UN Security Council (UNSC) reform

Why in the News?

The recently ongoing General Assembly session of the UNSC saw voices for reform of the institution dominated by the political strategies of only five countries can called for reforms of the council.

Call for UNSC reform:

1. It was announced that the Security Council reform must be accomplished in time for the 50th anniversary of the world organisation in 1995, but failed even after 75^th anniversary of the organisation.
2. The five permanent members (P5) (China, France, Russia, the United Kingdom, and the United States) enjoy veto powers over any Council resolution or decision, merely by virtue of having won a war 76 years ago. 

Agreement on diagnosis & not on prescription:

1. Agreed diagnosis:
   1. Security Council reflects the geopolitical realities of 1945 and not of today.
   2. Poor representation: Out of 193 member-states of the UN, and only 15 members of the Council (fewer than 8%) have membership in the UNSC. This comes after amendment to original Charter was in 1965 that expanded membership from 11 members to 15.
   3. Undue weightage to the balance of power
      1. For instance, Europe (excluding Russia), which accounts for only 5% of the world’s population, still controls 33% of the seats in any given year.
   4. Unjust for countries such as Japan and Germany whose financial contributions to the UN outweigh those of four of the P5 members 
      1. Japan and Germany are the second and third largest contributors to the UN budget for decades, but syill mentioned as ‘enemy states’ in the United Nations Charter.
      2. India, given its huge population size, share of the world economy, or contributions in kind to the UN (peacekeeping operations) has not been given an opportunity by the organisation.

Stances by countries

1. Small countries which constitute more than 50% the UN’s membership compete only occasionally for a 2-year non-permanent seat on the Council, as they accept the reality that reforms will not benefit them.
2. The medium-sized and large countries are for the reform of the membership of the Security Council as they wanted to break free of their current second-rank status in the world body.
3. Japan, Germany, Brazil and India have been demanding permanent membership in the UNSC.
4. US has endorsed increasing the number of both permanent and non-permanent representatives, with permanent seats also to Africa [and] Latin America and the Caribbean.

Why bringing reforms in the UNSC is difficult?

1. Bar to amending the UN Charter has been set high
   1. It requires two-thirds majority of the overall membership (129 of the 193 states in the General Assembly) followed by ratification of two-thirds of the member states for bringing an amendment to the UN charter.
   2. Any opposition by any of the existing permanent five can halt the amendment procedure.
2. Obstacles that remain:
   1. Divergent member state positions on the acceptable size and terms of any expansion
   2. Disagreement over current veto provisions and their potential extension to any new permanent members
   3. Growing uncertainties whether just expansion of membership shall improve its functioning.
   4. Current trend of intensified geopolitical rivalry and deepening political polarization have made the prospects for updating the council appear dull.

The world body- UNSC has failed:

1. It has failed to act on Russia’s unprovoked invasion of Ukraine.
2. Russia has resorted to use veto to block resolutions on Ukraine, Mali, Syria and North Korea. 
3. The west has used such obstructionism to halt reforms in financial institutions established at Bretton Woods in 1944, the World Bank and the International Monetary Fund.

Role of structural inequalities in the incidence of hypertension

Why in the News?

September 29 was observed as the World Heart Day to raise awareness about prevention, detection and treatment of cardiovascular diseases (CVD) and promote heart-healthy lifestyles.

Prevalence of Hypertension in India:

1. National Family Health Survey-5 (2019–2021) revealed that 18.3% of the country’s population has hypertension (high blood pressure).
2. The 2017-18 National NCD Monitoring Survey (NNMS) conducted by ICMR among the 18-69 years age group revealed a higher rate of 28.5%.
3. Both the survey indicates
   1. Low levels of awareness, treatment, and control of hypertension
   2. a yawning gap between awareness and treatment.
4. Only 28% of those with hypertension were aware of it and only 52% of those aware were actually being treated.
5. People with higher levels of education and better-paying jobs had a higher probability of having their BP measured and hence diagnosed early.
6. People living in south India had a nearly two-and-a-half times probability of having their BP measured, an indicator of stronger health systems.
7. Only 27.9 % of those detected with hypertension were aware of their disease status, 14.5 % were under treatment for hypertension and 12.6% had their BP under control.
8. Only 21% accessed treatment from a public facility

Reframing the structural inequalities:

