By Dr Arun Mitra
The declaration on health at the G20 summit has highlighted several objectives. These include Food security; Pandemic preparedness; equitable access to vaccines, therapeutics, diagnostics, and other medical countermeasures. Concern was shown for growing Antimicrobial Resistance (AMR), Mental health problems and the impact of climate change on health. The declaration also gives importance to the potential role of evidence-based Traditional and Complementary Medicine. The summit took up serious debate over the increasing use of narcotics around the world. In this background the declaration emphasized that to achieve better health of the citizens, the global health architecture is to be strengthened.
Since nutrition is the basic requirement for health, it is important to gauge the status of nutrition around the world and in our country. As many as 828 million people were undernourished in 2021 globally. Poverty, inequality, inadequate governance, poor infrastructure, and low agricultural productivity contribute to chronic hunger and vulnerability. South of the Sahara in Africa and South Asia are the regions with the highest hunger levels and are most vulnerable to future shocks and crises.
According to Bhavani R V , the UN Food and Agriculture Organisation’s (FAO) report on ‘Food Security and nutrition in the world’ puts the number of people undernourished in India in 2019-21at 224.3 million i.e., 16% of 1.4 billion population. India is 107 among 121 countries in the Global Hunger Index (GHI). The countries which fall below this are Sierra Leone, Uganda, Djibouti, Congo Rep., Sudan, Afghanistan, Zimbabwe, Timor-leste, Haiti, Liberia, Zambia, Madagascar, Chad, Yemen Rep. and Central African Republic.
The countries of the global south need food security for their citizens, but under the neoliberal economic policies and the diktats of the World Trade Organisation (WTO), many countries had to dismantle programs for food security. This has adversely affected nutritional status of the people. Situation is so pathetic that in India 800 million people were provided with 5 Kg of grain and one Kilo of cereals. This may fill their stomach but lacks the micro nutrients essential for physical and mental growth.
Equity in the supply of medicines, vaccines and other countermeasures has been a big challenge. The big vaccine producing companies exploited the situation during COVID Pandemic. They even forced the small counties to mortgage properties of their embassies as a guarantee for the supply of vaccines.
These vaccine making companies made huge profits at the cost of human needs. Pfizer made nearly $37bn (£27bn) in sales from its Covid-19 vaccine in 2021– making it one of the most lucrative products in history. The US drug maker’s overall revenues in 2021 doubled to $81.3bn says Julia Kollewe in the article published in The Guardian on 8th February 2022.
The Indian government’s free-market approach to vaccine distribution too has ensured profit to the companies over lives of the people. Aparna Gopalan in an article in The Intercept published on 19th June 2021 has pointed out that for each dose sold to private hospitals, Serum made profits of up to 2,000 % and Bharat Biotech up to 4,000 percent, what might be considered as “super profits”. In India, 38 new billionaires were minted in the first year of the pandemic, while the combined wealth of the country’s 140 billionaires went up by 90.4 %.
In the G20 there is ample opportunity for India to highlight the health problems facing the developing world in general and India in particular. This is also time to set the direction for global equity in health care.
As per the WHO there were 6,943,390 deaths globally till 14th June 2023. Unofficial figures could be even higher! During the Pandemic, the problem of unavailability of drugs, equipment and vaccines has been very acute. Smaller countries that lacked resources and knowhow to make vaccines or drugs suffered the most.
Developing countries which have so far been faced with pressure of communicable diseases, are now feeling the burden of the non-communicable diseases as well. India is hub to both communicable and non-communicable diseases. According to Global TB Report 2022 released by the World Health Organisation (WHO) there were 505000 deaths due to Tuberculosis in India in 2021 which comes to 1383 deaths per day.
The Non Communicable Diseases (NCD) too are at alarming level in India. Indian Council of Medical Research–India, Diabetes (ICMR-INDIAB) study, found prevalence of Diabetes among 11.4 per cent population. The new study published in The Lancet puts the prevalence of hypertension at 35.5 per cent; general obesity at 39.5 per cent and dyslipidemia (lipid imbalance which can cause heart diseases) at 81.2 per cent. One in every three Indians has hypertension and two in five are obese.
Based on the above it is important to envisage the steps required to bring down the disease burden. Disease prevention and control programmes have to be designed accordingly.
It is important to develop policies for inclusive growth which ensure jobs with proper remuneration and means of livelihood to all. Purchasing capacity of the people has to be improved to meet the nutritional requirements. To utter dismay the government has fixed floor level wage at Rs.178/- per day or Rs.5340/- per month in the wage code bill approved by the union cabinet. Trade unions have however demanded Rs.26000/- as the minimum wage to ensure healthy living.
To promote equity it is important to make necessary changes in the WTO. The intellectual Property Rights and the Patent laws at present benefit the big companies. Whole issue whether the drugs should be patented has to be reviewed. The founder of ORS, Dr Dilip Mahalanabis never patented his product saying that this is for public good and not for making profits. Will the companies and the governments follow suit? Many public health experts agree that a temporary waiver of the World Trade Organization’s Trade-Related Aspects of Intellectual Property Rights, or TRIPS, provision is a necessary first step toward increasing vaccine production and access and creating a more competitive pharmaceutical industry worldwide. Drug pricing policy has to be streamlined effectively to check exorbitant profits.
With Africa inducted into the G20 there is a good chance to develop communication between India, Africa nations, Argentina and Brazil to forcefully take up the matter of bringing changes in the TRIPS. The developing countries should exchange the technical knowhow to check mate the pressures from the developed world. The clause of compulsory licensing in the WTO should be used more frequently.
Finance allocation to health in our country has to be increased substantially. It has been hovering around 1.2% of the GDP as against the minimum required of 6%. Allocation to R&D in health has to be increased.
There is need to revive the manufacture of drugs, vaccines and medical equipment in the public sector so as to produce them at lower cost with quality control.
Health education of the people on scientific grounds is important so that they do not fall prey to the unscientific, non-evidence based treatment modalities like the use of Gau Mutra (Cow Urine) or Cow Dung.
To ensure equitable health services it is important to take bold initiatives. State should own the responsibility of healthcare to its citizens. Insurance based healthcare benefits only the insurance companies. Senior citizens are worst effected in such cases as they are unable to pay hefty premiums.
India can play a big role if our approach is not limited to mere electoral gimmickry. Time only will tell whether the Indian government stands up to its commitment. The civil society however should continue to put pressure. (IPA Service)