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16-31 DECEMBER, 2021

SCIENCE AND ENVIRONMENT

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O S TAY 2021

HE RE T

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 https://www.cseindia.org/c-gins/home

What is C-GINS?
C-GINS (Compendium of green infrastructure network systems) is the repository for best practices, projects and
approaches in support of Green Infrastructure (GI) and Water Sensitive Urban Design and planning (WSUDP)
principles. C-GINS is an open platform where the latest thinking on natural capital, ecosystem services and
nature-based solutions is brought together.
It provides a knowledge marketplace, which showcases case examples of GI and WSUDP to simplify how
we share, obtain and create knowledge to better manage our urban environment. Each of the case examples
provides an overview of the intervention, timeline, authorities/ stakeholders involved in the project, outcomes and
learnings tips for user education. The preference for sustainable technologies is mainly due to CSE's continuous
motivation towards usage of sustainable and environmentally harmonious interventions.

How to use C-GINS

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Zero the way to go
I
NDIA IS rapidly evolving its policies to deal with
garbage—the waste generated from the use of materi-
als at homes, institutions and factories. The evolution
must now reflect in our actions. Our “waste” must become
a resource—to be reworked, reused and upcycled. This
will minimise the use of materials in our world and
mitigate environmental damage. It’s a win-win solution.
We know that the “nature” of solid waste changes as
societies get richer and urbanise. Instead of biodegradable
(wet) waste, households generate more plastic, paper, metal
and other non-biodegradable (dry) waste. The quantity of
waste generated on per capita basis also increases. Many of
the country’s urban areas are already on the trajectory
where waste generation has risen exponentially.
In 2000, when the first Municipal Solid Wastes Rules
were notified they were based on the idea—prevalent in
most countries—that waste had to be collected, transport-
ed and then disposed of in secure landfill sites. The
objective was to “clean” cities by removing waste from our
vicinity. But this policy failed to reflect in practice and the
scourge of garbage grew in our cities. What could not be
collected or transported because of paucity of municipal
services fouled up our neighbourhoods. What was collected
got dumped and is today visible as “mountains” of shame.
Over the past few years there has been a rapid shift in
the strategy for waste management in the country.
Today’s policy, the Union government’s flagship Swachh
Bharat Mission (sbm) 2.0, focuses on source segregation,
processing of waste (wet and dry) and on minimising the
waste sent to sanitary landfill sites. According to the
guidelines of sbm 2.0, only the inert waste and process
rejects, which in no case should exceed 20 per cent of the
total waste and are not suitable for either dry or wet waste
treatment, can be sent to landfill sites. Therefore, the
premise of the guidelines is that cities must become
zero-landfill—they must recover and reprocess all waste.
The guidelines stress that waste-to-energy (wte) projects
are financially and operationally viable only with an
assured minimum input of 150-200 tonnes per day of
non-recyclable, segregated dry
waste of high calorific value. This
has also been our learning that wte
plants are not the silver bullets
they promise to be—incinerating
municipal waste to make energy. It
Waste-Wise Cities: Best practices in municipal solid waste management
To download the report, log on to www.cseindia.org
03Editors.indd 3
SUNITA NARAIN \ EDIT
is critical that the waste sent for incineration and energy
generation is of high quality and this requires high level of
segregation—best done at source. Without this, the plants
work below operational capacity and become defunct.
The guidelines also provide an opportunity to reclaim
the 3,000-odd landfill sites where, as per the Central
Pollution Control Board (cpcb), some 800 million tonnes of
waste is dumped. This will not just free up valuable land,
which can be greened and put to suitable use, but also
help avert environmental disasters. This requires
deliberately designed strategies to reuse the material that
is bio-mined from these legacy landfills. Cities must also
stop sending new waste to these landfills, otherwise they
will get filled up again even while being remediated.
The good news is that India’s solid waste management
strategy is now being designed for material recovery and
reuse. It is an approach aimed at a truly circular economy.
As the strategy demands full reutilisation of materials
and no waste, we will learn what we cannot recycle and
work towards minimising its use. This will make policy
and practice even more environment friendly.
That said, while the policy has evolved, our practice is
still to catch up. Source segregation remains our Achilles’
heel—it does not happen at the scale and pace needed.
Even if waste is segregated at the household level, it does
not get transported in a segregated manner to processing
facilities. In fact, processing happens incidentally, only
because there are people who need our waste for their
livelihoods—ragpickers, as we call them. City managers
are still working through the different options for process-
ing this waste and to manage it effectively to generate
revenue. Worse, plastic waste—particularly much of the
packaging waste—is growing and filling our cities. We
still do not acknowledge that much of the “plastic” we use
cannot be recycled and so needs to be phased out. The
current policy on “single-use” plastics—where certain
products have been identified for eventual elimination—is
just not good enough to deal with this gigantic problem.
We are in an exciting phase of development, where city
managers and leaders are reworking waste strategies.
The Centre for Science and Environment has partnered
with the Niti Aayog to document the best practices of
“waste-wise” cities as a textbook of new learning and
teaching. It is what needs to be practised, and at scale.
This is a real opportunity for change. D T E @sunitanar
DOWNTOEARTH.ORG.IN 16-31 DECEMBER 2021 DOWN TO EARTH 3
10/12/21 9:20 AM
 Down To Earth
Founded in 1992 to arm you with knowledge
critical to shaping a better world

FOUNDER EDITOR Anil Agarwal

EDITOR Sunita Narain
Contents NATIONAL POLLUTION CONTROL DAY SPECIAL

MANAGING EDITOR Richard Mahapatra

10
CHIEF COPY EDITOR Snigdha Das C OV E R S TO R I E S
ASSOCIATE EDITOR Vibha Varshney
MULTIMEDIA EDITOR Arnab Pratim Dutta
CREATIVE DIRECTOR Ajit Bajaj The pandemic’s third year
SUPPLEMENT EDITOR Sorit Gupto has started with the entry
REPORTING TEAM Shagun, Taran Deol of a new COVID-19 variant
Akshit Sangomla, Pulaha Roy and the world needs to
SENIOR ASSISTANT EDITORS Aditya Misra, prepare for a long period
Rajit Sengupta
of uncertainty
SUB EDITOR Dakshiani Palicha
WEB EDITORS Joyjeet Das, Rajat Ghai,
Anshika Ravi, Preetha Banerjee
DESIGN TEAM Chaitanya Chandan, Sanjit Kumar,
Mukesh Kumar Singh, Shri Krishan, Ritika Bohra,
Yogendra Anand
PHOTOGRAPHER Vikas Choudhary

24
PHOTO LIBRARY Anil Kumar
PRODUCTION Rakesh Shrivastava, Gundhar Das
TECH SUPPORT Rajendra Rawat, Jaidev Sharma
MULTIMEDIA Sunny Gautam,Adithyan P C Too may glitches in
INFORMATION AND RESEARCH SUPPORT India’s insurance-
Kiran Pandey, Susan Chacko,Madhumita Paul,
Sheeja Nair, Lalit Maurya, Dayanidhi Mishra focused approach to
CONSULTING EDITOR Anumita Roychowdhury
universal healthcare

Vol 30, No 15; Total No of Pages: 60

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50 Inequality 56 Factsheet
In a wealthier world, the divide Has legislators’ emphasis on
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DownToEarth
16-31 DECEMBER, 2021

SCIENCE AND ENVIRONMENT

FORTNIGHTLY ON POLITICS OFFORTNIGHTLY
DEVELOPMENT, ENVIRONMENT AND HEALTH Subscriber copy, not for resale `60.00
NATIONAL POLLUTION CONTROL DAY SPECIAL

54 Patently absurd 58 Civil Lines

Y Plant protection authority Climate change influences
E TO STA
2021

HER upholds the spirit of India’s global food intake by lowering

law to keep farmers first production, raising prices

omicron health insurance climate change

Cover design: Ajit Bajaj Cover photo: istock, Vikas Choudhary

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 Engage
PICK OF THE POST BAG
Overcrowded NCR
This refers to the editorial “Season of
despair” (1-15 December, 2021). The
Delhi-National Capital Region is
excessively populated. Apart from
all major headquarters and administra-
tive offices, it also has unneeded
residential complexes. Unless the
population is evenly disseminated,
pollution will persist.
H K MUKERJEE
EMAIL

A real stand-out
The objective of Down To Earth, through
both its English and Hindi editions, is to
present news, analyses and provide
insight into environmental conflicts
based at the grassroots level. It is a feat
it does well. It shows journalism is not a
well but rather a sea of subjects.
AYUSH SHARMA
BHOPAL

Fortification has merits Price confusion

This refers to the article ‘Supply snags’ (16-31 October, 2021). Fortification is a This refers to “Uttarakhand farmers fall
cost-effective practice used to deliberately increase the content of essential back on traditional food processing
micronutrients, that is, vitamins and minerals (including trace elements) in any methods to boost earnings”, published
food item. South Africa fortifies maize meal, China soy sauce and Vietnam fish online on October 29, 2021. As far as I
sauce. In India as well, external fortification of wheat distributed through the know, the price of raw honey in this
public distribution system (PDS) is a well-established practice. Also, private player Himalayan state is R1,000 per kg and
TATA Chemicals Limited has joined with the Indian Council of Medical Research- not R300 per kg as stated in the article.
National Institute of Nutrition in Hyderabad, Telangana, to launch fortified salt Get your facts straight.
MANISH
containing iron and iodine to prevent anaemia—a condition affecting two of three VIA EMAIL
women in the country—prophylaxis and endemic goitre. Various states have also
independently undertaken food fortification with help from global support groups.
With regard to rice, it is important that the authorities select appropriate
DTE responds
The price of R300 per kg was quoted for
technology and methods for fortification. The fortified rice needs good stability
P H OTO G R A P H : R E U T E R S

the bulk sales of raw honey by Rajendra

during transport and storage. It should also be able to retain added micronutrients
Singh Solanki, who runs a collective of
during cooking and preparation, so that it is absorbed while consumption
bee farmers in Thano region. Perhaps the
effectively. Consumers must also learn to accept and actively opt for fortified rice.
retail price of raw honey in the state is
JAYDEV JANA
NEW DELHI R1,000 per kg.

DOWNTOEARTH.ORG.IN 16-31 DECEMBER 2021 DOWN TO EARTH 5

05-06Engage-Dec 16-31.indd 5 09/12/21 4:22 PM

 DTE TV

Antimicrobial resistance
is a serious health threat
The development of modern
medicine has been one of the
humanity’s greatest weapons in
the fight against viruses, bacteria

and other microorganisms that

cause life-threatening diseases.
However, this advancement now
faces serious setbacks with the
Shift to slow fashion growing problem of antimicrobial
This is in reference to “The deception of greenwashing in fast fashion”, resistance (AMR), a phenomenon
published online on February 16, 2021. This is an important subject and it is where microorganisms change
crucial that more influential people continue to talk and write about it. Indeed, when they are exposed to
changing the current industry practices is difficult, but consistent efforts to antimicrobial drugs. AMR lowers
spread awareness will bear fruit. There are several designers up-cycling and humanity’s defences against
regulating the production of goods. I hope to read more about this subject! infection. Watch to learn how the
MARIA GAVELIN
phenomenon is evolving, and
VIA EMAIL what the world is doing to keep it
in check.
Erratum
The article "Come September" (16-31 October, 2021) erroneously implies FOR MORE VIDEOS, SCAN
that intensification of the negative phase of the Indian Ocean Dipole caused
more rainfall in September. It is the weakening of the phase that led to the
formation of low pressure areas and excess rainfall. We regret the error. NOTICE BOARD

SHOLAI SCHOOL (CLOAAT)

CENTRE FOR LEARNING
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TO US
P H OTO G R A P H : C R E AT I V E C O M M O N S

Inspired by the philosophy of J. Krishnamurti, Sholai

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We are looking for teachers interested in educating
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 EDGE OF
TOMORROW
The challenges the
world faced this year
were quite similar to
the ones seen the
year before—COVID-19,
climate change and
the impacts of these
two existential threats.
Just when 2021 was
nearing its end and the
world was cautiously
hopeful about the
pandemic being on the
wane, a new variant
descended. Around the
same time, peninsular
India witnessed heavy
rainfall and floods,
indicating the modes
and extremes with
which climate change
is unfolding, adding to
the mayhem. How we
respond to these
challenges will be the
defining feature of our
times. Let’s bid farewell
to 2021 with the resolve
to be prepared better
for the crises.

RISE OF OMICRON P10 MYTH OF INSURANCE P24 60 DAYS OF RAIN P42

8 DOWN TO EARTH 16-31 DECEMBER 2021 DOWNTOEARTH.ORG.IN

08-09Opener.indd 8 09/12/21 4:22 PM

08-09Opener.indd 9 09/12/21 4:22 PM
 COVER STORY /COVID -19
The world is seeing a repeat
of the early days of the
pandemic, with countries
reimposing lockdowns
and restrictions to curb the
spread of the new COVID-19
variant Omicron

10-22Cover story-Omicron.indd 10 10/12/21 9:16 AM

 VIRUS’
VARIANT WAYS
The third year of the global COVID-19 outbreak begins
with a new variant, much like the earlier Delta variant
that emerged at the start of the second year. Delta
caused deadly waves, but the new variant, named
Omicron, is more transmissible and shows signs of
breaching acquired immunity. The world should be
braced for a prolonged pandemic
TARAN DEOL and KIRAN PANDEY in New Delhi
with
ELSABE BRITS in Cape Town, South Africa, JACK MCBRAMS in Lilongwe, Malawi,
LERATO MATHEKA in Maseru, Lesotho, BUSANI BAFANA in Bulawayo, Zimbabwe and
MANUEL MUCARI in Maputo, Mozambique

T
HERE WAS a lull in covid-19 cases across the world as pandemic
neared completion of two years. Some had even started harbouring
hopes that covid was perhaps nearing its end. A century ago, the
Spanish flu pandemic (1918-20) had shown a similar trend, when
it declined towards the end of its second year. But it did not end
and continued for another year. Almost on cue, as covid-19 enters its third
year in November 2021, there is a consistent rise in new cases and deaths
across the world.
Pandemics, however, do not always follow patterns. Their trajectory
depends on the mutations of the pathogen. While the world hoped for respite,
sars-cov-2—the virus that causes covid-19—was changing. The indications
of this change were first reported by South Africa and explain the current
rise in covid-19 numbers.
In the week preceding November 19, South Africa was reporting just
P H OTO G R A P H : R E U T E R S

200-300 cases a day. The increase in covid-19 cases in Gauteng—the South

African province now reporting a majority of the country’s cases—was also
insignificant. Gauteng had already seen a wave of the Delta variant in July
2021 and 60-80 per cent of its population had begun showing antibodies in
serology tests. But the numbers continued to rise for days, startling

