The Hindu Editorials Notes – Mains Sure Shot ( 18th September 2019 )
Question – What is ‘vaccine hesitancy’ and how is it a threat to global health? Analyze ( 200 words)
Context – The World Health Organization included ‘vaccine hesitancy’ as one of the 10 threats to global health this year.
What is vaccine hesitancy?
- Vaccine hesitancy is “delay in acceptance or refusal of vaccines despite availability of vaccination services”.
- The WHO has included vaccine hesitancy as one of the ten threats to global health in 2019.
- A survey done by the Lancet magazine has found that vaccine hesitancy is prevalent in more than 90% countries in the world.
- In many areas, immunisation for measles, a vaccine-preventable disease that was largely eliminated following widespread use of the measles-mumps-rubella (MMR) vaccine, has decreased to less than the 95% threshold set by the WHO.
- Also the myth that vaccine hesitancy is a thing of under developed countries has been broken.
- For example, in the UK the coverage of the MMR vaccine decreased to 91·2%, its lowest level since 2011–12.
- In the USA, the percentage of children aged 19–35 months who received the MMR vaccine slightly decreased from 91·6% in 2011, to 91·5% in 2017, with very low rates of coverage reported in some communities (eg, 60% in ultra-Orthodox Jews in the state of New York where a measles outbreak is ongoing).
- Similar trends elsewhere have resulted in a 30% rise in measles cases worldwide—even in countries such as the USA, where measles had been eradicated in 2000.
The present global scenario:
- There have been around 3,65,000 measles cases reported from 182 countries in the first six months of 2019.
- The biggest increase, of 900% in the first six months this year compared with the same period last year, has been from the WHO African region, with the Democratic Republic of the Congo, Madagascar and Nigeria accounting for most cases.
- There has been a sharp increase in the WHO European region too with 90,000 cases recorded in the first six months — more than the numbers recorded for the whole of 2018.
- Last month the U.K., Greece, the Czech Republic and Albania lost their measles elimination status.
The reasons behind vaccine hesitancy:
- Religious reasons – One of the most common reasons parents offer for choosing not to vaccinate their children stems from their religious beliefs. They are the most difficult to deal with because these choices are not the by-product of ignorance but rather the intentional and calculated decision related to a staunch conviction. In addition, in contrast to other cited reasons for hesitancy like illiteracy or safety, those driven by religious assertions most often are linked to a complete refusal of all vaccines.
- Philosophical reasons – Some parents believe that natural immunity is better for their children than is immunity acquired through vaccinations.
- Personal beliefs – Others express the belief that if their child contracts a preventable disease, it will be beneficial for the child in the long term, as it will help make the child’s immune system stronger as he grows into adulthood. Some parents believe that the diseases for which we vaccinate are not very prevalent so their children are at minimal risk of contracting these diseases. For this reason, they also believe that the possible negative side effects of vaccine administration outweigh the benefits of the vaccines. Many parents do not see the preventable diseases as serious or life-threatening and would prefer to not put extra chemicals into their children’s bodies.
- Safety concerns – the greatest reason parents express for refusing vaccinations for their children are concerns about the safety of vaccines. Most of these concerns are based on information these parents have discovered in the media or received from acquaintances. Regardless of whether the stories stem from television, the Internet, radio, or from family and friends, parents are constantly bombarded with other peoples’ opinions about vaccinations.
- Less education – this too is one of the reasons for being apprehensive towards vaccine. A study found that younger people (18-34 years) with less education are less likely to agree that the measles, mumps, and rubella (MMR) vaccine is safe. According to a March 2019 report, only 52% respondents from 28 EU member states agree that vaccines are definitely effective in preventing diseases.
- Low awareness – this is one of the main reasons in India preventing vaccination. Low awareness of vaccine preventable diseases and recommended vaccines for adults. A 2018 study found low awareness to be the main reason why 45% of children missed different vaccinations in 121 Indian districts that have higher rates of unimmunised children.
- Media platforms (including social media) have been enormously influential in the spread of vaccine hesitancy. Vaccine-hesitant parents are usually more active in searching for information online than vaccine-compliant parents, and are susceptible to unverified reports of adverse effects of vaccination and scare tactics promoted by anti-vaccination campaigners.
How to deal with vaccine hesitancy?
- Paediatricians and family doctors have a key role in helping parents appreciate the benefits of vaccination; physicians’ advice has been shown to be the most important predictor of vaccine acceptance.
- A clear presentation of the risks that delaying or refusing vaccination might pose to the child is pivotal to help parents understand how critical their decision is.
- training modules to build capacity in health-care workers so that they can confidently engage in difficult conversations with hesitant caregivers.
- Government and health policy makers also play an essential role in promoting vaccination. They must take steps for educating the general public, and implementing policies that reduce the public health risks associated with vaccine hesitancy. For example, France has made vaccination with 11 vaccines mandatory for children—unvaccinated children cannot be enrolled at nurseries or schools. In Australia, parents of children who are not vaccinated are denied the universal Family Allowance welfare payments.
- Media platforms, especially social media platforms can be extremely beneficial if the merits are propagated systematically. And also the websites spreading anti-vaccine drives need to be identified and made accountable. For example, Realising this problem, Kyle Yasuda, president of the American Academy of Paediatrics, contacted the chief executive officers of Google, Facebook, and Pinterest requesting that they partner with the Academy to make sure parents using their platforms are seeing only credible, science-based information. In response, Facebook announced that groups and pages that share anti-vaccine misinformation would be removed from its recommendation algorithm. Such partnerships are crucial for allowing widespread promotion of evidence-based information explaining the benefits of vaccination.
