QUESTION : Discuss the possible benefits and associated concerns with India’s membership of the Quad. “In order to secure national and regional interests, India should now focus more on the maritime domain”. 

Challenges and Opportunities Before Quad
Recently, the Chinese Ambassador to Bangladesh, Li Jiming, warned Dhaka that there will be “substantial damage” in bilateral ties between China and Bangladesh if the latter joins the Quad.
• Bangladesh Foreign Minister A.K. Abdul Momen promptly and publicly challenged the Chinese envoy’s statement, underlining categorically that Dhaka pursues an independent foreign policy. 
• That China’s remarks would reverberate far beyond South Asia was expected and perhaps intended.
• The spokesperson of U.S. State Department remarked, “What we would say is that we respect Bangladesh’s sovereignty and we respect Bangladesh’s right to make foreign policy decisions for itself.”
• With its message to Bangladesh, Beijing was laying down a marker that nations should desist from engaging with the Quad.
• This episode captures the emerging fault lines in South Asia and the wider Indo-Pacific.
• For all its attempts to play down the relevance of the Quad, Beijing realises that the grouping, with all its weaknesses, is emerging as a reality and there is little it can do to prevent that.
• And so, it is agitated about Quad’s future role and its potential success in offering the regional states an alternative to its own strong-arm tactics.
• The Quad member states are figuring out a cohesive agenda amongst themselves and there are no plans for an expansion.
• There is a desire to work with like-minded nations but that can only happen if the four members of the Quad can build a credible platform first.
• Quad has not asked any country to join and no one has shown an interest.
• But China wants to ensure that after failing in its initial attempt to prevent the Quad from gaining any traction.
• Its message is well understood by other states who may harbour any desire of working closely with the Quad members.
o It is a four-nation alliance of India, Australia, USA and Japan which was established in 2007.
o It is often dubbed as an “Asian” or “mini” NATO, and is viewed as a counterbalance to China’s military and economic clout in the Indo-Pacific region. 
• The 2020 US-China Economic and Security Review
 Commission shows China’s growing power projection along the Indian Ocean rim with military or economic activities in countries like Pakistan, Sri Lanka, Maldives, Myanmar and Bangladesh.
o Interestingly, the QUAD, which used to be known as the quadrilateral security dialogue, is now known as the quadrilateral framework to indicate it has gone beyond a narrow security dialogue.
o The group, which began with an ambitious geostrategic vision 14 years ago, failed to take off initially due to hesitation among the four nations and objections by China.
o In December 2012, Shinzo Abe again floated the concept of Asia’s “Democratic Security Diamond” involving Australia, India, Japan and the USA to safeguard the maritime commons from the Indian Ocean to the western Pacific.
o In November 2017, India, the USA, Australia and Japan gave shape to the long-pending “QUAD” Coalition to develop a new strategy to keep the critical sea routes in the Indo-Pacific free of any influence (especially China).
o Since then, QUAD has taken several steps to bolster military and strategic ties with a series of working- and ministerial-level meetings.
 Participation in Malabar Exercise: 
o In 2020, all four QUAD Countries – Japan, India, Australia and the USA took part in the Malabar Exercise.
o Malabar exercise is an annual trilateral naval exercise between the navies of India, Japan, and the USA which is held alternately in the Indian and Pacific Oceans.
1. The objective needs a more precise definition: The Quad needs a more coherent purpose, strategic objective and an institutional framework.
2. China’s influence: China has strong economic ties with Quad members, especially Australia, which can be used to coerce or influence countries in its favor. This can turn out to be problematic for India.
3. Maritime orientation: The maximum focus on the Indo-Pacific makes Quad a maritime, rather than a land-based grouping. This has some valid questions, on the nature of cooperation towards the Asia-Pacific and/or Eurasian regions.
4. Different capabilities and burden sharing: The present four members of the Quad do not have the same levels of financial resources, strategic awareness, and military capabilities in the Indian Ocean. Convergence on a lot of issues are missing. Creating an imbalance.
