ALL ABOUT HEPATITIS

• World Hepatitis day is observed every year on July 28 to raise awareness about hepatitis.
• On World Hepatitis Day, there is always a push for more global awareness about the infection, its diagnosis, and how to prevent it.
• “Bringing hepatitis care closer to you” is the theme for the year 2022.
• It mainly aims to highlight the need to bring hepatitis care closer to the primary health care facilities, and communities, to ensure better access to treatment and care.

About Hepatitis

• Hepatitis is of five types, which are Hepatitis A, B, C, D, and E.
• Hepatitis is an inflammatory condition of the liver. It disturbs various metabolic processes such as bile production, excretion, fat and protein metabolism, activation of enzymes, and synthesis of proteins.
• 
  It can be acute that is inflammation of the liver that presents with sickness — jaundice, fever, vomiting, or even chronic inflammation of the liver that lasts more than six months, but essentially shows no symptoms.

Causes

• Usually caused by a group of viruses known as the “hepatotropic” viruses.
• Other viruses may also cause it, such as the varicella virus that causes chicken pox.
• SARS-CoV-2, the virus causing Covid-19 may also injure the liver too.
• Other causes include drugs and alcohol abuse, fat buildup in the liver, or an autoimmune process in which a person’s body makes antibodies that attack the liver.
• Hepatitis is the only communicable disease where mortality is showing an increasing trend which is a matter of concern.

Various types of hepatitis

Hepatitis A

It is an infectious disease of the liver that is caused by the Hepatitis A virus. It is acute and, in most cases, symptoms could not be recognized mainly in young people. Symptoms include vomiting, nausea, fever, severe abdominal pain, jaundice, and weakness.

Hepatitis B

it is an infectious disease caused by an infection with the Hepatitis B virus. It is contracted through flat tired wounds, contact with blood, saliva, and fluids of an infectious body. The symptoms include abdominal pain, fatigue, and jaundice.

Hepatitis C

It is an infection that is caused by the Hepatitis C virus in the liver. This can be transferred from needles that have been infected, at the time of birth, through the body fluids of an infected person, having sex with multiple partners specifically with HIV-infected persons.

Hepatitis D

It is one of the severe liver diseases that are caused by the virus Hepatitis D. It spreads from infected blood or the wound. Sometimes it might occur in conjunction with Hepatitis B.

Hepatitis E

This is a waterborne disease spread by the virus. It might be circulated through food, water, and contaminated blood. It can be either acute or chronic.

Treatment

• Hepatitis A and E are self-limiting diseases and require no specific antiviral medications.
• For Hepatitis B and C, effective medications are available.

Global Scenario

• Approximately more than 354 million people are suffering from hepatitis B and C.
• Southeast Asia has 20% of the global morbidity burden of hepatitis.
• About 95% of all hepatitis-related deaths are due to cirrhosis and liver cancers caused by mainly hepatitis B and C virus.

Indian Scenario

• Viral hepatitis is caused by hepatitis viruses A through E, and it remains a major public health problem in India.
• India has “intermediate to high endemicity” for the Hepatitis B surface antigen and it is an estimated to 40 million chronic HBV infected people, constituting approximately 11% of the estimated global burden.
• The population prevalence of chronic HBV infection in India is around 3-4 %.

Challenges

• Limited availability of reliable national and state epidemiological data.
• The pocket of hyperendemicity(the term hyperendemic is used to refer to a disease that is constantly and persistently present in a population across all age groups) mainly to a tribal and isolated community.
• Access to healthcare services is often out of reach for communities as they are usually available at centralized/specialized hospitals at a cost that cannot be afforded by all the people.
• People continue to die because of the last stage diagnosis or lack of appropriate treatment. Early diagnosis is the gateway to both prevention and successful treatment.
• In the Southeast Asia region, only about 10% of people with hepatitis know their status; and of them, only 5% are on treatment.
• Of the estimated 10.5 million people with hepatitis C, just 7% know their status, of which around one in five are on treatment.

India steps to tackle

By 2025, to reduce new infections of hepatitis B and C by 50% and deaths from liver cancer by 40%, ensure that 60% of people living with hepatitis B and C are diagnosed and that half of those eligible receive the appropriate treatment following steps are needed In India:

• There is a need to enhance the political commitment across all the countries of the region and it must ensure sustained domestic funding for hepatitis.
• Improving access to drugs and diagnostics by further reducing prices.
• Develop communication strategies to increase awareness.
• Innovate the service delivery to maximize the use of differentiated and people-centred service delivery options across HIV and deliver services according to people’s needs and preferences in line with the primary healthcare approach.
• Decentralising hepatitis care to peripheral health facilities which are community-based venues and locations beyond hospital sites brings care nearer to patients’ homes.
• An integrated Regional Action Plan for viral Hepatitis, HIV, and Sexually Transmitted Infection STIs 2022–2026 is being developed by WHO, which will ensure the effective and efficient utilization of limited resources available for the region and will guide countries to adopt a person-centred approach rather than a disease-specific one.
• The hepatitis B is also included under India's Universal Immunization Programme (UIP) which provides the free cost vaccination against eleven (excluding Hepatitis B) vaccine-preventable diseases i.e. Tuberculosis, Diphtheria, Pertussis, Tetanus, Polio, Pneumonia and Meningitis due to Haemophilus Influenzae type b (Hib), Measles, Rubella, Japanese Encephalitis (JE) and Rotavirus diarrhoea,

To achieve the global target of eliminating viral hepatitis by 2030, governments across the world have to provide adequate funding to develop a robust mechanism that effectively fights this disease.