1. The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), 2010:
   1. Implemented in all states since March 2016.
   2. The programme is primarily limited to screening and treatment and is also part of the Comprehensive Primary Health Care (CPHC) package.
2. 2018 Astana Declaration on Universal Healthcare and SDGs are a reaffirmation of commitment to the primary healthcare approach. Universal Healthcare’s core functions included:
   1. Service provision
   2. Multisectoral action
   3. Empowerment of citizens. 
   4. Governments must commit more resources to primary health care,
   5. Implementing interventions to retain the rural health workforce,
   6. Training frontline health workers to deliver core health interventions
   7. Engaging them in multi sectoral collaborations.
3. WHO’s Commission on Social Determinants of Health (CSDH) provides credible evidence to show that so-called lifestyle risk factors are not really outcomes of choices, but compromises.
   1. Therefore, socioeconomic influences on CVD  has to be focused that operates across the lifespan of an individual, that includes:
      1. Low birth weight
      2. Growth retardation
      3. Educational and environmental factors
      4. Job stresses in adult life and inadequate medical care, especially for the elderly.

India and the Palestinians

Why in the News?

India has expressed support to Israel stating that “people of India stand in solidarity with Israel in this difficult hour”, soon after the Hamas attack on Israel.

Why was India’s diplomatic policy leaned towards Palestine in the initial years?

1. India voted against UN Resolution 181 (II) in 1947, which partitioned Mandatory Palestine between Jews and Palestinian Arabs.
2. Prime Minister Jawaharlal Nehru preferred a federal state instead, with Arabs and Jews enjoying the widest possible autonomy, with a special status for Jerusalem.
3. Though India was deeply sympathetic towards the Jewish people for the historical persecution they faced, it was opposed to the creation of a Jewish state in Palestine because it would be unjust towards the 600,000 Arabs who already lived there. 
4. After the State of Israel came into existence, a couple of factors coloured India’s perspective. 
   1. India recognized Israel in 1950, but it did not establish diplomatic relations until 1992.
   2. India was sympathetic towards the Arabs and sensitive to their opinion as India faced partition and had a sizable Muslim population. 
   3. Pakistan was firmly in support of Palestine, and India had to match that stance.

Did establishment of diplomatic relations with Israel alter India’s support for the Palestinians?

1. India’s reluctance to establish diplomatic relations with Israel until 1992 was due to Cold War dynamics- Americans, were firmly behind Israel, and thus the Soviets had come out in support of the Arabs.
2. India, though non-aligned had inclination towards Soviet and so continued with its pro-Palestine stance.
3. After the cold war, India took an extremely bold decision to establish diplomatic relations with Israel, without caring about the fallout with the Arab countries.
4. However, India’s principled policy of backing the Palestinian cause was not abandoned.
5. Thus, India based on its national interest turned out a policy of maintaining good relations with Israel as well as keeping up support for Palestine and further developing relations with the Arab world.

Has India of late embraced Israel at the expense of the Palestinians. Why?

1. India is closer today to Israel than ever before with close economic relationship, especially in the defence sector, where India is one of Israel’s biggest clients.
2. With regard to Palestine, India has toned down its voice of support especially in fora such as the United Nations, in the recent years.
3. A feeling of India’s pro-Palestine stance over the years has not yielded dividends in terms of national interest. Palestine has often offered unqualified support to Pakistan on the issue of Kashmir.
4. However, India’s formal position remains unchanged i.e., the two-state solution, with Israel and Palestine living side by side as good neighbours. 
5. Prime Minister Narendra Modi visited Ramallah in the West Bank in 2018, becoming the first Indian PM to do so.

Should India worry about a backlash to its pro-Israel stance in the current escalation?

1. Regimes in Arab countries have lost interest in the Palestinian cause.
2. Countries such as Saudi Arabia want to normalise relations with Israel.
3. While the Hamas attack will bring back the issue of Palestine in conversations on the Arab table, it is unlikely to affect India’s relationship with these countries.

Concerns about govt.’s fact check unit

Why in the News?

Recently, the Bombay High Court has reserved its verdict relating to challenging of the constitutionality of the Information Technology (Intermediary Guidelines and Digital Media Ethics Code) Amendment Rules, 2023 (IT Rules).