5. Doubts on maintaining and sustaining relations with China:
 China perceives Quad as an Anti-China coalition. India now is almost a nodal country facing the risk of allowing its relations with China to ebb further and maybe inviting some wrath in the form of jeopardizing its cybersecurity as its proceeds to increase its engagement with the Quad.
6. Differing perspectives. On various issues there are differing perspectives, such as the crisis in Myanmar viewed through different lenses between the USA and India. Similar has been India’s silence to Japan’s conveyed concern that China is seeking to change the status quo in the East and South China Sea.
7. The unhappiness of Japan and Australia towards India to stay out of Regional Comprehensive Economic Partnership. 
 Need For Clear Vision: The Quad nations need to better explain the Indo-Pacific Vision in an overarching framework with the objective of advancing everyone’s economic and security interests.
 Expanding Quad: India has many other partners in the Indo-Pacific, therefore India should pitch for countries like Indonesia, Singapore to be invited to join in the future.
 Need for a Maritime Doctrine: India should develop a comprehensive vision on the Indo-Pacific which would ideate on the current and future maritime challenges, consolidate its military and non-military tools, engage its strategic partners.
• Can try to prevent nations from the West to the East from coming out with their Indo-Pacific strategies.
• Preventing the operationalisation of the Quad+engaging with the Quad more proactively.
• Even Bangladesh is planning to come out with its own Indo-Pacific strategy and Beijing has now warned Dhaka that a close cooperation with the Quad should not be part of the policy mix.
•  As the Quad gains more momentum and the churn in the waters of the Indo-Pacific leads to new countervailing coalitions against China, Beijing’s belligerence can only be expected to grow. 
Beijing is more likely to demand clear-cut foreign policy choices from its regional interlocutors, as its warning to Bangladesh underscores. But as Dhaka’s robust response makes it clear, states are more likely to push back than become subservient to Chinese largesse.

QUESTION : Why is it said that the mental health is one of the most neglected social issues in India. Discuss the need for multiple interventions to prevent mental health disorders especially among adolescents. 

Mental Health Related Issues In India
• Mental health issues are a major health challenge in the world today.
• According to the World Health Organization (WHO), there is a 10-25-year life expectancy reduction in patients with severe mental disorders.
• Thus, there is an urgent need in India to address mental health issues that are being exacerbated by COVID-19. 
• Mental illnesses include anxiety disorders, psychotic disorders, mood disorders, substance use disorders, personality disorders and eating disorders.
• The majority of suicides in the world are related to psychiatric problems or to the illnesses listed above.
• Globally, the suicide rate was 10.6 per 1,00,000 population.
o In India, it was 16.3 per 1,00,000 in 2016.
o The suicide rate was higher among males compared to females. 
• India introduced the National Mental Health Policy (NMHP) in 2014, and a rights-based Mental Healthcare Act in 2017 (which replaced the Mental Healthcare Act of 1987).
• Along with NMHP, National Health Mission, National Adolescent Health Programme, and Ayushman Bharat have the necessary components to address the mental health issues of all sections of the population. 
Globally – 
• Median mental health spending across the world was 2% of the total government health expenditure in 2015.
o For low-income countries – 0.5%
o For lower-middle-income countries – 1.9%
o For upper-middle-income countries – 2.4% and
o For high-income countries – 5.1%.
• There was higher allocation in developed countries than in developing countries.
• Government expenditure on hospitals dealing with mental health issues as a percentage of total government expenditure on mental health in developed countries ranges from 3% to 15%.
Indian Scenario –
• As per WHO, in India, the share of mental hospitals per 1, 00,000 population is as low as 0.01 in line with developing countries.
o Probable reason: Due to the lack of focussed attention given to mental health compared to other major diseases in India.
• Government expenditure on hospitals on mental health issues as a percentage of total government expenditure on mental health is 1.3% in India.
• In 2016, India was ranked 114 with just 0.03 units per 1, 00,000 population in the distribution of mental health units in general hospitals globally.
o 99th position in the distribution of mental health outpatient facilities, with 0.18 units per 1, 00,000 population.
o 64th position in the distribution of mental health day treatment facilities.
o 107th position in number of mental health workers.
 Nurses, social workers and psychologists working in the mental health sector in India are 0.796, 0.065, and 0.069, respectively per 1,00,000 population.
