1. More, and for more: Boosters for the aged and vaccines for children can help India combat the virus

• Page 6/Editorial
• GS 2: Health

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Context: Prime Minister Narendra Modi announced on Christmas night that ‘precaution’ or third doses of vaccine would be available from January 10 for health-care, frontline workers, and those over 60 with co-morbidities on their doctors’ advice. Vaccines would also be available for those in the 15-18 age group from January 3.

Case for booster shots to prepare for omicron:

2. Hospitalization is needed only in case of comorbidities: Since the emergence of Omicron, there has been a clamour among senior citizens for booster shots.
3. Omicron shows Signs of impact on young population: There are close to 44 crore Indians below 18, a third of whom are 12-17 years old.

 The Problem of scalability:

4. The announcement, however, was nearly simultaneous with another significant development: of Covaxin being approved by the Drugs Controller General of India for use in those over 12 years. This would make it the second vaccine after ZyCov-D (which has still to hit the market) to be approved in the 12-plus years category.
5. Less number of Covaxin than covishield: The experience with Covaxin has shown that despite approval on the same day as Covishield this January, it has been extremely slow to scale up, with the two-dose vaccine only accounting for about 10% of the nearly 141 crore doses that have been administered so far.
6. Production Problem of ZyCov-D: Given that ZyCov-D’s output is unknown, it is unclear if it will be practically available in January 2022.

Questions on Procedure of approval:

7. Prime Minister’s impromptu announcement is also puzzling. For more than a month, a National Technical Advisory Group on Immunisation in India committee has reportedly been weighing the pros and cons of approving vaccines for children and senior citizens. Just a day before Mr. Modi’s announcement, the ICMR head had said that this matter was still under debate in India’s medico-bureaucratic hierarchy.
8. The extent to which antibody levels waxed or waned following immunisation, whether booster doses of the same vaccine would be effective, and whether Covaxin and Covishield were differentially protective against Omicron.
9. On the latter point, it was said that the ICMR awaited data as the Omicron variant had not yet been artificially grown in its labs.
10. The logic of ’15 above sub-group’: Technical clearance for vaccines is for those 12 and above, but Mr. Modi announced these will be for those above 15 years. It is not clear if there is evidence that this group of sub-adults is more vulnerable. India’s health administration should be transparent with the data at hand and not let itself be in thrall of political calculations.

Vaccination pace in India:

11. About 90% of adults have got one dose and over 70% Indians have been exposed to the virus in the past 20 months, there are 40% adults who have not got a second shot.
12. The demand for first shots is nosediving and with private hospitals claiming excess stocks, it is very likely that the economic elite of India and their adolescents will mop up available stocks.

Conclusion: The government needs to be more transparent about the decisions that are taken behind to closed doors to instill more confidence on issues like vaccination.

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2. The elderly are assets, not dependents: Proof of a truly developed country lies in the way it not only nurtures its young but also cares for its elders, equally

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Context: In the past few decades, concerns about “population explosion” have given way to joy about a “demographic dividend”.  The “Asian Tigers” — countries such as South Korea, Taiwan, Hong Kong and Singapore — as also China, have exemplified the benefits of demographic dividends.

Benefits of larger young population:

• Lower dependency ratio: It is expected to give a push to economic growth due to the lower dependency ratio which results from having a larger proportion of the population in the working-age group.
• Innovation & entrepreneurship: The larger youth population is also expected to give an impetus to innovation and entrepreneurship.

Therefore focus is on young – Risks against demographic dividend:

• Poor health, like inadequate education, could well nullify the demographic advantage. Of concern is data from the latest National Family Health Survey (NFHS)-5, which indicates that while much progress has been made, the metrics for infant and child health continue to be dismal, with some being even lower than what they were five years ago.
• Other factors – Poor education, poverty etc.

Focus is also needed on the Elderly: 

• Aging of population: Life expectancy in India has risen from 50 (1970-75) to 70 years (2014-18);
• The number of elders (those over 60 years) is already 137 million, and expected to increase by 40% to 195 million in 2031, and 300 million by 2050.
• They are not merely dependents: While one perspective would look at them as dependents (and, therefore, a drag on the economy), a rather different view would look at them as a potential asset: a massive resource of experienced, knowledgeable people. Converting them from dependents to productive members of society depends on two primary factors: their health and their capabilities.

