📰 India’s proposed Assumption Island deal drifts
No official word from the Seychelles yet, but President Danny Faure had announced cancelling the agreement
•Nearly two weeks after an official announcement by Seychelles President Danny Faure cancelling the agreement with India for the development of Assumption Island in the Indian Ocean, the government has refused to respond to the move, with Defence sources saying they are yet to be informed of the decision.
•“We have seen the reports. We are awaiting further details,” an official told The Hindu on Saturday referring to a press conference by Mr. Faure on June 4 when he announced that the “Assumption project will not move forward”.
•“In next year’s budget, we will put funds for us to build a coast guard facility on Assumption ourselves. It is important for us to ensure that we have a military post in this area,” Mr. Faure told journalists in Victoria, according to the Seychelles News Agency.
•Mr. Faure made it clear that he would have no further discussions on the subject with Prime Minister Narendra Modi when he visited India on June 25 and 26, and that he was not going table it in the Seychelles National Assembly for ratification. The External Affairs Ministry refused to comment on the issue despite several requests.
Security setback
•The decision by the Seychelles President to drop the deal in the face of protests over a perceived loss of sovereignty is a blow to the government’s “SAGAR” (Security and Growth for All in the Region) programme, announced by Mr. Modi during a visit to Indian Ocean Rim (IOR) countries in March 2015.
•It also comes amid India’s troubles with another IOR country, the Maldives, where the government has demanded that India withdraw two helicopters, pilots and personnel from its atolls that had been sent there to help with maritime patrols.
•Discussions regarding development of Assumption Island began in 2003, but were formalised in 2015 during Mr. Modi’s visit.
•The deal was to include a 20-year access to the base, as well as permission to station some military personnel on ground with facilities on the island funded by India, owned by the Seychelles and jointly managed by both sides. In a reply in Parliament, the Ministry said that the agreement was “renegotiated” at the request of the Government of Seychelles in January to help push the deal through the National Assembly.
Attempts futile
•However, despite two visits by the Foreign Secretary (in January by then Foreign Secretary S. Jaishankar and in May by Vijay Gokhale), as well as discussions during two meetings between Mr. Modi and Mr. Faure on the sidelines of the Solar Summit in Delhi and the Commonwealth Summit in London, Victoria and New Delhi appear to have been unable to save the deal.
•In an attempt to engage with the Opposition in the Seychelles that had led protests against the agreement, India had raised the issue with Leader of the Opposition Wavel Ramkalawan, who was a special guest at the PIO Parliamentary Conference this year, which was addressed by the Prime Minister and External Affairs Minister Sushma Swaraj and had met President Ram Nath Kovind.
•However, he rebuffed the Indian request, saying during a speech in New Delhi that “Seychelles would never accept any naval base of any country, be it the U.S. or India or any other”. Naval officials pointed out that India’s defence maritime cooperation with the Seychelles is long-standing and some of the upgrade work on Assumption Island was already under way. According to a source, India has resurfaced the old airstrip on the island as part of the infrastructure development project worth over $500 million. The cancellation of the agreement in a strategically important island could have far-reaching implications, said a government analyst, who preferred not to be named.
📰 ‘Time to shift focus from land to water productivity in farming’
Report released by NABARD cites 10 major crops across the country; recommends re-alignment of cropping patterns to water availability
•Indian agriculture needs to stop being “obsessed” with land productivity and instead start worrying about water productivity, says a report released by the National Bank for Agriculture and Rural Development (NABARD) this week.
•Titled Water Productivity Mapping of Major Indian Crops, the report is part of a research project with ICRIER, mapping a water atlas for 10 major crops — rice, wheat, maize, red gram or tur, chickpea or channa, sugarcane, cotton, groundnut, rapeseed-mustard and potato. These together occupy more than 60% of the country’s gross cropped area.
•Given that Indian agriculture uses almost 80% of all the country’s water resources, which are increasingly under stress, changing the objective of agriculture development to increasing productivity per unit of water, especially irrigation water, is crucial, says the report.
Stark difference
•The stark differences between land and water productivity are seen in rice and sugarcane cultivation, the report says. Punjab reports the highest land productivity for rice, producing four tonnes per hectare. However, it only produces 0.22 kg of rice for every metre cube of irrigation water. Jharkhand and Chhattisgarh, on the other hand, produce 0.75 and 0.68 kg for the same amount of water. However, low irrigation coverage results in low land productivity in these States. Jharkhand has only 3% of its land under irrigation.
