📰 The case for vaccinating children against COVID-19
Protecting all children, especially those who have risk factors, should be a humanitarian priority for the Government
•There is a general misconception that vaccination ought to be reserved against diseases that cause death in large numbers. COVID-19 is generally a mild disease in the large majority of healthy young children infected with SARS-CoV-2.
•However, children living with diabetes, chronic heart/lung/kidney/neurological diseases, obesity, and with an immunocompromised state due to immunodeficiency syndromes or immunosuppressant therapies are at high risk of severe disease, need for hospitalisation and expensive treatments, even of mortality. Older children and adolescents have a higher risk of severe COVID-19, approximating adult risk levels. All such children deserve COVID-19 vaccination to preserve good quality of life.
MIS and diabetes
•Four to six weeks after COVID-19, irrespective of severity, some among otherwise healthy children develop Multisystem Inflammatory Syndrome (MIS). Statistics available in India showed 5% mortality among 800 children hospitalised for MIS; more than half required intensive care and prolonged hospital stay. Without a national registry of MIS, we do not know its real burden. The U.S. Centers for Disease Control and Prevention (CDC) reported 91% protective effectiveness of two doses of Pfizer’s mRNA vaccine against MIS in children 12 to 18 years. COVID-19 vaccination prevents MIS.
•Another post-COVID-19 disease in adults and children is diabetes, starting within weeks. In a report from the CDC on 80,893 children (below 18 years), the incidence of post-COVID-19 diabetes was 31 per 10,000 versus control, 11.8/10,000 after other respiratory infections. India already has a heavy burden of diabetes in children. COVID-19 vaccination will prevent post-COVID-19 diabetes.
•The Brihanmumbai Municipal Corporation’s COVID dashboard (January 13, 2022), showed 16,426 total deaths, of which 19 were in children below 10, and 43 in children between 10 and 18 years (total of 62 or 0.38%). January data from UNICEF show that 0.4% of a total 3.5 million COVID-19 deaths were in children and adolescents. India’s reported deaths were 4.86 lakh till January 17, 2022 — child deaths at 0.4% rate would amount to 1,944. Independent analysis by expert epidemiologists (Science, January 6, 2022) estimated a six to seven-fold higher number of deaths, suggesting a far higher number of child deaths.
Other factors
•It is estimated that 2,00,000 children are born with congenital heart defects every year in India. New cases of cancer in children are about 50,000 per year. A huge number of children have neurological disorders. As in a United Nations estimate, about 40 million in India are disabled due to various diseases, among whom over 7% are children. India has the second highest number of obese children in the world (~14.4 million). The burden of childhood nephrotic syndrome annually is about 1,40,000. Sickle cell disease is highly prevalent in the tribal populations in India. The Indian Society for Primary Immune Deficiency estimates that over a million children have primary immune deficiency disease. These are all conditions that are known as risk factors for severe COVID-19. Protecting them with COVID-19 vaccination is a humanitarian priority.
•India’s third COVID-19 wave began from December 28, 2021. On January 3, 2022, children above 14 years are allowed vaccination, undoubtedly a step in the right direction. They become eligible for the second dose four weeks later — thus, children are not getting the benefit of protection during the present wave. Although we have not been able to protect children with vaccination so far, the Government of India must now plan for protection against the inevitable future endemic COVID-19. Paediatricians caring for children with the above listed conditions associated with high risk of COVID-19 and its complications, need approval to protect them with vaccination.
•SARS-CoV-2 (except the Omicron variant) invades many body tissues and organs. Damage to the pancreas is the reason for new onset diabetes. COVID-19 is a new disease and the extent of damage to the health of children will be known only in due course. All facts considered, rolling out vaccination with vaccine(s) of assured safety is the right way forward.
Vaccine safety
•Since the risks of severe COVID-19, its related complications and mortality are much higher in adults, a risk-benefit comparison has so far favoured vaccination, even with vaccines with some known serious adverse reactions. Globally, both mRNA vaccines and Adenovirus vectored vaccines are recognised to cause some specific and defined diseases that need to be immediately diagnosed and treated in order to prevent mortality
•Since risk of COVID-19 severity is low in children, only vaccines with little or no risks of serious adverse reactions are justified in them. Thus, vaccine safety is the most crucial criterion for approval. Fortunately, the indigenous inactivated virus vaccine with adjuvant promoting cell-mediated and antibody arms of immunity had been investigated for safety in children at and above two years, and found to be safe without any serious adverse reaction. Obviously for this reason the Government has allowed it for exclusive use in children between 15 and 18 years. We argue for vaccinating younger children also with the same vaccine.
•The urgency for vaccination is the continued high risk of disease, complications and death in children who, on account of their chronic diseases or prolonged treatments are vulnerable. Selective vaccination of high-risk groups will not be feasible under the emergency use approval (EUA) of vaccines in children. Once safe vaccines are licensed for general use, health-care givers can vaccinate selected children under their care.
