📰 Supreme Court cautions courts against granting bail in heinous offences
‘The nature of the offence is one of the basic considerations for the grant of bail’
•The Supreme Court has cautioned courts against mechanically granting bail in heinous offences, saying the seriousness of the charge is a basic consideration before setting an accused free on bail.
•A recent judgment by a Bench led by Justice Indira Banerjee set aside a Kerala High Court order bailing out a man accused of stabbing to death a 30-year-old dentist in front of her father in September 2020. The accused had gone absconding for several days before his arrest.
•Though the trial court denied him bail, the High Court set him at liberty.
•“The nature of the offence is one of the basic considerations for the grant of bail — more heinous is the crime, the greater is the chance of rejection of the bail, though, however, dependent on the factual matrix of the matter,” Justice Banerjee, who authored the judgment, observed.
•The court agreed that grant of bail was a judge’s discretion.
•“However, calls for exercise of such a discretion in a judicious manner and not as a matter of course. Order for bail bereft of any cogent reason cannot be sustained,” the judgment said.
•The apex court said the accused had reached the clinic of the victim with a knife.
•“He had attacked the deceased and inflicted very serious stab injury and caused damages to her internal vital organs... the High Court overlooked the materials on record, which prima facie indicate that the respondent (accused) had committed cold-blooded murder of a young lady doctor, as a fall-out of a soured relationship... After committing the crime, the petitioner had absconded and he could be apprehended only on October 6, 2020 on receiving secret information by the investigation agency...” the court noted.
•The court listed the criteria a judge should consider before granting bail.
•Primarily, Justice Banerjee observed, that “while granting bail the court has to keep in mind not only the nature of the accusations, but the severity of the punishment”. Other criteria include “reasonable apprehensions” of influencing witnesses or tampering of evidence.
📰 ‘COVID-19 led to rise in maternal deaths, stillbirths’
The impact on pregnancy outcomes high on poorer countries, says study
•The failure of the health system to cope with COVID-19 pandemic resulted in an increase in maternal deaths and stillbirths, according to a study published in The Lancet Global Health Journal.
•Overall, there was a 28% increase in the odds of stillbirth, and the risk of mothers dying during pregnancy or childbirth increased by about one-third. There was also a rise in maternal depression. COVID-19 impact on pregnancy outcomes was disproportionately high on poorer countries, according to the study published on March 31.
•The report is an analysis of 40 studies across 17 countries including Brazil, Mexico, the U.S., Canada, the U.K., Denmark, Netherlands, Italy, India, China and Nepal.
•“The disruption caused by the COVID-19 pandemic has led to avoidable deaths of both mothers and babies. Policy makers and healthcare leaders must urgently investigate robust strategies for preserving safe and respectful maternity care, even during the ongoing global emergency. Immediate action is required to avoid rolling back decades of investment in reducing mother and infant mortality in low-resource settings,” the authors urge.
•The study attributes the worsening trend to the failure of the “inefficiency of the healthcare system and their inability to cope with the pandemic” instead of strict lockdown measures. This resulted in reduced access to care.
•In the Indian context, an analysis of HMIS data by Population Foundation of India shows that during the months of national lockdown last year between April and June, compared to the same period in 2019, there was a 27% drop in pregnant women receiving four or more ante-natal check-ups, a 28% decline in institutional deliveries and 22% decline in prenatal services.
•The impact was high among the marginalised across various settings such as in Nepal where hospital deliveries decreased most markedly among disadvantaged groups; and in the U.K., where 88% of pregnant women, who died during the first wave of the pandemic, were from black and minority ethnic groups, the study states.
•The authors recommend that personnel for maternity services not be redeployed for other critical and medical care during the pandemic and in response to future health system shocks.
•Further, wider societal changes could have also led to deterioration in maternal health including intimate-partner violence, loss of employment and additional care-responsibilities because of closure of schools.
The policy has absolutely no consideration for Group 3 patients who require lifelong treatment support, say organisations
•Caregivers to patients with ‘rare diseases’ and affiliated organisations are dissatisfied with the National Policy for Rare Diseases, 2021 announced on Wednesday. Though the document specifies increasing the government support for treating patients with a ‘rare disease’— from ₹15 lakh to ₹20 lakh — caregivers say this doesn’t reflect actual costs of treatment.
•There are 7,000-8,000 classified rare diseases, but less than 5% have therapies available to treat them. About 95% rare diseases have no approved treatment and less than 1 in 10 patients receive disease-specific treatment. These diseases have differing definitions in various countries and range from those that are prevalent in 1 in 10,000 of the population to 6 per 10,000. India has said it lacks epidemiological data on the prevalence here and hence has only classified certain diseases as ‘rare.’
