer to:

CNA dated June 14, 2020: Can a COVID-19 vaccine be developed soon?

Category: HEALTH

1. Strengthening public health capacities in disasters

Context:

• The article analyzes important lessons for India’s health care sector from the COVID-19 pandemic experience.

Lacunae in India’s approach:

Inadequacy of the Indian public health sector:

• Given that the public sector investment in the health sector has been found to be inadequate over the years, the health sector infrastructure has been found to be too inadequate to meet the demands generated during the pandemic.
• Though the public health expenditure as a percentage of GDP has been increasing since 2015-16, it still remains within a narrow band of 1.02 – 1.28 per cent of GDP. The country has a long way to go in achieving the targeted public expenditure of 2.5 per cent of the GDP by 2025 under the National Health Programme.

For more information on the challenges in the Indian health sector, refer to:

• CNA dated March 25, 2020: Ironing out wrinkles in India’s pandemic response

Drawbacks in private sector:

• The private sector accounts for a large share of the Indian health sector. India also envisages a publicly financed health insurance based hospital care service model, which would very likely be private-sector led.
• Though the private sector has been able to play a crucial role in filling the vacuum left by the low public health sector presence, there are several drawbacks associated with the private health sector.
  • A large majority of private hospitals in the country are small enterprises. Many of these small hospitals are unsuitable for meeting disaster-related care needs.
  • The Indian private health sector is characterized by weak regulation and poor organization and is considered inadequate for mounting a strong and coordinated response to disasters.
  • The private sector, led by the profit motive, has in many instances indulged in overcharging despite the capping of treatment prices by the governments. This illustrates how the requisitioning of private sector services during disasters can hardly be a dependable option in the Indian context.
  • Private hospitals do not prefer to invest in disaster preparedness as they consider it non-profitable or economically non-viable.

Neglect of public health in disaster management:

• In 2005, India enacted the Disaster Management Act, laying out an institutional framework for managing disasters across the country. The act prescribed a systematic scheme for prevention, mitigation, and responding to disasters of all kinds.
• Disaster management considerations were to be incorporated into every aspect of development and the activities of different sectors, including health. Though some headway has been achieved, the approach continues to be largely reactive, and significant gaps remain particularly in terms of medical preparedness for disasters.
• The public health angle in disasters and disaster management has been largely under-emphasised and this has been evident during the pandemic.

Neglect of critical public health issues:

• The Disaster Management Act fails to identify progressive events as disasters, thus neglecting pressing public health issues such as tuberculosis and recurrent dengue outbreaks.
• This has resulted in the neglect of many pressing public health issues which too have a substantial impact on the health profile of the Indian population.

Way forward:

Planning for future challenges:

• The health services and their future development plans must consider the possibility of disaster-imposed pressures as well.

Greater role for public sector:

• Given the lacunae in the private sector, a strong public sector capacity is imperative for dealing with disasters. Additionally, there is a need to strengthen public sector capacities, including capacity-building of staff.

Integration of disaster management with primary health care:

• There is ample scope for greater integration of disaster management with primary care. Making primary health care central to disaster management can be a significant step towards building the health system and community resilience to disasters.
• Community engagement, disease surveillance, and essential health-care provision, important characteristics of primary care, are central themes to disaster management as well.
• This becomes all the more relevant for a developing country like India, which owing to its low-income settings cannot afford to invest in the costly secondary and tertiary health care sectors. The primary care sector offers a low cost and highly effective investment opportunity in the healthcare sector.

Legal framework:

• The legal framework for disaster management must push a legal mandate for strengthening the public health system with suitable regulation of the critical private sector.