Limited succour (The Hindu)

Understanding the HPV vaccine’s risk  (The Hindu) 

Mixing work with study  (The Hindu)

Limited succour

(The Hindu)

Synoptic line: It throws light on the issue of budgetary focus for senior citizen.

(GS paper III)

Overview

 

  • Underscoring the importance the Centre attaches to providing economic support for India’s growing population of senior citizens, finance minister in his budget speech mention “to care for those who cared for us is one of the highest honours” and announced several tax and related incentives to ease the financial burden on people aged 60 and above, all of which are very welcome given that the elderly face steeply escalating health-care costs on declining real interest and pension incomes.

 

Key highlights

 

 

  • From affording a five-fold increase in the exemption limit on interest income from savings, fixed and recurring deposits held with banks and post offices to ₹50,000, and doing away with the requirement for tax to be deducted at source on such income, the Budget offers much-needed relief.

 

 

 

  • A little more money is left in the hands of elderly savers who are heavily dependent on interest income to meet their living expenses. Another useful tax change is the proposal to raise the annual income tax deduction limit for health insurance premium and medical reimbursement to ₹50,000 for all seniors. And a crucially allied step is the move to set the ceiling for deduction in lieu of expenses incurred on certain critical illnesses to ₹1 lakh, irrespective of the age of the senior citizen.

 

 

 

  • There are proposal  for extending the ‘Pradhan Mantri Vaya Vandana Yojana’(PMVVY) by two years, up to March 2020, and doubled the cap on investment in the scheme to ₹15 lakh. This annuity-cum-insurance scheme entitles the senior citizen policyholder to a guaranteed pension that equates to an annual return of 8% on investment. 

 

 

 

  • The PMVVY is annuity-cum-insurance scheme, which entitles the senior citizen policyholder to a guaranteed pension that equates to an annual return of 8% on investment. This pension plan, unlike the entirely government-funded Indira Gandhi National Old Age Pension Scheme for the elderly who live below the poverty line, is contributory and is run by the Life Insurance Corporation of India.

 

 

  • With more than 70% of the 104 million elderly living in the rural hinterland, any serious initiative to improve the lot of senior citizens must incorporate adequate budgetary support for social welfare spending on the relevant programmes.

 

 

  • There is Budgetary provisions ₹6,565 crore for the pension scheme for the elderly poor, its outlay for the Ministry of Social Justice and Empowerment’s assistance to voluntary organisations for programmes relating to the ‘aged’ at ₹60 crore is starkly inadequate

 

 

Way ahead

 

 

  • Budget measures are laudable insofar as they recognise that the right to a life with dignity doesn’t retire with the crossing of a chronological threshold, much more needs to be done to address the needs of this rapidly growing demographic cohort. 

 

  • However, as the number of the elderly in India set to surge by 2050 to almost 300 million, or about a fifth of the population, governments need to make more comprehensive efforts to address the nation’s greying demographic.

Question-Budget 2018 does well to focus on senior citizens, but action must be broad based.” Analyse.

 

Understanding the HPV vaccine’s risk

(The Hindu)

Synoptic line: It throws light on the issue of human papillomavirus (HPV) vaccine controversy.

(GS paper III)

Overview

 

  • Human papilloma virus (HPV) vaccines are vaccines that prevent infection by certain types of human papillomavirus. Available vaccines protect against two, four, or nine types of HPV. All vaccines protect against at least HPV type 16 and 18 that cause the greatest risk of cervical cancer.

 

  • The World Health Organization (WHO) recommends HPV vaccines as part of routine vaccinations in all countries, along with other prevention measures. But recently the human papillomavirus (HPV) vaccine has run into more trouble.

 

Assessment

 

  • The human papillomavirus (HPV) vaccine has run into more trouble. In January, a Rome-based epidemiologist, highlighted in a paper worrying gaps in published data on the vaccine, designed to prevent HPV-related cervical cancer.

 

  • It was found that only two-thirds of the clinical trials on the HPV vaccine, manufactured by Merck Sharp and Dohme (MSD) and GlaxoSmithKline (GSK), had been published. The vaccine safety experts had questioned the European Medicines Agency’s (EMA) assertion that HPV vaccines are safe, after they found that the EMA had relied mainly on MSD’s and GSK’s analysis of clinical trial data to reach this conclusion. This is a problem because drug manufacturers have been known to cherry-pick data to show safety.

 

  • Clinical trials experiments to gauge the effectiveness and safety of drugs face a transparency crisis. As drug makers often don’t share all trial data, their claims cannot be re-examined by neutral outsiders. The flu drug Tamiflu, manufactured by Roche, is the most famous example of this crisis.

 

  • In 2010, in the wake of the H1N1 influenza pandemic, the WHO added Tamiflu to its core list of essential medicines. Following this, several countries spent billions of dollars on stockpiling the drug. But when a Cochrane Collaboration team led by Dr. Jefferson analysed again all the data on Tamiflu, some of which Roche had withheld earlier, they found that the drug wasn’t as effective as the company had claimed, and WHO dropped Tamiflu from its core drugs list in 2017.

 

Problem

 

  • HPV vaccines have been in the middle of a controversy because of suspicions that they may be causing a trio of rare illnesses called Postural Orthostatic Tachycardia Syndrome (POTS), Complex Regional Pain Syndrome (CRPS) and Chronic Fatigue Syndrome (CFS).

 

However, it is important to note that these are only suspicions; there is no evidence that these illnesses are caused by the vaccine. 