DOWNTOEARTH.ORG.IN 16-31 DECEMBER 2021 DOWN TO EARTH 11

10-22Cover story-Omicron.indd 11 10/12/21 9:16 AM

 COVER STORY /COVID -19
scientists. Between November 21 and
November 28, covid-19 cases in Gauteng
rose by over 360 per cent.
On November 19, the country’s
National Institute for Communicable
Diseases (nicd-sa) decided to increase
genomic surveillance to check whether
something was brewing. On November 23,
a private laboratory submitted six
genomes of the virus that reported a
failure in one of the probes used in rt-pcr
(reverse transcription polymerase chain
reaction) tests. A probe is used to detect
the presence of a specific genetic fragment,
and its failure indicates the gene is
missing, pointing to a change in the virus.
On November 24, another 100 samples
from 30 clinics in Gauteng were subjected
to genotyping to check whether the virus
was mutating. The same day, South Africa
reported to who that it had isolated a new
variant of sars-cov-2. This variant, later
named Omicron, is by far the most heavily
mutated form of the virus. Of its 50
mutations, 32 are on the spike protein
alone. More mutations mean greater
transmissibility and a higher probability
10-22Cover story-Omicron.indd 12
of evading the immunity shield. On
November 26, who named Omicron a
“variant of concern” (voc), a label given to
variants that are more contagious,
deadlier and more resistant to vaccines
and treatments than previous strains.
Gauteng now accounts for 52 per cent of
the active cases in South Africa. The surge
has been linked to Omicron by experts,
even as epidemiological studies are under-
way to verify the role of the new variant.
While nicd-sa notes that those who
tested positive for Omicron displayed no
unusual symptoms, anecdotal evidence
from doctors in the region associated the
variant with extreme fatigue, dry cough,
fever, muscle pain and night sweats. Salim
S Abdool Karim, epidemiologist and
director of the Centre for the aids
Programme of Research in South Africa
(caprisa), said at a media briefing on
The latest wave in November 30, “we have been amazed at
South Africa has
targeted a younger
how fast the numbers are going up.”
age group. While On December 1, a week after Omicron
28% are 30-39 years
old, children aged was isolated, nicd-sa declared that the
0-9 years account country’s fourth wave of covid-19 had
for 19% of cases
officially set in, driven by the new variant.
P H OTO G R A P H : J E K E S A I N J I K I Z A N A
10/12/21 9:16 AM
 Within two weeks, South Africa saw an
exponential rise in covid-19 cases. In
Gauteng’s Tshwane district, infections
skyrocketed from 8,569 between
November 21-27 to 41,921 in the week
from November 28 to December 4.
A detailed analysis on the experience
of covid -19 patients at the Steve Biko/
Tshwane District Hospital Complex in
Pretoria by Fareed Abdullah, director of
the Office of aids and TB (tuberculosis)
Research at the South Africa Medical
Research Centre (samrc), provides a view
into the latest wave. Although nicd has
maintained that almost all cases in
the district were due to Omicron, the
hospital could not confirm the same. In
an article published on samrc’s website
on December 4, Abdullah makes a “rea-
sonable assumption” that the cases are
due to the new variant and can be used
to understand its features.
Abdullah says that during November
14-29, some 166 people were admitted to
the hospital. Ten of them died in the two
weeks preceding December 2. Four of the
deceased were between the ages of 26
and 36; five were over 60 and one was a
child whose cause of death was not
covid -19. The in-hospital death rate was
6.6 per cent, significantly lower than the
23 per cent seen during all the previous
waves. “This compares favourably to the
proportion of deaths at the complex over
the past 18 months, which was 17 per
cent,” he says. Mortalities may increase
from December 3 onwards, he adds, as
the severity of the disease becomes
clearer. The average length of
hospitalisation also went down to 2.8
days in the two weeks to December 2
from 8.5 days for the previous 18 months.
As of December 2, there were 42
people in the covid -19 ward of the
hospital, of which 29 did not need oxygen
support. These are “incidental” cases;
they were not admitted because of the
virus but rather showed to be positive for
it when tested as per the hospital
protocol. Of the remaining 13 on oxygen,
10-22Cover story-Omicron.indd 13
Pre-emptive measure
World Health Assembly moves to fortify
global pandemic response, preparedness
I
n the face of the current global health emergency and to ramp up joint
international efforts against future such crises, the World Health
Assembly (WHA) declared a global treaty to “strengthen pandemic
prevention, preparedness and response” in its session held between
November 29 and December 1, 2021. An intergovernmental negotiating
body will negotiate and draft the treaty under Article 19 of the World
Health Organization’s (WHO) Constitution. The body will hold its first
meeting on March 1, 2022 to decide on timelines and work procedures. It
will hold its second meeting on the status of the working draft on August 1,
2022. The body will also be required to hold public hearings and “deliver a
progress report to the 76th World Health Assembly in 2023; and submit its
outcome for consideration by the 77th World Health Assembly in 2024.”
Article 19 of WHO’s constitution allows for the adoption of conventions
or agreements by the WHA “on any matter within WHO’s competence.” This
is the second such initiative taken under the Article since WHO’s inception
in 1948. The first was the WHO Framework Convention on Tobacco Control
that came into effect in 2005. WHO Director General Tedros Adhanom
Ghebreyesus called the treaty a “once-in-a-generation opportunity” to
better prepare the global health system against future shocks.
“nine (21 per cent) have a diagnosis of
covid -19 pneumonia,” says Abdullah.
The remaining four required oxygen for
non-covid -19-related conditions.
This trend was seen in other hospitals
as well. On December 3, of the 37 patients
at the Helen Joseph Hospital in
Johannesburg, 31 did not need any oxygen
support, while of the 80 patients at the Dr
George Mukhari Academic Hospital,
north of Pretoria, only 14 were on supple-
mental oxygen and one on a ventilator.
“This is a picture that has not been
seen in previous waves. In the beginning
of all three previous waves and throughout
the course of these waves, there has
always only been a sprinkling of patients
[who could survive] on room air in the
covid-19 ward and these patients have
usually been in the recovery phase waiting
DOWNTOEARTH.ORG.IN 16-31 DECEMBER 2021 DOWN TO EARTH 13
10/12/21 9:16 AM
 COVER STORY /COVID -19

NEW THREAT
In just over a week, Omicron spread to 48 countries. The new variant is moving faster than Delta
that has now reached 192 countries since it was declared a variant of concern this May
Countries affected by Delta variant Omicron variant

Source: Weekly epidemiological updates on COVID-19 by World Health Organization

for the resolution of a co-morbidity prior to while 57 per cent of people above 50 have
discharge,” Abdullah notes. Moreover, as received at least one dose, the figure for
of December 2, there were only four the 18-49 age group stands at 34 per cent.
patients in the high-care-ward and one in
intensive care—a substantial decline SPREADS FAST AND WIDE
from what was seen in the previous waves. In just two weeks (as of December 7) since
Of 38 adults in the covid-19 ward of the Omicron’s identification as a new variant,
hospital, 24 were unvaccinated, six were it has been reported in at least 48 coun-
vaccinated while the status for the rest tries, including India (see ‘New threat’).
was unknown. In addition, says Abdullah, Currently, it has spread to Africa, Asia,
the latest wave targeted a much younger the Americas, West Asia, Europe and
age group, with at least 80 per cent of Australia, which became the first country
those admitted from November 19 to on December 6 to report community trans-
December 2 below the age of 50. A majority mission of the variant.
of those infected (28 per cent) were 30-39 India reported its first two Omicron
years old, while children aged 0-9 years cases on December 2 from Karnataka.
accounted for 19 per cent of cases. The variant was detected through ge-
Abdullah argues that this could be due to nome sequencing by the Indian sars-
the vaccination coverage in the region: cov-2 Genomics Consortium (insacog), a

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10-22Cover story-Omicron.indd 14 10/12/21 9:16 AM

 Quick start REPLAY 2020
At its peak, Delta spread to 15 new nations in a week in August 2021. Across the world, the situation has
become reminiscent of the beginning of
Omicron has spread to twice as many countries in its first week*
the pandemic in early 2020. About 56
Week-wise new countries affected by Delta variant Omicron variant countries, including India, have re-im-
30 posed travel restrictions since the last
week of November to curb the spread of
Omicron from “at risk” countries; particu-
25 larly the 16 countries that are part of the
Southern African Development Commu-
Number of affected countries

nity and other neighbouring nations. This

20 led to an outburst of protests from the con-
tinent, with countries alleging the curbs
were “racial” and “irrational”. “We are
15 shocked by the decision of high income
countries to suddenly ban travel from our
countries, particularly South Africa,
10
which helped identify this new complex
variant. This is unfortunate, especially
for countries that have not yet registered
5
any case of the new variant. Afro-phobia
and political discrimination are a reality
0 that still exist,” Semano Sekatle, Leso-
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 tho’s the health minister, tells Down To
W E E K S * Earth. who has demanded that countries
reconsider the curbs. Takeshi Kashai,
* Since the virus strain was declared a variant of concern;
Source: Weekly epidemiological updates on COVID-19 by World Health Organization who’s Western Pacific Director, said at a
media briefing on December 3, “Border
controls can buy time but every country
and every community must prepare for
new surges in cases.”
forum of 37 laboratories in the country There is also increasing evidence that
established by the Union Ministry of Omicron might have been spreading much
Health and Family Welfare. The two pa- before and outside South Africa. The
tients are both male, 66 and 46 years old. Netherlands’ National Institute for Public
The government has taken quick Health and the Environment said the var-
action to contain the spread of the variant iant was identified in retests of samples
(see ‘India is not prepared for the long taken on November 19 and 23, before
term’, p20). In addition, almost 8,000 peo- South Africa detected it. This puts a ques-
ple who arrived from “at risk” countries tion mark on where the variant originated
aboard 37 international flights between and how it travelled. Oliver Pybus, co-di-
December 1 (midnight) and December 2 rector of the Oxford Martin School Pro-
(8 am) were subjected to rt-pcr tests. Of gram for Pandemic Genomics in the UK,
these, 10 tested positive for covid-19. Their was quoted by The Guardian on December
samples had been collected for genome 1 saying “evidence suggests omicron has
sequencing, the ministry said. As of been circulating since late October.”
December 7, the country had a total of 23 Mozambique reported its first two
cases of the variant and the government cases of Omicron in the first week of
has initiated contact tracing of all the con- December. The suspected cases, detected
firmed cases. CONTINUED ON P18 >>

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10-22Cover story-Omicron.indd 15 10/12/21 9:16 AM

 ADVERTORIAL

Holistic Management of
Wastewater in Ganga Basin
T
he inadequate management of wastewater has the completion period whereas the remaining 60% of
emerged as one of the biggest threats to riverine the cost is paid to the private developer over the term of
ecosystems and public health in the Ganga Basin. the Concession, subject to sustained performance. The
While the conventional methods of wastewater result-oriented approach is the most important feature of
treatment like sewerage network and sewage treatment Hybrid Annuity Mode as both the Annuity and Operation
plants need to be strengthened, especially in terms of and Maintenance payments are linked to the performance
durability and performance, equally urgent is the advocacy of the STP, a major departure from the past. In order to
at the policy level and intervention at the implementation complement HAM, One-City-One-Operator method has
level of some of the alternate methods of treating wastewater also been adopted to further improve accountability. It
and excreta, most notably, Faecal Sludge and Septage broadly means operation, maintenance, rehabilitation
Management (FSSM). Such initiatives acquire even greater and new construction (as per requirement) of assets for an
significance in the backdrop of increasing acceptance of entire city by one operator. So far, 28 HAM projects are
the fact that connecting all households, especially in urban at various stages of execution under the Namami Gange
areas, to sewerage networks is an extremely daunting Programme. Within HAM, 12 projects are on One-City-
task. The importance of FSSM also reflects in the vision One-Operator approach.
of Swachh Bharat Mission (Grameen), Phase-2 as Faecal
Sludge Management is one of the focus areas of ODF to Faecal Sludge and Septage Management
ODF Plus. Another policy issue that demand attention (FSSM)
is the de-centralized approach to integrated wastewater
management which is being increasingly vouched as an Broadly, faecal sludge management involves collection,
attractive solution for addressing the problems of water transportation, proper treatment and safe disposal of the
pollution and scarcity. septage. Faecal sludge is both solid and liquid waste that
Namami Gange Mission, an integrated river accumulates in onsite sanitation systems e.g. septic tanks.
rejuvenation programme, has adopted a holistic approach Presently, in India, septage management practices are at a
to manage wastewater in the Ganga Basin while also rudimentary stage largely due to ineffective local practices.
working for improving ecology and flow, strengthening Despite a national policy on FSSM, very few Faecal Sludge
people river connect and working in partnership with Treatment Plants (FSTP) have been constructed.
knowledge institutions and experts to achieve the overall
improvement of basin.
From augmenting the performance of the sewerage
networks and sewage treatment plants through innovations
such as Hybrid Annuity Mode (HAM) and One-City-
One-Operator to partnering with Centre for Science and
Environment for FSSM projects to bioremediation, a
multi-thronged approach has been adopted to address
the challenge of wastewater in the Ganga Basin. The
importance accorded to river-sensitive planning and water
sensitive design in urban areas under Namami Gange
Programme with National Institute of Urban Affairs
(NIUA) and CSE also attests to the vigorous advocacy of
including river health at the planning stage rather than
viewing the riverine ecosystems as mere water sources
for the population that can be dealt with at some later
stage. This issue is at the very helm of effective wastewater
management. Let us shed some light on some of these
aspects one by one.

Hybrid Annuity Mode (HAM) and One-

City-One-Operator
In a step that marked a paradigm shift in the water sector,
Hybrid Annuity Mode (HAM) has been introduced, for
the first time, for sustainable and dependable solution
to ensure sustainable performance and accountability of
sewage treatment infrastructure. Under HAM, 40% of
the capital cost is paid in 4 or more installments during

