india introduces injectable polio vaccine in routine immunization

india introduces injectable polio vaccine in routine immunization
Babies getting their third dose of oral polio vaccine (OPV) will now also be administered an injection with inactivated polio vaccine (IPV), as part of India’s efforts to boost its polio immunization programme. IPV and OPV together can provide additional protection to a child.

India was certified polio-free on 27 March 2014, but the immunization programme continues in the country since two of its neighbours remain polio-endemic and due to the threat of vaccine-derived polio.

In the first phase, the injection will be introduced in six states: Assam, Bihar, Uttar Pradesh, Gujarat, Madhya Pradesh and Punjab.

“The last polio case was reported in India in 2011. But the risk is still there with the virus being active in Pakistan and Afghanistan. Hence, we are introducing IPV for double protection against polio,” said Union minister for health and family welfare J.P. Nadda, at an event to launch the vaccine. “By 2016 April, we will switch from trivalent to bivalent vaccine. We have to ensure that core and support systems work, along with a robust cold chain system and improved routine immunization,” added Nadda.

Trivalent vaccines protect against three strains of the polio virus while the bivalent variety protects against two. Immunization programmes the world over are switching to the bivalent vaccine since the third strain has been eradicated, and the trivalent vaccine could theoretically re-introduce it.

There are challenges that come with the introduction of the vaccine. IPV is an expensive vaccine and each dose costs around Rs.120 and unlike OPV, the IPV which is an injectable vaccine can only be given by trained health workers at vaccination sites. There are also issues of vaccine availability which the health ministry is trying to resolve.

“IPV is a key step towards global endgame strategy. It is a tough task to convince a population to continue with OPV after a country is declared polio-free and even harder to introduce IPV on top of that,” said Louis George Arsenault, country representative India, Unicef. “A lot of people doubted India could get polio-free, but it happened. We now look forward to a transition from OPV to IPV. If India can do it, so can the world,” he added.

IPV is not a new vaccine and was first used in 1955. Thirty countries have already introduced IPV in their national immunization schedule, while 126 countries including India will introduce IPV soon.

A vaccine boost to India’s polio fight

The launch of the inactivated polio vaccine injection marks a shift in addressing vaccine derived poliovirus cases.

After nearly five polio-free years, and with the launch of the inactivated polio vaccine (IPV) injection in the national immunisation programme tomorrow (November 30), India will be pushing for “endgame polio”.

The injectable vaccine, which uses killed polio viruses, will be used alongside the oral polio vaccine (OPV).

For now, immunisation using IPV will be restricted to Bihar, Chhattisgarh, Gujarat, Madhya Pradesh, Uttar Pradesh and West Bengal. In the first quarter of 2016, it will be expanded to the other Northern and Northeastern States and in the second quarter, will encompass the four southern States and Maharashtra. “Immunisation using IPV injection is in a reverse order, with the well performing States getting it last,” said virologist Dr. Jacob John, formerly with the Christian Medical College, Vellore.

R. Prasad

Though cheap and easy to administer, OPV HAS an inherent safety issue —in rare cases, live viruses used in a weakened form can turn virulent, spread within communities and cause polio in unprotected children. In 2011, such a scenario caused seven vaccine-derived poliovirus (VDPV) cases in India.

IPV aims to prevent vaccine caused polio cases, where viruses used in OPV cause flaccid paralysis. Till date, India, like many other countries, has been relying on an OPV campaign-style programme several times a year to keep the naturally-occurring wild polioviruses at bay.

All three strains of the poliovirus (type 1, type 2 and type 3) are used in OPV. Of these, type 2 is responsible for more than 95 per cent of VDPV cases. Ironically, type 2 wild poliovirus had been eradicated since 1999. Since then, all type 2 cases have been caused solely by vaccine polioviruses.

The move also marks a shift in addressing vaccine-derived poliovirus cases, with the Global Polio Eradication Initiative removing the type 2 strain globally from OPVs.

To begin with, one dose of IPV will be administered along with the third dose of OPV and DPT to children who are 14 weeks old. Even after being immunised with IPV, it is essential that all children are immunised with OPV every time it is offered. IPV when used in combination with OPV can quickly boost immunity against poliovirus and offer double protection.