IT Rules, 2023:

1. The Rules permit a Fact Check Unit (FCU) of the Union Government to identify “fake or false or misleading” online content “related to the business of the Central Government” and require its removal on demand.
2. This was brought in through 2023 IT Rules which amended the 2021 IT rules.
3. Changes to Rule 3(1)(b)(v) of the IT Rules, 2021 which deals with responsibilities of intermediaries.
   1. The intermediaries have to make “reasonable efforts” to ensure that users do not “host, display, upload, modify, publish, transmit, store, update, or share any information” which is “identified as fake or false or misleading by a fact check unit of the Central government” in respect of “any business of the Central government.”
   2. Non-compliance with the above provision can attract risk of losing the safe harbour protection provided under Section 79 of the IT Act, 2000 to intermediaries.
   3. The safe harbour safeguard exempts intermediaries from liability for any third-party information made available or hosted by them.

Why has FCU provision been challenged:

1. The provision shall enable government-led censorship online.
2. Government shall turn out to be the “prosecutor, the judge, and the executioner” of what constitutes the ‘truth’ online.
3. But govt. contended that the FCU will only notify contents that are fake, false, or misleading to intermediaries or online platforms, and that intermediaries can choose to take it down or leave it up with a disclaimer.

What did the High Court say?

1. The amended Rules lack necessary safeguards, no matter how well-intentioned the rules are.
2. The Rules do not seem to offer protection for fair criticism of the government.
3. The term “any business of the Central government,” is an ambiguous term and wondered if speeches made ahead of the 2024 Lok Sabha elections would fall within its ambit.
4. It held that if the consequences of a law are unconstitutional, struck down no matter its good motive.
5. A judge held that the amendment violates Article 14 of the Constitution by discriminating between false news about the government and other false news.
6. It questioned the sudden need for a FCU pointing out that the Press Information Bureau (PIB) has been efficiently fact-checking for years.
7. Terms such as “fake, false, and misleading,” can lead to subjective interpretation i.e., what is misleading for one may not necessarily be misleading for another. 
8. There is no recourse or remedy recommended for the user in the new rules after the post has been removed or whose account has been suspended by the intermediary after being flagged by the FCU.

New royalty rates for strategic minerals

Why in the News?

The centre has recently approved royalty rates of 3% each for lithium and niobium and 1% for Rare Earth Elements (REEs).

What does the new royalty rates imply?

1. The Second Schedule of the Mines and Minerals (Development and Regulation) Act, 1957 (MMDR Act) was amended to specify the rate of royalty in respect of 3 critical and strategic minerals, namely, lithium, niobium and Rare Earth Elements.
2. It will enable the Centre to auction lithium, niobium and REE blocks for the first time in the country.
3. The royalty rates, an important financial consideration, shall benefit the bidders during auction of mines.
4. The centre can determine the bid parameters as they develop the method for calculating Average Sale Price (ASP) of these minerals.
5. Without exclusively mentioning the royalty rates for lithium, niobium and REE, its default royalty rate would be 12% of ASP which is considerably high as compared to other critical and strategic minerals.
6. Therefore, a reasonable royalty rate has been specified:
   1. Lithium- 3% of London Metal Exchange price
   2. Niobium- 3% of Average Sale Price (both for primary and secondary sources)
   3. REE- 1% of Average Sale Price of Rare Earth Oxide
7. The move is also expected to increase employment in the mining sector by encouraging domestic mining and lower imports.
8. It shall also provide impetus to set up related end-use industries such as electric vehicles (EVs) and energy storage solutions, which shall act as a prerequisite for India to meet its commitment to energy transition, and to achieve net-zero emissions by 2070.
9. The Centre is planning to launch the 1^st round of the auction of critical and strategic minerals such as lithium, REE, nickel, platinum group of elements, potash, glauconite, phosphorite, graphite and molybdenum shortly.

Push for Lithium:

1. India currently imports all the lithium needs.
2. The domestic exploration push for lithium is now focused on
   1. J&K
   2. Brine pools of Rajasthan and Gujarat
   3. Mica belts of Odisha and Chhattisgarh.
3. The push is also perceived to be a stepped-up economic offensive against China, a major source of lithium-ion energy storage products that are imported into the country.

REEs value chain & Niobium:

1. The rare earths are either sourced from or processed in China, and it can be difficult to secure supplies, thus constituting another hurdle in the EV supply chain.
2. In EV, REE are used not in batteries, but as magnets in motors that are made with REEs such as neodymium, terbium, and dysprosium.
3. Niobium:
   1. It is a silvery metal with a layer of oxide on its surface, which makes it resistant to corrosion. 
   2. It is used in alloys, including stainless steel, to improve their strength, particularly at low temperatures.
   3. Alloys containing niobium are used in jet engines, beams and girders for buildings, and oil and gas pipelines.
   4. It is also used in magnets for particle accelerators and MRI scanners because of its superconducting properties.
   5. The main source of this mineral is the mineral columbite, which is found in countries such as Canada, Brazil, Australia, and Nigeria.

