The Compound Eye

Policy Focus

National Health Bill 2009; Public Health Bill, 2017

In the current pandemic climate, we often hear of the archaic Epidemics Act of 1897 as a vehicle for the policy response. But in the past couple of decades, two other Bills have been proposed to govern public health in the country. Both Bills were proposed by the Ministry of Health and Family Welfare .While neither Bills saw the light of day, they have interesting differences in the approach to public health governance. 

1. National Health Bill, 2009

A Bill to provide for protection and fulfilment of rights in relation to health and wellbeing, health equity and justice, including those related to all the underlying determinants of health as well as health care; and for achieving the goal of health for all; and for matters connected therewith or incidental thereto.

This Bill outlined core obligations of the government in facilitating health outcomes - obligations such as ensuring access to health services, nutritious food, safe drinking water and sanitation. It lays emphasis on rights of individuals and the collective population, with a clear point on rights of healthcare providers to be treated with dignity and respect. 

Further the Bill constituted the National Health Board with members sourced from across various government ministries and tasked with amongst other things: formulating policy, laying down standards for various health-related procedures and setting up a National Health Information System. 

The Bill also delineates the obligations of a State and devolves power down to the levels of Gram Panchayat, block, and district.

It also mandates the formation of forums as a redressal mechanism for health rights. 

The Bill provides a holistic view of public health with an emphasis on improving health outcomes and not just fighting infectious outbreaks.  

2. Public Health Bill, 2017

The Public Health (Prevention, Control and Management of Epidemics, Bio-terrorism and Disasters) Act, 2017 was proposed by the DGHS to replace the Epidemics Act, 1897. The Bill empowers state administration to take a slew of measures to contain a public health emergency. These measures include some of the steps we are currently seen in action: 

1. quarantine or restrict the movement of any person or class of persons 

2. isolate any person or class of persons infected or suffering from any such disease 

3. authorize any official or person to enter and inspect, without prior notice, any premises where public health emergency has either occurred or is likely to occur.

4. Direct any clinical establishment to admit, isolate and manage cases arising out of public health emergencies and to furnish any report or return in such form and in such manner as may be prescribed and to provide such services as directed

5. disseminate such information as deemed appropriate and take such other appropriate measures in such circumstances including closure of markets, educational and other institutions and social distancing.

It further outlines penalties for violation of provisions of the Bill: 

Clause 5. (1) Any contravention due to negligence of any provisions of this Act or any Rule or Order made or issued thereunder shall be punishable with a fine not exceeding ten thousand rupees for the first contravention and not exceeding twenty five thousand for repeat contravention.

(2) Any willful or intentional contravention of any provisions of this Act or any Rule or Order made or issued thereunder will be a cognizable offence punishable with a fine which shall not exceed fifty thousand rupees for first contravention and not exceed one lakh rupees for repeat contravention and may also lead to punishment by imprisonment which may extend upto a period of two years.

The Compound Take: The two bills tackle fundamentally different issues in public health governance. The National Health Bill espouses the role for better health outcomes while the Public Health Bill is more focussed on tackling pandemics, and particularly threats from biowarfare. 

The National Health Bill assigns duties to the government and devolves power to local governments to take actions to enable public health. The Public Health Bill on the other hand provides for powers for the state and union government. The Bill leaves out crucial bits of decision-making - what constitutes a public health emergency and mechanism to assign one, role for individual consent to some of the more invasive measures and a sunset clause for when would the provisions become inapplicable. 

With the experience of COVID-19, it is evident that a restructuring of public health governance in India is essential. But this restructuring also has to be evidence-based and not merely a tool to allow governments to behave in any way they want.  

It's Controversial

The Funding of Science: 

A preprint published on MedRxiv argued via seroprevalance studies that COVID-19 infection was much more widespread in the population of Sant Clara than previously thought. They deduced that since the infected population was greater, true mortality rates for COVID-19 were much lesser (0.12%–0.2%) than projected (~5%). 

Commentators on the website were quick to point flaws in the methods used in the paper. But more concerning issues with the paper were revealed later: 

1. The Authors did not disclose funding for the project. One of key funders was David Neeleman, founder of JetBlue Airways and a vocal critic of lockdowns as a mechanism to contain the disease. There is an obvious conflict of interest here: Mr Neeleman would benefit from flight operations resuming to pre-COVID levels and the reduced mortality threat as assessed by the study could aid in policy changes to that effect. 

2. A whistleblower complaint filed with Stanford also suggests that the authors disregarded warnings raised by two Stanford professors who were part of study and looking at the accuracy of the antibody test. 

Stanford is looking into the allegations and the parties concerned have denied any foul play. 

Science in India

Hydroxychloroquine: Good or Bad? 

The WHO has suspended testing HCQ (sometimes also referred to as "Trump's Drug" in popular media) based on safety concerns. The century old anti-malarial drug has been demonstrated to cause decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19.

ICMR however, continues recommending the drug as a prophylactic against COVID-19. In a statement. ICMR DG Balram Bhargava said, "We found there were no major side affects except for nausea, vomiting, palpitation occasionally. Hence in our advisory we have recommended that it should be continued for prophylaxis as there is no harm. There may be benefit."

ICMR has expanded the use of HCQ to all frontline workers. Initially it was advised for healthcare workers. 

There are two things to consider here: the settings for the two studies are different, one is preventive and the other is for treatment. But the ICMR study is an observational one and no data has been published. 

While getting peer-reviewed papers is time-consuming. ICMR should consider putting its data out at least in a preprint forum. If indeed HCQ is of help as a prophylactic, healthcare workers around the world need to know.  

Meanwhile, Things Just Got Weird:

Picky parents lead to picky children: A study has found that lower levels of picky eating in children were associated with parents imposing few restrictions on foods and a lack of pressure to eat. A senior author on the paper advised parents not to force kids to clean their plate or bribe children with food. 

Neanderthal gene linked to increased fertility: A study has linked progesterone receptor gene, inherited from Neanderthals, with increased fertility in women. And we thought we had left our Neanderthal past behind. They seem to be still influencing our future! 

Antarctic penguins release laughing gas in their feces: And no insignificant amount according to statements given by Bo Elberling, author of the research. There was enough emitted nitrous, in fact, that one researcher went "completely cuckoo," while "nosing about in guano for several hours," Elberling said. The fun in experimental science. 

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Shambhavi Naik Research Fellow
shambhavi@takshashila.org.in
080 4372 5304

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