“One dose of IPV will prime the immune system and the immune response will be quicker whenever OPV or IPV is given subsequently”, said Dr. Pankaj Bhatnagar, Technical Officer of the WHO India National Polio Surveillance Project, New Delhi.

There is a scientific reason for choosing 14 weeks for IPV immunisation. “When IPV is given to children at 14 weeks and later, nearly 70 per cent of them will develop antibodies against polio viruses. It will be around 30 per cent if given to children younger than 14 weeks”, he said.

The switch from OPV with all three strains to only two strains (type 1 and type 3) will happen towards the end of April 2016. “India will make a switch from a trivalent [containing all three virus strains] to a bivalent [containing only two strains] on April 24,” Dr. John said.

“There are a risk when this switch is made,” he warned. “Vaccine-derived type 2 will spread silently and cannot be stopped and children will continue to shed type 2 strain for 4-6 weeks after the last OPV dose. [A] new crop of children who do not get the trivalent oral polio vaccine can get exposed to [the] type 2 strain shed by vaccinated children,” he said.

It is to minimise this that the Global Polio Eradication Initiative requires all countries using the three-strain to introduce at least one dose of the injectable vaccine before making the switch.

“We will be building the immunity of the community against type 2 through IPV and OPV immunisation so that at the time of switching from trivalent to bivalent OPV there will be no risk,” said Dr. Pradeep Haldar, Deputy Commissioner – Immunisation, Ministry of Health and Family Welfare, Government of India.

Since the injectable vaccine contains all three strains in a killed form, it cannot cause vaccine-derived poliovirus. Superior safety apart, IPV has other advantages. Nearly 60 per cent who receive IPV will develop immunity when compared with/to the 10 to 30 per cent when OPV is used.

The higher the injectable polio vaccine coverage, the lower the risk. Hence, routine immunisation coverage in States like Uttar Pradesh and Bihar must be stepped up for IPV to become effective.

“In the beginning of this year only 64 per cent of children were fully immunised. It will reach 82 per cent by the March 2016. Of the 9 million children who were not fully immunised, 40 per cent have already been covered and another 10 per cent will be covered by March 2016,” said Prof. Ramanan Laxminarayan, Vice President — Research and Policy at the Delhi-based Public Health Foundation of India. He established the Immunization Technical Support Unit that supports the immunisation programme of the Ministry of Health and Family Welfare.

India imports inactivated polio vaccine injections at a cost of $2 per dose. Since wild polioviruses are the raw material for IPV, no Indian manufacturer is allowed to make IPV in India. Companies now using biosafety level 3 facilities for IPV manufacturing will move to biosafety level 4 once wild polio is eradicated globally. After that all, OPV will be discontinued and IPV will remain the mainstay.

Wondering what’s COP21, ADP? Here’s a glossary for U.N. climate talks

 

It sounds like English. Yet to the untrained ear the language used in the U.N. climate talks is about as comprehensible as Klingon.

Sometimes you wonder whether the negotiators are trying on purpose to make a simple idea sound more complex than it is. But it’s also a matter of international law.

Many delegations have teams of lawyers that analyse every syllable for potential hidden meanings. Before everyone’s comfortable with the wording of a concept or idea, it’s often turned into an acronym.

Here’s the list:

COP 21: No, the three letters have nothing to do with the Danish capital, Copenhagen, where one of the most famous, or perhaps infamous, climate conferences was held in 2009. COP stands for Conference of the Parties, referring to the countries that have signed up to the 1992 United Nations Framework Convention on Climate Change. The COP in Paris is the 21st such conference.

UNFCCC: To sound like an insider, pronounce this U-N-F-triple-C. Or just say “the framework convention.”

INDC: This acronym first appeared in the U.N. climate talks in Warsaw in 2013. It stands for Intended Nationally Determined Contribution and refers to the climate pledges that countries have made ahead of the Paris conference. Every word has legal implications indicating that the INDC isn’t a binding promise. The pledges are “intended,” not set in stone, and they are “nationally determined,” not imposed from the outside.

ADP: This is perhaps the most useful abbreviation in the talks, considering the time it takes to read out the full name of The Ad Hoc Working Group on the Durban Platform for Enhanced Action. The ADP is a subsidiary body created in Durban, South Africa, in 2011 for negotiations on the universal climate agreement that’s supposed to be adopted in Paris. The Paris conference will deal with other things as well, like pre-2020 ambition.