About:

What are critical minerals?

1. Critical minerals refer to mineral resources, both primary and processed, which are essential inputs in the production process of an economy, and whose supplies are likely to be disrupted on account of non-availability or risks of unaffordable price spikes.
2. These minerals lack substitutability and recycling processes.
3. The availability risks occur due to global concentration of extraction and processing activities, the governance regimes, and environmental footprints in resource abundant countries.
4. These minerals are crucial for the high-tech products required for clean energy, national defence, informational technology, aviation, and space research,
5. India needs critical minerals to meet its climate change mitigation objectives
6. The country must focus on securing supply chains (exploration, mining, processing, and manufacturing) for critical minerals and acquiring foreign mineral assets to ensure their continuous supply.
7. India’s transitions towards renewable power generation and electric vehicles shall increase the demand for several minerals such as copper, manganese, zinc, and indium.
8. India does not have reserves of nickel, cobalt, molybdenum, rare earth elements, neodymium and indium,
9. The country’s requirement of copper and silver are higher than its current reserve.
10. Enhanced domestic mineral exploration and extraction has to be carried out to ensure uninterrupted supplies of critical minerals, with particular attention to deep-seated minerals.

INDIA NEEDS TO GO NUCLEAR

India’s growing energy needs:

1. India has been registering rapid economic growth and is expected to surpass Germany and Japan to become the third largest economy by the end of this decade.
2. The economic growth triggers demand for energy, which is reflected in India’s primary energy consumption being the third-highest globally, and most of which is based on fossil energy.
3. India’s developmental aspirations require a manifold increase in per-capita energy use even while transitioning to net-zero GHG emission. 
4. Fossil fuels turn out to be a major contributor to global warming, becoming an existential crisis for humanity. 
5. Transition to net zero is now a global consensus-based goal to be achieved before a 2045–2070 time frame and requires
   1. Massive transformation of energy systems, involving new technologies,
   2. Restructuring of energy systems at supply-and-demand ends
   3. Large costs. 

Addressing the dual challenge: development vs net-zero targets

1. If India wants to reach a Human Development Index (HDI) comparable to advanced countries of the world, it shall require more than four times our present energy consumption (for instance, a minimum of 2,400-kilogram oil equivalent (kgoe) energy consumption per capita per year will be required).
2. Deployment of renewable energy such as solar, hydro, etc., cannot enable India to become an advanced country. Thus, only way out is a rapid scale-up of nuclear energy.

Nuclear energy to combat climate change:

1. Nuclear energy has emerged as one of the cleanest and safest of energies capable of effectively countering climate change.
2. With a closed nuclear fuel cycle, waste issue has also been reduced to a negligible level. 
3. Nuclear energy should be scaled up to a couple of thousand GWe for an optimum solution to reach net-zero in a developed India.
4. Six-pronged national strategy for a rapid scale up of nuclear energy:
   1. Indigenous 700 MWe PHWR (Pressurised Heavy Water Reactor), the first unit of which is already in commercial operation, should be the prime workhorse for base load electrical capacity addition. Additional units have to be constructed for implementation.
   2. Small Module Reactors (SMR) have to build indigenously at a large no. of sites that would be vacated by retiring coal plants in the coming decades.
   3. Well-proven 220 MWe PHWR units can be offered as partially owned captive units for electricity and hydrogen for energy-intensive industries such as metals, chemicals, and fertilisers.
   4. A high temperature reactor for direct hydrogen production without resorting to electrolysis has to be developed which would enable cheaper green hydrogen production and reduce pressure on excessive electrification of the energy system in the country.
   5. Second and third stage nuclear-power programme development has to be fastened to unleash thorium energy potential in accordance with the pre-existing plans for long-term sustainable energy supply.
   6. Rapid deployment of new nuclear-energy capacity has to be done to credibly address the climate-change challenge at the global level.

THE COST OF CHEAP DRUGS

Why in the News?

Lack of information about effects of unbranded generic medicines hampers patients’ freedom of choice.