•For sugarcane, another water-guzzling crop, Tamil Nadu reports the highest land productivity, producing 105 tonnes per hectare. Karnataka, Maharashtra and Andhra Pradesh also have high rates of land productivity. However, all four States in the water-stressed sub-tropical belt have an irrigation water productivity of less than 5 kg/m3. In fact, an average of 40 rounds of irrigation are needed in Tamil Nadu. The Gangetic Plain States of Bihar and Uttar Pradesh, on the other hand, need five and eight rounds of irrigation respectively.
•The report recommends that cropping patterns be re-aligned to water availability, using both demand and supply side interventions. With water and power subsidies skewing cropping patterns, it also recommends reform in these areas, with a shift from the price policy approach of heavily subsidising inputs to an income policy approach of directly giving money to farmers on per hectare basis. The prices will then be determined by market forces.
📰 Why Modi should visit Costa Rica
The country has a plan to eliminate fossil fuels. And it’s working
•Everybody knows that our Prime Minister loves to travel. In the four years that he has been in office, Prime Minister Narendra Modi has clocked an impressive number of air miles, going on 40 foreign trips from the U.S. and the U.K. to Uzbekistan, Mozambique and Mongolia. But there’s one country he should plan on visiting soon, particularly if he wants to see his vision of a clean energy-driven India become a reality. And that country is Costa Rica.
•Why Costa Rica, you may ask. After all, the Republic of Costa Rica is just a tiny dot on the map, sandwiched between Panama and Nicaragua, with a population of less than half of that of Bengaluru and a GDP less than half the current market value of the Indian tech giant TCS.
Small nation, big achievements
•But a tiny country such as this has some remarkable achievements to its credit. In 1949, after a bloody coup in which 2,000 people died, it decided to abolish its army altogether and remains one of the few countries in the world without one. Its citizens receive free education and healthcare (it spends 6.9% of its GDP on education, more than double of India’s measly 2.7%); ranks 66 in the United Nations’ Human Development Index (India ranks 131); was one of the first countries in the world to implement a green tax, which helped reverse deforestation; and has actually managed to implement a ban on single-use plastics.
•And it is one of the greenest countries on earth. Last year, the entire Costa Rican grid ran on renewable power for a record 300 days. Besides hydro, wind and solar, it is a world leader in geothermal energy. It plans to move from a staggering 98.6% renewable power base to 100% this year. By 2020 it will become carbon neutral, matching its greenhouse emissions with the carbon emissions it saves.
•But the real reason Mr. Modi should visit Costa Rica is to meet its 38-year-old President, Carlos Alvarado. One of the first things the former journalist did on assuming office was to declare that Costa Rica would become the world’s first ‘zero carbon’ economy in two decades, starting with the initial goal of eliminating fossil fuels from the transportation sector by 2021.
•Even for a very small country, that’s a very ambitious goal. And like all such goals, it is unlikely to be achieved in that time frame. Costa Rica has one of the fastest-growing car markets in the world (around 25% per year), and nearly half its carbon emissions come from the transport sector. Besides, it is bang in the middle of the Pan American Highway, and banning petrol and diesel within its borders would pretty much kill most of its foreign trade.
•But the important thing, says Costa Rican economist Monica Araya, who is also the founder of Costa Rica Limpia (Clean Costa Rica), an organisation which has been working with all stakeholders towards a zero carbon economy, is that if the messaging is strong enough and is backed by a proper plan, and if the right people champion it, “fairy tales can become reality.”
•Speaking last month in Montreal at a global summit on sustainable mobility called Movin’ On, a Michelin-sponsored think-fest which has now grown over 20 years into a sort of Davos on sustainable mobility (disclosure: I was there at the invitation of Michelin), Araya outlined the necessary ingredients: a clear vision of desired outcomes, a sustainable road map to reach there and, most importantly, a “coalition of champions” to drive the idea forward among all stakeholders — people, business and the government.
•Costa Rica has all three. Carbon reduction is baked into its national development plan. Earlier this year, it eliminated taxes on electric vehicles. More importantly, the government, partnering with civil society groups, has been preaching to the people the benefits of going going electric — demonstrating that it is possible to drive to the beach and back from the capital in an electric car and working with fishermen on electrifying fishing vessels. The President too used a hydrogen fuel bus to the venue to sign the proclamation on eliminating fossil fuels.