16-17Namami Gange Advertorial.indd 16 09/12/21 11:49 AM


Recognizing the need of effective Faecal Sludge and
Septage Management, the National Mission for Clean
Ganga sanctioned the construction of first Faecal Sludge
Treatment Plant (FSTP) national project in Chunar in
Uttar Pradesh. The 10 MLD FSTP is a pilot project with
CSE’s technical support. The project envisages regular
emptying of septic tanks, geo-tagging of all the properties
with details of Online Sanitation System and development
of management information system (MIS). Another
project of core treatment of faecal sludge at Bijnor STP is
also underway under Namami Gange Programme. NMCG
looks to sanction more FSSM projects in Bihar and West
Bengal and proposes mandatory co-treatment of Faecal
Sludge at upcoming STPs in the Ganga Basin and is also
sensitizing different states in India through the forum of
Central Monitoring Committee set up by NGT to monitor
the polluted stretches of rivers in country.
At the state level, Odisha leads in creating FSSM assets.
It has already commissioned 10 FSTPs through AMRUT
funding and more than two dozen are in different stages of
implementation. Within the Ganga Basin, Uttar Pradesh
has a FSTP in Jhansi even as UP Jal Nigam has been tasked
to scale up the construction of FSTPs in various towns.
Karnataka, Telangana, Andhra Pradesh, Maharashtra and
Leh also have some pilot projects.
In an attempt to facilitate knowledge exchange on
best practices in this sector and urge states to construct
FSTPs, a webinar was organised by NMCG in July 2020 on
‘Mainstreaming Faecal Sludge and Septage Management
(FSSM) in Ganga Basin’. Director General, NMCG, Shri
Rajiv Ranjan Mishra participated in a session on ‘Public-
Private Partnerships in Faecal Sludge and used Water
Management: Experiences and Opportunities’ on 12th
October 2021 where he stressed on the need for one stop
solution for city-wide sewage treatment and integration of
140 MLD DINAPUR STP, VARANASI
16-17Namami Gange Advertorial.indd 17
ADVERTORIAL
new and existing sewage treatment infrastructure. In
the same month, a Memorandum of Understanding was
signed between NMCG and WASH Institute to work jointly
on ‘Sustainable Urban Development’ with special focus
on FSSM under the umbrella of Integrated Wastewater
Management.
De-centralized Planning for Wastewater
Management
Wastewater originates at the household level; its solution
must also come from the lower tiers of governance for
effective results. Local ownership is pivotal to wastewater
management. Sewage includes domestic, municipal,
or industrial liquid waste products disposed of, usually
through a pipe or sewer. Sewerage is the physical
infrastructure, including pipes, pumps, channels etc. to
take sewage from its origin to the point of treatment or
disposal. In the septic systems, on the other hand, the
sewage is treated or reused on site or in the vicinity of the
source of generation. For proper wastewater management,
especially in the septic systems, a de-centralized approach
is sustainable and cost-effective. A de-centralized approach
is suitable for areas as big as a town, a neighborhood, a
gated community or an individual house.
River-Centric Planning
Localizing national policies and instruments like National
Water Policy 2012, National Policy on FSSM 2017 etc. is
one of the recommendations of the ‘Strategic Guidelines for
Making River-Sensitive Master Plans’ jointly prepared by
NMCG and NIUA. It was released in June 2021 by the Hon.
Union Minister for Jal Shakti. Creating a strong awareness
on the importance of river-city and people-city connect
and making city planners understand the importance of
integrating river sensitive thinking into a Master Plan has
been one of the targeted areas of NMCG for the past few
years. Urban River Management Plan is being developed to
provide a template for such approach. There should not be
any doubt in the fact that local planning in both rural and
urban areas plays a major role in successful management
of wastewater. From that standpoint, it is essential that de-
centralized planning in wastewater sector is mainstreamed
for successful implementation of multiple efforts being
made in the direction of pollution abatement in Ganga
Basin. One of the better ways to achieve this is including
river health at urban planning stage. The capacity building
initiative with CSE for Water Sensitive Urban Design and
Planning is making an important contribution and getting
extremely good response. This would also help in better
preparedness to deal with impacts of climate change as
water and vegetation can provide much needed cooling
in cities which are becoming heat centers with present
approach to planning. It is imperative for planners and
managers to view rivers, water and ecology as an essential
balancer and not just a resource to be injudiciously used.
The proposed River City alliance would further help in
carrying forward this approach with an institutional
structure.
For sustainable development and sustainable
urbanisation, the planning should be done from the
standpoint of respecting riverine ecologies. Everything else
will automatically fall into place.
09/12/21 11:49 AM
 COVER STORY /COVID -19
in the provinces of Inhambane and Ma-
puto city respectively, were detected in
tests of archive samples from November.
Even though the travel history of these
two cases is not known, the result again
indicates the variant had been circulating
before its isolation in South Africa.
The travel bans are also contested on
their efficacy in controlling the spread of
the virus. In January 2021, a study pub-
lished in the journal Nature by research-
ers from the London School of Hygiene &
Tropical Medicine in the UK found that
“blanket travel bans will not prevent the
international spread, and they place a
heavy burden on lives and livelihoods.”
They say, “In addition, they can adversely
impact global health efforts during a
pandemic by disincentivising countries to
report and share epidemiological and
sequencing data.” Based on the impact of
such restrictions in 2020, the study says
that though they contribute to
controlling the spread, “stringent travel
restrictions might have little impact on
epidemic dynamics except in countries
with low covid-19 incidence and large
numbers of arrivals from other countries,
or where epidemics are close to tipping
points for exponential growth.”
OMICRON V DELTA
The arrival of Omicron also marks a year
since the emergence of the now omni-
present Delta variant that caused deadly
waves across the world, including in South
Africa and India. who has recognised five
vocs and two “variants of interest” (vois) in
two years since covid-19 hit; Delta was
first detected in India in December 2020.
who’s epidemiological update on covid-19
from November 23 maintains that Delta
continues to dominate globally “with the
prevalence of other variants continuing to
decline”. The original strain that began
this pandemic is nowhere to be seen.
Data indicates that Delta is 40-60 per
cent more transmissible than the Alpha
variant and almost twice as transmissible
as the original strain of sars-cov-2 found
18 DOWN TO EARTH 16-31 DECEMBER 2021 DOWNTOEARTH.ORG.IN
10-22Cover story-Omicron.indd 18
in Wuhan, China. Patients infected with
Delta have a significantly higher viral
load, which increases transmissibility.
Looking at the initial trends, Omicron
seems to be spreading faster than Delta;
but the world is also responding to it more
quickly (see ‘Pre-emptive measure’, p13).
Delta was termed a voi on April 4, 2021
and re-categorised as a voc on May 11,
2021. Omicron, on the other hand, went
from being a “variant under monitoring”
to voc in just two days (see ‘Time to act’,
p21). The Delta variant was confirmed in
48 countries as of May 18, 2021, five
months after the first case was reported in
Preliminary India, as per who. Thereafter, it was de-
reports suggest tected in six to nine new countries every
the new variant week. The widest geographical spread
is breaching was seen between August 17 and August
immunity 24, 2021, when 15 new countries reported
acquired either the strain (see ‘Quick start’, p15). By the
through natural first week of October 2021, Delta was
infection or found in at least 191 countries across all
vaccination. continents.
Major vaccine Omicron, in comparison, was detected
makers are in 16 new countries across four continents
already in just five days after first being isolated.
recalibrating The likelihood of its spreading further at
their strategies the global level is “very high”, says who.
as new The potential impact of Omicron can
information on be gauged through the R0 value, or the av-
the variant erage number of new cases spread by each
infection. It is used to measure how fast a
becomes
variant could spread. The current R0 val-
available
ue of the new variant is 2, as per a Decem-
ber 2 article in the journal Nature. The
value was 1 in September when Delta was
spreading, albeit not significantly. Tom
Wenseleers, an evolutionary biologist at
Katholieke Universiteit Leuven, a re-
search university in Belgium, was quoted
by the journal Nature on December 2 say-
ing that Omicron can “infect 3 to 6 times
as many people as Delta, over the same
time period...That’s a huge advantage for
the virus—but not for us.” However, ca-
prisa’s Salim Abdool Karim cautioned dur-
ing his briefing on November 30 that Omi-
cron’s high transmissibility may not make
it more clinically dangerous.
10/12/21 9:16 AM
 Another grave concern that arises
with this variant is of re-infection; who
cited preliminary evidence on November
26 that Omicron increases the risk of such
an occurrence. It has, however, main-
tained that the information available at
the time was limited, and will be updated
in the coming days or weeks. This has
only raised more questions about waning
immunity against covid-19—whether
acquired through natural infection or
vaccination. Preliminary reports suggest
the new variant is breaching immunity
acquired through either way. The first
known Omicron case in the US was of a
fully vaccinated person from California
who returned to the country on November
22 after visiting South Africa.
nicd-sa has also gone on record to say
that people earlier affected by other
variants like Delta are getting re-infected
with Omicron, but vaccines are still
believed to be protecting against serious
infection. Sarah Gilbert, a professor of
P H OTO G R A P H C O U R T E S Y: W H O
vaccinology at the University of Oxford in
the UK and one of the developers of its
vaccine with AstraZeneca, said in a public
lecture on December 5, “[Omicron’s] spike
protein contained mutations known to
increase the transmissibility of the virus.
10-22Cover story-Omicron.indd 19
But there are additional changes that may
African countries
with confirmed mean antibodies induced by the vaccines,
cases of Omicron
have increased
or by infection with other variants, may be
testing, imposed less effective at preventing infection with
travel restrictions
and launched
Omicron.” Vaccine-makers are also recali-
vaccination drives brating their covid-19 strategies based on
new information about the variant. “The
recently described Omicron variant
includes mutations seen in the Delta vari-
ant that are believed to increase trans-
missibility and mutations seen in the Beta
and Delta variants that are believed to
promote immune escape. The combination
of mutations represents a significant
potential risk to accelerate the waning
of natural and vaccine-induced immuni-
ty,” said US-based pharmaceutical com-
pany Moderna in a press release on
December 3. Moderna has begun working
on Omicron-specific vaccines should the
need arise, along with other vaccine man-
ufacturers such as Pfizer. Added Johnson
& Johnson on November 26: “We are
closely monitoring newly emerging
covid-19 virus strains with variations in
the sars-cov-2 spike protein and are
already testing the effectiveness of our
vaccine against the new and rapidly
spreading variant first detected in south-
ern Africa.”
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10/12/21 9:16 AM
 COVER STORY /COVID -19
‘India is not prepared for the long-term’
Public health analyst and epidemiologist CHANDRAKANT LAHARIYA speaks to
TARAN DEOL on what to expect post the emergence of Omicron. Excerpts
Will India see a third COVID-19 wave?
We should stop seeing a wave as a
distinct entity. We need to remember that
once cases come down to a particular
low level, the only direction they figure
can go is upwards. There is some
uncertainty; we do not know when and to
what level the cases may rise. This will
be determined by external factors. But
there is no doubt about a possibility of an
upward trend, which can be sustained for
a few weeks.
What are these “external factors”?
First is the adoption of COVID-19-appropriate behaviour by
individuals. At some point people will become lax. Second is
the emergence of a new variant which can escape immunity
and has high transmissibility.
The third factor is the immune status of an individual.
Currently, we know vaccines and natural infection provide
some protection. But at some point this immunity will start to
decline. Then, if there is a new variant that can infect or an
existing variant that can re-infect, cases will rise. The fourth
factor is vaccination coverage.
Is India ready for the possible rise in cases?
As we are currently focusing on COVID-19, the response has
improved. Testing and availability of beds in hospitals have
gotten a boost, albeit without any fundamental changes.
Moreover, the number of cases is unlikely to go as high as it
did in the second wave. So with high vaccination coverage
and less likelihood of moderate to severe disease, India is
better prepared. But for the long-term, this is not enough. We
need a stronger healthcare system and long-term investment.
The government must fulfil promises made so far.
In addition, we are seeing outbreaks of dengue and other
diseases in different parts of the country. Most of the health
workforce has been diverted to COVID-19. There will come a
point when these services will need to be resumed, in which
case we will be unprepared for another wave.
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10-22Cover story-Omicron.indd 20
The World Health Organization (WHO)
warned of reinfection due to Omicron.
What WHO is saying must be put in the
right context. Omicron has been declared
a variant of concern as it has a number
of mutations associated with different
characteristics such as immune escape,
high transmissibility or a reduced
response to treatments. By November
30, it became the most dominant of all
variants—accounting for 90 per cent of
cases—according to data available from
South Africa’s Gauteng province. This
rise is much faster than other variants. It is too early to say
there is a higher risk of reinfection or immune escape.
However, this is a good opportunity to review the situation
and ramp up the pandemic response in all settings.
Is immunity against COVID-19 waning?
Antibodies decline with time. For COVID-19, it is not only
antibodies but also cell-based immunity that helps fight the
infection. However, these are not measured, and doing so is
an invasive process. Studies show that protection lasts for at
least 9-12 months; we do not know beyond this because
vaccines have been in use only for a year. The point ot
remember here is that even though antibody levels decline,
protection against severe disease, hospitalisation and death
remains almost unchanged. This is also why we should wait
for more evidence before discussing booster doses.
Will tweaking vaccines be effective against new variants?
Tweaking vaccines is a natural process. Manufacturers and
researchers always try to improve vaccines. Currently, this
virus is changing and new variants are emerging. So the right
approach is to develop vaccines which are multi-valent and
can cover multiple variants. There is also global discussion
about variant-neutral vaccines. This essentially indicates use
of futuristic technology and artificial intelligence to predict
variants. It is also possible that every few years, there comes
a newer vaccine that is different from the original vaccine.
10/12/21 9:16 AM
 Waning immunity is currently Time to act
measured through an antibody test.
The world took half a month to upgrade Omicron to a variant of
Several studies on the efficacy of covid-19
concern, which is considerably faster than the usual 8-10 months
vaccinations, yet to be peer-reviewed,
have shown a decline in antibodies after
WORLD’S RESPONSE MUTANT SPREAD
about five months of the second dose. This
allows the spread of breakthrough Alpha
infections. However, immunologists have Spike protein Countries
cautioned against an overreaction to the 07 February 18 December 09 November mutations affected
waning immunity concept. caprisa has 2020 2020 2021 9 *
195
noted that based on previous vocs,
hospitalisation and severe disease even in Beta
the case of re-infection may be unlikely Spike protein Countries
since that effect depends on the memory T 15 February 18 December 05 November mutations affected
cells of the adaptive immune system and 2020 2020 2021 10 145
not the antibodies present. Memory B and
Gamma
memory T cells are the human body’s key
reserve to avoid severe disease or death. Spike protein Countries
Their lifespan changes based on the virus. 07 April 11 January 05 November mutations affected
For instance, a vaccine for measles gives 2020 2021 2021 12 99
lifelong protection, while the influenza vi-
Delta
rus calls for regular immunisation. The
rate at which the memory cells fade after Spike protein Countries
covid-19 vaccination remains unclear. 11 May 11 May 25 November mutations affected
2020 2021 2021 9 192
AFRICA IN CRISIS MODE Omicron
Africa, which struggled throughout the
pandemic and had just begun reporting a Spike protein Countries
decline in covid-19 cases, has been hit mutations affected
11 November 26 November 26 November
hard by the new variant. For the week 2021 2021 2021 30 30
ending December 2, cases in the continent
reported a weekly rise of 54 per cent, First sample collection date Last sample collection date
driven by a surge in southern countries Date when World Health Organization declared it a variant of concern
like South Africa and Botswana.
Apart from crippling the healthcare Source: World Health Organization; Outbreak.info; Updated till December 3, 2021

system, covid-19 has also disrupted

African economies and triggered high
job losses, straining public services,
affecting education and pushing up debt.
The continent faces a debt of over US $300
billion, severely limiting recovery and
development, as per projections by the
United Nations Economic Commission for
Africa. According to who, only 7.5 per cent
of population in the continent is fully vac-
cinated. About 80 per cent of the
population is yet to get the first dose. In
such a scenario, many countries, especial-
ly the ones adjacent to South Africa, are
trying everything to avoid a fourth wave.
Zimbabwe: This northern neighbour of
South Africa first confirmed the variant
on December 2 and has announced new
lockdown measures to contain the virus,
mandating that all travellers undergo rt-
pcr tests and quarantine at their own cost.
More than 2.8 million Zimbabweans have
been vaccinated against covid-19 since
February this year, a far cry from the tar-
get of 10 million. “We are strengthening
our surveillance at the port of entry and
testing everyone who comes in. Those not
tested are not allowed to leave the coun-
try. We are ramping up vaccination as

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 COVER STORY /COVID -19
well,” says Agnes Mahomva, chief coordi-
nator for the national covid-19 response in
the Office of the President and Cabinet.
Despite a projected economic growth of
7-8 per cent in 2021, Zimbabwe is battling
an economic crisis marked by decades of
high inflation and growing unemploy-
ment. Hard lockdown measures may
impact the economy negatively while
hitting the poor. Thomas Chirwa, a street
vendor in the city of Bulawayo, says, “I
have heard about the new coronavirus
[variant], whose name I cannot pronounce.
It spells trouble for us because it will lead
to another lockdown.” City-based human
rights activist Effie Ncube feels the re-
strictions unnecessarily increase pressure
on the already suffering population.
“Many people returning home have just
enough money to get their families
through a few days. Now they have to
spend it all to quarantine themselves.”
Mozambique: The country borders both
Zimbabwe and South Africa and con-
firmed Omicron cases on November 30.
Mozambique now stares at a repeat of the
economic loss it suffered in the last two
years due to several lockdowns. Mozam-
bique’s Confederation of Economic Associ-
ations (cta) opines that measures such as
suspension of flights from other countries
will have a significant negative impact
on national economic activity. Nuno
Quelhas, chairperson of cta’s private sec-
tor commission for covid-19, says the curbs
are a huge blow to tourism. Travel flows in
the country, for both tourism and busi-
ness, recorded a clear recovery until the
third quarter of 2021, when the sector
grew 14 per cent compared to the same
period in 2020. There were clear signs
that 2021 would surpass the 2020 travel
influx, which had amounted to US $180
million. However, with this situation, the
scenario could be reversed.
Lesotho: The country landlocked by
South Africa has implemented massive
checks at its borders. As of December 6,
Lesotho had yet to report a case of
Omicron. However, 0.4 million of the Ba-
22 DOWN TO EARTH 16-31 DECEMBER 2021 DOWNTOEARTH.ORG.IN
10-22Cover story-Omicron.indd 22
sotho people, an ethnic group of the coun-
try, work across the border in South Afri-
ca; mainly in the Omicron hotspot Gaut-
eng. In December 2020, Lesotho was hit
by a sudden surge in infections when the
Basotho community returned from South
Africa for the holiday season. “We are
doing everything in our power to ensure
we are not shocked by another wave this
December,” says health minister Semano
Sekatle. Members of the Lesotho Defence
Force and Lesotho Mounted Police Service
Africa, which have been deployed at both legal and
has already identified illegal border posts. “Every
individual will be tested and vaccinated
struggled to
upon entry in Lesotho. All those missed at
stay afloat
border posts are expected to report to
throughout the
health facilities, village health workers
pandemic and
and other community leaders so that they
had just begun can be transferred for testing and vacci-
reporting a nation,” he says. “If the citizens choose not
decline in to get vaccinated, the country will have no
COVID-19 other choice but to restrict movement.”
cases, has Malawi: The country shares a long bor-
been hit hard der with Mozambique and has a vaccina-
by Omicron. tion rate of just 6.1 per cent. While it had
The continent not reported any Omicron case as of De-
faces a debt of cember 7, its Presidential Taskforce on
over US $300 covid -19 reviewed the status of the pan-
billion, severely demic and the adequacy of the measures
limiting currently in place. “Arriving travellers
recovery and that are not able to show an electronic
development certificate at point of entry, shall be ex-
pected to access covid -19 vaccine that
will be available for free at the point of
entry before being processed to enter/re-
enter the country, as a preventive meas-
ure,” reads a November 26 statement
from the health ministry. Gama
Bandawe, a virologist with the Malawi
University of Science and Technology,
says the current situation was expected.
“The presence of so many unvaccinated
people on the continent indicated the
emergence of other variants which are
more transmissible and perhaps deadli-
er,” he said. However, he notes that the
global reaction to Omicron and subse-
quently, to Africa, was not expected. D T E
@down2earthindia
10/12/21 9:16 AM
 Advertisement

23Chhattisgarh pcb ad.indd 23 09/12/21 11:56 AM

 ANALYSIS /HEALTH INSURANCE

Insurance alone is not

enough to provide universal
health coverage. During the
pandemic, people enrolled
in both public and private
schemes were left to fight
COVID-19 on their own

24-40Cover story-PMJAY-CC.indd 24 10/12/21 9:17 AM

 MYTH OF
COVERAGE
The insurance-centric approach to healthcare proved far
from effective during the pandemic. Will the government
once again focus on reinforcing health infrastructure?

An analysis by SHAGUN in New Delhi

with
G RAM MOHAN from Chittoor, Andhra Pradesh, RANJU DODUM from
Itanagar, Arunachal Pradesh, MOHD IMRAN KHAN from Patna, Bihar,
K A SHAJI from Thiruvananthapuram, Kerala, RAKESH KUMAR MALVIYA
from Bhopal, Madhya Pradesh, GAJANAN KHERGAMKER from Pune,
Maharashtra, PRIYA RANJAN SAHU from Khorda and Bhubaneswar, Odisha,
BHAGIRATH from Hapur, Uttar Pradesh

T
HE NOVEL coronavirus has not only turned our world upside
down, it has also served as a lens through which we are able to see
ourselves, our planet and even our policies with a new and shocking
clarity. So it was not a surprise when two research institutes, Public
Health Foundation of India and Duke Global Health Institute, US,
revealed that India’s flagship health insurance scheme, dubbed the world’s
largest fully government-subsidised scheme, failed to deliver when it was
needed the most. Their report, released in July this year, showed that the
Pradhan Mantri Jan Arogya Yojana (pm-jay), launched in 2018 with a promise
to provide an annual insurance coverage of `5 lakh per family to the poorest
P H OTO G R A P H : V I K A S C H O U D H A R Y / C S E

40 per cent of the population, provided cushion to only 14.25 per cent of people
hospitalised for covid-19 that is caused by the sars-cov-2 virus, between April
2020 and June 2021.
On December 3, Union Minister for Health and Family Welfare
Mansukh Mandaviya in a reply to the Lok Sabha also acknowledged that
pm-jay paid for only 0.52 million covid-19 hospitalisations across the coun-
try. Though no official data is available on total covid-19 hospitalisations in
the country, the share is negligible keeping in mind that the scheme claims
to cover 165 million beneficiaries across the country.