PRE-2020 AMBITION: This refers to actions taken by countries to limit greenhouse gas emissions before the Paris agreement would take effect in 2020. This part of the discussions is meant to remind big polluters that the Paris deal doesn’t mean they’re off the hook for another five years.

CBDR: This acronym lies at the core of the most difficult issue left to resolve in Paris. The principle of “Common But Differentiated Responsibilities” is enshrined in the 1992 framework convention. It recognises that countries in different stages of development have different obligations in dealing with climate change. Until recently it’s been implemented as a strict division between rich and poor countries, where only the former are obliged to reduce their emissions. The U.S. and other developed countries want to scrap that firewall in the new deal, while many developing countries including India insist that it live on in some form.

REDD-PLUS: It refers to efforts to protect forests, which when destroyed release carbon into the air, contributing to climate change. REDD stands for Reducing Emissions from Deforestation and Forest Degradation. The plus sign was added in 2010 to indicate that three more elements had been inserted into the discussions — conservation of forest carbon stocks, sustainable management of forests and enhancement of forest carbon stocks.

2015 set to be ‘hottest year on record’, says UN

2015 set to be ‘hottest year on record’, says UN
The U.N. weather agency has said that 2015 will be the hottest year on record and 2016 could be even hotter.
Why?
Due to a combination of a strong El Nino and human-induced global warming.
The El Nino weather pattern, marked by warming sea-surface temperatures in the Pacific Ocean, also causes extremes such as scorching weather and flooding. Meteorologists expect El Nino to peak between October and January and to be one of the strongest on record.
Other notable observations made:
Global average surface temperatures in 2015 are likely to reach the symbolic and significant milestone of 1° Celsius above the pre-industrial era. A preliminary estimate based on data from January to October showed that the global average surface temperature for 2015 was around 0.73 °C above the 1961-1990 average of 14.0°C, and approximately 1°C above the pre-industrial 1880-1899 period.
The years 2011-2015 have also been the hottest five year period on record, with temperatures about 0.57 °C (1.01 degrees Fahrenheit) above the 1961-1990 reference period. Global ocean temperatures were unprecedented during the period, and several land areas — including the continental United States, Australia, Europe, South America and Russia — broke previous temperature records by large margins.
Next year may yet be even warmer, since levels of greenhouse gases in the atmosphere have risen to a new record every year for the past 30 years, and the El Niũo phenomenon is likely to continue into 2016

Climate Change Finance, Analysis of a Recent OECD Report: Some Credible Facts Needed

Climate Change Finance, Analysis of a Recent OECD Report:
Some Credible Facts Needed
India raises the issue on a roadmap for USD 100 billion in climate change financing a year by 2020 and calls for more credible, accurate, and verifiable numbers on the true size of the mobilization of climate change finance commitments and flows from developed to developing countries: Shaktikanta Das, Secretary, DEA
During the recent Lima World Bank/IMF meetings, India had raised the issue on a roadmap for USD 100 billion in climate change financing a year by 2020. This is stated by ShriShaktikanta Das, Secretary, Department of Economic Affairs (DEA), Ministry of Financein his ‘Foreward’ to the Discussion Paper entitled “Climate Change Finance, Analysis of a Recent OECD Report: Some Credible Facts Needed” prepared by the Climate Change Finance Unit, Department of Economic Affairs, Ministry of Finance, Government of India. The Discussion/Review Paper is also attached here with for ready reference and record.

Shri Das has further stated in his aforesaid ‘Foreward’that India had also raised questions on the correctness of the recent OECD report---which claimed that significant progress had already been made. Secretary, Department of Economic Affairshas also stated that in the conclusion of their Review of OECD report, our Climate Change Finance Unit, Department of Economic Affairs, Ministry of Finance and its experts have mentioned that the OECD report appears to have overstated progress. The attached Discussion/Review paper suggests that much more work has to be done. Shri Das further mentioned that we need to establish more credible, accurate, and verifiable numbers on the true size of the mobilization of climate change finance commitments and flows from developed to developing countries.
http://pibphoto.nic.in/documents/rlink/…/nov/p2015112901.pdf

Every election is presidential

 

Elections are not won and lost due to major shifts in the core vote. It is the ‘non-core’ voter and the first generation voter, with no firm loyalty to aparty, who defines the final outcome.