Generic Medicines:

1. As per FDA, “A generic drug is a medication created to be the same as an already marketed brand-name drug in dosage form, safety, strength, route of administration, quality, performance characteristics, and intended use”.
2. A generic medicine can act as an equal substitute for its brand-name counterpart.
3. A generic drug may have minor differences from the brand-name product with respect to different inactive ingredients. 
4. The lost cost factor of Generic drugs is because of abbreviated pathway i.e.,
   1. Branded drugs will have patent protection only for a few years,
   2. After the expiry of which other pharma companies can manufacture the same drug.
   3. The generic drugs so produced do not undergo animal and clinical (human) studies that were required of the brand-name medicines to demonstrate safety and effectiveness. Hence, the less cost-factor.

The spectre of big bad pharma:

1. Manipulate trials
2. Get temporary monopolies through patents and other means.
3. Bribe doctors and harm patients. 
4. Tax evasion
5. Spurious and substandard drugs
6. Non-adherence to temperature
7. Lack of other quality controls.

Cost of drugs:

1. Broadly, medicines are of three types: 
   1. Still on patent and therefore, a brand
   2. Off-patent and generic, but nonetheless produced by a reputed company, with a brand
   3. Off-patent, generic and unbranded.
2. Out of the 8,500 MSME units, we know only 2,000 are GMP (good manufacturing practices)-compliant, though adherence to GMP has been mandatory since 1988.
3. GMP are needed not only for exports, but for the domestic market too.
4. Mashelkar Committee, 2003:
   1. Extent of substandard drugs varied from 8.19 to 10.64 per cent
   2. Extent of spurious drugs varied between 0.24 per cent to 0.47 per cent.
5. Asymmetric information on drugs provides no true freedom of choice.

About:

Guidelines for doctors to prescribe generic drugs:

1. Doctors can only write the generic names of the medicine on the prescription instead of a brand name.
   • For instance, Paracetamol has to be prescribed for fever, instead of Dolo or Calpol.
2. The generic names have to be written legibly and shall avoid prescription of any unnecessary medications and irrational fixed-dose combination tablets.
3. This mandate can be relaxed only for or medicines with,
   • Narrow therapeutic index (drugs where a small difference in dosage may lead to adverse outcomes)
   • Biosimilars (a different version of biologic products that are manufactured in living systems) and,
   • Similar other exceptional cases.

What is the intend behind the guidelines issued?

1. Lower healthcare costs
   • Generic medicines on an average tend to be 30%- 80% cheaper than the branded versions.
   • It helps in reducing the Per Capita Out-of-Pocket Expenditures related to healthcare in a substantial way.
2. Increased treatment adherence by patients.
3. It shall also encourage people to purchase unbranded quality medicines from “Jan Aushadhi kendras” set up by the GoI.

Why are the doctors protesting?

1. Uncertainty about the quality of generic drugs
   1. Quality control of drugs is very weak especially with regard to generic drugs in India.
      1. Around 3% of all medicines tested over the last three years, including generics, branded generics, and branded medicines were of poor standard quality.
   2. Prescription of drugs without assured quality would be detrimental to health of patients and may not assure recovery of the patient which can lead to,
      1. Hampering of the Doctor’s reputation.
      2. Can lead to increase in violence against doctors by the kin of hospitalised patients.
2. It promotes use of brands with good profit margin in the pharmacies as doctors don’t write a specific brand name, any medicine with the relevant active ingredient in the pharmacy stocks will be given.
   1. The pharmacy usually stocks branded medicines instead of generic ones as the latter has low profit margin.
   2. If generic drugs are unavailable, the responsibility of substitution is shifted to pharmacists. This will only promote good profit margin brans irrespective of it being good or bad.
3. Prevalence of medicines that have skipped the mandatory approval process that was rolled out few years ago.
   1. Only a few years ago, it was made mandatory for companies making generics to carry out
      1. Bio-equivalence studies - to ascertain that the generic drug elicits the same response as a branded version.
      2. Stability studies- to demonstrate the quality of the drugs’ variance over a period under specific environmental conditions.

Way forward:

1. Government should ensure uniform quality across all the generic drugs.
2. Stringent regulatory requirements for the quantity of the drug and the permissible impurities in its generic version as given by United States Food and Drug Administration in its Orange Book.

The Orange Book provides information of approved drug products with therapeutic equivalence evaluations on a monthly basis.

3. A legislation to ensure compliance in generic drug manufacturing and testing has to be formulated instead of guidelines.
4. Experts formulating medical education curriculum shall include emphasis in patient expenses and use of generic medicines as they are adequately emphasized during their UG and PG training.
5. 4E” (Education, Engineering, Economics, and Enforcement) methodology for promoting generic drug utilization and development in Europe can be adopted in India as well.

Operation Polo