• The distribution of community residential facilities globally for the median year 2016 showed India at the 58th position, with 0.017 units per 1,00,000 population among the WHO member countries.
• Mental disorders include depressive and anxiety disorders, schizophrenia and bipolar disorder.
• One in seven people in India had a mental disorder ranging from mild to severe in 2017.
• The proportional contribution of mental disorders to the total disease burden had doubled between 1990 and 2017.
• This situation was worse in the southern States compared to the northern States due to the nature of development, urbanisation and other factors.
• Depressive disorders were more prevalent among females than males which could be due to sexual abuse, gender discrimination, stress due to antenatal and postnatal issues and other reasons.
• Family, Educational institution, Society, Traditions and Culture, etc. inculcate mental illness as weakness in personality and character. This leads to lack of disclosure and rise in depression.
• High Expectations from youth: They are taught to be responsible, ambitious, competitive. Good job and a settled life is worshipped and others are condemned. 
• Wrong notions of success – Money, luxury, status, material success are wrongly considered as measure of success.
 Causing neglect of real reason of mental illness
• Rapes, sexual harassment victims are considered as women of questionable character. 
• Stereotypes and prejudices are negative consequences of ignorance and misinformation 
• Increasing the number of personnel in the mental health sector,
• Working towards reducing discriminatory attitudes
• More counselling facilities, especially in rural areas, with special support for women through the provision of women doctors are needed.
• More telemedicine, telephone-based helpline numbers, and mental health apps are also needed.
• School-based programmes on mental health to improve the mental health of children.
• Higher fund allocation for treatment of mental health, especially to those States in need of funds.
• Devising an integrated approach for detecting, treating, and managing patient needs.
• Creating online mental health awareness campagines.
• Creating a road map for mental health awareness.
o This should include the traditional media, government programmes, the education system, industry, and social media. 
Mental health may not be the primary concern in developing economies like India as there may be other communicable/non-communicable diseases along with challenges regarding funding, delivery of mental health packages etc.
However, it is high time that these challenges need to be considered more seriously in the wake of COVID-19 as mental health issues are widely prevalent among the Indian population due to lockdowns and related issues.

QUESTION : Define the term ‘Genome Sequencing’ and what Genome India Project provides an opportunity for India to make great progress in the fields of biotechnology, agriculture and healthcare? Discuss. 

Genome Sequencing During Covid-19
• Genomic sequencing is one of the first steps in effective response against COVID-19 pandemic.
• This requires keeping track of emerging variants and then conducting further studies about their transmissibility, immune escape and potential to cause severe disease.
• However, in the COVID-19 pandemic response, India has been slow in adoption and has used sub-optimally in genomic sequencing. 
• Recently, findings of the Council of Scientific and Industrial Research-Institute of Genomics; Integrative Biology and National Centre for Disease Control and Academy of Scientific and Innovative Research study was released.
o This is the first detailed study of SARS CoV-2 genomic sequencing data from any Indian State and provides very useful insight on the behaviour and impact of Delta variants.
• By April 2021, the Delta variant became the most circulating variant in Delhi and was 50% more transmissible than the Alpha variant.
• It is also likely to be associated with high viral load and resulted in a higher proportion of breakthrough infection (people already vaccinated getting infected).
o Public Health England (PHE) also reported that the Delta variant has become the most common circulating strain in the U.K., replacing Alpha and found that Delta variant may be responsible for more severe disease.
• However, the authors did not find any difference in severity of disease or case fatality rate due to the Delta variant.
The Genome India Project (GIP) is a gene mapping project cleared by the Department of Biotechnology.
GIP will involve 20 leading institutions of the country with the Centre for Brain Research of Indian Institute of Science (IISc) Bangalore as the nodal point.
While referring to new schemes, the 2020 Budget says “Mapping of India’s genetic landscape is critical for next-generation medicine, agriculture and for biodiversity management.” 
Some ethical, social and legal issues associated with the project are listed below.
1. Genetic discrimination: Discrimination based on genetic makeup in case of health insurance, employment etc is possible. This could provide a genetic angle to the burning questions regarding indigenous population, race / caste-based politics and origin tracing.