Actor Shatrughan Sinha summed it up correctly when he said that it was a victory of the Bihari over the bahari (outsider) in the elections to the Bihar legislature. But, then, most State Assembly elections over the past two decades and more have been contests between local alternatives. The days of national leaders overpowering regional ones in State elections are long gone. Some recent exceptions prove the rule.

Sanjaya Baru

It is surprising, therefore, that Bharatiya Janata Party president Amit Shah and Prime Minister Narendra Modi chose to ignore this fact — that elections in parliamentary India have become presidential. After all, Mr. Modi’s own victory in Gujarat and New Delhi symbolised this reality.

Belated recognition
It appeared that there was a belated recognition of this shift in political sentiment when the BJP national leadership named Kiran Bedi the candidate for Delhi Chief Minister against Arvind Kejriwal. Her defeat only underscored the importance of credible local candidates. Mr. Kejriwal’s victory was his, not that of his party. Even a political scientist and psephologist like Yogendra Yadav did not want to concede this reality when he challenged the bossism of Mr. Kejriwal. But Mr. Kejriwal ran a presidential campaign to win an essentially mayoral election.

More than development or the caste and communal loyalties of voters, or the simple arithmetic of pre-election alliances, the Bihar verdict was shaped by the fact that the voters had to make a choice between local leaders and no one else in particular. Regional and caste-based parties may have initially been voted to power on the strength of their ideology and manifesto, but their fortunes have become increasingly linked to the popularity of their leaders.

True, the core support of any political party is composed of its loyalists, of those who share the party’s ideology and programme. But elections are not won and lost on the basis of the size of the core. It is the swing vote — the accretion to the core — that makes all the difference.

In 2009, while loyalists of the BJP and the Sonia Congress might have voted for their party of choice, the floating voter took a call on who he or she wished to see as the Prime Minister of India — Manmohan Singh or Lal Krishna Advani. Both the BJP and the Congress went into that election having named their prime ministerial candidates. The votes that made a difference were cast in favour of Dr. Singh.

In 2014, the voter opted for Narendra Modi over Rahul Gandhi. Both national parties ran presidential campaigns, seeking votes for their chosen or perceived candidate for the top job. What has been happening at the national level over the past decade and more has been happening at the State level for some time now, cutting across parties and States. Consider the record.

In the 2004 Lok Sabha elections, the victory of the Congress was defined by the impressive gains it made in Andhra Pradesh under the leadership of the late Y.S. Rajasekhara Reddy. It was Dr. Reddy’s sustained grassroots campaign that unseated the Telugu Desam supremo, Nara Chandrababu Naidu, and gave the Congress a decisive edge over the BJP. The National Democratic Alliance led by Atal Bihari Vajpayee lost also because in Tamil Nadu the Congress ally, M. Karunanidhi, ousted J. Jayalalithaa. Dr. Reddy repeated his performance in 2009 with his highly personalised campaign and helped Dr. Singh return to power.

In most other States where the Congress won the elections, the vote was as much for its chief ministerial candidate as it was for the party — Oommen Chandy in Kerala, Tarun Gogoi in Assam, Shiela Dikshit in Delhi and Siddaramaiah in Karnataka. The Karnataka voter punished the BJP because of B.S. Yeddyurappa’s tenure and rewarded Mr. Siddaramaiah.

All regional or caste-based parties have long approached the voter in the name of the leader. Which is at least one reason all of them have become family controlled parties. The phenomenon of ‘dynasty’ in Indian politics began with Indira Gandhi’s personalised campaign of 1980, managed by her younger son Sanjay. The natural consequence was the feudal succession that was staged after her death when Rajiv Gandhi was made party leader and Prime Minister. The leader’s family slowly took possession of the party.

Regional and caste-based parties may have initially been voted to power on the strength of their ideology and manifesto, but their fortunes have become increasingly linked to the popularity of their leaders.

In his recently published memoir, The Chinar Leaves, Indira loyalist Makhan Lal Fotedar reminds us that even as late as in the early 1980s, party leaders such as R. Venkataraman, P.V. Narasimha Rao, Pranab Mukherjee and even Madhavrao Scindia were viewed as potential prime ministerial candidates. Once the family domination of the Indian National Congress was complete, regional parties followed suit.