India’s case
•This is the kind of symbolism and social movement that Mr. Modi is actually good at. Besides, he is already a sustainability convert. He is driving the growth of solar power in India and has already declared that he wants all transport vehicles to be electric by 2030.
•That is unlikely to happen without the other ingredients that Araya was talking about. India is one of the world’s largest car markets and the second biggest two wheeler market. Explosive urbanisation is also driving demand for public transportation, while 7%-plus GDP growth and heavy dependence on road transport mean that our problems are likely to get worse faster.
•We are the world’s third biggest energy importer, spending roughly $12 billion a month on crude oil alone. We are also home to 13 of the world’s 15 most polluted cities. We are running out of time.
📰 Vitamin D armour for cancer
U.S. based study limited to white, postmenopausal women with breast cancer
•Higher levels of vitamin D are associated with decreasing risk of breast cancer, says a study led by researchers at University of California San Diego School of Medicine, U.S. The scientists pooled data from two randomised clinical trials with 3,325 combined participants and a prospective study involving 1,713 participants to examine the association between risk of female breast cancer and a broad range of serum 25-hydroxyvitamin D —25(OH)D — concentrations, which was chosen as the marker because it is the main form of vitamin D in the blood.
•Researchers identified the minimum healthy level of 25(OH)D in blood plasma to be 60 nanograms per millilitre, substantially higher than the previous medically recommended standard of 20 ng/ml.
•“We found that participants with blood levels of 25(OH)D that were above 60 ng/ml had one-fifth the risk of breast cancer compared to those with less than 20 ng/ml,” said principal investigator and co-author Cedric F. Garland, DrPH, adjunct professor in the UC San Diego Department of Family Medicine and Public Health, in a press statement. The risk of cancer appeared to decline with greater levels of serum vitamin D.
•Dr. Garland, who has previously studied connections between serum vitamin D levels and several types of cancer, said the study builds upon previous epidemiological research linking vitamin D deficiency to a higher risk of breast cancer. Epidemiological studies analyse the distribution and determinants of health and disease, but it has been argued that they do not necessarily prove cause-and-effect.
•“This study was limited to postmenopausal breast cancer. Further research is needed on whether high 25(OH)D levels might prevent premenopausal breast cancer,” he said. As the population was also mainly white women, further research is needed on other ethnic groups.
Long-time advocate
•Dr. Garland and others have advocated the health benefits of vitamin D for many years. In 1980, he and his late brother, Frank C. Garland, also an epidemiologist, published an influential paper that posited vitamin D (produced by the body through exposure to sunshine) and calcium (which vitamin D helps the body absorb) together reduced the risk of colon cancer. The Garlands and colleagues subsequently found favourable associations of markers of vitamin D with breast, lung and bladder cancers, multiple myeloma and adult leukaemia.
•To reach 25(OH)D levels of 60 ng/ml would generally require dietary supplements of 4,000 to 6,000 international units (IU) per day, less with the addition of moderate daily sun exposure wearing very minimal clothing (approximately 10-15 minutes per day outdoors at noon), Dr. Garland said. The success of oral supplementation should be determined using a blood test, preferably during winter months, he added.
•According to the National Academy of Medicine, U.S., the current recommended average daily amount of vitamin D3 is 400 IU for children up to one year; 600 IU for ages one to 70 years (including pregnant or breastfeeding women); and 800 IU for persons over the age of 70.
•Blood serum levels exceeding 125 ng/ml have been linked to adverse side-effects, such as nausea, constipation, weight loss, heart rhythm problems and kidney damage.
📰 Handling a threat
•The Ministry of Health and Family Welfare is in the process of finalising an Accelerated Plan for Elimination of Lymphatic Filariasis (APELF). Lymphatic Filariasis (LF), a mosquito-borne parasitic disease, has been endemic in India since antiquity. In 1955, the government launched the National Filaria Control Programme to eliminate LF. Of the 256 districts in the country where it is endemic, 99 have successfully tackled filariasis. However, till 2016, 8.7 million cases of LF were reported, with 29.4 million recorded as suffering from disability associated with the disease. In addition, 650 million people across 256 districts in 21 States and Union Territories still face a risk. Therefore, India needs to up its game if it is to meet the global LF elimination target of 2020.
•India’s mass drug administration (MDA) strategy has been successful in consistently reaching more than 80% of the population under risk. However, there are still a number of challenges in more than half the number of LF endemic districts in the country despite observing a regimen that involves distributing at least 10 rounds of the two drugs (Diethylcarbamazine citrate and Albendazole, or DA).