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24-40Cover story-PMJAY-CC.indd 25 10/12/21 9:17 AM

 COVER STORY /HEALTH INSURANCE
Analysts have long warned of such a
limitation of health insurance schemes,
government-funded or private, and insist-
ed on strengthening public health infra-
structure to ensure universal health cov-
erage (see ‘A contentious solicitation’,
Down To Earth 16-30 September, 2018).
The pandemic has laid bare the fault lines
in the system.
What appears bewildering is that
instead of learning lessons from the great
disaster, government think-tank niti
Aayog in October released a report that
says insurance is the way to accelerate
India’s progress towards universal health
coverage. Its report, “Health Insurance for
India’s Missing Middle”, notes that nearly
70 per cent of the country’s population is
protected by some health insurance
coverage, including state government
schemes, social insurance schemes, and
private insurance. Some 30 per cent, or
400 million individuals, are the “missing
middle” who still lack any form of financial
protection for health. Since India’s out-
of-pocket expenditure is 63 per cent of the
current health spending, among the
highest in the world, and over 7 per cent of had put in place public health infra-
K Lahari of Andhra
India’s population is pushed into poverty Pradesh says she structure to tackle the pandemic.
every year due to healthcare costs, the had to pay at

report recommends health insurance

multiple hospitals
to get her husband CASH STILL A MUST
provide greater financial protection against admitted though he
Hospitals demand cash at admission,
had a valid
health shocks and improve delivery of PM-JAY card insist on a signed declaration that
healthcare for better health outcomes. PM-JAY would not be used for ICU
To assess the effectiveness of health
insurance schemes, both government- Twenty-six-year-old K Lahari of Durga-
funded and private, in reducing out- samudram village in Andhra Pradesh’s
P H OTO G R A P H : G R A M M O H A N , R A K E S H K U M A R M A LV I YA

of-pocket expenditure while ensuring uni- Chittoor district remembers how relieved
versal health coverage, Down To Earth she felt when she got to know that her
travelled to nine states where family was eligible under the National
hospitalisation rates were high during the Health Protection Scheme pm-jay. The
pandemic. We found that while the government had selected the family for
government insurance schemes did not the scheme on the basis of the deprivation
cover all the target groups and eligible criteria in the 2011 Socio-Economic Caste
individuals, even those enrolled under Census. While submitting biometric de-
insurance schemes were forced to fight the tails for the pm-jay card, Lahari was told
pandemic on their own and cough up large that her family could go to a hospital of
amounts of money to avail treatment. The their choice—any public or empanelled
only states where people did not have to private facility—and get hospitalised
pay from their pockets were those which without paying a rupee. Lahari now

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24-40Cover story-PMJAY-CC.indd 26 10/12/21 3:54 PM

 blames the scheme for the death of her
husband K Sekhar, who worked as an
auto-rickshaw driver and was the sole
breadwinner of the four-member family.
At the peak of the second wave of the
covid-19 pandemic when Sekhar contract-
ed the infection, Lahari had to take him to
four different hospitals in 15 days. The
first private hospital that Sekhar was
rushed to illegally demanded `20,000 in
cash as security amount, she says. A day
later, the hospital informed Lahari that
their oxygen supply was critically low and
the patient should be shifted out.
The second private hospital, too, de-
manded `20,000 at the time of admission
and an additional `30,000 two days later,
failing which they threatened to “throw”
Sekhar out. “We had already tried our
luck at government hospitals, but they
were full. So we sought help from a What-
sApp group of volunteers and our case got
escalated to the deputy commissioner of
Chittoor who asked another private hospi-
tal to admit Sekhar,” she says. The third
hospital also demanded money and the
family lodged a complaint at the pm-jay
desk at the hospital. The scheme directs
that complaints of denial of treatment by
an empanelled hospital need to be re- Balai Alewa of CARD INELIGIBLE
solved within six hours. “The hospital was Madhya Pradesh Private hospital says PM-JAY covers
says a hospital in
fined. After four days, they discharged Vadodra, Gujarat,
surgeries, not hospitalisation;
Sekhar, though his oxygen levels were no- told him that the expenses never get reimbursed
PM-JAY card did not
where close to normal,” Lahari says. cover hospitalisation
The family went to a fourth hospital, costs In April this year, when the pandemic was
which admitted Sekhar in the icu only rampaging through the country, Balai
after they signed a statement that they Alewa, a farmer of Barwani district in
will not use pm-jay for the treatment. He Madhya Pradesh, had to travel more than
died of a heart attack a few days later. 200 km to Gujarat to get his 19-year-old
“The prime objective of pm-jay is to son treated for covid-19. “We initially
reduce catastrophic out-of-pocket health admitted him to a private hospital in
expenditure by improving access to Barwani, but his health kept deteriorating.
quality health care for its underprivileged We decided to shift him to a better
population,” reads the scheme’s website. empanelled hospital in Gujarat’s Vadodra
Yet by the end of 15 days, Lahari had lost district,” says Alewa. Under pm-jay, the
her husband and spent around `5 lakh, benefits are portable across India, and
sourced mostly through non-institutional this helped the family. His son survived
loans. She is now struggling to make ends after battling the infection for 17 days, but
meet while taking care of her three the hospital bill has left him in tears.
children and repaying the loans. Doctors at the Vadodra hospital

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 COVER STORY /HEALTH INSURANCE

IC
AFFORDABILITY

Av
U

er
In number of workdays required

H
ag
O
e
to pay for average cost by

co AL
SP

st
Casual workers*

to ISA
IT

tre
Regular-wage workers*

at
Self-employed*

co
vid
-1 N
IT
9
O
COVID
COSTS H
471
`1 ISOLA
O
SP

,2 TIO
IT
Every ICU
A

8,1 N
L
hospitalisation, DAYS

10
on an average,
cost more than
what a casual
worker earns in
228
`6 ISOLA
H

almost 1.5 years

7,4 TION
O

DAYS
M
E

70

249.2 312
`8
TE

DAYS
29
ST

DAYS
IN

3.1 DAYS
G

1.5 DAYS
`2

2 DAYS
120.1
,2
29

8.2 DAYS DAYS

*
As defined by
4 DAYS the Periodic
Labour Force
5.4 DAYS
164.5 DAYS
Surveys,
National Sample
Survey Office

Source: Costs and Affordability of COVID-19 Testing and Treatment in India released by Public Health Foundation of India and Duke Global Health Institute

slapped the family with a bill of FEW EMPANELLED

`1.5 lakh, saying that the pm-jay Finding an empanelled hospital is a
card only covered surgeries, not futile exercise in areas where
hospitalisations. “We paid the bill hospitals are few and far between
by mortgaging our house built under
the Pradhan Mantri Awas Yojana and Aman Singh lost his father this May
selling a portion of our farmland,” says after trying to admit him in a hospital
Alewa. After returning, the family tried to for more than four days. A labourer from
get the money reimbursed. “We lodged a Simbhaoli village in Hapur district of
complaint with the Barwani district offi- Uttar Pradesh, Singh says he first visit-
cials and got a sanction for the money. ed a private practitioner who treated his
They asked us to submit the sanctioned father for cough and cold. A few days
letter at the pm-jay office in the state capi- later, Singh had to rush his father to a
tal Bhopal. But officials there have reject- nearby private hospital owing to his
ed our application without giving us a deteriorating health. “Doctors there
clear reason,” Alewa alleges. confirmed that my father was suffering

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24-40Cover story-PMJAY-CC.indd 28 10/12/21 3:54 PM

 from covid -19 and that his oxygen levels
were dangerously low, but refused to
admit him as the wards were over-
flowing,” Singh says. Since beds were
also not available in the two government
hospitals designated for covid -19 treat-
ment, Singh approached another private
hospital. “They agreed to admit my
father but demanded `16,000 saying
they were not empanelled under pm-jay.”
Singh says he was never informed that
under pm-jay, beneficiaries can go to only a
list of empanelled private hospitals. This
has remained a major problem, particu-
larly in smaller towns and villages, where
hospitals are few and far between. Singh
then approached three empanelled hospi-
tals and they all refused a bed. He finally,
admitted his father to a non-empanelled
hospital where he died. “We lost crucial
time trying to locate an empanelled hospi-
tal and this cost him his life,” says Singh,
who has taken a loan of `80,000.
A similar concern is voiced by Ashish
Kumar, a school student, who lost his fa-
ther inside an ambulance parked outside
a government hospital in Bihar’s Patna
district, while waiting to get him admit-
ted. “We had a valid pm-jay card and we
were referred to the special covid -19 hos-
pital by the doctors in the government
hospital in our village because of his de-
teriorating health. Still, my father was
not admitted,” says the resident of Bher-
haria English village. He laments about
the futility of the insurance scheme when village and earns `6,000 a month. As per
Ashish Kumar, a
there are not enough hospitals to treat school student, says the state government’s Samagra Social
PM-JAY could not
patients. get him a bed for
Security Mission portal, which implements
his father who died pm-jay in the state, Dhakad is below

THE OUTLIERS
in an ambulance
parked outside a poverty line and eligible for the scheme.
Many have been left out of the
government hospital “Both my brothers, who work as farmers,
in Patna
insurance scheme’s ambit despite are enrolled under the scheme. My name
P H OTO G R A P H : M O H D I M R A N K H A N

being eligible is surprisingly not there in the list despite

Jitender Dhakad of Badi village in Raisen
district of Madhya Pradesh strongly
believes that he would not have gone
bankrupt during the pandemic had his
family been enrolled under pm-jay. Dhakad
works as a clerk at a private school in his
my applying for inclusion several times,”
he says. During the second wave of the
pandemic, when his wife contracted
covid-19, Dhakad travelled 90 km to
Bhopal, trying to find a hospital bed.
“Only a few hospitals in my home district
were treating covid-19. Even in Bhopal,

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 COVER STORY /HEALTH INSURANCE
government hospitals had no beds to
offer.” He then approached a private
hospital which gave him an estimate of
`1.5 lakh for 10 days of treatment. Dhakad
had to deplete all his life savings and
borrow from his brothers for the treatment.
issued PM-JAY cards,
pm-jay, which aims to provide insur-
ance coverage to the poorest 40 per cent of
the population, has not only left out indi-
viduals like Dhakad, but also certain com-
munities. Thousands of sex workers in
Pune’s Budhwar Peth zone, for example,
fought a solitary battle against the pan-
demic. They say while most people would
refuse to even carry out covid-19 tests in
the area, the few who would agree charged
as much as `10,000 per test. “The situa-
tion was no better in government hospi-
30 DOWN TO EARTH 16-31 DECEMBER 2021 DOWNTOEARTH.ORG.IN
24-40Cover story-PMJAY-CC.indd 30
tals, where authorities would tell us the
result verbally. This meant that if and
when one of us tested positive, admitting
the person was impossible,” says Vinita
Rane, a sex worker who also volunteers
with local non-profit Saheli hiv/aids Kar-
yakarta Sangh. “Forget insurance, the
civic authorities used lockdown as an op-
portunity to penalise the community. The
police had barricaded the locality to stop
movement from within the area,” says
Tejaswi Sevekari, executive director, Sa-
heli hiv/aids Karyakarta Sangh. There
are some 3,000 sex workers in the region
and most are now in debt, she adds.
Several ragpickers Down To Earth in-
teracted with in Pune’s Shivajinagar area
also said they were not enrolled under the
scheme. This is despite pm-jay manual
clearly stating that ragpickers are covered
under the scheme, along with people who
survive on alms and other similar catego-
ries. “My mother was collecting waste
door-to-door till the day she was diag-
nosed with covid-19 this March,” says
Yashoda Garad, a ragpicker in Pune’s
Shivajinagar area. While government
hospitals refused to entertain them, a pri-
vate hospital charged `5,000 to carry out a
covid-19 test and then admitted her for a
day because the family could pay the
charges only for that long. Soon, her health
Suresh Shikre lost his deteriorated and the family was forced to
mother Shantabai borrow `1 lakh to keep her in a private icu
Shikre, who worked
as a ragpicker, to for a week. “Her health improved and she
COVID-19. None of was brought home only to fall ill again a
the ragpickers in
Pune’s Shivsagar few days later. We took her back to the
area have been hospital and after eight days they de-
though the scheme manded `90,000 more,” recalls Garad. By
covers them
then the family had incurred a debt of
over `2 lakh. “Knowing that we cannot
borrow more money, I asked the hospital
P H OTO G R A P H : GA JA N A N K H E R GA M K A R
authorities to discharge my mother. She
died the next morning,” Garad says.
The cost of icu hospitalisation of a
covid patient on an average is equivalent
to what a casual worker (someone who is
employed from time to time according to
exigencies of work) earns in almost 1.5
years (see ‘covid costs’, p28).
10/12/21 3:54 PM
 ‘States’ reliance on public hospitals to
tackle crisis left little scope for PM-JAY’
ROHIT JHA, deputy director of National Health Authority, the nodal agency
for the Pradhan Mantri Jan Arogya Yojana (PM-JAY), speaks to SHAGUN on
the performance of the health insurance scheme during the pandemic
Government data suggest that not
many people availed PM-JAY
services for COVID-19 treatment.
Do you think the scheme failed
during the pandemic?
The pandemic is an event that
nobody could have predicted.
Moreover health is a state subject
and different states followed
different policies to tackle it. For
example, Maharashtra and many
other states relied on public
hospitals to tackle the crisis, leaving
little scope for the use of PM-JAY.
The primary focus of states
remained on widespread testing.
During the first wave, only public hospitals were treating
COVID-19 patients and during the second, the share of
private hospitals remained limited. Another reason could be
that PM-JAY uses biometric details to verify patients and
people were avoiding such contact.
The biometric requirements, however, were waived off during
the pandemic. Also, the scheme is technology-enabled and
people were apprehensive to use shared resources such
as computers, which could have led to a delay in updating
the numbers.
Several case studies suggest that hospitals overcharged
patients and denied treatments during the pandemic. Will
the National Health Authority review to understand the
ground situation?
A joint review mission will begin soon. It will have a group
of officers from the National Health Authority and state
health agencies and will be chaired by officers of the rank
of principal secretary. The team will interact with ground-
level workers, beneficiaries, hospitals and ASHA workers to
understand how the scheme is being implemented.
24-40Cover story-PMJAY-CC.indd 31
Do you think the insurance
model has been fruitful in
achieving the objective of
universal healthcare?
The primary mandate of the
scheme is to reduce out-of-
pocket expenditure of people.
This is taken care of by the
insurance cards that ensure
free and cashless hospitalisation
to the beneficiaries across
the country.
The scheme also aims at
improving public health resources
and infrastructure. This is why the
scheme, for the first time,
reimburses public and private hospitals at par to treat eligible
patients. The reimbursements are untied funds which public
hospitals are spend to improve their resources and
infrastructure. Many public hospitals in Jharkhand, Uttar
Pradesh, Madhya Pradesh and southern states have already
benefited from the scheme.
We are doing two other things to promote public
hospitals. First, all public hospitals with in-patient services
are automatically empanelled under the scheme. Second, we
have a beneficiary facilitation agency which helps patients
identify public hospitals with relevant services.
Doctors and private hospitals have alleged the current
reimbursement rates are unscientific and should be
revised. Do you agree?
We are clear that we do not want to pay hospitals at rates
which are not viable. We have revised the cost of more than
400 packages and we are continuously working on seeing
that hospitals are sufficiently remunerated and incentivised
to operate under the scheme. Some packages have seen an
increase of 200 per cent in rates.
DOWNTOEARTH.ORG.IN 16-31 DECEMBER 2021 DOWN TO EARTH 31
10/12/21 9:17 AM
 COVER STORY /HEALTH INSURANCE

Hollow promises
From lapses in implementation to public-private distrust, the
world’s largest government-run health insurance scheme is
riddled with problems. Pandemic just exposed the fault lines

T
HE FAILURE of pm-jay to cushion
the blow of the pandemic was
expected. Since health is a state
subject and pm-jay is implemented
by the state governments, several of
them delayed including covid -19 under
the scheme. Madhya Pradesh formally
included covid -19 treatment under the
scheme as late as May 7 this year, when
the second wave was at its peak. A
similar lapse was also reported in
Telangana. The delay in state notification
and lack of clarity meant private
hospitals avoided admitting patients
under pm-jay.
This is the reason almost 90 per cent
of covid -19 hospitalisations under the
scheme took place in the four states that
included the disease under pm-jay at the
beginning of the outbreak. Karnataka
treated the highest 0.13 million covid -19
patients under the scheme, followed by
Andhra Pradesh (0.12 million), Maha-
rashtra (0.1 million), and Kerala (0.07
million). Uttar Pradesh, which reported
1.7 million cases till December 6, 2021,
saw 909 hospitalisations under the
scheme. In Bihar, which saw 0.72 million
cases, the number of pm-jay hospitalisa- Jasoda Nayak of
expenditure has not decreased under
tions was 17 (see ‘Not many takers’, p34). Bhubaneswar, pm-jay, because private hospitals are
Odisha, lost her
pm-jay did not help reduce out-of- father to COVID-19 mainly in urban areas and most people
pocket expenditure because of the inher- in May after who use the scheme are from rural or
P H OTO G R A P H : P R I YA R A N JA N S A H U

ent problems associated with such
schemes. pm-jay is more of a discount
that patients get and not free cashless
treatment, which is the basic premise on treatment costs due
which it was launched, says Sulakshana
Nandi, national joint convenor of
Jan Swasthya Abhiyan, a people’s
health movement. People’s out-of-pocket
spending R55,000
for a ventilator at peri-urban areas, says Nandi. Yet,
a private hospital. during the allocation of the Union health
Several patients
faced exorbitant budget, we have seen that the govern-
ment continues to prioritise pm-jay at the
to paucity of
state facilities cost of other health programmes, such as
disease control programmes and child
health programmes. What’s worse, 75-80
per cent of the budget meant for pm-jay

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24-40Cover story-PMJAY-CC.indd 32 10/12/21 3:54 PM

 Himalaya Wellness Committed to Preserving Biodiversity

Being a leading global healthcare brand, Himalaya Wellness

Company is conscious of the need for sustainability and has
pledged to conserve biodiversity through several initiatives.
One of the major initiatives is the tree plantation drive being
conducted since 2012.

