📰 Supreme Court wants vacancies in consumer dispute bodies filled up in 8 weeks
It asks Centre to do ‘legislative impact study’ on Consumer Protection Act
•The Supreme Court on Wednesday gave the Centre and the States eight weeks to fill up the vacancies in the consumer disputes redressal commissions.
•“Is there some ‘muhurrat’ required for taking steps? States are defeating the purpose for which the consumer protection laws have been made... they have been made for the benefit of people,” Justice Sanjay Kishan Kaul, heading a Bench, also comprising Justice Hrishikesh Roy, said.
•The Bench asked the Centre to conduct a comprehensive “legislative impact study” on the Consumer Protection Act of 2019.
•“We want to know the impact of this legislation on litigation,” Justice Kaul said. The court gave the government four weeks to complete the study. When the government complained about the paucity of time, Justice Kaul said, “you make legislations instantly. You rush through so many things, you can rush through this too...”
‘Is it deliberate?’
•The court asked if the governments, both at the Centre and in the States, had deliberately kept the vacancies pending to dissuade people from filing complaints.
•“You don’t want complaints to be processed, for citizens to get justice? There is no manpower, there is no infrastructure.... People get fed up. You say ‘we will get this thing done’ or ‘we will get that thing done’, and then nothing happens. You seem to have only vacancies and not appointments,” Justice Kaul slammed the governments. The legislative intent behind the Consumer Protection Act was to empower ordinary citizens, he noted.
•“However, the ground reality is different. There is little attempt made to translate the legislative intent to administrative infrastructure, facilities, staff, Members in order for the functioning of the consumer disputes commissions,” the Bench stated.
•The Centre had dilly-dallied over the appointments of Members in the National Commission.
Ongoing litigation
•Additional Solicitor General Aman Lekhi, for the Centre, said there was an ongoing litigation in the court regarding the tenure of tribunal members. The Centre was waiting for its outcome. Mr. Lekhi also referred to the recent passing of the Tribunal Reforms Bill of 2021, which had the same provisions regarding tenure, etc, as the Tribunals Reforms (Rationalisation and Conditions of Service) Ordinance, 2021 that was struck down by the court in the recent verdict in the Madras Bar Association case. The to and fro of litigation and legislation had caused “confusion”, delaying appointments.
•Justice Kaul addressed the law officer, “Somebody will keep challenging. Now, somebody will challenge this law too... That does not mean you stop appointments. Mr. Lekhi, when you want to do something, there is no ‘confusion’. My question is simple. You have appointed four persons, when are you appointing the remaining three people? You need to have the requisite number of people to deal with the cases filed”.
•The court said if it could ask the States to comply with a eight-week deadline, it could “jolly well” also ask the Centre to do the same thing.
•Justice Kaul said, “The schedule for the States will equally apply for the Centre”.
•The court asked the States to advertise the existing and potential vacancies in two weeks. Those States which have not set up selection committees should do so in two weeks, it ordered. “All vacancies to be filled up by States, Union Territories within maximum eight weeks.”
📰 Building consent: On PG Medical Education Regulations 2021
A consensus on the Postgraduate Medical Education Regulations 2021 is a must
•The Indian Medical Association (IMA), the largest organisation of doctors in India, has demanded that the National Medical Commission (NMC) withdraw the draft Postgraduate Medical Education Regulations 2021. In its current form, it notes that there shall be common counselling for admission in all medical educational institutions to all Post-graduate ‘Broad-Specialty’ courses (Diploma/MD/MS) on the basis of the merit list of the National Exit Test. Currently, admissions to such programmes are based on the post-graduate NEET. Half the seats to the various courses are based on the all-India quota and the rest are admitted by the State governments, which comply with reservation norms. The IMA contends that the draft regulations leave States with no power or discretion to manage admissions to State medical colleges, which rely on State funds. If States did not have the freedom to decide on student intake, they would find it hard to provide quality medical services to the local population. The proposed regulations follow from the provisions of the National Medical Commission Act, 2019, that itself replaced the Medical Council Act of India and was a subject of extreme friction between medical professionals and the Centre. In both instances, the heart of the objection is States’ discomfort with ceding powers to the Centre. The familiar argument of the States is that health care is a State subject. Through the decades, while the Centre plays the critical role of funding and conceiving targeted programmes to ameliorate disease and improve overall health-care standards, the matter of implementation has always been left to the States.
•The Centre has an important role in setting standards and amplifying best practices so that minimum — but ever improving — standards of health care are delivered across all States. Much like cadres of the IAS are deputed to States based on centralised examinations, there is, in principle, no reason for such a system not to be effective, but the Centre needs to be extremely responsive to States’ views on the same. The very real problem, laid bare during the pandemic, is the shortage and extremely uneven availability of quality health care. Through the years, attempts are being made to improve this by trying to bridge alternative systems of medicines with modern medicine, but these have always been marred by political and religious overtones, and a convergence seems unlikely in the near future. The import of the proposals should not be made hostage to a Centre-States power struggle. Efforts must be made to build more consensus involving stakeholders, such as the IMA, State medical councils and representatives of health-care groups.