Age of eligibility
•As of now, the ethical, scientifically sound and wise decision ought to be step-wise lowering of age of eligibility: first to above 12 years, then to above five years and eventually to above two years, in rapid succession, ensuring safety in each age group. Expanding the age range for EUA of the vaccine does not necessarily mean that all families may opt for their otherwise healthy children to be vaccinated. However, without EUA, children who need prophylaxis against COVID-19 will continue to be denied the benefit of vaccination.
By failing to decide key constitutional cases in a timely way, the apex court has not acted as the ‘sentinel on the qui vive’
•American lawyer James M. Beck described the U.S. Supreme Court as a lighthouse whose gracious rays of justice and liberty light up the troubled surface of the water, making America a free and strong nation. M. Jagannadha Rao, a former Indian Supreme Court judge, citing Beck, said that what is true of the American Supreme Court is equally true of the Indian Supreme Court. In the 73rd year of our Republic, it is time to put this belief to test especially in the wake of mounting majoritarianism and surging ethnocultural nationalism.
•In the last few years, the Indian Supreme Court has delivered some judgments of far-reaching consequence. It declared the right to privacy a fundamental right; decriminalised consensual sexual conduct between adults of the same sex; recognised transgender persons as the third gender; and outlawed triple talaq. These decisions shore up the belief in republican values like liberty and equality reified in our Constitution.
Black marks
•Notwithstanding these bright spots, there are several black marks on the Supreme Court’s record. The Vidhi Centre for Legal Policy has developed an excellent comprehensive tracker of all the pending cases before the five-judge, seven-judge, and nine-judge constitution benches of the Supreme Court. According to this tracker, there are 25 main cases pending before the five-judge constitution bench and five cases each pending before the seven-judge and nine-judge benches. These cases relate to significant constitutional and other legal matters that can have serious repercussions on the fundamental rights of ordinary citizens and our core republican values. Related to these main cases, there are more than 500 connected cases. These cases cannot be decided till the legal issues in the main cases before the constitutional benches are addressed. Some of the important cases gathering dust in the Supreme Court are as follows.
•First, a deluge of petitions was filed before the Supreme Court challenging the constitutionality of the Citizenship (Amendment) Act, 2019, that provides non-Muslim communities from Bangladesh, Pakistan, and Afghanistan a fast-track route to Indian citizenship. More than two years later, the matter continues to languish in the apex court. Second, innumerable petitions have been filed challenging the Presidential Order of August 5, 2019 that effectually diluted Article 370 of the Constitution and split Jammu and Kashmir into two Union Territories. To date, the court has done precious little to decide this vexed question of law.
•Third, petitions challenging the constitutionality of the Constitution(One Hundred and ThirdAmendment)Act,2019 that provides reservations in public educational institutions and government jobs for economically weaker sections are also languishing in the Supreme Court. It is shocking that the case has not been heard since August 5, 2020, while the law has already been implemented.
•Fourth, a momentous case known as Vivek Narayan Sharma v. Union of India is in the Supreme Court for more than five years. This case relates to the legality of demonetisation of all ₹500 and ₹1,000 notes aimed at curbing black money. It was the most audacious economic experiment in the life of the Indian republic that went horribly wrong because more than 99% of the cash came back into the banking system, according to the Reserve Bank of India. Appallingly, the Supreme Court hasn’t heard this case since September 2, 2019.
•Fifth, the Supreme Court has failed to accord proper hearing in the last four years to the constitutional challenge to the electoral bonds scheme. This scheme strikes at the heart of our polity because anonymous funding of political parties is the root cause of corruption in public life.
Constitutional duty
•Granville Austin, a distinguished constitutional scholar, said, “the Supreme Court is …custodian of the equality under the law that lies at the heart of the country’s constitutional democracy. Unless the Court strives in every possible way to assure that the Constitution, the law, applies fairly to all citizens, the Court cannot be said to have fulfilled its custodial responsibility”. By abjectly failing to decide key constitutional cases in a time-bound manner, the Supreme Court has not acted as the “sentinel on the qui vive”. The Court should perform its constitutional duty of being a formidable counterforce to brute majoritarianism. The power of judicial review that the Chief Justice of India, N.V. Ramana, calls as critical to democracy should be exercised assiduously. Or else, India’s hard-fought constitutional democracy would be in grave peril.
📰 A hazy picture on employment in India
The trends in employment have not shown any clear and consistent patterns over the years
•The two important indicators of structural transformation in any economy are rates of growth and changes in the structural composition of output and the workforce. India has experienced fairly consistent changes in the first indicator, especially after the 1991 reforms, but the trend in employment has not revealed any consistent or clear pattern.
•The growth rate of the economy, measured by gross value added (GVA) at constant prices, accelerated from 4.27% in the 20 years before the economic reforms to 6.34% in the 20 years following the reforms and to 6.58% between 2010-11 and 2019-20 at 2011-12 prices. This growth trajectory was accompanied by a steady decline in the share of agriculture from 30% in 1990-91 to 18% in 2019-20 and a steady increase in the share of non-agriculture output in total economic output.