•Where drugs are available, they are prohibitively expensive, placing immense strain on resources.
•Currently few pharmaceutical companies are manufacturing drugs for rare diseases globally and there are no domestic manufacturers in India except for those who make medical-grade food for those with metabolic disorders. Due to the high cost of most therapies, the government has not been able to provide these for free. It is estimated that for a child weighing 10 kg, the annual cost of treatment for some rare diseases, may vary from ₹10 lakh to more than ₹1 crore per year with treatment being lifelong and drug dose and cost increasing with age and weight.
•The policy was first prepared by the Centre in 2017 but put on hold. There were “implementation” challenges pointed out by States with the key question again remaining about costs: How would States and Centre share the costs of treatment?; What diseases would be covered? and who would benefit? An expert group was constituted in 2018 to review these questions. The committee submitted its report this January and after a further round of consultation the policy was made public this week.
Three groups
•Saliently, a ‘rare disease’ has been categorised into three groups. Diseases in the first group would be eligible for a one-time treatment cost of up to ₹20 lakh provided the beneficiaries conformed to definition of the Pradhan Mantri Jan Arogya Yojana and were treated in government tertiary care hospital. For Group 2 diseases, States could “consider” supporting patients of such rare diseases that could be managed with special diets or hormonal supplements.
•The government would notify selected Centres of Excellence at premier government hospitals for comprehensive management of rare diseases. The Centres of Excellence would be provided a one-time grant to a maximum of ₹5 crore each for infrastructure development for screening, tests, treatment.
‘Several lives lost’
•“The new policy offers no support to patients awaiting treatment since the earlier National Policy for Treatment of Rare Diseases 2017 was kept in abeyance. In the absence of any funding support, close to 130 patients are left with no option but to wait for the inevitable. Several patients — mostly children — have already lost their lives in the interim period. Unlike conditions under Group 1 and Group 2, patients with Group 3 disorders require sustainable treatment support,” said Manjit Singh, National President, Lysosomal Storage Disorders Support Society (LSDSS).
•The Ministry of Health and Family Welfare cited the need to balance competing priorities of public health in “resource constrained” settings.
•“Looking at the number of rare disease patients diagnosed and considered eligible for treatment by the respective State technical committees, the immediate requirement of funds to support the immediate treatment needs of the diagnosed patients shouldn’t have exceeded ₹80 crore to ₹100 crore annually. If one is to look at it holistically, the Centre’s contribution would work out to ₹40 to ₹50 crore — if it is able to convince the State(s) for a load-sharing model, as a few States like Kerala, Tamil Nadu and Karnataka have already indicated,” said health economist Prof. Viswanath Pingali.
‘No consideration’
•“It is alarming that the Union government has left patients with Group 3 rare diseases to fend for themselves in the National Policy for Rare Diseases 2021. The new policy has absolutely no consideration for Group 3 patients, who require lifelong treatment support. In the absence of a sustainable funding support for Group 3 patients, the precious lives of all patients, mostly children, are now at risk and at the mercy of crowdfunding. The Union government has failed these children who were hoping for help. Even Group 1 is only for few and Group 2 has been openly left for the State government,” said Prasanna Shirol, co-founder and executive director, Organisation for Rare Diseases India, an umbrella organisation.
•His daughter Nidhi is afflicted with Pompe disease when she was 7 and now at 22 is in a “semi comatose state.” Mr. Shirol said one room in his house had been converted as an intensive care unit for two decades. “What the policy doesn’t capture is that these are diseases that last a lifetime. It also doesn’t realise how those who can’t afford such treatment will be unable to even make it to the prescribed tertiary hospitals for treatment. As a group, we shall soon be placing our objections to the new policy.”
•Patients and their support groups have earlier written to the Health Ministry seeking an immediate seed-funding of ₹80 crore to ₹100 crore while rolling out the national policy so that the life-saving therapy of all those patients with treatable Group 3 disorders such as LSDs can be provided, thereby reducing further loss of life; design and execute a 100-day roll-out plan after the national policy is notified to prioritise treatment of all eligible rare disease patients and prioritise and encourage States with a matching grant, which have demonstrated a proof of concept in providing life-saving therapy to rare disease patients, such as Karnataka, Kerala and Tamil Nadu.