Thus, the Dravida Munnetra Kazhagam transformed itself from being a normal, ideology-based party to a party dominated by the leader’s family. The All India Anna Dravida Munnetra Kazhagam and the Telugu Desam Party, as indeed the many Congress breakaway groups, began as ‘leader-oriented’ parties rather than cadre-based parties. The Lohia Socialists of the north imitated these examples. Coming to power on the strength of an ideology and in pursuit of a cause, they all became ‘leader’ oriented.

Even in ideology-based parties like the BJP and the CPI(M), elections have been fought in the name of the leader with a mass appeal. In 1998 and 1999, the BJP’s Lok Sabha campaign revolved around the personality of Mr. Vajpayee. The turning point came, as BJP observers pointed out at the time, when the crowds came to hear only Mr. Vajpayee speak and thinned out when Mr. Advani rose to speak.

In Gujarat, Mr. Modi became the BJP’s face, as did Vasundhara Raje Scindia in Rajasthan, Shivraj Singh Chouhan in Madhya Pradesh and Raman Singh in Chhattisgarh. Mr. Modi’s attempt to secure control of his party in these States has been refuted by the assertion of State leaders. Mr. Modi’s success in Maharashtra and Haryana in ‘nominating’ State Chief Ministers after the elections were fought in the name of the party, a la Indira Gandhi and Rajiv Gandhi, may have encouraged him to overreach in Delhi. He failed to learn the lesson in time for Bihar.

The experience of the Left only underscores the point. In West Bengal, the CPI(M) was made invincible by the personality of the late Jyoti Basu. It was only when a dynamo like Mamata Banerjee arrived on the scene, and Basu was followed by a less charismatic figure, that the CPI(M) lost power. In Kerala, the victory of the Left Front in 2006 was defined by the personality of ‘Comrade VS.’ It remains to be seen what alternative the Left will present in West Bengal and Kerala to the popular incumbents — Mamata Banerjee and Oommen Chandy — in next year’s elections.

Many political analysts made the point in the 2012 State elections in Uttar Pradesh that the Congress would have repeated, or even improved upon, its 2009 Lok Sabha performance had the voters been given the choice of electing Rahul Gandhi their Chief Minister. In many ways, Mr. Modi repeated in Bihar the mistake Rahul made in U.P. — seeking votes for a party rather than an individual.

‘Winners’ preferred

Bihar shows that the era of centrally nominated Chief Ministers is over. Even national parties have to pick ‘winners’ now as CMs. Going forward, therefore, the Congress ought to know that victory in Assam would depend on whether the voters in Assam want more of Mr. Gogoi or would like to see him go.

All this is not to suggest that party loyalties and ideology do not matter. Of course, they do for a large majority of voters who remain loyal to their party. That forms a party’s core support base. But elections are not won and lost due to major shifts in the core. It is the ‘non-core’ voter and the first generation voter, with no firm loyalty to a party, who defines the final outcome.

The ‘floating’ voter opted for Manmohan Singh in 2009 and for Narendra Modi in 2014. The challenge for the prime ministerial candidates of 2019 will be to retain the loyalty of the core constituency while gaining new voters — both from rivals and from first generation voters. It is a race in which Mr. Modi still remains leagues ahead of all potential rivals, and there are so many of them among the self-made CMs around the country!

A well-functioning insolvency resolution framework is fundamental for dealing with business failures

From non-performing to performing

A well-functioning insolvency resolution framework is fundamental for dealing with business failures 

A well-functioning insolvency resolution framework is fundamental for dealing with business failures

The ministry of finance recently released the draft Insolvency and Bankruptcy Code (IBC), proposed by the Bankruptcy Law Reforms Committee. The government of India greeted this bill as among its biggest and most crucial reforms. To a person unconnected with finance, it may be unclear why this is important or what ails the current framework. A well-functioning insolvency resolution framework is fundamental for dealing with business failures that inevitably occur in any economy. Additionally, an effective insolvency resolution process is one tool, among others, for banks and other creditors to address low recovery rates.