📰 An urban jobs safety net
It is time to formulate a wage employment-based national urban livelihood scheme similar to MGNREGS
•During the pandemic, we have again and again faced the difficult choice of saving lives versus protecting livelihoods. According to the World Economic Outlook report of April, 2021 of the International Monetary Fund (IMF), almost all countries, except China, experienced economic contraction last year. The global GDP shrunk by 3.3%. The contraction in the U.S., Brazil, Japan, Canada and Euro Area was in the range of 3.5%-7%. India’s GDP plummeted by 8%. China, on the contrary, posted a growth of 2.3%. The report stated that 95 million people have fallen into the ranks of the extreme poor category. The unemployment rate in the Euro Area, the U.S. and Canada shot up to 7.1%, 8.1% and 9.6%, respectively. Spain, Greece, Turkey, the Philippines, Argentina, Brazil, Colombia, and Peru among others are grappling with unemployment rates in double digits. As per the Centre for Monitoring Indian Economy’s estimates, the unemployment rate in India peaked to 23.5% in April 2020 before falling to 6.9% in February 2021.
Rural-urban livelihood divide
•In the wake of economic deceleration, the challenge is to minimise livelihood losses. Traditionally, governments have addressed this issue from a sectoral viewpoint. Given the contemporary realities, the need is to approach this from a rural-urban perspective for two reasons. First, when there is an economic shock, it is essential to provide people with formal access to a livelihood safety net. Second, the livelihood safety net must have comprehensive coverage. Such a net, provided by the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS), exists only in rural areas. Urban India does not have any such cushion. Though the Indian government operates the National Urban Livelihoods Mission, which is focused on self-employment through skill up-gradation and credit linkages through banks, the scheme does not have guaranteed wage employment provisions akin to what MGNREGS provides. During the lockdown last year, we saw migrant labour moving in large numbers from the urban to rural areas, which is symptomatic of the rural-urban livelihood security divide. This divide needs to be bridged if the livelihood loss is to be minimised. Policy experts have considered migration in India to be essentially a rural to urban phenomenon. This pandemic has demolished that myth. MGNREGS, designed to check such migration, provides a livelihood safety net in rural India. Last year’s migration tragedy and the economic slowdown have highlighted the need for a similar livelihood safety net in urban India.
Insights from Himachal Pradesh
•A few States have experimented with a wage employment-based urban livelihood scheme. Himachal Pradesh (H.P.) launched the Mukhya Mantri Shahri Ajeevika Guarantee Yojana (MMSAGY) last year with the objective of enhancing livelihood security in urban areas by providing 120 days of guaranteed wage employment to every household at minimum wages in FY 2020-21. Any adult member of a household, less than 65 years of age, residing in the jurisdiction of the urban local body (ULB) and willing to engage in unskilled work at projects being executed or in sanitation services being provided by the municipality can register under the scheme. A job card is issued to the beneficiary within seven days of registration and employment is provided within a fortnight. Otherwise, the beneficiary is eligible to be compensated at a rate of ₹75 per day. Initially, when the scheme was conceived, there was scepticism due to lack of fiscal space during the pandemic to launch a new scheme. The government then decided to fund the wage component from the grants already available to ULBs under the State and Central Finance Commissions. In a year of its operation, a quarter million man-days, benefiting about 3% of the total urban households in H.P., were generated. If the scope of MMSAGY is broadened to include muster-roll based works, other municipal services, etc., it could enhance livelihood opportunities.
•H.P.’s experience has provided some crucial insights. One, an urban livelihood scheme can be launched within the existing fiscal space. If not, the Union and States can provide resources together. Two, separate minimum wages for rural and urban areas do not cause migration to urban areas since the higher cost of living in urban areas has an offsetting effect. Three, the focus must shift from asset creation to service delivery. Restricting it to asset creation or wage-material ratios may be sub-optimal in urban settings. The focus should be on enhancing the quality of municipal services. Four, such a scheme is like an ‘economic vaccine’ and will protect people against unemployment. It should be administered at the national level rather than at the State level.
📰 The importance of the booster dose to plan ahead
The execution of such a vaccination campaign is what will help get India out of COVID-19’s stranglehold
•The COVID-19 vaccination is relatively new to the world, but the history of vaccination goes back a few centuries. The Expanded Programme on Immunisation was launched by the World Health Organization in 1974 and since then all countries of the world have gained considerable experience in rolling out several vaccines for children and pregnant women.