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IRRATIONAL FREEBIES CULTURE

Recently the Supreme court bench said it will see to what extent it can or cannot intervene to stop political parties from distributing irrational freebies.

Even the court asked the central government whether distributing irrational freebies during election campaigns is financially viable.

It also referred to the use of the expertise of the Finance Commission in curbing the irrational poll freebies.

Supreme court view

The Supreme Court had also issued the notice to the Centre and Election Commission of India on the plea against freebies offered by the state parties.

Election Commission of India Dilemma:

• ECI said it has no power to regulate or take any action against the parties making such poll promises and distributing freebies.
• ECI stated that offering freebies before or after the election is a policy decision of the political parties.
• The ECI had said that though the Directive Principles of State Policy enshrined in the Constitution enjoined upon the State to frame various welfare measures for the citizens and, therefore, there could be no objection to the promise of such welfare measures in election manifestos, political parties should. But the problem is making promises which are likely to vitiate the purity of the election process or exert undue influence on the voters in exercising their franchise.
• ECI also stated that it cannot regulate the state policies and decisions which may be taken by the winning party when they form the government.

Freebies

• There is no such thing as a freebie in economics because ultimately somebody has to bear the cost of the supposedly free giveaways. The concept is popularly known the “There’s No Such Thing as a Free Lunch”.
• It means that everything has to be paid for by taxes if not today then tomorrow.
• Political parties promise to offer free electricity, water supply, monthly allowance to unemployed or even daily wage workers, and women as well as gadgets like laptops, smartphones, and tablets to secure the vote of the people.
• The states have become habituated to giving freebies, be it in the form of loan waivers or free electricity, cycles, laptops, TV sets, and so on.
• In the last 30 years there has been rising inequality and some kind of relief to the population in the form of subsidies may not be unjustified but actually necessary for the economy to continue on its growth path, as argued by some political parties.

Reason for freebies

• The failure of the parties and governments to deliver development to the ordinary people has led to the increasing phenomenon of “freebies” and the parties have to resort to it to win over the voters.

Need for freebies

• Facilitates Growth and helps in reducing poverty and inequalVarious examples show that some expenditure outlays do have overall benefits such as the Public Distribution System, employment guarantee schemes, support for education and enhanced outlays for health, mainly during the pandemic.
• Helps the Lesser Developed States: With the states that have a comparatively lower level of development with a larger share of the population suffering from poverty, such kinds of freebies become need/demand-based and it becomes essential to offer the people such subsidies for their upliftment.
• In the states which lack development, freebies become need/demand-based and it becomes essential to offer the people such subsidies for their upliftment.

Challenges of freebies

Financial irregularity and fiscal mismanagement

• The irrational freebies have played havoc with state finances. Coming to the election-bound states, UP’s public debt is Rs 6.1 lakh crore, Punjab’s Rs 2.8 lakh crore, Uttarakhand’s Rs 68,000 crore, and Goa’s Rs 18,844 crore. A recent RBI report said the outstanding liabilities of states had increased from Rs 16.48 lakh crore in 2011 to Rs 42.92 lakh crore in 2019.

• The CAG had pointed out that the share of capital expenditure has reduced from 14.39% in 2013–14 to 8.26% in 2017–18 in Delhi. All this is mere because the AAP government has to finance its election promises of free power, water, and public bus service for women.

The burden on Public Exchequer:

• If states continue with fiscal profligacy, they will be heading towards the unsustainable high debt with catastrophic consequences for macro-economic stability and the ability of India to sustain high growth.

Lacking equity or fairness:

• Promise/distribution of irrational freebies from the public fund before the election unduly influences the voters, shakes the roots of the free-fair election, disturbs level playing field, vitiates the purity of the election process, and also violates Articles 14.
• Even debt-ridden States, were promising/distributing these freebies to garner votes and create uneven playing fields in the elections.
• Distributing private goods services, which were not for public purposes, from the public fairly violates the Constitution.

Promotes tax avoidance:

• Freebies may even trigger non-compliance amongst taxpayers and eventually lead to lower revenue.

Freebies provide no sustainable solution

• Freebies in the form of loan waivers not only hamper banks’ financial capabilities but also encourages poor credit system and do not benefit farmers in long run.
• As Madras High court stated that the freebies culture In Tamil Nadu is making people lazy and those migrant workers from the north and northeastern parts of the country had to be employed in every other field of work be it hotels, industries, shops, and saloons. Migrants are employed even for agricultural work in the State.

Creates Dependency than the empowerment of poor

• Freebies violate the constitutional mandate of extending benefits for a public purpose and instead create private benefits. For example, often the distribution of free laptops is seen as enhancing the capacities of the students on par with the new generation’s needs, but it does not increase the purpose of quality education.
• Due to a lack of proper infrastructure facilities and specialized teachers, parents prefer to move their students to private schools. Freebies deny the due share of state resources towards the development of the poor.

A Step Away from the Environment:

• When the freebies are about giving free power, it would lead to overuse of natural resources such as declining water table, wastage of electricity, and various other things
• Also, focusing on renewable energy systems will also get distracted.

Way Forward

• The focus must be shifted from freebies to development promising better rule of law, equal pay for equal work, clean water, equal quality education, quality healthcare, quality infrastructure, speedy justice, free legal aid, citizen charter, judicial charter, efficient police system, the effective administrative system rather than arbitrarily promising irrational freebies from the public fund, which will empower the individual, reduce inequality and poverty.
• The Centre must enact a law governing the promises made by political parties in their election manifestos and empower the Election Commission of India to take action against parties that make irrational promises.
• Clearly define freebies and what they can include so that it does not come in the way of long-term development.

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