India, an extremely biodiverse country, has over 45,000 species

of plants in 2.4% of the world’s land area . However, many life
forms are at risk due to rapid urbanization and development
activities; hence prioritizing and preserving biodiversity is the
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has planted over 8,00,000 trees across the Western Ghats,
Meghalaya, the Eastern Ghats, and Bengaluru. The local
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Saplings of fruit and vegetable-bearing, fodder-providing, and nitrogen-fixing trees are planted
in rural communities. This gives the local communities complete autonomy of the plants and
the produce, which they may either use for economical upliftment or for personal consumption.

Himalaya also worked on building eco-villages to generate sustainable farming or secondary

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Globally, we are facing a huge environmental crisis, and the time to act is now.
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1
https://india.mongabay.com/2020/09/nature-in-peril-as-biodiversity-losses-mount-alarmingly-states-the-living-planet-report/

33Himalaya ad.indd 33 09/12/21 11:50 AM

 COVER STORY /HEALTH INSURANCE
NOT MANY TAKERS
Of the 0.52 million COVID-19 patients who availed PM-JAY insurance scheme, almost 90% were in just five states

COVID-19 patients treated under Number of hospitals against which allegations related to denial of treatment were reported
PM-JAY (as on December 3, 2021) under PM-JAY (includes patients for COVID-19 and other treatments as on July 27, 2021)

Himachal
Jammu and Kashmir Pradesh Haryana Uttarakhand Uttar Pradesh Assam
624 (61) 49 (3) 610 (266) 2,384 (87) 909 (593) 819 (13)
Chandigarh Meghalaya
6 (9) Sikkim 3,661 (1)
Rajasthan Bihar 10
(2) Nagaland
18,052 (6) 17
(214) 11 (2)
Madhya Pradesh
Manipur
13,780 (274)
621 (11)
Dadra and Nagar Haveli and Mizoram
Daman and Diu Tripura

3 (1) 44 (1) 240

Maharashtra Jharkhand
100,178 (51) Andhra Pradesh 1,303 (253)
Goa 120,477 (1) Chhattisgarh
1 Puducherry 29,696 (38)
Karnataka 305
129,983 (48)
Kerala Andaman and
Tamil Nadu Nicobar Islands
71,932 (21) 27,007 (24) 6 Source: Ministry of Health and Family Welfare

gets diverted to private hospitals. This because it is not profitable. For instance,
money could easily have been diverted to he explains, private hospitals usually
public healthcare sector to improve its charge `12,000 for a bone fracture treat-
services. After all, it’s the public sector ment. Under pm-jay, they receive `4,000
that has been mainly catering to for the same treatment.
covid -19 patients, especially those from R V Asokan, honorary secretary gen-
the poor economic sections, says Nandi. eral of the Indian Medical Association
A district grievance manager for (ima), says there is also a trust deficit
pm-jay in Uttar Pradesh, on the condition that the government has towards the
of anonymity, says they receive a consid- private sector. “At least 300 surgeries
erable number of complaints everyday and procedures covered under the
against private hospitals. “Many com- scheme can only be done at government
plaints do not get registered as people do hospitals. What is the point of keeping
not know how to lodge them,” says the private hospitals out of the list,” he says,
official. The reason private hospitals adding that pm-jay is a colossal failure
avoid treating patients under pm-jay is and has made no impact on the ground.

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Profit primary
In face of mounting numbers, private players
often delayed or denied insurance claims
during the pandemic
W
HILE PM-JAY could do
little to alleviate the
enormous financial burden
that covid-19 brought on the
poor, the experience of those who could
pay for the private health insurance was
not satisfactory either. As the number of
covid-19 cases increased, so did the trouble
of getting cashless treatment or getting
claims reimbursed.
Almost 10 months have passed since
K G Philip and his wife Elizabeth of Veli
village in Kerala’s Thiruvananthapuram
district have recovered from covid-19 in-
fection after treatment at two different
pandemic care centres identified by the
state government on the outskirts of
Thiruvananthapuram district. The treat-
ment had caused enormous financial dif-
P H OTO G R A P H : K A S H A Z I
ficulties to the family. Their only hope was
the Corona Rakshak policy by a private
insurance company, to which they sub-
scribed right from the beginning when the
pandemic scare gripped the nation.
DOWNTOEARTH.ORG.IN 16-31 DECEMBER 2021 DOWN TO EARTH
24-40Cover story-PMJAY-CC.indd 35
Private hospitals avoid
treating people under
PM-JAY as it is not profitable
Corona Rakshak and Corona Kavach
are two short-term covid -specific policies
designed by the Insurance Regulatory
and Development Authority of India
(irdai) in 2020. While Corona Kavach is
an indemnity-based product which
provides cashless covid -19 treatment or
reimbursement of the amount spent
on treatment, Corona Rakshak is a
benefit-based policy which promises a
fixed amount of compensation to every
covid -19 patient.
Philip had paid a total premium of
`19,500 and the insurance provider prom-
ised reimbursement of `2.5 lakh to each
affected family member on recovery and
submission of bills. Yet, the company is
denying reimbursement to those who have
received treatment at government-
allotted covid care centres. Despite the in-
tervention from the district collector and
the insurance ombudsman in his favour,
Philip awaits reimbursement.
As per the General Insurance Council,
35
10/12/21 9:17 AM
 COVER STORY /HEALTH INSURANCE
set up by irdai, 2.6 million private insur-
ance claims were recorded between March
2020 and September 2021 from across the
country. Of these, 2.2 million claims were
settled and 0.2 million claims rejected.
But several beneficiaries Down To Earth
spoke with say that the amounts paid
were lower than the claims.
Suraj Dash’s mother and sister were at
a private hospital in Bhubaneswar,
Odisha, after being infected with the
virus during the peak of the first wave in
September last year. “My insurance policy
had a coverage of `5 lakh. The insurance
company reimbursed `1.20 lakh despite
the hospital bill being more than `5.30
lakh,” says Dash, who had lost his father
to covid-19 days earlier. The company de-
ducted the expenses on “consumables”
which ranged between `10,000 and
`25,000 a day.
Ghalib Kaleem, a social activist based
in Patna, remembers his bitter experience
with a private health insurance company
during the second wave. After his condi-
tion deteriorated, he was admitted to a
private hospital in Patna in the third week
of April 2021 and stayed in an icu ward for
seven days which cost him over `2 lakh.
“As I had a health insurance policy, I was
not worried about the hospital expenses.
But I was shocked when the insurance
company officials informed me that covid
treatment was not covered because it is a
pandemic. The hospital where I was treat-
ed also did not help me with the insurance
claim, stating the same reasons,” he says.
Finally, after several complaints, the in-
surance company has reimbursed Kaleen
just `22,000.
Insurance companies also rejected a
sizeable amount of hospitalisation claims
on the ground that the patients should
have been home isolated, but were unnec-
essarily admitted to hospitals.
“Health insurance is a product
designed in the pre-covid times which
does not factor in the unforeseen costs
during a pandemic. For instance, covid
hospitalisation requires isolation and
sterilisation, which are costly. Room
36 DOWN TO EARTH 16-31 DECEMBER 2021 DOWNTOEARTH.ORG.IN
24-40Cover story-PMJAY-CC.indd 36
charges are also very high post covid,”
says Mahavir Chopra, founder of Beshak,
a community platform for insurance
awareness.
Explaining the reason for lower claim
settlement, Nadhamuni, an official of
private health insurer, Star Health
Insurance, based in Andhra Pradesh,
says: “The insurance companies shelled
out huge claim sums during the first wave
but during the second wave, in tune with
the norms set by the All India Institute of
Medical Sciences and the World Health
Organization, cases were classified as
mild, moderate, and severe and claims
The country were settled on that basis.”
recorded 2.6 Analysts, however, believe that the
million private lack of standard treatments or established
insurance protocols for covid-19 is responsible for
claims between the poor settlement of insurance claims.
March 2020 While the insurance business is regulated
and September by irdai, the private healthcare market is
27, 2021. Of unregulated and unethical practices are
these, rampant, states an article co-authored by
Ravi Duggal, an independent researcher
0.2 million
and activist based in Mumbai, and
claims
published in Economic and Political
amounting to
Weekly on July 31, 2021.
`1,319 crore
To bring in clarity and transparency,
were rejected. gic in June 2020 issued a schedule of rates
Of the settled for covid claims being filed with its mem-
cases, many ber insurance companies and included ppe
were paid kits and bio-medical waste in the charges.
lower than It advised insurers to pay claims as per
the amounts government rates or, in cases where this
claimed was not applicable, follow its rate chart.
Officials with private insurance com-
panies say following any such norm was
difficult during the pandemic situation.
Bhaskar Nerurkar, head of health at Bajaj
Allianz General Insurance, says the gic
rates covered three ppe kits for normal pa-
tient per day and four kits for icu admis-
sion at the rate of `650 per kit per day,
even though the actual rate of consuma-
bles were higher due to the shortage.
Similarly, several people were forced to
travel long distances for beds but trans-
portation was not covered under the
scheme. A case in point is Odisha, where
at least 30 young people succumbed to the
10/12/21 3:54 PM
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37Disha Cell MyFile.indd 37 09/12/21 11:51 AM

 COVER STORY /HEALTH INSURANCE
HOUSEHOLD BURDEN
Households have collectively spent 3.6 times more money on COVID-19 treatment (excluding testing),
as compared to government, which focused more on testing

Government expenditure (` crore) Household expenditure (` crore)

29,031.4 DURING FIRST WAVE DURING SECOND WAVE

( APRIL-JUNE 2021)
17,947.4 (APRIL 2020 TO MARCH 2021)

17,947.4
15,915.6

9,199.4
6,294.1

2,900.7
2,044.8
1,984.6

1,222.7

1,105.5
1,108.7
836.6

599.4
NA

NA
TESTING HOME HOSPITAL ICU TESTING HOME HOSPITAL ICU
ISOLATION ISOLATION HOSPITALISATION ISOLATION ISOLATION HOSPITALISATION
Source:“Costs and Affordability of COVID-19 Testing and Treatment in India” released by Public Health Foundation of India and Duke Global Health Institute

infection because the state lacked extracor- ing this, irdai asked insurance companies
poreal membrane oxygenation (ecmo) treat- to communicate their decision on the au-
ment machine. There was just one ecmo thorisation of cashless treatment for covid-
machine at a private hospital in the state. related claims to network providers within
Doctors said the patients had to be airlifted an hour of receiving the request.
to other states for treatment, which was ex- Coverage of home-based care was an-
pensive. The first ecmo connection to a pa- other issue taken up by the Delhi High
tient costs `10 lakh and the subsequent Court, when shortage of beds across the
per-day charge is `3 lakh. The cost for air- country, especially in the national capital,
lifting the patients ran into lakhs of rupees. had become grave. The court, in May 2021,
asked irdai to consider cases of patients
RELUCTANCE SETS IN who underwent home-treatment due to
As the cases rose, insurance companies be- dearth of infrastructure and consider such
gan to refuse cashless covid-19 treatments. insurance claims. This despite the fact that
“From the hospitals’ point of view, they irdai, in a circular issued back in June
needed ready money to run the establish- 2020, had asked the insurers to cover the
ments and to avoid the burden of uploading costs of availing covid treatment at home
bills online and seeking reimbursements,” maximum up to 14 days in certain condi-
says a gic official on condition of anonymity. tions. Following the court’s direction, the
In the two years since the start of the monitoring agency issued a reminder in
pandemic, courts had to often step in to re- July 2021 about the same.
solve health insurance-related issues. On A major problem was the limit of
April 28, 2021, the Delhi High Court di- `15,000-20,000 fixed by many insurers for
rected all insurance companies to process home care. But this limit was inadequate
the insurance claims in 30 to 60 minutes, for most patients who needed oxygen cylin-
so that the discharge of patients is not de- ders and related expenses like regulators,
layed and hospital beds are not blocked nursing charges, other important injec-
due to delays in processing claims. Follow- tions and medicines at home.

38 DOWN TO EARTH 16-31 DECEMBER 2021 DOWNTOEARTH.ORG.IN

24-40Cover story-PMJAY-CC.indd 38 10/12/21 3:54 PM

 MOUNTING COSTS
There is enough proof that the average
claim amount increased substantially
during this time, suggesting that hospitals
overcharged. The average claim settled
during this period was between `99,000
and `100,000. This is more than three
times the average claim pre-covid, which
was `39,000, claims Mayur Trivedi,
associate professor at the Indian Institute
of Public Health, Delhi. Trivedi calculated
the numbers based on irdai data of total
claim amount and number of claims.
A recently concluded survey of 400 peo-
ple on expenditure incurred by them on
covid treatment initiated by Manoj Kumar,
a professor at the Jawaharlal Nehru Uni-
versity, Delhi, found that the expenditure
on covid surpassed even treatments for
heart and lung diseases combined in nor-
mal times. While average cost of covid
treatment was `1,12,179 in government
hospitals and `2,97,577 in private hospitals
in the pre-covid scenario, cost for all symp-
toms combined like fever due to unknown
origin, respiratory issues with or without
fever, and heart diseases, chest pain, and
breathlessness was `4,622 in government
hospital and `28,932 in private hospitals.
As a result, insurers are demanding
re-pricing of policies from irdai, claiming
that they are incurring losses. In fact,
this year, many insurers have stopped
selling or renewing Corona Kavach poli-
cies. A survey of 11 insurance companies
by Beshak shows at least seven have ei-
ther stopped renewing or selling it despite
offering the policies on their websites.
While insurance companies blame the
pandemic for the poor show, their claim set-
tlement ratio during the pre-covid times
was also not encouraging. Estimates by the
75th Health Round of National Sample Sur-
vey Office 2017-18 indicate that only 56.51
per cent of the inpatient medical expendi-
ture was reimbursed on insurance policy
arranged by individual households from
insurance companies, while the balance
43.5 per cent had to be paid from their own
pocket. The share of reimbursements made
24-40Cover story-PMJAY-CC.indd 39
under the Central Government Health
Scheme and the Employment State Insur-
ance Scheme, which now out source a large
proportion of hospitalisations to private
sector, was also low at 49.57 per cent and
47.92 per cent in 2017-18, indicating over
half of the inpatient care expenditure was
not settled even under employer-based so-
cial insurance schemes.
POOR SIGNS
Health experts say the government cannot
rely only on insurance to achieve universal
The average health coverage. “Even at the time of crisis,
cost of COVID the government was not able to regulate
treatment was the private sector. This is telling because
`1,12,179 in usually during times of crisis, the govern-
government ment temporarily gives a lot of powers to
hospitals and district collectors and other officials, and
`2,97,577 in still the machinery failed to check the ram-
private pant malpractices committed by the pri-
hospitals. vate players,” says Sulakshana Nandi, na-
Before the tional joint convenor of Delhi-based non-
pandemic, profit network Jan Swasthya Abhiyan.
average Experts claim that if the government
cost for treating fails to spend on healthcare, the entire bur-
den is shifted to the people. Indian house-
all symptoms of
holds still pay 63 per cent of their health
other diseases
expenditures from their own pocket, as per
was `4,622 in
57th round of National Sample Survey. This
government is required because of the minuscule gov-
hospitals and ernment expenditure (1.18 per cent of gdp)
`28,932 in on health, which leaves many primary
private health centres, sub-divisional and district
hospitals hospitals dysfunctional. This is among the
reasons the country’s health system could
not handle the covid-19 load. Overall,
households collectively spent 3.6 times
more money on covid-19 treatment (exclud-
ing testing), as compared to government
(see ‘Household burden’ on p38). Its impact
was also felt in non-covid hospitalisations
during the pandemic.
Economic Survey 2020-21 states that
an increase in public health expenditure
from the current 1 per cent to 3 per cent of
gdp can reduce out-of-pocket (oop)
expenditure by half. “oop for health
increase the risk of vulnerable groups
slipping into poverty because of catas-
DOWNTOEARTH.ORG.IN 16-31 DECEMBER 2021 DOWN TO EARTH 39
10/12/21 9:17 AM
 COVER STORY /HEALTH INSURANCE
trophic health expenditures,” it states. It

‘Our insurance-based
adds that an increase in government
healthcare spending over a decade in

model seems costly’ varied countries such as China, Indonesia,

the Philippines, Pakistan and Thailand
Countries delivering universal healthcare via significantly decreased oop expenditures.
There is another clear trend that
the old tax-based system getting good results emerged from the pandemic—states that
were quick to act fought the virus better. In
SHAILENDER KUMAR HOODA
Arunachal Pradesh, for example, the