The immune response
•Broadly speaking, vaccines may be classified as replicating live infectious vaccines, and, non-replicating non-infectious vaccines. Currently used live virus vaccines inoculated by injection include measles, rubella, mumps and chickenpox vaccines. The inoculum dose contains a few thousands of live but attenuated viruses — they replicate in body tissues without producing overt disease. The final effective dose that stimulates the immune system may be billions or trillions of viruses and the stimulus sustained for days to weeks as the injected viruses continue to multiply within the human body. Therefore, immune responses to replicating live virus vaccines — both antibody and T-cell immunity — are robust and long-lasting.
•The non-replicating injected vaccines include nearly all others — the most common being diphtheria, pertussis (whooping cough), tetanus, hepatitis B, Haemophilus influenzae b, pneumococcal, human papilloma virus, inactivated poliovirus, inactivated hepatitis A vaccines. For them, the dose confronted by the immune system is what is injected. What is injected is a tiny amount of antigen, measured in micrograms, plus stabilisers and preservatives in some, and adjuvants in a few, all chemicals and salts in minute quantities.
Why go in for a booster dose
•In order to get robust and long-lasting immunity with non-replicating vaccines, we need to give multiple doses — the initial one, two or three doses given in quick succession, at intervals of one or two months, are “priming doses” — meant to prime the immune system to the antigens in the vaccine. The immune system responds well, but with relatively low levels of antibody and subdued T-cell immunity. Over time, in a few months to one year, the antibody levels wane in almost all vaccinated individuals. To reach and maintain high and protective levels of antibody, we need one or more injected “booster dose(s)”.
•Every non-replicating vaccine requires priming and boosting. Influenza vaccine boosters are recommended annually; tetanus vaccine once in five to 10 years. For others such as human papilloma and hepatitis A and B vaccines, one booster dose may suffice for decades of protection.
•All current COVID-19 vaccines fall in the non-replicating category and for robust and long-lasting immunity, they require, quite predictably, priming doses to induce early immunity, and booster dose(s) to sustain, long-term, high antibody titres, overcoming waning immunity.
The current schedules
•The current COVID-19 vaccination schedules are only priming doses — the immunity induced by one dose (Johnson & Johnson vaccine), Pfizer vaccine (two doses three weeks apart), all others (two doses at four weeks or more inter-dose interval) are expected to wane, as experience with all previous non-replicating vaccines have taught us. The usual interval between priming and boosting is six months to one year, because protective levels of antibodies will be present for at least that duration, when the priming doses include two or three injections.
•Limited experience with antibody titres after natural infection or after vaccination against COVID-19 informs us that the antibody titres decline such that a proportion does not have even detectable virus neutralising antibody levels after six months. There is further evidence that those who are elderly, men particularly, and those with organ transplants, cancer treatment or co-morbidity, have weaker primary antibody responses than their younger/normal counterparts. This implies that they may remain vulnerable to severe disease and death; they are in urgent need for booster dose(s) to ensure and sustain protective immunity.
•The initial expectation that the COVID-19 pandemic would be a short-lived one is proven wrong. It is now 20 months from the first case and numerous variants have emerged, and chains of transmission continue even in countries which have achieved wide vaccination coverage such as Israel and the United Kingdom. It seems inevitable the pandemic will evolve into a permanent ‘pan-endemic’ state and vaccination is here to stay for years to come, until we manage to eradicate the virus altogether using vaccines.
•It is apparently this realisation, that immunity wanes and the pandemic is evolving into endemic long-term prevalence, that prompted Pfizer Company to seek approval for a booster dose in the United States, and Israel’s Ministry of Health to start booster doses to all above 60 years of age.
The strategy ahead
•In India, we have an ethical dilemma — as long as there is inadequate vaccine supply, everyone deserves priming doses before even the highly vulnerable early vaccine recipients are offered booster doses. The solution is to accelerate vaccine procurement without counting the cost.
•For every country planning vaccine roll-out, the science of vaccinology demands that all those getting priming doses should receive at least one booster dose — at a well-chosen interval. The science of immunology teaches us that a booster dose delivered at an interval of at least four, preferably six to 12, months after the last priming dose, will stimulate the production of ‘long-lived’ antibody secreting cells, as well as ‘long lived (virtually life-long) memory cells’. Those who get a third dose one month after the second dose should count it as three-dose priming instead of a true booster which requires four months to one year of wait.
•India will do well to plan a vaccination strategy for completing two priming doses in all adults and children, third dose to the special category described above, and one booster dose to everyone one year later. Meticulous planning and the execution of such a vaccination campaign is what will get the country out of the stranglehold of this virus and its variants that have emerged and any that might emerge with higher transmission efficiency than even the Delta.