📰 Prudence prevails: on speculation about inflation
That inflation is a concern for policymakers is reassuring for consumers and savers
•The Finance Ministry has put to rest all speculation about the inflation targeting framework that will guide the interest rate decisions of the RBI’s Monetary Policy Committee over the five-year period starting on April 1. In a terse notification, the Department of Economic Affairs announced that the inflation target for the quinquennium ending on March 31, 2026, will be 4%, with an upper tolerance level of 6% and a lower tolerance level of 2%. Economic Affairs Secretary Tarun Bajaj said that the framework’s parameters would remain unchanged from what had prevailed in the five years that ended on March 31. The government’s announcement is a welcome step in reiterating that inflation targeting remains the centrepiece of the monetary policy framework and signals that the fiscal and monetary authorities are in lockstep in ensuring the primacy of price stability as the bedrock for all macro-economic development. This is particularly apposite at a time when inflation pressures are mounting in an economy that is still struggling to regain its footing from the devastating contraction in the just-ended fiscal year, when the COVID-19 pandemic and the drastic measures to curb its spread resulted in widespread precarity. The latest Consumer Price Index data show retail inflation accelerated by almost 100 basis points to a three-month high of 5.03% in February, with food and fuel costs continuing to remain volatile. Also, with the prices of multiple raw materials on an upward trajectory, an IHS Markit India Business Outlook survey last month showed companies were planning to raise selling prices over the coming 12 months to cope with rising costs.
•The RBI’s officials have in recent months maintained an unwavering focus on emphasising the need to retain the flexible inflation targeting framework. In a December working paper titled ‘Measuring Trend Inflation in India’, the Deputy Governor overseeing monetary policy, Michael Debabrata Patra, and a colleague underscored the importance of ensuring the appropriateness of the inflation target. Observing that there had been a steady decline in trend inflation to a 4.1%-4.3% band since 2014, they said a target far lower than the trend ran the risk of imparting a ‘deflationary bias’ that would dampen economic momentum, while a goal much above the trend could engender expansionary monetary conditions that would likely lead to inflation shocks. And in February, the RBI’s researchers authoring its Report on Currency and Finance — themed ‘Reviewing the Monetary Policy Framework’ — made clear that the framework had served the economy well, attested by a decline in inflation volatility and more credible anchoring of inflation expectations. That the government’s economic officials have heeded these calls will certainly reassure investors and savers that inflation remains a central concern for all policymakers.
📰 A missing science pillar in the COVID response
India’s fight against the resurgence of the coronavirus is a challenge requiring strengthened data and better science
•The optimism that India might have beaten the COVID-19 pandemic has given way to pessimism from a sharp increase in new cases and deaths from the disease. Maharashtra seems to be particularly affected, but nearly all States are reporting increases. The epidemiology of COVID-19 is poorly understood, but some early understanding of the transmission of the virus can enable a more effective science-driven response.
Spread of variants
•First, the surge is probably driven by variants from the original, as variants worldwide comprise much of the current wave. A resumption of global travel meant that spread of variants into India was inevitable, with the only question being when. Evolutionary theory would expect SARS-CoV-2, the virus that causes COVID-19, to mutate to become more transmissible. After all, the only task of a virus is to reproduce. However, the expected concomitant decrease in lethality has not yet been documented. Anecdotal reports that the current surge is occurring more in younger adults and accompanied by unusual symptoms also support the idea that variants are responsible. Direct evidence is needed from genetic sequencing of the virus.
•Second, it was, and remains, wishful thinking that India had achieved “herd immunity”. The patterns of infection in India clearly suggest multi-generational transmission, with younger adults the engine of transmission into the elderly. Various serosurveys have consistently found that half or more of tested urban populations have antibodies to the virus. However, this high level of infection is not the same as a markedly reduced level of transmission, which is what is required for herd immunity.
•Notions of herd immunity do not fully capture the fact that for largely unknown reasons, viral transmission is cyclical. Delhi had two major peaks, in 2020, of death rates and case rates, one in June and another in November, and now is entering a third major wave. Within Mumbai, the current wave appears to be affecting more affluent areas and private hospitals, in contrast to last year where the highest infection levels were in the slums and poorer areas. Our forthcoming mortality-based analyses (https://bit.ly/3sY0KYZ) suggest several sub-waves exist within major viral peaks, reflecting subtle changes in community transmission. The ebbs and flow of vaccine transmission are far more variable than we assume.
•As well, much of infection in India might well be mild, with less durable immune protection than induced by vaccination. ‘Asymptomatic infection is more commonly reported in Indian serosurveys, exceeding 90% in some, in contrast to high-income countries, where about one-third of infections report as asymptomatic’. Recent findings from Wuhan, China show most seropositive infections were asymptomatic and among these, the important protective antibodies were low during follow-up periods. Milder infection might well also correlate with lower severity of clinical illness, helping to explain the Indian paradox of widespread transmission but with low mortality rates.