•Sri Lanka — which was certified by the World Health Organisation (WHO) as having eliminated LF as a public health problem in 2016 — has shown that coverage and compliance of services during the MDA campaign is boosted if there is strong commitment to the social and communication sciences, including substantial investments in evidence-based social-mobilisation campaigns. A rapid scale-up of MDA that has focus on coverage and compliance is essential to decrease the number of rounds required to attain LF elimination. In future rounds of MDA, high community demand and compliance will be the critical indicators of success.
•The WHO’s recent recommendation of adopting the triple drug therapy or IDA (a combination of Ivermectin along with Diethylcarbamazine citrate and Albendazole) has shown encouraging results in clinical trials across the globe and in India. IDA has the potential to rapidly shorten the number of rounds of MDA required in the community, which can be particularly promising for high-burden countries such as India where compliance to treatment has been a challenge.
•Like any other vector-borne disease, management of the environment is an important aspect of prevention. While the use of insecticide-treated bed nets or larval control to check the breeding of vectors or mosquitoes that spread the disease can be valuable tools, an integrated approach could be particularly beneficial. Collaborating across government departments to build cross-linkages with other national programmes such as the Swachh Bharat Mission or malaria prevention efforts could help rein in disease transmission.
•The presence of high levels of infection and clinical cases even after several rounds of effective MDA is referred to as persistent foci. These hot spots need to be looked into from the point of operational issues and parasite genetic variations. The re-emergence of infection in non-endemic areas due to migration of people from areas with ongoing transmission needs to be tackled. For example, in Surat city (Gujarat), a high microfilaria rate was noticed in the north zone of the city where the migrant population influx is high.
•Elimination efforts do not end with achieving the desired results in MDA. The most traumatic impact of the disease is the suffering caused by the full-blown manifestation of filariasis in those who are infected. Morbidity management and disability prevention (MMDP) of lymphedema and hydrocele must assume greater importance so that the quality of life of affected individuals can be improved. Roping in the Indian Medical Association, which has a vast network of private practitioners, to help support awareness drives and participate in MMDP activities in endemic districts has the potential to rapidly increase access to services to those who still cannot access the public health system. It will be important to adopt innovative strategies that can be scaled up for India to create history and achieve another milestone by eliminating LF.
📰 Treating latent TB of the uterus improves pregnancy outcomes in infertile women
Treatment led to better quality eggs, implantation rate
•For the first time, researchers have been able to find a direct association between latent TB of the endometrium (inner lining of the uterus) and fewer eggs in the ovary, technically called low ovarian reserve, in infertile women.
•Compared with infertile women who did not have latent TB, there was significant improvement in pregnancy outcome in women with latent TB who had successfully completed the standard TB therapy lasting six months. Results of the study were published in the journal Human Reproduction.
Low ovarian reserve
•“We came across infertile women with low ovarian reserve having latent TB. So we wanted to find out if there was indeed any association between latent TB and low ovarian reserve in these women. Loss of fertility due to latent TB has not been studied before,” says Dr. Padma Rekha Jirge.
•Dr. Jirge is a gynaecologist at the Department of Reproductive Medicine, Shreyas Hospital in Kolhapur and corresponding author of the paper.
•The team led by her undertook an observational study involving 431 infertile women with latent TB and 453 infertile women without latent TB. The women included in the study were in the 21–38 years age group and had infertility for more than two years and had received at least six cycles of ovulation induction with or without undergoing intrauterine insemination or IVF.
•Though latent TB is generally believed not to have any clinical significance, earlier studies have shown that latent TB does cause silent inflammation. The present study did not look at whether latent TB was causing inflammation leading to loss of eggs. “The objective of the present study was not to find out how latent TB caused a reduction in ovarian reserve,” Dr. Jirge says.
Other causes
•“Inflammation of the endometrium could affect the ovaries too or the TB bacteria could be present in the ovaries as well,” says Dr. Deepak Modi from the National Institute for Research in Reproductive Health, Mumbai and one of the authors of the paper.
•After completion of treatment for latent TB, infertile women had nearly 52% successful pregnancy compared with 40.5% in the case of infertile women who did not have latent TB.
•Latent TB treatment did improve the chances of pregnancy. But the study did not look at whether the treatment halts the decline in eggs. “The women must be followed up for one year and the hormone that serves as a marker for ovarian reserve has to be tested to know if treatment halts ovarian decline,” says Dr. Modi.