T
HE ENORMOUS strain of the pandemic has exposed the gaps in the government channelised its Emergency
health system across the world. Countries have followed diverse ap- Response and Health System Prepa-
proaches to address their healthcare needs. The industrialised West redness Package worth `141.94 crore to
largely relies on curative steps to handle the crisis, leaving little space for prepare for the pandemic. As a result, the
preventive care. In developing nations, the focus is on primary healthcare. state managed to set up 32 covid-19 health
While developed nations claim to have robust systems, research centres (326 beds), 66 covid-19 care centres
suggests that none of them outperformed the rest, before or during the (2,497 beds), 383 quarantine facilities
COVID-19 outbreak. The question is then to identify which features of a (13,411 beds) and two dedicated covid-19
health system trigger favourable outcomes? This largely depends on how hospitals before the second wave. The
the system is financed and how services are delivered and regulated. The network of hospitals also aided in providing
world’s health systems are either financed through government taxes free vaccinations for all. The government
(Spain, New Zealand, UK), social health insurance (Germany, Belgium, claims that 75 per cent of the state’s eligible
Switzerland, Netherlands, Japan, US), government-run health insurance population has received their first vaccine
(Canada, Taiwan, South Korea) or the market (India, Africa, South America and another 39 per cent has received both
and, to a degree, China), where people largely pay out-of-pocket (OOP). dosages. The success can be gauged from
While most nations now rely on insurance-based financing for universal the fact that not a single person availed pm-
health coverage (UHC), the system does not necessarily guarantee effect- jay in the state even though almost 89,000
ive care. The US example always gets cited for delivering care through the families are covered under it.
insurance model, but despite spending almost twice as much as other Odisha is another state that handled
advanced countries, it suffers from high disease burden, infant mortality the crisis better than most others. Though
and low life expectancy. Canada and Taiwan have a single-payer mecha- the state has its own health assurance
nism where people choose their providers and claims are settled on time. scheme called Biju Swasthya Kalyan
India is relying on a new approach for UHC: strategic purchasing of Yojana for coverage of poor people, its
services from private providers through insurance where funds are directly focus has been on building dedicated
transferred to providers. But this appears to be costly. Thailand has accom- covid -19 hospitals and setting up health
modated this model to deliver tertiary care while maintaining primary and infrastructure since the onset of the
secondary care in the public system. In the past two decades, Thailand and pandemic. On March 27, 2020, when the
China were able to reduce OOP over 20 percentage points, while Indians state had reported just three covid -19
still pay 61 per cent from their own pocket. This is due to minuscule govern- positive cases, the government announced
ment expenditure (1.18 per cent of GDP) on health, which leaves primary setting up of two dedicated hospitals each
health centres, sub-divisional and district hospitals dysfunctional. It is the with a capacity of 500 beds in Bhubaneswar
reason the country’s health system could not handle the COVID load, and in partnership with two private medical
its impact was also seen on non-COVID hospitalisations during the pan- educational institutions. The government
demic. Sri Lanka and Cuba, however, still continue to deliver care through was also prompt in organising training of
the old (tax-based) system and are consistently getting good results. doctors and paramedics in all districts.
(Hooda is an associate professor at the Institute for Studies in Industrial If the government is serious about its
Development, New Delhi) goal of ensuring universal healthcare, it
(For complete column, log on to www.downtoearth.org.in) needs to increase its investments on
public healthcare. D T E
@down2earthindia

40 DOWN TO EARTH 16-31 DECEMBER 2021 DOWNTOEARTH.ORG.IN

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 A Down To Earth ANNUAL

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 COVER STORY /CLIMATE CHANGE

Persistent rainfall in
October-November
has wreaked havoc
in peninsular India,
resulting in large-scale
displacement and
infrastructure damage

42-49Cover story-Floods-1.indd 42 09/12/21 4:24 PM

 RAINING FOR
60 DAYS
Incessant heavy rains over south India for the past
two months indicate a drastic change in the
country’s monsoon system and hint at the
new climate extremes of a perpetually warming world
ANALYSIS BY AKSHIT SANGOMLA in New Delhi with
K A SHAJI in Thiruvananthapuram, AISHWARYA SUDHA GOVINDARAJAN and
HARIPRASAD RADHAKRISHNAN in Chennai and M RAGHURAM in Mangaluru

A
WORST-CASE scenario was averted on December 4 when cyclone
Jawad weakened into a deep depression hours before making landfall
in Odisha and then shifted track towards north-northeast, weakening
along the way. The India Meteorological Department (imd) had earlier
warned that Jawad could intensify and be the first cyclone to hit
Odisha in December in 130 years. Incessant rainfalls triggered by remnants of the
cyclone have caused large-scale damage to the standing paddy and other crops in
Odisha and West Bengal. In Odisha one farmer has reportedly committed suicide
over crop loss due to Jawad.
Though Jawad did not intensify into a “severe cyclonic storm”, its movement to the
northern Bay of Bengal in December, when cooler sea surface temperature and wind
conditions are unfavourable for sustaining cyclones, is as unusual as the weather
pattern prevailing over large parts of India since the monsoon season ended. An
analysis of imd data shows that between October 1 and December 7, as many as 17
states received “large excess” rains, or 60 per cent more rainfall over the long-term
average; and another 10 received “excess” or 20-59 per cent more rains than normal.
Overall, the country has received 53 per cent more rainfall than normal. The pattern
has been particularly stark in the country’s peninsular region. While the region ex-
perienced its wettest November since 1901, October too was among the wettest. Be-
tween October 1 and December 1, at least five districts—Coimbatore in Tamil Nadu,
Pathanamthitta and Kottayam in Kerala and Dakshina Kannada and Mysuru in
Karnataka—reported excess or large excess rains every week (see ‘Hard rains’ p44-
P H OTO G R A P H : R E U T E R S

49). While as many as 10 districts reported excess or large excess rainfall in the first
four weeks of October 1-27, their number almost doubled after October 28.
Anecdotal evidence suggests that the impact of the unseasonal rains over the
southern peninsula has been much more devastating compared to the damages
recorded during this year’s monsoon season.

DOWNTOEARTH.ORG.IN 16-31 DECEMBER 2021 DOWN TO EARTH 43

42-49Cover story-Floods-1.indd 43 09/12/21 4:24 PM

 COVER STORY /CLIMATE CHANGE
KERALA KERALA eral times during the months to reduce
October rains highest since 1901 LOSS & DAMAGE the risk of dangerous overflows.
Rajani Sudheer of Kerala’s Kottayam dis- The southwest monsoon traditionally
trict had a narrow escape from landslides Deaths begins in Kerala on June 1 and ends by

that swept away 127 houses in her village
Koottickal on October 18. She and her
family were away that week when the vil-
lage, located on the hilly tracts of the
Western Ghats, saw continuous rainfall.
On October 18, the village received 50 mm
of rainfall within two hours. “It triggered
a dozen landslides. An entire family got
buried under debris as a hillside behind
their house crashed down,” says Sudheer,
who now lives in a relief camp along with
other residents in the village.
Across the state, the government has
set up 184 relief camps since October
that house over 2,600 families displaced
by the unseasonal incessant rainfall. Al-
most all the 14 districts in the state re-
ceived “large excess” rains in October.
That month, says imd, Kerala received
590 mm of rainfall in October—highest
since 1901, and twice the amount the
state received the previous year. Prior to
2021, the state recorded such high Octo-
ber precipitation on just three occasions:
in 2002 (511.7 mm), 1999 (567.9 mm) and
in 1932 (543.2 mm). As the heavy rains
continues to lash most parts of the state,
major dams, including Mullaperiyar and
Idukki, had to raise their shutters sev-
42
October 15. By that time, the intensity of
the downpour subsides considerably.
Around the same time, the northeast
Displaced monsoon sets in, but brings in only mild
3,581 showers. “September and October usually
mark a break between intense rainfalls in
families
Kerala. However, this year there has been
no respite from rains. Our region is wit-
Infrastructure nessing occasional high intensity down-
damaged pours even in the first week of December,”
R223.5 says Sudheer.
Though December marks the end of
crore
northeast monsoon and the onset of
Crop loss winter, most parts of Kerala reported
flash floods, mudslides, landslides and
R493.4 heavy rainfall till the first week of
crore the month. The monsoon calendar seems
to be changing for the state. Since 2018,
Financial loss to Kerala has witnessed scanty rainfall in
the state June and July and has faced extreme, un-
R800 expected rain fury of short durations in
August, September and October. This
crore year, the state has received rains even
Figures are for October during summer and winter, with excess
and November 2021; rainfalls recorded in January, March,
Compiled from multiple
sources
April, May, September, October and No-
vember across state. Data with imd shows
this year (till November 24), the state has
received 3,523.33 mm of rainfall, which is

HARD RAINS
(ending Oct 6)

Of 131 southern districts,

46 saw large excess rains
and 13 saw excess rains

India saw four floods this

WEEK 1

October and November due to

unusually high number of Oct 1-6
Easterly
trough causes
depressions and low-pressure rainfall in
southern
areas in the Indian Ocean peninsular
India

EXCESS (RAINS) LARGE EXCESS

(RAINS)

TROUGH LOW-PRESSURE AREA DEPRESSION

44 DOWN TO EARTH 16-31 DECEMBER 2021 DOWNTOEARTH.ORG.IN

42-49Cover story-Floods-1.indd 44 09/12/21 4:24 PM

 the highest in six decades; in 1961, Kera-
la had recorded 4,257 mm.
TAMIL NADU
November rains 137% above normal
The weather conditions of the state have
been rough since the onset of northeast
monsoon. Between October 1 and Decem-
ber 7, at least 28 of the state’s 38 districts
have received “large excess” rainfall. The
remaining 10 districts received “excess”
rainfall. The worst affected districts are
Cuddalore, which has received 1,124 mm
(92 per cent more than the normal) rain-
fall during the post-monsoon period, and
Chennai, which has received 1,154 mm, or
69 per cent more rainfall than the normal.
Overall, Tamil Nadu experienced 75 per
cent more rainfall during the months. Ac-
cording to the State Disaster Manage-
ment Authority, 8,075 of the 14,138 irriga-
tion tanks across Tamil Nadu were com-
pletely filled, while 2,806 were nearly
filled as of November 30. Speaking to me-
dia persons, the state’s minister for disas-
ter management kkssr Ramachandran
TAMIL NADU ployed industrial pumps to drain rainwa-
LOSS & DAMAGE ter from waterlogged streets, and have set
up relief centres and medical camps.
Deaths As per weather blogger Pradeep John,
106 Chennai had its third wettest November
in history with the Nungambakkam sta-
tion, which represents the city, recording
Displaced 1,044.3 mm rainfall, only trailing behind
15,164 1,088.3 mm in 1918 and 1,049.3 mm in
2015. Analysts say the 2021 flooding in
people
Chennai is different from the deluge in
2015. The latter was due to the abrupt dis-
Infrastructure
charge of water from the Chembarambak-
damaged
kam reservoir on a single day, while the
1,328 current floods is due to poorly planned
huts, houses storm drains irrelevant to the topography.
Crop loss KARNATAKA
10,750
110% more rains in October, November
Heavy and intense rainfall since October
hectares 1 has battered 22 of the 30 districts in the
state, mostly in the southern part of it.
Figures are for October
and November 2021; One of the severely affected areas was the
Compiled from multiple sources Bengaluru urban district, where the Kem-
WEEK 3 (ending Oct 20)

Of 131 southern districts,

has said that a good southwest monsoon, 32 saw large excess rains
which brought significant inflow to most and 17 saw excess rains
waterbodies across Tamil Nadu a few WESTERN
DISTURBANCES
months ago, left little room for the intense UTTARAKHAND
FLOODS
northeast monsoon. Chennai, which is the
worst affected district, has almost turned
into a floodplain. Civil officials have de-
Oct 17-18
Low-pressure area and Oct 17-19
Western Disturbances
WEEK 2 (ending Oct 13)

Of 131 southern districts, Depresion deintesifies

65 saw large excess rains interact and cause into a low-pressure area
and 14 saw excess rains floods in Uttarakhand and reaches Bihar

Oct 14 Oct 15
Low-pressure
A depression forms off
area forms over
Andhra Pradesh coast
Lakshadweep
Oct 14
Oct 13 Low-pressure area
Low-pressure from week 2
area forms Oct 16-17 advances over
over South Low-pressure Bay of Bengal
Andaman Sea area reaches KERALA FLOODS
off the coast
of Kerala and
causes floods in
the state

DOWNTOEARTH.ORG.IN 16-31 DECEMBER 2021 DOWN TO EARTH 45

42-49Cover story-Floods-1.indd 45 09/12/21 4:24 PM

 COVER STORY
pegowda International Airport got flooded
twice in a month, forcing the authorities to
evacuate passengers by tractors. “The city
recorded an unprecedented 1,000 per cent
/CLIMATE CHANGE
KARNATAKA sidy for drip irrigation equipment, input
LOSS & DAMAGE subsidy for crops and crop cultivators
rights cards for all tenant farmers.
Deaths The losses incurred by the farmers

increase in rains than the normal rainfall
[period],” says J Manjunath, deputy com-
missioner of the Bengaluru urban district.
Areas that got flooded are in the low-lying
regions that were once were part of lakes.
The other major affected district is
Kodagu, on the Western Ghats, which has
received 300 per cent more rainfall than
normal since 2018. On the coastal areas,
due to unseasonal rains, arecanut planta-
tions have sustained heavy damage.
Farmers fear that the crop will soon de-
velop “fruit rot” disease due to unseasonal
rainfall. In Malnad, old Mysuru and Bay-
aluseeme regions, crops like tomatoes, cu-
cumbers, long beans, French beans, cauli-
flower and various types of gourds over
16,000 hectares have suffered damage,
say the agriculture department statistics.
ANDHRA PRADESH
500% excess rains in parched land
Hit by heavy rainfall, farmer leaders in
Ananthapuramu district have embarked
on a month-long padayatra since Novem-
ber 20. They plan to cover 170 villages to
demand compensation for their crops such
as banana that were damaged in recent
floods. R Chandra Sekhar Reddy, district
secretary of the All India Kisan Sabha,
says they also demand restoration of sub-
24
can be largely attributed to the washing
away of two earthen dam projects–An-
namayya and Pincha–built in 1978 in the
Displaced neighbouring ysr district (formerly called
12,000 Kadapa district) in the arid Rayalaseema
region. The district saw nearly 63 per
people
cent excess rainfall. M Surendra Reddy, a
retired superintendent engineer, formerly
Infrastructure
with the state’s irrigation department,
damaged
says the breach was due to the overflow of
R223.5 nearby water bodies. Good rainfall over
the last two years and diversion of water
crore
from the Krishna had filled almost all riv-
Crop loss ers and ponds, leading to a deluge in No-
vember. “No project is designed to with-
500,000 stand the breach of all water bodies at
ha once. The Annamayya project (63.4 billion
litres) was designed with regard to the
Financial loss maximum rainfall seen in the previous 25
to the state years. But this downpour has been the
R689 highest this drought-stricken region has
seen in 50 years,” he says. Similarly, the
crore
earth bund of the Pincha dam project (22
Figures are for October billion litres) caved in due to the overflow-
and November 2021; ing of ponds at its starting point, he adds.
Compiled from multiple
sources
WHY THE RAINS?
The catastrophe unleashed during Octo-
ber and November defies logic as none of
the two rain-bearing weather systems
was active during the period. The south-

Of 131 southern districts,

WEEK 4 (ending Oct 27)

Of 131 southern districts,

WEEK 5 (ending Nov 3)

25 saw large excess rains 44 saw large excess rains

and 12 saw excess rains and 15 saw excess rains
Oct 26
Onset of Oct 27-Nov 3
northeast Remnants of
monsoon low-pressure from
Bay of Bengal
moves to Arabian
Oct 27
Sea, causing heavy
Low-pressure
rains along the way
area forms
over Bay of
Bengal
Oct 21-23
Easterly trough
forms