Data must guide decisions
•India needs to increase the quantity, quality and public availability of actual data to guide decision-making. Theories or mathematical models are hugely uncertain, particularly early on in the epidemic. Better understanding of the unique patterns of Indian viral transmission has a few pillars, which can be achieved quickly. First, collection of anonymised demographic and risk details (age, sex, travel, contact with other COVID-19 patients, existing chronic conditions, current smoking) on all positive cases on a central website in each State remains a priority.
•Second, greatly expanded sequencing of the viral genome is needed from many parts of India, which can be achieved by re-programming sequencing capacity in Indian academic and commercial laboratories. Third, far better reporting of COVID-19 deaths is needed. Daily or weekly reporting of the total death counts by age and sex by each municipality would help track if there is a spike in presumed COVID-19 deaths. The Registrar General of India’s verbal autopsy studies are invaluable, but must be reactivated to review deaths occurring in 2020, given that the last available results are from 2013.
•Third, the Indian Council of Medical Research’s national serosurvey had design limitations such that it probably underestimated the true national prevalence. A far larger and better set of serial surveys is required. Finally, we need to understand better why some populations are not affected. For example, COVID-19 infection and death levels in Thailand and Vietnam are remarkably low, and cannot be assigned to their stronger testing and tracing programmes. Widespread existing immunity, perhaps from direct exposure to bat coronaviruses might be one explanation. Rapidly assembled comparative studies across parts of India and Asia are a priority.
Counter growing inequity
•The science pillar of a response is complementary to action. The central and State governments have already pushed for a rapid expansion of COVID-19 vaccination. India can learn from Chile, which has successfully provided at least one dose to over half of its population. Affluent and connected urban elites of India are vaccinating quickly, but the poorer and less educated Indians are being left behind. Vaccination campaigns need to reach the poor adults over age 45, without having to prove anything other than approximate age. Follow-up studies among the vaccinated can establish the durability of protection, and, ideally, reduction in transmission.
•Similarly, India must capture and report data on who is vaccinated, including by education or wealth levels. The poor cannot be left in the dark.
Adult vaccination plan
•COVID-19 could well turn into a seasonal challenge and thus, the central government should actively consider launching a national adult vaccination programme that matches India’s commitment and success in expanding universal childhood vaccination. The Disease Control Priorities Project estimates an adult national programme would cost about ₹250 per Indian per year to cover routine annual flu vaccination, five-yearly pneumococcal vaccines, HPV vaccines for adolescent girls and tetanus for expectant mothers. Per year, vaccines for one billion adults might save about 200,000 lives from the targeted diseases. Annual flu vaccination reduces the risk of influenza pandemics and perhaps even COVID-19 infection. Indeed, we might already be in the era where major zoonotic diseases are not once-a-century events, but once a decade. Thus, adult and child vaccination programmes are essential to prepare for future pandemics.
•More draconian steps, such as another full national lockdown should be considered carefully, as they incur a huge toll on the poor and stunt education of Indian children. It also remains unclear if the population would comply. The resurgence of COVID-19 presents a major challenge for governments, yet the best hope is to rapidly expand epidemiological evidence, share it with the public and build confidence that the vaccination programme will benefit all Indians.
📰 In Geneva face-off, outrage versus hope
The Human Rights Council is where Sinhala and Tamil nationalisms meet and confront each other
•“Hey Geneva” laments Ajith Kumarasiri (musician, songwriter, and composer in Sri Lanka) in powerful Sinhala rhythm and blues. “We no longer kill.” “We don’t shoot anymore.” “Give us our island back.” Geneva as an idea is firmly embedded in the Sri Lankan consciousness. For many Sri Lankans, especially the Sinhalese, it is an attack on national honour, a place where their vulnerability as a small island is exploited. For many Tamils and now Muslims, it is a place of hope. For human rights activists the world over, it is their forum.
The setting
•The Human Rights Council in Geneva is a place where Sinhala and Tamil nationalisms meet, confront each other and fight countless shadow battles. In some of the side events of the Council, before the novel coronavirus pandemic, people have fainted, come to fisticuffs and been removed by UN security. It is the place where both communities have large demonstrations next to the legless chair that reminds the Palais de Nations of the consequence of war. There are heated, blood-chilling speeches aimed at the supporters. For bystanders, much of this drama is quite unsettling.
•The government playbook with regard to the Geneva process at the UN Human Rights Council is to present it as an enormous power play full of double standards. It is seen as western countries ganging up on Sri Lanka for its closeness to China. Imperialism and neocolonialism remain in the frame. There is no government recognition that there may be any grievance or a victim. This just compounds the insensitivity.