•“We know when the ovarian environment is affected the quality of eggs also gets affected. So what we saw was after the treatment, women had better quality eggs and the implantation rate was also proportionately higher when IVF was done,” says Dr. Jirge.
•“If doctors come across infertile women with lower than normal anti-Mullerian hormone (AMH) [which serves as a marker for ovarian reserve] then they may test for latent TB of the endometrium and start treatment to improve the pregnancy outcome,” says Dr. Modi. Dr. Jirge next wants to study inflammation markers to find out if TB is affecting the ovarian environment.
📰 In a first, WHO recommends quadrivalent influenza vaccine
The quadrivalent vaccine will have two A virus strains — H1N1 and H3N2 — and two B virus strains — Victoria and Yamagata
•Sanofi Pasteur’s injectable influenza vaccine (FluQuadri) containing two A virus strains — H1N1 and H3N2 — and two B virus strains — Victoria and Yamagata — for active immunisation of adults of age 18 to 64 years was approved in May last year by the Drug Controller General of India (DCGI). The application for the paediatric indication is under review by the DCGI and final approval is expected by the end of this month.
•Sanofi’s quadrivalent influenza vaccine was licensed for use by the U.S. Food and Drug Administration (FDA) in 2013; it is licensed in 26 countries.
Better protection
•While a trivalent influenza vaccine contains both A subtype viruses, it has only one of the B subtype virus, the quadrivalent vaccine offers greater breath of protection as it includes both B subtype viruses. It is because of greater breadth of protection that a few other companies too have shifted from a trivalent to a quadrivalent vaccine.
•Since the vast majority of influenza vaccines manufactured were trivalent till recently, the World Health Organisation (WHO) used to recommend two A subtypes and one B subtype, plus an optional fourth strain (the other B virus strain). But this February 2018, for the first time, the WHO issued an official recommendation for a quadrivalent vaccine. “It is recommended that quadrivalent vaccines for use in the 2018-2019 northern hemisphere influenza season,” the WHO noted.
•The quadrivalent vaccine will contain four influenza virus strains (two A subtypes and two B subtypes — H1N1 and H3N2, and Victoria and Yamagata respectively). The WHO recommendation then mentioned which B strain should be removed in the case of a trivalent flu vaccine.
•The viruses used in the vaccine are killed and this eliminates the possibility of the virus in the vaccine itself causing infection. In India, the vaccine will be available as single dose pre-filled syringe. Eventually, it will be available in a vial for public health use. In the case of H1N1, there are two strains — California and Michigan — that cause influenza. In India, the Michigan strain was earlier circulating and has been replaced by the California strain. For 2018, the WHO has recommended the Michigan strain for the southern hemisphere, including India.
•Each year, the vaccine changes to reflect the different strains in circulation. Year round, scientists across the globe track, analyse and classify the viral strains causing illness. This allows the WHO to select the strains in February for the upcoming season’s vaccine.
•Since 2011, there have been about 97,000 H1N1 cases and over 7,100 deaths in India according to the Integrated Disease Surveillance Project (IDSP) data. Till June 3 this year, there have been 1,740 seasonal influenza cases and 191 deaths caused by H1N1. The years 2015 and 2017 witnessed a sharp increase in the number of cases and deaths. There were 42,592 and 38,811 cases and 2,990 and 2,270 deaths in 2015 and 2017, respectively.
Indian context
•Despite the high number of infections and mortality each year, India does not have in place a national policy for influenza immunisation. Pregnant mothers, children aged below five and young people with asthma, cardiovascular disease, diabetes and high blood pressure are at a greater risk of infection and death. The Ministry of Health issues only H1N1 vaccination guidelines for different vulnerable groups including healthcare workers.
•“If you want to reduce the influenza burden in adults, then we must target children as they act as reservoirs,” Dr. Su-Peing Ng, Sanofi Pasteur, Head of Global Medical Affairs.
•“Influenza can be seasonal or pandemic. What we observed during the 2009 pandemic is that countries which traditionally had good seasonal vaccine coverage could reach 50% coverage during the pandemic. Other countries achieved only 20% vaccination coverage during the pandemic. So seasonal vaccination is part of pandemic preparedness,” said Dr. Pier Luigi Lopalco, Professor of Hygiene and Preventive Medicine at the University of Pisa, Italy.
•“When people can use the seat belt each time they drive why not get vaccinated against influenza just once a year?” asked Dr. Su-Peing.