46 DOWN TO EARTH 16-31 DECEMBER 2021 DOWNTOEARTH.ORG.IN

42-49Cover story-Floods-1.indd 46 09/12/21 4:24 PM

 west monsoon began withdrawing on Oc-
tober 6. Though it should have completely
withdrawn from the country by October
15, the process continued till October 26,
during which the wind system remained
weak. The delayed withdrawal of the
southwest monsoon also pushed the entry
of the northeast monsoon, which brings
rainfall over the southern peninsular re-
gion, towards the end of the month. Then
what caused the incessant rainfall?
Analysts link the sustained rains to the
interplay of a few unique weather events at
a time when the atmospheric temperature
was unusually high. “The entire northern
hemisphere, including the oceans, has re-
mained warm from January through Octo-
ber in 2021, with the only exception of the
Siberian High,” says Raghu Murtugudde, a
climate scientist at the University of Mary-
land, US. The Arctic sea-ice loss this year
led to high sea-level pressure over western
Europe and northeastern China, which
steered planetary waves southeastward in-
stead of their eastward trajectory. These
waves, which produce circulation anomalies
in the upper atmosphere, entered India late
in the season and delayed the monsoon
withdrawal, Murtugudde adds.
Then La Niña kicked in on October 14.
This cooling phase of the El Niño South-
ern Oscillation (enso) phenomenon, during
which the sea surface temperatures over
the eastern and central Pacific Ocean re-
main cooler than average, affects the
Of 131 southern districts,
WEEK 6 (ending Nov 10)
39 saw large excess rains
and 15 saw excess rains
Nov 6
Low-pressure
area forms
over Arabian Nov 10
Sea from Low-pressure
remnants area moves
of week 5 towards Tamil
Nadu and Andhra
Pradesh coasts
Nov 7
Low-pressure area Nov 9
intensifies into a CHENNAI Low-pressure area
depression FLOODS forms over
Andaman Sea
42-49Cover story-Floods-1.indd 47
‘Big changes in peninsular
monsoon pattern’
In long run, all these human-made blunders have to be
solved, but there is no immediate solution
S JANAGARAJAN
I
see a lot of changes in the monsoon conditions in peninsular India.
Three decades ago, rainfall was spread through the northeast monsoon.
Now we experience 25 cm of rain in one day, and 70-80 cm in one
week. This pattern has happened thrice since 2005. The second change is
a disruption in the hydrological cycle due to temperature rise because of
climate change.
Events that are not because of climate change include large floods and
episodes of landslides in the peninsular states of Kerala, Karnataka and
Tamil Nadu. These are mainly because of the declining area under forest. In
the Western Ghats, we have lost around three-fourth of the dense forest.
This loosens the soil and the velocity of the water increases unexpectedly.
The water-withholding capacity of the soil decreases upstream and floods
occur downstream.
My suggestion for Kerala, Karnataka and Maharashtra—states that
have been severely battered by the recent incessant rainfall—will be to
develop some sort of a council which I would call the Western Ghat
Protection Council. To make sure the area under dense forest is increasing
and that soil erosion and landslides are controlled, make sure that the
quarrying work in the ghats is reduced. The Western Ghats are considered
the water tower of South India. Protecting them at any cost is extremely
important.
Regarding the Chennai floods, though rivers like the Kosasthalaiyar and
the Adyar deliver around several cusecs of water into the sea, not all the
waters are absorbed by it. That is why even the sea is stagnated, and the
colour of the water has changed. There is also reverse flow [from the sea].
This is something that never happened before.
Tamil Nadu as a whole is blessed with a lot of water. The average
rainfall here is 93 cm in addition to Chennai’s 140 cm. But if we do not think
about conservation we are at risk, since Tamil Nadu is only next to Punjab
and Haryana in groundwater exploitation. In several districts of the state,
where there is no possibility of recharge, groundwater is mined.
At the moment, I don’t see the Tamil Nadu government implementing
any big action or mitigation plans. It has constituted a few committees to
look into the aspects of this flood. Hopefully, the state implements a few of
their recommendations. In the long run, all these human-made blunders
have to be solved, but there is no immediate solution.
(The author is a former professor at Madras Institute of
Developmental Studies)
DOWNTOEARTH.ORG.IN 16-31 DECEMBER 2021 DOWN TO EARTH 47
09/12/21 4:24 PM
 COVER STORY
trade winds which carry this weather dis-
turbance across the world. In India, La
Niña generally triggers the formation of
low-pressure areas, which contribute to
increased rainfall. Thus, a moisture-laden
atmosphere combined with La Niña condi-
tions is likely to have created conducive
conditions for the formation of more low-
pressure areas, and rainfall events.
An analysis of imd data shows between
/CLIMATE CHANGE
ANDHRA records at least two cyclones during Octo-
PRADESH ber and November, which break the low-
LOSS & DAMAGE pressure cycle by dissipating the accumu-
lated heat energy of the ocean. But this
year, none of the low-pressure systems in-
Deaths
tensified to become a cyclone. “The forma-
46 tion of so many low-pressure systems act-
ed as self-inhibitors for strong cyclone
Villages growth,” says Murtugudde. The frequent
affected low-pressure areas sustained the mois-

October 1 and December 1, the Indian
Ocean saw the formation eight low-pres-
sure areas; five of them intensified to be-
come depressions. On an average, India
records three depressions during the two
months. Such high number of depressions
during the months of October and Novem-
ber have been recorded only in 10 years
since 1901.
The impact of the low-pressure areas
on the spread of the rainfall over southern
peninsula can be gauged from the fact in
the first four weeks (October 1-27) when
excess and large excess rainfall was re-
corded in up to 60 per cent of the 131 the
districts in Kerala, Tamil Nadu, Karna-
taka and Andhra Pradesh, three low-
pressure areas were active in the Indian
Ocean. After October 28, as many as five
low-pressure areas were formed, which
fuelled the rainfall to become widespread
and cover up to 82 per cent of the districts.
In an ideal scenario, the Indian Ocean
WEEK 7 (ending Nov 17)
1,990
ture levels for two months.
The other reason for the unusual rains
is the warming up of the Arabian Sea over
People affected the past decade. This causes higher evapo-
231,000 ration which increases the chances of the
formation of a low-pressure area. Tradi-
tionally, the sea surface temperature of
Crop loss
the Arabian Sea was 1.5-2 per cent lower
0.53 than that of the Bay of Bengal. But the
temperature has increased recently, says
million ha
S Abhilash, assistant professor, Depart-
Financial loss ment of Atmospheric Sciences. Cochin
to the state University of Science and Technology,
R6,170 Kochi. This could be the reason for the for-
mation of three low-pressure areas on the
crore Arabian Sea. As a result, this year, low-
Figures are for October pressure areas in the north Indian Ocean
and November 2021; region formed in pairs—one in the Bay of
Compiled from multiple
sources Bengal and another in the Arabian Sea.
imd recorded three such instances betw-
een October 1 and December 1. On one oc-
casion, the pairing created a low-pressure
trough (elongated regions carrying winds
WEEK 8 (ending Nov 24)

Of 131 southern districts, Of 131 southern districts,

98 saw large excess rains 98 saw large excess rains
and 6 saw excess rains and 10 saw excess rains

ANDHRA
Nov 17 Nov 11-13 PRADESH
Low-pressure Low-pressure area FLOODS
area forms in from week 6 turns
Arabian Sea into a depression

Nov 18
Nov 17-20 Depression
Trough forms between Nov 13-17 Low-pressure area reaches Andhra
Bay of Bengal and Low-pressure area forms and forms over Arabian Pradesh coast
Arabian Sea intensifies into a depression off Sea, creates a trough
crossing north Kerala the coast of Tamil Nadu till Madhya Pradesh

48 DOWN TO EARTH 16-31 DECEMBER 2021 DOWNTOEARTH.ORG.IN

42-49Cover story-Floods-1.indd 48 09/12/21 4:24 PM

 and rain) over the Indian landmass and it
resulted in widespread rainfall.
Another weather anomaly that brought
more than usual showers is the way low-
pressure areas moved north and interact-
ed with the Western Disturbances—ex-
tratropical storms in the upper layers of
the atmosphere that travel from the Medi-
terranean region and bring most of the
rainfall and snowfall to the north and
northwestern India during the winter
season. In the third week of October, a
low-pressure area from the Bay of Bengal
moved northwards and situated itself over
Bihar. The winds from the system inter-
acted with a western disturbance over
Punjab and caused intense rainfall in the
north and northwest India. This caused
floods in Uttarakhand and brought heavy
rainfall in most northern states on Octo-
ber 17 and 18. The Western disturbance is
usually formed over Afghanistan and
north Pakistan, but in this instance, it
settled much lower in Punjab. The reason
for this aberration is still not known. This
phenomenon was repeated again on De-
cember 1 when a low-pressure trough
formed off the coast of Maharashtra
moved northwards, interacted with the
western disturbances, and brought heavy
showers in Maharashtra, Gujarat, Mad-
hya Pradesh, and parts of Rajasthan. D T E
@down2earthindia
Of 131 southern districts,
WEEK 9 (ending Dec 1)
72 saw large excess rains
and 6 saw excess rains
Nov 30
Low-pressure area
forms over Andaman
Sea. It intensifies into
cyclone Jawad on
December 3
42-49Cover story-Floods-1.indd 49
‘Blame denuded Western
Ghats, warming Arabian sea’
Need climate literacy, mitigation awareness at the
panchayat and gram sabha levels for timely action
S ABHILASH
G
oing by the findings of the India Meteorological Department (IMD),
this year’s unseasonal rains are the outcome of two low-pressure
weather systems that have evolved over peninsular India.
However, some independent climate experts are attributing the floods to
cloudburst. Even while blaming climate change for the heavy rains, we
must not forget the human contributions which aggravate the rain-related
calamities. The state has to wake up and evolve strategies to address the
impact of illegal constructions and changes in land-use patterns in the
Western Ghats region, which happened in the last quarter-century. Since
Kerala’s land area is narrow, the impacts of human interferences in the
Western Ghats region are easily getting extended to middle of its land and
coastal areas. Since rivers and streams connect hills and coastal regions
through the middle land, flash floods occur across the state, and
authorities fail to get enough time for evacuation and other rescue
interventions. The pattern of rains has changed drastically in Kerala from
2018. The rain calendar has been altered. The gap between the southwest
monsoon and northeast monsoon is no longer there. Even a single high-
intensity rain event can cause destruction anywhere in the state. As in the
case of Western Ghats, the weather pattern on the Kerala coast has also
changed in recent years. In the past, the sea surface temperature of the
Arabian Sea was lower by about 1.5-2 per cent than that of the Bay of
Bengal. As a result, there were fewer cyclonic circulations over the Arabian
Sea. Now, the sea surface temperature of the Arabian Sea is on a steady
rise. Studies have found a 52 per cent increase in the frequency of
cyclones over the Arabian Sea in the last two decades. Kerala needs long-
term mitigating actions rather than short-term rehabilitation and rescue
activities during each calamity. There are many limitations in forecasting
rains at present. Advance warning facilities on extreme rainfall events
have to be improved.
As cloud bursts are now region-specific and area-specific, we have to
decentralise the mitigation strategies. Mitigation and rescue missions are
presently awaiting nods from weather forecasters and experts in New
Delhi or Thiruvananthapuram. Climate literacy and climate change
mitigation literacy must be undertaken at the panchayat and grama sabha
levels. Kerala has a long tradition of decentralised democracy and
grassroots-level planning. That model must be emulated in the case of
climate mitigation as well.
(The author is assistant professor at the Department of Atmospheric
Sciences, Cochin University of Science and Technology, Kochi)
DOWNTOEARTH.ORG.IN 16-31 DECEMBER 2021 DOWN TO EARTH 49
09/12/21 4:24 PM
 ECONOMY /INEQUALITY
Some more unequal
A
The world today is PERSON born today will
inherit a world that has
richer than ever, but never been more affluent.
the wealth gap But it is also a highly unequal
world, and the gap between the
between the rich haves and have-nots will further
and the poor has widen as he or she grows up. The
first thing the inheritor will
also widened to realise is that nearly half of
levels last seen at the the world’s population has
neither the wealth nor the capital
height of imperialism necessary for a decent life.
200 years ago Next, the person would find
that his or her country is richer
RICHARD MAHAPATRA than it has ever been. But the
government, after going on a
NEW DELHI privatisation spree for decades,
50 DOWN TO EARTH 16-31 DECEMBER 2021 DOWNTOEARTH.ORG.IN
50-52Special Report- Inequality-S.indd 50
is poorer and holds fewer assets.
This means the government is
also deprived of adequate wealth
or capital to meet an economic
shock like that caused by the
covid -19 pandemic, and is forced
to borrow from private sources,
adding to the inheritor’s debt.
On the other hand, the rema-
ining half of the world's
population has become richer; it
owns more wealth and earns
more income than the country
itself. To put it in perspective,
global wealth is now concentrated
in the hands of a few private
individuals, who have,
10/12/21 9:18 AM
 effe-ctively, become the econo-mic
rulers of the world.
Such a situation also prevailed
in the early 20th century and the
periods before it, when western
imperialism was at its peak and
democracy was not as widespread.
However, shockingly, if the
inheritor today belongs to the
poorest half of the world, his or her
income is half of what his or her
ancestor in the same population
group would have had, way back
in 1820. On the other hand, the
world’s richest 1 per cent now
control more than one-third of the
global wealth generated since the
1990s. In fact, the number of
billionaires rose to new records in
2020—the year of the pandemic.
Thus, the inheritor is convinced
that “the rich are getting
richer and the poor are
getting poorer”, a trend
that has prevailed for a
while now.
This is the state of the
planet, as found by the
“World Inequality Report
2022”. Released on Decem-
ber 7 by The World Inequ-ality
Lab, a global research initiative,
the report comes after the maiden
year of a pandemic that has
disrupted the world economy and,
for the first time in many decades,
pushed up the rates of extreme
global poverty. Over 100 researchers
across the world have for four years
(since the last edition of the report
came out in 2018) measured the
pace at which inequality is
widening and quantified it in terms
of wealth and income, gender and
even carbon emissions.
According to the report, there
has been unbridled inequality in
both income and wealth with
the rise of democracy, economic
50-52Special Report- Inequality-S.indd 51
liberalisation and the free market.
It is following a similar trend as
seen during the starkly different
era of western imperialism; in
many countries it is even worse
than at that time. During both
1820 and 2020, the top 10 per cent
of income-earners accounted for
50-60 per cent of total income,
while the bottom 50 per cent has
consistently recorded 5-15 per
cent. “This inequality does not
question democracy, but rather the
choices we make under democracy,”
says Lucas Chancel, co-director at
the World Inequality Lab and
lead editor of the report (see
"'50% India without significant
wealth'", p52).
The other worrying aspect is
the huge imbalance between
SUCH IS THE CONCENTRATION OF WEALTH IN THE
PRIVATE SECTOR THAT IT NOW OWNS MORE THAN
GOVERNMENTS. IN PAST FOUR DECADES, THE
GOVERNMENTS HAVE REPORTED A CONSISTENT
DECLINE IN ASSETS
wealth and income levels. Wealth
is the capital or assets that an
individual or country holds now
and that the next generation will
inherit. Income, on the other hand,
is the flow of money for an
activity. The level of wealth held
often decides the capacity to
increase the level of income
earned. Global wealth was around
€510 trillion (US $575.5 trillion) in
2020, about 600 per cent of the
global income level. This ratio was
just 450 per cent in the 1990s.
Says the report, “A wealth-to-in-
come ratio of 450% (i.e. equivalent
to 4.5 years of national income) im-
plies that a country could decide to
stop working for 4.5 years and still
enjoy the same living standard
DOWNTOEARTH.ORG.IN 16-31 DECEMBER 2021 DOWN TO EARTH
as before, thanks to the sale of all
its assets. After this period, the
country would no longer have any
assets and would have to start
working again to meet its needs
and to accumulate new capital. A
rise from 4.5 years to six years
[with a ratio of 600 per cent] at the
global level is a very significant
shift, indicating a return of the
relative size of the stock of wealth
vs. the flows of income in contem-
porary capitalism...after the drop
of wealth-to-income ratios in the
mid 20th century.”
WIDENED RIFT IN INDIA
Among countries, India stands out
in terms of income and wealth
inequality. For instance, per capita
annual earning of the bottom
50 per cent of the population is
R53,610, while a person belonging
to the top 10 per cent earns 20
times this amount. Similarly, the
top 1 per cent of the country holds
more than one-fifth of the national
income while the bottom half
accounts for just 13 per cent of
the same—this share has been
reducing in recent decades. “Since
the mid-1980s, deregulation and
liberalisation policies have led to
one of the most extreme increases
in income and wealth inequality
observed in the world. India stands
out as a poor and very unequal
country, with affluent elite,” says
the report.
India’s wealth distribution also
signals how fast inequality is
51
10/12/21 9:18 AM
 ECONOMY /INEQUALITY
growing. One household in India,
at an average, has wealth worth
'50% India without significant wealth' R983,010. But the general wealth
Average economic growth hides the disparity in distribution, held by the bottom 50 per cent is
LUCAS CHANCEL, co-director at the World Inequality Lab of “almost nothing” at R66,280, just
6 per cent of the Indian average.
the Paris School of Economics and lead editor of the “World
Across the world, it is this group
Inequality Report 2022”, tells DOWN TO EARTH. Excerpts: that is deprived of wealth or capital
to inherit. Even in the case of rich
What has been the level of inequality in India's economic countries where the bottom half
growth journey? has higher wealth than the corres-
Economic growth in India has been extremely unequal. Liberalisation and the free ponding group in poor nations, if
market have led to wealth generation, economic growth and to some extent, poverty one adjusts the high level of debt,
reduction. But the average economic growth hides the disparity in distribution. Wealth net holdings would be near zero.
distribution has been very unequal, with over 50 per cent of the population without any “This situation is particularly wor-
significant wealth at all. rying for future income inequality
Globally, the inequality level mirrors that of the early 20th levels because inequality in asset
century. If you compare various countries, inequality is ownership has direct consequences
bridging. India is closer to Europe now. But, intra-country on income inequality through capi-
inequality has widened. tal income, and indirect consequ-
ences through unequal inheritan-
Has the rise of democracy been ces,” warns the report.
ineffective in fixing inequality? Such is the concentration of
We have studied many democracies, including India. The wealth in the private sector that it
country came out of colonisation and adopted policies that owns more wealth and income
ensured interventions to regulate the economy and to bridge than governments. In the last four
inequality. A few instances are the five-year plans, high tax decades, countries have become
rate and strategic economic management policies like wealthier while their governments
inheritance tax (abolished in 1985). have consistently reported a
After the 1970s, the view that high tax rates and decline in assets. Globally, public
regulation would not help in wealth generation, saw global acceptance. Hence, wealth or assets held by govern-
inequality does not question democracy or its efficacy, but rather the choices we are ments dropped in the last five
making under democracy. Inequality hurts democracy, which is why governments need decades. “The share of wealth held
to intervene and regulate to fix this trend. by public actors is close to zero or
negative in rich countries, mean-
Which frontiers must such interventions prioritise? ing that the totality of wealth is in
People accumulate wealth across generations through inheritance. It has a snowball private hands,” says the report. By
effect, wherein successive generations will gain more, but in their concentrated section. 2020, private wealth in rich
More capital incentivises banks to lend. This is why the rich section’s wealth grows countries was valued at twice the
faster. But it also creates a gap between people; in most countries, 50 per cent of the level in 1970. “Indeed, in the UK
population does not own anything. This is the inequality on which future government and the US, national wealth
interventions must focus. consists entirely of private wealth,
Public wealth has been declining for two reasons: first, governments have been as net public wealth has become
privatising assets and natural resources at low costs. Second, governments contract negative,” finds the report. Coun-
debt to the private sector, making it richer. Without assets, governments have low tries like China and India saw a
resources to invest and to mitigate climate change impacts, particularly in the energy faster increase in private wealth
sector. Currently, governments have more debts than assets. This calls for strategic than rich nations after they
management of the economy. abandoned the regulated economic
models and adopted the free
market. D T E @richiemaha