2. Genome editing: Changing the DNA leading to change in physical traits. While treatments such as gene therapy have the potential to treat several diseases, there are ethical concerns regarding the extent to which the same can be employed – a slippery slope that could lead to genetic enhancement.
3. Privacy: There are privacy issues regarding consent of research participants, usage of the findings and associated risks. There are knowledge and cultural barriers to fully understand the potential benefits and identifying risks attached to gene mapping. Further, the question of storage and protection of data needs to be addressed considering the possibility of misuse of data.
4. Unequal access: Limited access to genetic testing and preventive medication could further the prevailing inequality and create social tensions. 
• Origin of epidemic: Genome sequencing helps researchers understand the arrangement of the make up of DNA or RNA. Sequencing the genome will help us understand where the certain virus for instance of SARS-CoV-2 came from and how it spread.
• Control the spread: Sequencing is useful to know and check if the strain is evolving. By knowing change in genes it can help in preventing its spread. For instance, scientists already know the number of mutations that arise on an average in a month in the case of COVID-19, its incubation period, and the average time between cases in a chain transmission.
• Healthcare: Participants of genome-sample collections represent diversity of the country’s population. It will help in following ways:
• Personalised Medicine: The first obvious use would be in personalised medicine, anticipating diseases and modulating treatment according to the genome of patients. Several diseases develop through the interplay of the environment with multiple genes, which differ across populations.
• Determining gene-disease link: Human genome sequencing is important to establish a link between diseases and the unique genetic make-up of each individual. For instance, cardiovascular disease generally leads to heart attacks in South Asians. If such propensities can be mapped to variations across genomes, it is believed public health interventions can be targeted better.
• Better understanding of diseases like cancer: While genes may render some insensitive to certain drugs, genome sequencing has shown that cancer too can be understood from the viewpoint of genetics, rather than being seen as a disease of certain organs.
• Drug efficacy: Another advantage of genome sequencing is that information regarding drug efficacy or adverse effects of drug use can be obtained. Drugs developed in the Western world and sold in India are pricey and may not be effective on the Indian gene. Mapping of India’s genetic landscape is critical for next generation medicine.
• Agricultural usage: It will enhance India’s scientific capabilities. Next step would be genome sequencing of crops that would help in better understanding of the genetic basis of susceptibility of crops to blights, rusts and pests. It may become possible to deter them genetically, and reduce dependence on chemicals.
• Evolutionary studies: Global science would also benefit from genome sequencing, which would provide data useful for the mapping of the spread and migration of a range of life forms in the old World and thus would help in better understanding of human evolution. 
(1) Scale up genomic sequencing, across all States.
• There should be sufficient samples collected for genomic sequencing to track district-level trends in circulating variants.
• More genomic sequencing is needed from large urban agglomerations.
• A national-level analysis of collated genomic sequencing data should be done on a regular basis and findings shared publicly.
(2) Invest and support more scientific and operational research on vaccine effectiveness.
• Such data should be analysed on a regular basis and should include various stratifiers such as age, gender and comorbid conditions, etc.
(3) Re-strategize the vaccine policy 
• There are early indications of immune escape and reduced vaccine effectiveness against the Delta variant (especially after one shot). Thus, policy makers should deliberate on issues like:
o Whether to shift of focus of vaccination to achieve saturation coverage of the high risk population, with both shots, than one shot to everyone;
o Whether to reduce gap between two doses of Covishield for anyone older than 45 years;
o Whether to hold vaccination of 18-44 years till vaccine supply is assured etc.
(4) Take suggestions from the epidemiologists 
• The State and district officials should engage the epidemiologists in coming up with practical and operational implications and strategies.
(5) Take Strick measures wherever necessary 
• As Indian States plan to open up after COVID-19 restrictions, the settings with predominantly the Delta variant in circulation (which has higher transmissibility) should aim for far stricter adherence to COVID appropriate behaviour, in public places. 
• Thus, there is a need for rapidly expanding genomic sequencing, sharing related data in a timely and transparent manner, and understanding of the impact of new variants on transmissibility, severity and vaccine effectiveness.

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