This is particularly relevant for India where economic growth is contingent upon the financial health of the banking sector. Banks in India face acute problems of asset quality. Perceiving that laws did not sufficiently empower secured creditors to activate recovery by seizing security, the Recovery of Debts Due to Banks and Financial Institutions Act, 1993, and Securitization and Reconstruction of Financial Assets and Enforcement of Security Interest (SARFAESI) Act, 2002, were enacted to facilitate the enforcement of security by banks and financial institutions.

Asset reconstruction companies were constituted under SARFAESI to buy bad debts from banks and recover from defaulters. Domestic banks also have recourse to corporate debt restructuring and joint lenders forum mechanism to resolve stress in consortium loans.

None of these initiatives seems to have helped. Gross non-performing assets (NPAs) as percentage of total advances went up from 3.4% in March 2013 to 4.45% in March 2015. The picture is grimmer when volume of restructured assets is also considered in stressed advances. As a percentage of total advances, overall stressed advances increased from 9.2% to 10.9% between 2013 and 2015. Average recovery rate for secured debt is as low as 20%. One factor responsible for all this is a weak legal framework for resolving failure. Once debts go bad, creditors’ ability to realize value is predicated on a robust insolvency resolution mechanism.

Accumulation of bad debts in bank balance sheets has systemic risk implications for the entire economy. As capital gets tied up in provisioning for bad debts, banks get inhibited from extending fresh credit, slowing down the real sector. Absence of a well-functioning insolvency framework that protects creditors’ rights also thwarts the development of alternative lenders, such as corporate bond market. There are admittedly other issues systemic to the banking system and capital market that compound these problems. However, an insolvency law focused on preserving viable businesses as going concerns and liquidating unviable ones is the cornerstone of a mature financial system and India urgently needs one.

Aparna Ravi highlights in a paper titled The Indian insolvency regime in practice—an analysis of insolvency and debt recovery proceedings that the current framework in India is highly fragmented with decisions frequently stayed or overturned by judicial forums having overlapping jurisdiction. There is no clarity on whether the right of secured creditors initiating recovery under SARFAESI will prevail, or unsecured creditors initiating winding-up under the Companies Act or the company triggering proceedings under the Sick Industrial Companies (Special Provisions) Act, 1985, (SICA).

Substantive issues exist with even initiation of insolvency resolution or the process of winding up. SICA is triggered when more than half a company’s net worth has eroded. Board for Industrial & Financial Reconstruction (BIFR) and the high courts are reluctant to liquidate unviable companies. Ironically, the trigger for winding up a company is too low. The default is Rs.500. Courts, therefore, do a full hearing on merits at admission stage itself, limiting efficacy. Creditors, especially non-banks, do not have access to a mechanism to assess the viability of an enterprise and address the problem, without the threat of other proceedings initiated by the debtor or other creditors torpedoing them. Even when proceedings are triggered, debtor’s existing management retains control, thereby creating the risk of asset stripping.

Under SARFAESI, creditors are empowered to take over management of a company but only that part of the company connected to the secured asset. Since potential liability to creditors is high, this is rarely invoked. There is no corresponding provision for non-banks. There is also no linearity of proceedings. Under SICA, even if BIFR recommends liquidation, a reference is made to the high court, which would re-examine the recommendation and might even reverse it.

With the proposed IBC, the labyrinth of extant Indian laws dealing with corporate insolvency are being replaced by a single comprehensive law that (a) empowers all creditors—secured, unsecured, financial and operational to trigger resolution, (b) enables the resolution process to start at the earliest sign of financial distress, (c) provides a single forum overseeing all insolvency and liquidation proceedings, (d) enables a calm period where other proceedings do not derail existing ones, (e) replaces existing management during insolvency proceedings while keeping the enterprise as a going concern, (f) offers a finite time limit within which debtor’s viability can be assessed and (g) under bankruptcy, lays out a linear liquidation mechanism.

The proposed framework strengthens creditors, without discrimination. While this will not necessarily be a magic bullet that will make the mass of NPAs vanish from bank balance sheets, it can facilitate better recovery and faster closure of troubled assets. IBC will prevent new loans from getting added to existing stock of NPAs. It will aid development of alternative debt securities, spread the risk of corporate failure across larger sets of creditors, and lead to the double benefit of lower systemic risk as well as deeper debt finance for a rapidly growing economy of entrepreneurs.