•The government’s aim this year was to have no resolution at all, while the major Tamil groups wanted the Human Rights Council to begin a pathway to the International Criminal Court. In the end, the resolution decided to create capacity at the Office of the United Nations High Commissioner for Human Rights (OHCHR) to collect, preserve and consolidate evidence not only on war crimes but also on other gross violations of human rights and serious violations of humanitarian law. There is no date or time period.
Geopolitics ‘plus’
•Though geopolitics is the framework for decision making at the Human Rights Council, the actual process is more nuanced and may be described as geopolitics “plus”. Unless one acknowledges this “plus” factor, one will never understand the actual workings of the Human Rights Council. The activism, agitation and the momentum around a resolution created by this “plus” factor spills over and creates the atmosphere in which the resolution is adopted.
•The “plus” factors around the Sri Lankan resolution were easy to identify. First came the legal experts of the Office of the High Commissioner for Human Rights, as well as the Special Rapporteurs and procedures who took very strong positions. The pivotal input by the Office was the Report of the High Commissioner on “Promoting Accountability and Reconciliation in Sri Lanka”. Michelle Bachelet as a High Commissioner, a torture victim, President, and a Minister of Defence, put her full weight behind the report. More than anything else, her report and words made the resolution inevitable.
•In addition to the work of OHCHR, the Tamil groups nationally and globally were extremely active. But, it was Muslim civil society and the Muslim diaspora that made the difference for this resolution. Their passion, energy and sense of injustice filled the spaces. Despite heavy lobbying from Pakistan, (the Coordinator on Human rights and humanitarian issues in the Organisation of Islamic Cooperation, at Geneva), and from Bangladesh, after Prime Minister Mahinda Rajapaksa’s visit in March, despite pressure from China and after the Rajapaksas made personal calls to OIC members, the large majority of Muslim countries still decided to abstain.
Elements to a global cause
•Though the diasporas are always active, it is an international civil society made up of a whole array of disparate groups that dominate the agitational space of the Human Rights Council. These groups are often at odds with each other but act in solidarity when it comes to global causes. Sri Lanka has again become a global cause. Once you get on the agenda of international civil society, it is difficult to get off. As Christine Schöwebel-Patel, the academic in international law and political economy, has recently written, there is a kind of “branding” in a communications sense that takes place and has severe consequences for country and community.
•The events unfolding in Geneva are particularly disturbing because of their shortsightedness. In 2014, Sri Lanka faced a hostile Council and was an outlier in the international system very much like today. Most people have conveniently forgotten this history. The Resolution of the Human Rights Council in 2015 (https://bit.ly/3md0P8x) that Sri Lanka cosponsored after the government changed was to pull Sri Lanka out of the rut that it had fallen into. If that resolution were not passed, Sri Lanka would have had the evidence collection and preserving mechanism in some form by 2016.
•The 2015 resolution accepted international best practices, an office for missing persons, an office for reparations, a truth commission and a judicial process for those guilty of serious crimes. At that time, the focus was on the need for a system that gave confidence to the victims. Victim groups were clear that a purely domestic process had failed them before. As a result, it was agreed to have a framework with an element of foreign participation.
•International, resolution 30/1 became a great success though victim groups thought it was a failure due to a lack of implementation. International hostility disappeared; Sri Lanka was dropped from international punitive agendas, became open to GSP plus (or the European Union’s Generalised Scheme of Preferences Plus) and other trade and financial benefits and was welcomed back into UN peacekeeping. Despite its international success, 30/1 was reviled nationally as a resolution that “sold out the soldiers” — blurring the lines between the few who have committed war crimes and the large majority who have not.
•Fundamentally, there was also a lack of understanding of what “co-sponsorship” meant and the enlightened self-interest that it entailed. Co-sponsorship has always meant accepting international standards while keeping control of the national process — the legislation to be enacted and the personnel to be appointed. By arbitrarily withdrawing from the resolution, Sri Lanka created the space for the Human Rights Council to create a new mechanism to collect and preserve evidence. This process is now independent of the Colombo government and will eventually have a life of its own.
The two sides
•With this dedicated capacity at the OHCHR, the human rights issues regarding Sri Lanka will not go away. For many Sri Lankans, especially the Sinhalese, this is an outrage of double standards. There is real fury at what they see as global inequity. For many members of the minorities, opposition leaders, journalists, lawyers, victim groups and civil society activists who claim they are being harassed, prosecuted and intimidated on a daily basis by a surveillance state, there is relief to know that someone will be watching.
