Editorial 1: Numbers game
The context
- The latest State of World Population Report, 2023, an authoritative analysis by the UN, has officially stamped what has been known for a while: that India will become the most populous country in mid 2023, surpassing China’s 142.5 crore by about 3 million.
Drivers of the demographic shift
Mortality and Fertility:
- Crude Death Rate (CDR): The CDR — the number of persons dying per year per 1,000 population
- Life Expectancy at Birth: the overall mortality level of a population.
- Total Fertility Rate (TFR): the number of babies an average woman bears over her lifetime
History of India’s population trends
- In the ‘socialist’ era, the growing population was a convenient excuse to explain India’s poverty and the state’s inability to improve average standards of living. These seeded deranged ‘sterilisation’ programmes that violently compromised dignity and freedom.
- Globalisation and the opening up of the economy in the 1990s saw India as a vast, untapped market, with ‘fortunes at the bottom of the pyramid’ that framed population as an advantage.
Positive implications on India
- India will continue to have one of the world’s youngest populations until 2030. Currently, in a demographic window of opportunity – a “youth bulge,” will last until 2025 thus, prospecting to reap the demographic dividend – share of the working-age population will peak at 57% towards the mid-2030s.
- More working-age population means more tax revenues and thereby more saving potential which will increase growth rate. A relatively lower number of those needing care such as the elderly and young children.
Challenges
- Despite overtaking China, India’s population growth is slowing. The National Family Health Survey (NFHS-5) reported in 2021 that the total fertility rate had, for the first time, dipped to below the replacement level fertility (RLF) of 2.1
- Having the most people on the planet could prove to be a big negative for India unless it can provide food, education, housing, health services and jobs to its people.
- The effect of overpopulation is serious enough on the environment, and on top of that, overpopulation can also affect the economy of a country.
- Can lead to exploitation of natural sources because more the people, the more the usage.
- India’s income rate gets viciously affected by overpopulation. Not only does the income drop, but it also fails to recover from the failure.
- The number of jobs, employment sources, and scope of expansion in different sectors are not able to keep pace with the country’s overpopulation or increase in numbers.
- Earlier population debates did not account for the climate crisis and the fact that many migrants, afteryears of skilled and unskilled labour abroad, were becoming permanent immigrants.
- Over 16 lakh Indians have renounced citizenship since 2011, including 2 lakh people in 2022, the highest during the period.
Conclusion
- While the pendulum of opinion regarding population has swung from ‘disadvantage’ to ‘advantage’ in national discourse, it is relevant to analyse the question while factoring in newer developments. Economic opportunity, more than national pride, shapes the working population’s aspiration and, in its absence, a naturally decelerating population will be of limited advantage.
Editorial 2: A new edge to the fight against tuberculosis
Context
- At the One World TB Summit in Varanasi, Uttar Pradesh in March 2023, Prime Minister instilled fresh energy to the global tuberculosis (TB) elimination response and reiterated India’s commitment to spearhead this effort.
About Tuberculosis
- TB is caused by a bacterium called Mycobacterium tuberculosis, belonging to the Mycobacteriaceae family.
- In humans, TB most commonly affects the lungs (pulmonary TB), but it can also affect other organs (extra-pulmonary TB).
- It can spread from person to person through the air.
- TB is preventable and curable - around 85% of people who develop the disease can be successfully treated with a 4/6-month drug regimen.
India‘s progress since the past years
- With 28% cases, India was among the 8 countries accounting for more than two-third of the total TB patients’ count. As per World Tuberculosis Report 2022 released by World Health Organisation (WHO) there has been an 18% decline which is better than the global average of 11%.
Government initiatives:
- India’s National TB Elimination Programme, or the NTEP has introduced several measures to find, notify and treat TB cases
- Ni-kshay Mitra is a component of this initiative that ensures additional diagnostic, nutritional, and vocational support to those on TB treatment.
- India conducts its own National TB Prevalence Survey to assess the true TB burden in the country which is the world’s largest such survey ever conducted.
- The Union Ministry for Health and Family Welfare also launched the ‘TB Harega Desh Jeetega Campaign’, along with the Survey.
- Currently, two vaccines VPM (Vakzine Projekt Management) 1002 and MIP (Mycobacterium Indicus Pranii) have been developed and identified for TB which are under clinical trials.
The challenges
- Lack of widespread awareness about the disease.
- Lack of access to quality care.
- Rise in Drug-Resistant TB (MDR, XDR and TDR).
- Disruptions due to Covid-19.
- Underreporting and underdiagnosis.
- Decline in Diagnosis and Expenditure.
Way forward:
- Need of introducing disruptive approaches and new tools to change the way we prevent, diagnose, and treat.
- Engaging PPP models : The Mission COVID Suraksha programme to develop vaccines was a good example of a public private partnership.
- Establishment of centers of excellence will facilitate collaboration between Indian Council of Medical Research laboratories and the private sector.
- Strengthen and expand research and development efforts for TB and develop new tools that will help India to meet the End TB targets.
- Prioritize TB vaccine trials.
- We do have the Bacille Calmette Guérin (BCG) vaccine for TB, but it does not adequately protect adolescents and adults who are at the highest risk for developing and spreading TB.
- While COVID19 vaccines were developed within a year, we must prioritize and pick up the pace to find an effective TB vaccine.
- Testing for, and diagnosing TB needs to become more accessible and affordable so much so that each person with suggestive symptoms can test and get results within minutes, at minimal costs. This can be achieved through
- Point of Care Tests (POCTs).
- New innovations such as nasal and tongue swab based.
- Handheld digital x-ray machines (with artificial intelligence based software) can be taken to villages and urban settlements to screen individuals.
- Development and introduction of new therapeutic molecules can play a crucial role in the long run. Shorter, safer, and more effective regimens like the 1HP regimen for latent TB infections, the four month regimen (HPZM) for drug susceptible TB, and the six month regimen (BPaL/M) for drug resistant TB.
Conclusion
- If we could overcome COVID¬19 even with innumerable challenges, by drawing upon the innate human spirit to adapt, learn, experiment, and innovate, then we can do it to end TB too.