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6 February 2017 Editorial



Targeting old scourges

The reference in the Union Budget to new elimination targets for some major communicable diseases barely hints at the enormous burden carried by millions in India with tuberculosis, kala-azar (leishmaniasis), filariasis, leprosy and measles. It would appear incongruous that an emerging economy with no timetable for universal health coverage and a lack of political will to loosen its purse strings for higher government expenditure has set ambitious deadlines to rid itself of deadly scourges. Last year it was revealed that India has a higher burden of new patients with TB than estimated earlier — 2.8 million in 2015 compared to 2.2 million in the previous year, a quarter of the world’s cases. Having set concrete goals, the Centre must now demonstrate its seriousness by moving away from the flawed policies of the past. The promise of a well-funded five-year scheme to meet the TB challenge beginning in 2017 is welcome, although steady progress towards the new elimination deadline of 2025 will also depend on improved capabilities in the health system to meet the daily drugs requirement and a feeling of ownership at the State level. The World Health Organisation has been pointing to the lack of integration of private practitioners with the national mission on tuberculosis for guaranteed access to drugs, and lack of continuous monitoring of such patients.

India’s campaign on leprosy is in reality a ‘post-elimination’ struggle resulting from complacency, since it announced at the end of 2005 that it had eliminated it as a public health problem, based on a rate of less than one person in 10,000 having it. Such self-congratulatory moments weakened both policy focus and funding in some pockets in eastern India, where it exceeded the accepted prevalence rate. Health Minister J.P. Nadda’s admission in the Rajya Sabha that there were 1,02,178 leprosy cases on record as of September 2016, and districts of ‘high endemism’, shows the battle was never truly won. Detecting new cases early and preventing them from progressing to disability-inducing grade two level is crucial, although complete removal by 2018 as envisaged in the Budget may prove difficult. Rehabilitation of patients is also a weak spot. Kala-azar, though underreported and mainly confined to Bihar and Jharkhand, is a promising candidate for elimination in the current year, since the few thousand cases are caused by a protozoal parasite with no animal reservoir; control of the vector, the sand fly, holds the key. If good medical protocol is pursued, pockets of filariasis in many States can be removed. Rehabilitation programmes for these diseases require more resources and policy support.








Road to the Élysée Palace (NOT IMP FOR UPSC)

The presidential race in France may be gaining momentum, but clarity it is not. Centre-right Les Républicains candidate François Fillon, until recently seen to be the most likely to win the race, is engulfed by allegations of payments made to his wife, Penelope Fillon, and their children for official work they may not have done. What looked like a passing storm now looks like a weather pattern that could linger. In a rival camp to the left, Benoit Hamon’s recent victory in the French Socialist Party’s presidential primaries indicates voters are disenchanted with the ideological drift and absence of acuity in the ruling party’s policies. His comfortable victory over the centre-left rival, former Prime Minister Manuel Valls, represents a shift leftward for the Socialists, back to their ideological roots, stemming a drift towards the centre seen not just in their party but also in the Republicans. With the business-friendly Mr. Valls out of the race, Mr. Hamon faces the prospect of losing his opponent’s supporters to former Economy Minister Emmanuel Macron, a 39-year-old independent centrist who is a better ideological fit for many centre-left Socialists than is Mr. Hamon. Following the election, rifts in the party have become more open, with some senior leaders saying they cannot support Mr. Hamon and others asking him to adopt policies that would appeal to a broader spectrum of voters. Among Mr. Hamon’s policies are a universal basic income of about €750 a month, further cuts in the 35-hour work week, and a plan to legalise marijuana. Not all these are palatable to Socialists to Mr. Hamon’s right.

A poll last week placed nativist Marine Le Pen of the far-right National Front in the lead for round one of the presidential race, with Mr. Fillon and Mr. Macron neck-and-neck behind him. The Socialists were expected to come in fourth. This did not last, however. Growing dissatisfaction with Mr. Fillon’s response to ‘Penelopegate’ has altered the results significantly; one poll showed that over 60% of respondents want Mr. Fillon to step down. The party is considering finding a replacement candidate. This has bolstered the chances of Mr. Macron and Ms. Le Pen, a candidate who has benefited from the anti-European Union, anti-migrant, populist wave washing over Europe and across the Atlantic. She is still unlikely to win the second round of the race since her opponent will attract the mainstream vote. This is a good thing as the National Front coming to power would further unravel Europe and be a destabilising force in a world much in need of tolerance and stability. For the moment the Élysée Palace appears well within sight for Mr. Macron.

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