To conclude/ way ahead:
- Vaccine hesitancy is threatening the historical achievements made in reducing the burden of infectious diseases, which have plagued humanity for centuries. Only a collaborative effort between paediatricians, family doctors, parents, public health officials, governments, the technology sector, and civil society will allow myths and misinformation around vaccination to be dispelled.
GS-1 or GS-2 Mains
Question – With the government announcing Jal Jeevan Mission to provide piped drinking water to all rural households by 2024, what are the aspects that should be kept in mind? ( 250 words)
Context – the announcement of the Jal Jeevan Mission.
What is Jal Jeevan Mission?
- It is a mission undertaken by the Jal Shakti Ministry to provide piped water to all rural households by 2024.
- Under the Jal Jeevan Mission, the government will focus on rainwater harvesting and water conservation in 256 districts in the first phase and carry out other initiatives, including renovation of traditional water bodies and tanks, reuse of water and recharge structures, watershed development and intensive afforestation.
The present scenario:
- over 70% of India’s surface water (rivers and lakes) and groundwater is polluted.
- Reservoirs around the country have dried up and groundwater levels have plunged to all-time lows.
- According to both governmental and non-governmental data sources, more than 70% of India’s surface water and groundwater is unfit for domestic use because it has become contaminated. This leaves only a little more than a quarter of the freshwater to meet the needs of 1.3 billion people.
What the government needs to focus on:
- This is a nobel drive by the ministry but it has to be cautious while deciding from which source will the water be extracted to fulfil the cause.
- The World Health Organisation has calculated that an individual needs around 25 litres of water a day for basic hygiene, food, mopping, cleaning, etc. and 2.5 litres a day for drinking. So the source of water has to be sustainable as well as affordable and environment friendly.
- According to Vikram Soni, an emeritus professor of physics at the Jawaharlal Nehru University, New Delhi, who has worked on issues of public water consumption, there are two non-invasive schemes which can perennially provide natural mineral water and unpolluted bulk water for our cities – forest aquifers (to provide unpolluted drinking water) and flood plains (as bulk water source).
- While the forest aquifers can provide healthful mineral water purely for drinking purposes, the floodplains are a great perennial source for bulk water for cities.
What is a floodplain?
- A Flood plain is a plain or nearly flat surface close to the bed of a river or stream. If there is little water in the river, the plain will be dry, if there is a lot of water, the surplus water will flood this area. So this area bordering a river naturally provides a space for retention of flood and rainwater.
- This water is recharged every year by rains and it is this recharge which can be tapped to provide water for our cities.
- River floodplains are exceptional aquifers, where any withdrawal is compensated by gravity flow from the surrounding area. Some of these floodplains contain up to 20-times more water than the virgin flow in rivers, and since recharge here is by rainfall and during late floods, the water quality is good.
What are forest aquifers?
- An aquifer is an underground layer of water-bearing permeable rock.
- Forest aquifers means the aquifer rocks underneath a forest area.
- It is a source of unpolluted natural mineral water that underlies forests. This water is of the highest international quality. Unpolluted rain falls on the forest, percolates through the humus or leaf cover on the forest floor while picking up nutrients, and then through the underlying rock while picking up minerals. It finally settles in underground aquifers. This is natural mineral water.
- Since this is high-quality natural mineral water purely for drinking, we need only 2-3 litres a day. Most of the country can still source this water.
How can they be used as a source to provide water to the cities that will run out of ground water in a few years?
- They would have to be tapped in a “strictly ecological manner”.
- The idea is not new and is already being used. The Borivali National Park, with its thick cover of trees spread over 68 sq. km and its two major lakes, Tulsi and Vihar, have been used from the time of the British to supply water to Mumbai.
- Shimla too has a large forest sanctuary spread over three hill ranges that was set up before independence to provide the city with water.
- Bengaluru’s Bannerghatta forest sanctuary and Mumbai’s Sanjay Gandhi National Park have underground forest aquifers that can supply natural mineral water for the entire population of Bengaluru and Mumbai. So can the Delhi Ridge, for Delhi.
- Even the Aravallis can provide the best quality natural mineral water to all the cities in Rajasthan.
- However, taking more water than nature can recharge every year will be damaging. We need healthy and perennial ‘conserve and use’ solutions for the future.
- For this, before this water is launched, these water reservoirs will have to be accorded the status of water sanctuaries, similar to wildlife sanctuaries, national parks, tiger reserves, etc. This is to prevent overexploitation.
- Our national parks and tiger reserves stand protected only because they come under this law. In the same way, these water sanctuaries will have to be protected by a similar law passed.
- Also, only the government should have access to extract water from these sources and the water should be distributed by government agencies through public kiosks etc at about Rupees 2-3 per liter. Every household,based on the number of members, should have a fixed limit upto which they can buy per day.
- The local people who traditionally live around these sources must be involved in the process to conserve and maintain the flow.
- Also this should not mean that we abandon the already polluted water. There is a need to increase the number of sewage treatment plants to prevent raw sewage from entering rivers, lakes and ponds, and to make grossly polluting industries comply with water quality regulations.
To conclude/ way forward:
- Building mammoth infrastructure projects and spending crores of rupees may create huge water reservoirs but won’t help create more water. Each panchayat has to be entrusted with regenerating the forests that used to be the hallmark of our nation. The interconnection between living forests and un-encroached river basins is the only way forward.
- The water levels of the floodplain aquifers need to be monitored scrupulously to be well above the river water level to avoid contamination by river water.
- We must maintain stable water levels for the subterranean forest aquifers to ensure sustainability.
- As said we need to declare the floodplains and forest aquifers as water sanctuaries similar to national parks and tiger reserves. If not, we will lose this amazing gift of natural infrastructure, as has already happened in some cases.