 

  • This is also important to remember that even if HPV vaccines are eventually shown to cause these illnesses, researchers estimate that they probably do so in a small percentage of people. But regulators must still decide what to do with such safety signals.

 

For India

 

  • This is an especially critical issue for India, given that it is introducing HPV vaccines in its Universal Immunisation Programme (UIP). This means millions of girls in India aged between 9 and 14 years will get the vaccines for free.

 

  • Reports on POTS, CRPS and CFS in HPV vaccine recipients began emerging a few years after the vaccines were launched around 2007. POTS are an abnormal increase in heart rate when a patient stands up, while CRPS is unexplained, severe pain in a limb. CFS, as the name suggests, is debilitating tiredness that leaves patients unable to function normally.

 

  • CFS is sometimes accompanied by POTS. All three are poorly understood conditions and often go undiagnosed. POTS and CFS sufferers may have other symptoms like nausea, sleep disturbances, and chronic pain, and unless a physician recognises this constellation of symptoms, she may confuse the illness for something else.

 

  • This difficulty in diagnosing these syndromes means that no one really knows their background incidence or how common these syndromes are in the general population. Some researchers estimate that upto 1% of adolescents have POTS, but others have questioned these estimates. This makes it tricky to establish if some people are getting these illnesses due to vaccines.

 

  • The HPV vaccine controversy is far from over. Dr. Jefferson is now in the middle of a systematic review of all trial data from MSD and GSK, which may or may not change what we know about HPV vaccines. The question then is, what should India do in the meantime?

 

  • There are no ‘yes’ or ‘no’ answers to such questions. Decisions on vaccines often have to be taken using imperfect information, he says. India has the largest burden of cervical cancer in the world. Around 70,000 women die of it each year, and around 70% of these cases are caused by infections from HPV strains, which the vaccines prevent.

 

  • Given the rarity of these side effects and high burden of disease, waiting for more information on the POTS-HPV vaccine link could be unethical. And there are precedents of India going ahead with a vaccine, despite small risks. For example, the oral polio vaccine caused polio in one out of around every 1-2 million doses. But India accepted the risks of the vaccine because the disease itself was so rampant. Eventually, from a burden of over 2 lakh cases a year, India became polio-free in 2014 using this vaccine.

 

Way ahead

 

  • India seems inclined to go ahead. K. Vijayraghavan, a member of India’s National Technical Advisory Group on Immunisation, which gave the vaccine the green signal last month, says there isn’t enough evidence on POTS or CRPS to delay the programme. There is a small risk of the vaccine being linked to the syndromes, but the benefits outweigh the risks, the Group has concluded. Focusing on risks alone would mean that no vaccine would ever get approved.

 

Question There’s needs for more effort, but given the high burden of cervical cancer in India, waiting longer could be unethical. Analyse in the back human papillomavirus (HPV) vaccine controversy

 

Mixing work with study

(The Hindu)

Synoptic line: It throws light on the issue of findings of the Annual Status of Education Report (Rural) 2017.

(GS paper II)

Overview

 

  • Recently, the Annual Status of Education Report (Rural) 2017 published by a non-governmental organisation and containing data from 26 districts in 24 States, has some national-level findings that should cause concern. Basic education has slipped in priority in the national policy matrix over the decades.

 

Assessment of the report

 

 

  • The Census and several other data sets have pointed to various dimensions of the problem.  Focussing on the 14-18 years age group, the ‘Beyond Basics’ study has tried to assess, inter alia, whether this cohort of young people is enrolled in any educational institution, whether they are both enrolled and pursuing work, how well they have been prepared in previous schooling, their access to technology, and what occupies their time. This is an important segment of the population, on the threshold of adulthood, and, importantly, political participation.

 

 

  • A national-level finding is that as a group, 14.4% of youth aged 14 to 18 years are not enrolled in school or college. Yet, this figure conceals variations by age, while it is 5.3% for 14-year-olds; it rises to 30.2% at age 18. The imperative clearly is to look at factors that prevent them from being part of formal higher secondary education, of which availability and affordability of schools would be important.

 

  • A large-scale vocational education system on the lines of the “dual” German model i.e. classroom instruction plus apprentice training would help raise the productivity of both individuals and the economy.

 

  • ASER’s statistics indicate that overall, only 5.3% of the age group is enrolled in a vocational course, while 60.2% of out-of-school youth are engaged in some form of work. These trends underscore the need to scale up substantive skill-building programmes, making them free or highly subsidised.

 

  • The role of agriculture as a provider of jobs and prosperity must also be viewed. Among those who are already working in the 14-18 age groups, 79% are engaged in farming and that too in their family farms.

 

  • By contrast, agriculture as work ranked very low as an aspiration among the youth. It show that for a significant number of youth, a useful education in agriculture, coupled with access to the formal economy for finance and marketing, could raise the quality of life.

 

  • In fact, the ability of farmers to adopt technology, avail benefits offered by the government and demand stronger institutions would be enhanced, if elementary education is improved. It would also produce the additional benefit of promoting health-seeking behaviour among these youth.

 

Way ahead

 

  • There is work on teaching-learning process becomes engaging and effective. A large-scale vocational education system would help raise the productivity of individuals and the economy.

 

Question Various reports suggests that, basic education has slipped in priority in the national policy matrix over the decades, analyse in the context of Annual Status of Education Report (Rural) 2017. Also suggest some measures.