Changing health-care needs

• More medical attention of a diverse range: As per the first ever Longitudinal Ageing Study in India (LASI), 11% of the elderly suffer from at least one form of impairment (locomotor, mental, visual and hearing).
• Non-communicable diseases (NCDs): It is estimated that 58 lakh Indians die from NCDs in India annually, and cardiovascular disease (CVD) prevalence is estimated to be 34% amongst 60-74 year olds, rising to 37% in those above 75 years.
• Growth rate of elders far exceeds that of the young, perhaps the biggest challenge that the country would face is to provide a range of quality, affordable, and accessible health and care services to the elderly.
• An Array of specialised medical services at home including tele or home consultations, physiotherapy and rehabilitation services, mental health counselling and treatment, as well as pharmaceutical and diagnostic services. These needs are particularly evident now, with elders being advised to stay indoor as a precaution against the novel coronavirus epidemic.
• Mental and emotional problems

Challenges in this regard:

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• Poor Health quality status in India: As per the 2016 Healthcare Access and Quality Index (HAQ), India improved its HAQ score from 24.7 in 1990 to 41.2 in 2016. However, we still are significantly below the global average of 54 points, ranking at the spot of 145 out of 195 countries. The low HAQ worsens even further in smaller cities and rural areas where basic quality health-care services are very inadequate.
• Socio-cultural Factors such as familial neglect, low education levels, socio-cultural beliefs and stigma, low trust on institutionalised health-care services and affordability exacerbate the situation for the elders. .
• Inequity in health–care access compounds the problems for the elderly, who are already, physically, financially and at times psychologically restricted in understanding, responding to, and seeking medical care for various ailments. Consequently, most of them live their years in neglect.
• Socio-economic Factors:  An overwhelming proportion of the elders are from the lower socio-economic strata (including many who are destitute). They are unable to afford the cost of health care and slip into ever poorer health. The vicious cycle of poor health and unaffordable health costs is further accelerated by their inability to earn a livelihood.
• Dearth of Health workers: Presently, India has a major deficit in infrastructure and skilled medical care resources, with 1.3 hospital beds, 0.65 physicians, and 1.3 nurses for every 1,000 people.
• Lack of digital literacy: limits the availability of services.

Government schemes are inadequate:

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• Poor Insurance coverage: Despite Ayushman Bharat, the Government’s health insurance scheme for the deprived, and private health insurance, a NITI Aayog report indicates that 400 million Indians do not have any financial cover for health expenses. One can be sure that a very large number of elders are among the uncovered.
• Poor pension coverage: Both the Centre and States have pension schemes for the elders, but these provide but a pittance — as low as ₹350 to ₹400 a month in some States. Even this is not universal.
• Geriatric care: A 2007 law requires States to ensure earmarked facilities for elders in every district hospital, headed by a doctor with experience in geriatric care. Yet, a status report filed by the Government in the Supreme Court of India in 2019 stated that 16 States and Union Territories (‘of 35’) did not have a single ward/bed dedicated to elders.

Way Forward – Opportunities in challenges

•  The success of the COVID-19 vaccination strategy gives hope: a seniors-first approach led to over 73% of elderly population receiving at least one dose and around 40% being doubly vaccinated by October 2021.
• Reimagine health-care policy for the next few decades: As senior citizens require the most diverse array of health-care services, the creation of adequate services for them will benefit all other age-groups.
• Legislating pro-elderly health care and insurance policies,
• Rapidly increase the public health-care spending, and invest heavily in the creation of well-equipped and staffed medical care facilities and home health-care and rehabilitation services.
• Adding healthcare workers: Over the next decade, we have the potential to add more than 3 million beds, 1.54 million doctors and 2.4 million nurses.
• Accelerate implementation of programmes such as the National Programme for Health Care of the Elderly (NPHCE). The Ayushman Bharat and PM-JAY ecosystems need to be further expanded and similar, special health-care coverage schemes and services need to be created for senior citizens from the lower economic strata. The National Digital Health Mission has tremendous potential to expand medical consultations into the interiors of the country. However, this requires a digital literacy campaign for senior citizens.

Conclusion: These essential steps will help to convert elders into a massive resource for socio-cultural and economic development, giving an altogether different perspective to “demographic dividend”. After all, the proof of a truly evolved and caring nation lies in the way it not only nurtures its young but also how it cares for its aging population.