Employment patterns
•But when it comes to deciphering trends in employment pattern in India, there are wide variations in the conclusions drawn by experts and studies on employment. This is partly due to economical, sociological and technological factors that have brought about changes in the workforce and employment and partly due to gaps in data on various aspects of employment.
•Two major sources of data on workforce and employment have been the decennial population census and the nationwide quinquennial surveys on employment and unemployment by the National Sample Survey Office (NSSO). The last available data from the Census refer to 2011. Similarly, the quinquennial NSSO data on employment and unemployment are available up to 2011-12. This was replaced by the Periodic Labour Force Survey (PLFS), started in 2017-18 on an annual basis. The PLFS data set is now available for three consecutive years i.e., 2017-18, 2018-19 and 2019-20. The PLFS is based on a different sampling framework and uses s different analytical approach vis-a-vis NSSO surveys on employment. As a result, the time series data on employment and unemployment available from NSSO surveys are not comparable with PLFS data. At best, the NSSO data can be used as a reference point.
•Though the PLFS data cannot be used to infer an underlying trend, as they are available only for three years, they can be used to reveal the effect of various policies and developments during the current NDA regime as well as to understand and shape the employment scenario based on concrete statistics.
•PLFS data show an increase in the worker to population (WPR) ratio from 34.7% in 2017-18 to 38.2% in 2019-20. This is a reversal of the previous trend which showed a decline in WPR after 2004-05. The change also implies that employment has increased at a much faster rate than growth in population. The increase in WPR has been reported in the rural and urban population and in the male and female population. This increase in WPR is even more significant as it has occurred in the midst of an increase in the labour force participation rate.
•It is interesting to note that the data from the PLFS surveys do not support the assertion that women are going out of the workforce. Female WPR ratio increased from 17.5% to 24% between 2017-18 and 2019-20. When this ratio is multiplied by the female population, it shows an annual increase of 17% of women workers. Another positive indication from PLFS data is that the gap between the male and female worker participation rate is narrowing down. As against 100 male workers, there were 32 female workers in the workforce in 2017-18. This number increased to 40 in 2019-20. Women constituted 24% of the workforce in the country in 2017-18 and 28.8% in 2019-20.
•Also, the unemployment rate in the female labour force in rural areas is far lower than the male labour force, whereas the opposite holds true in urban areas. This is despite the fact that the female labour force participation rate in rural India is 33% higher than the rate in urban areas. The reason could be that there is less gender discrimination in informal jobs, which dominate rural areas, than in the formal sector which dominates urban areas.
The unemployment scenario
•PLFS data show that the unemployment rate based on principal status plus subsidiary status declined from 6.1% in 2017-18 to 4.8% in 2019-20. This shows that the number of jobs increased at a faster rate than the increase in the number of job seekers between 2017-18 and 2019-20. But despite this, the number of unemployed persons has increased by 2.3 million between 2017-18 and 2018-19, mainly because of an increase in the number of job seekers (52.8 million) in these two years.
•The sectoral composition of the workforce shows that 45.6% of the workers in India are engaged in agriculture and allied activities, 30.8% in services and 23.7% in industry. According to PLFS data, there is no increase in the share of industry and services in total employment. This means that the labour shift out of agriculture is not happening. Between 2019-20 and 2017-18, 56.4 million new jobs were created. Out of this, 57.4% were created in the agriculture and allied sectors, 28.5% in services and 14.5% in industry. Within the broad industry group, employment in the manufacturing sector showed a meagre increase of 1.8 million in two years; and construction activity added 6.4 million new jobs.
•That a majority of the new entrants to the labour force between 2017-18 and 2019-20 got absorbed in the agriculture sector has serious implications. The young labour force, which is getting increasingly educated, sought more remunerative work outside agriculture but only a few succeeded. This is because the industry and services sectors have adopted capital-intensive and, in many cases, labour-displacing technologies and production strategies. This is getting further aggravated with the rising adoption of modern technologies like Artificial Intelligence and Internet of Things. This raises a big question about the future of new entrants into the labour force.
•That there is a dichotomy between the rising share of industry and services in national income without a sizeable increase in employment share is a fairly well-established fact for post-liberalisation India. This puts a serious question mark on the relevance of conventional models of economic growth and development (like the dual-sector model of Arthur Lewis centred on the large-scale shift of the labour force from agriculture to industry. Perhaps it is pertinent to question the conventional economic development models and their applicability for emerging economies like India. Instead, should we rethink our strategy of striving for an industry-led growth model and explore a more relevant agri-centric model of economic transformation to create more attractive, more remunerative and more satisfying employment in and around agriculture?
•Besides this there is also an urgent need to generate much more employment in the manufacturing and services sector compared to the number of jobs they have offered in the recent past. This should include (i) changes in labour laws which discourage industry to adopt labour-intensive production (ii) employment-linked production incentives and; (iii) special assistance for labour-intensive economic activities.