52 DOWN TO EARTH 16-31 DECEMBER 2021 DOWNTOEARTH.ORG.IN

50-52Special Report- Inequality-S.indd 52 10/12/21 9:18 AM

 Advertisement

53KRIBHCO ad.indd 53 09/12/21 11:52 AM

 PATENTLY ABSURD /LATHA JISHNU
Plant protection authority
sets right its potato blunder
A public campaign forced it to revoke registration of PepsiCo’s
potato variety, but the agency needs to reset its priorities
A
CONTROVERSIAL potato variety used
to make a global brand of chips is no
longer shackled; it is free for cultivation
by farmers without the threat of penal action for
violating intellectual property rights (iprs).
Nearly four years after PepsiCo India unleashed
a series of minatory measures against farmers
in Gujarat, an unsavoury and unsettling
chapter in India’s agriculture has ended with
the plant protection authority revoking the
registration it had given to PepsiCo’s FL 2027
potato variety (also known as the FC5 variety)
used in the manufacture of Lay's chips.
In the process, the authority has indicted
itself in no uncertain terms—an unusual
occurrence in officialdom—by listing a series of
procedural lapses by the registrar, some of them
major, in approving the registration despite
omissions and fudging in the application
submitted by PepsiCo. Perhaps this is the
real cause for celebration, if it means the
process of registrations at the statutory
body, the Protection of Plant Varieties &
Farmers' Rights (ppv&fr) Authority,
will be more streamlined
hereafter.
54 DOWN TO EARTH 16-31 DECEMBER 2021 DOWNTOEARTH.ORG.IN
54-55Column-Latha copy.indd 54
More important in its revocation judgement
is the authority’s affirmation of the overarching
spirit of the law, which says the farmer’s
interests are supreme. It has accepted a major
contention of the revocation petition filed by
farm activist Kavita Kuruganti, that the grant
of registration was not in the public interest. In
other words, something that violates the rights
of farmers as enshrined in India’s unique plant
protection law is not in the public interest.
The revocation of PepsiCo’s registration on
December 3 has lessons for the authority and
the farming community. When the Protection of
Plant Varieties and Farmers’ Rights Act was
enacted in 2001 to comply with the World Trade
Organization’s requirements on laws to protect
iprs in agriculture, there was unease and
annoyance. The farm community in India and
those working to protect farmers’ rights
were apprehensive about the
introduction of iprs in agriculture, an
alien concept in a country—as in
other parts of the world—where
farmers store, reuse and freely
share seeds. The law that was
passed after years of debate
has huge lacunae, but the
fears of the community were
to a large extent assuaged
with the inclusion of a chapter
I L L U S T R AT I O N : YO G E N D R A A N A N D / C S E
in the Act that seemingly
makes the rights of farmers’
paramount over those of
breeders and commercial
interests by protecting
their traditional practice
of reusing and
sharing seeds.
This was the
09/12/21 4:25 PM
 cause for annoyance, globally. Developed admission of its “inadequate and indifferent”
countries subscribe to a framework of rules laid scrutiny of the claims made in the application, all
out by the International Union for Protection of of which are blamed on a registrar who was not
New Plant Varieties (upov) called the upov named. Some of the lapses are egregious, such as
convention, that protects breeders’ rights and allowing the registration of FL 2027 as an extant
bars farmers from reusing saved seeds or variety although the company had initially
exchanging them with other cultivators. For sought its registration as a new variety. This was
two decades, India has faced pressure to join permitted without the company making the
upov, but the country has remained steadfast in necessary amendments in writing. Calling it
keeping its law untouched. However, at home, “highly deplorable” and a textbook case of what
there has been dissatisfaction with the way the happens when the rules are flouted, the authority
law is being implemented by the plant says in its order that the violation of rules has
protection authority, whose functioning has caused hardship to farmers.
been largely under the radar till the PepsiCo The judgement is indubitably an
case became a cause célèbre. acknowledgement of the compelling nature of the
PepsiCo, which applied for the registration case made out by Kuruganti and other activists.
of its FL 2027 potato variety in 2011, was She fought the case on her own, taking on a
granted the same five years later. battery of lawyers from a leading
In 2018 and 2019, the company The plant legal firm who appeared for PepsiCo.
began intimidating potato growers protection This is a victory all right, but it is
in Gujarat for violation of its ipr. authority's primarily related to the procedural
Claiming that the farmers were candid aspects of the authority’s functioning.
using its variety illegally, it filed ipr admission of There are, however, other
infringement cases against a clutch procedural issues that call for urgent action.
of cultivators, the first such cases lapses in For instance, why did PepsiCo
on planting material to be filed in approving the change the category of its potato
India. There was widespread registration of variety from new to extant or
outrage, too, over PepsiCo’s demand the potato "varieties of common knowledge"?
for an absurdly high compensation variety is a N S Gopalakrishnan, a leading ipr
of R1 crore from each farmer (see welcome sign academic who has analysed decades
"Farmers' rights are a hot potato", of data on plant registrations, offers
Down To Earth, 1-15 May, 2019). Compensation an unsettling answer. He says that unlike upov,
comes into play because registration is a kind which focuses only on registration of the newly
of ipr which gives the breeder or company bred varieties that meet specified standards,
exclusive rights to produce, sell, market, the Indian law is facilitating the enclosure of
distribute, import and export the said what were once publicly available varieties used
variety—but without impinging on the farmers' freely by the farming community. Corporate
freedom to save, sow, resow, exchange, share entities and public institutions are registering
and sell harvest, including seeds of any more and more extant varieties because ppv&fr
registered variety. is using the gaps in the law to enable modern
The spirited campaign by farmers’ breeders and seed industries to enclose publicly
organisations to counter PepsiCo’s intimidation available varieties.
has done much to clarify the understanding of One does not have to reiterate the importance
the law. For instance, a "frequently asked of preserving and developing traditional varieties
questions" (faq) booklet on ppv&fr’s website and breeding practices of the farming community
was pulled out after farmers’ groups pointed to promote sustainable agriculture in India. It is
out anomalous interpretations of different in this context that the norm-setting practices
sections of the law. A new unambiguous set of and procedures followed by ppv&fr for registering
faqs has replaced it. extant and farmers’ varieties need to be
More surprising is the authority's candid scrutinised carefully. D T E @ljishnu

DOWNTOEARTH.ORG.IN 16-31 DECEMBER 2021 DOWN TO EARTH 55

54-55Column-Latha copy.indd 55 09/12/21 4:25 PM

 FACTSHEET /AIR POLLUTION

EMPTY
DISCOURSE
The concerns surrounding increased air pollution in the country have
long made it a problem that threatens people’s health and the
environment. It is only recently that the country’s political and legislative
system has acknowledged the gravity of this crisis. The 2019 Winter
Session of Parliament saw air pollution highlighted in both the Houses,
accounting for nearly 11 hours of discussions. However, the growing
interest in the matter is yet to translate into meaningful legislative action

1.2MILLION
3
DECADES
72
MEMBERS OF PARLIAMENT (MPs)
58 MPs
Indians died since the last from 16 states discussed in both Houses focused
in 2019 from amendment to national air pollution in both the Houses on increased winter air
exposure to air laws addressing in the 2019 Winter Session pollution in Delhi and the
pollution air pollution of Parliament National Capital Region

209

INCREASED Questions raised in the

Lok Sabha on air pollution
INTEREST (2000-2019)
Members of Parliament have
raised at least 368 questions
79
on air pollution in the country
between 2000-2019; 200 of 48
32
which were after 2016

0
2000-2005 2006-2010 2011-2015 2016-JULY 2019

56 DOWN TO EARTH 16-31 DECEMBER 2021 DOWNTOEARTH.ORG.IN

56-57Factsheet-Air-Pollution.indd 56 10/12/21 9:18 AM

 NATIONAL POLLUTION CONTROL DAY SPECIAL

PROBLEM AREAS
in air quality governance as identifed
in questions and discussions

Insufficient legal Inadequate Financial and Unconstructive Lack of public

enforcement of policies and technological or non-existent awareness
mitigation measures institutions gaps political dialogue

SECTORS BLAMED
Since 2016, crop residue burning has emerged as the most commonly mentioned source of air pollution

Sources of air pollution in 2016-2019

(209 questions)
Lok Sabha questions
2011-2015
(2000-2019) (79 questions)
2006-2010
22 (32 questions)
2000-2005
(48 questions)
31
NUMBER OF QUESTIONS

19
4
12 7
4
3
8 10 1
5 5
3 4 3
1 3 2
22 1 1 2
2 1 1 1 1
Household Thermal Industries Vehicles Crop residue Waste burning Dust Firecrackers Other sources
biomass power plants (brick kilns, burning
burning and fly ash effluents,
construction,
cement)
SOURCES OF AIR POLLUTION

NEGLIGIBLE ACTION Despite the greater attention on air pollution, India is yet to
see any major legislative impact on the ground

OUTDATED LAWS REPEATED ORDINANCES BIG DECLARATIONS

The three laws pertaining to air quality
governance—the Water (Prevention
and Control of Pollution) Act, 1974; the
Air (Prevention and Control of Pollution)
Act, 1981 (also called “the Air Act”);
and the Environment (Protection) Act,
1986—have seen little change since
enforcement. The last amendment was
on the Air Act in 1987.
The Centre passed an Ordinance
in October 2020 setting up a
new Commission on Air Quality
Management in Delhi and
the NCR. It lapsed and was
promulgated again in March
2021. It was replaced with a Bill
that passed in both the Houses in
August 2021.
The Union finance minister said in the
budget speech for 2020-21 that grants
would be allocated to cities taking
measures to ensure cleaner air, which
the Centre has initiated. During his
Independence Day address in 2020,
the Prime Minister announced a new
mission on air quality, but no
measures have been taken.

Source:“Airing Differences? Reading the Political Narrative on Air Quality Management in India”, Centre for Policy Research, November 2021

DOWNTOEARTH.ORG.IN 16-31 DECEMBER 2021 DOWN TO EARTH 57

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 CIVIL LINES /RICHARD MAHAPATRA
Climate's
food trap
T
HE YEAR is coming to an end. With the
rise of the new covid-19 variant
Omicron, the pandemic is nowhere near
its end. The other existential crisis—climate
change—has also continued, with record-
shattering milestones. In early December, the
world got another rude shock that impacts all
of us—the Food and Agricultural Organization
(fao) reiterated climate change’s role in jacking
up food prices. The rise impacts the world’s
poor even more because the pandemic has
already pushed millions into the poverty trap
and every third person in the world is not able
to have adequate food.
The average food prices (after adjusting
for inflation) in the 11 months of 2021 were
the highest in 46 years, said fao. The global
food price rise was driven predominantly by
wheat, which reported an increase due to
drought and high temperature in major
producing countries, including the US and
Canada. In 2021, as various trade reports
show, spring wheat production declined by 40
per cent in the US due to drought and heat.
Russia, the world’s largest exporter of wheat,
is estimated to harvest less due to
unfavourable weather conditions this season.
It has imposed a tax on wheat export to
ensure plenty of stock for domestic
consumption. Carlos Mera, head of Agri
Commodities Markets at Rabobank
headquartered in the Netherlands, was
quoted in the media: “Events like the French
Revolution and the Arab Spring have been
blamed on high food prices.” He was referring
to the 2010 drought in Russia that brought
down wheat production and increased wheat
prices across the world in 2011 leading to
widespread protests and the fall of many
governments.
Since then, a decade has passed by. We now
face steep price rises even more frequently, for
instance, the recent tomato price hike in India.
There could be various reasons for such price
58 DOWN TO EARTH 16-31 DECEMBER 2021 DOWNTOEARTH.ORG.IN
58Civil Lines-CC.indd 58
hikes, but weather is definitely turning out to
be a major cause. Climate change is fuelling
extreme and erratic weather events and
prolonging drought and heat waves. These
lead to widespread crop damage and also
affect crop yields in the long term.
In the first two decades of this century,
disasters have significantly increased— from
360 events a year in the 2000s to 440 in the
2010s. Only 100 disasters struck a year in the
1970s. Agriculture is by far the worst
impacted sector by extreme weather events
and disasters. In poor-, low- and middle-
income countries, agriculture absorbed
26 per cent of medium- to large-scale disasters
in 2008-18. According to the fao estimate, in
2008-18, poor-, low- and
middle-income countries
Loss in food
lost US $108.5 billion to
production
increases disaster-induced decline
prices, which, in crop and livestock
in turn, production.
influences What does this
people’s food translate into? The
intake impact of climate
change on agriculture is
twofold: it immediately
leads to reduction in production and in
consumption. Both affect the availability of
food and its price, resulting mostly in steep
increases, as we experience currently. In other
words, every loss in agricultural production is
equal to keeping food away from the needy.
Consider this: due to disasters, the world is
losing up to 4 per cent of potential crop and
livestock production. It converts into a loss of
some 6.9 trillion kilocalories per year, or the
annual calorie intake of 7 million adults, as
fao says. Further, if one interprets this loss in
context of poor-, lower- and middle-income
countries, it is a loss of 22 per cent of calorie
intake daily due to disasters. So, climate
change-induced disasters not only impact the
farmers in terms of income loss, but also
reduce availability of food. This is the climate
food trap that captures every one of us. D T E
@richiemaha
09/12/21 4:25 PM
 SCHOOL OF WATER AND WASTE

AAETI

ADVANCED RESIDENTIAL TRAINING PROGRAMME

DECENTRALISED WASTEWATER TREATMENT AND LOCAL REUSE
Dates: DECEMBER 21 – 23, 2021 TARGET PARTICIPANTS
Architects, planners, engineers, researchers and other water and
Course Duration: THREE DAYS (24 HOURS) sanitation professionals working with consultancies, design firms, non -
Venue: ANIL AGARWAL ENVIRONMENT TRAINING government organizations, universities and research centres.
INSTITUTE (AAETI), NIMLI, RAJASTHAN
ALUMNI OF THE ONLINE COURSES
Training Type: RESIDENTIAL
l Basics of decentralised bodies in Uttar Pradesh.
wastewater treatment and l Preparation of Water &
The School of Water and Waste, Centre for Science and local reuse Sanitation Safety Plans – for
Environment (CSE), New Delhi, is organising a three-day
lS
 afe water, sanitation and target Gram Panchayats in
advanced residential training Programme on Decentralised
health for all during and West Bengal.
Wastewater Treatment and Local Reuse. The training will
postCOVID-19 l CSE-NMCG Online Training
mainly focus on step by step planning and designing of
decentralised wastewater treatment systems at different scales l T he SaniPath Tool: on Decentralised Wastewater
as well as regulatory and policy frameworks. assessing exposure to fecal Treatment and Local Reuse
contamination in urban -Issues Challenges & Potential
AIM settings Participants will be awarded a
Build a cohort of practitioners and managers (both government lO
 n site and Off Site Sewage ‘Certificate of Completion’ upon
and private) who will design and implement Decentralised Management for Citywide successful completion of the
Wastewater Treatment Systems (DWWTs). Sanitation – for urban local training programme.

TRAINING HIGHLIGHTS TRAINING FEES

l Understand techno- l Develop understanding
For Indian Participants:
economic feasibility of of enabling institutional,
different nature based regulatory and policy INR 19,800 (for single occupancy accommodation) (Includes
decentralized wastewater frameworks. DWWM tuition fee, training material, external expert lectures and sessions,
management. including stakeholder boarding and lodging, transport from New Delhi to AAETI and back)
l Step by step designing and mapping and engagement.
implementing decentralized l Learn from real LIMITED FULL AND PART FELLOWSHIPS AVAILABLE!
wastewater treatment implementers and gain
FULL FELLOWSHIP includes travel, boarding & lodging costs and
system (DWWTs) for local on-ground experience from
training kit & fees costs. Single occupancy accommodation and group
reuse including operations successfully implemented
pick-up & drop for local travel from pre-defined locations in Delhi.
and management. BMPs.
PART FELLOWSHIP doesn’t include to & fro Delhi travel (from your
TRAINING DESIGN respective location) costs but covers full boarding & lodging costs
and training kit & fees. Single occupancy accommodation and group
The training will follow a mix method Harvard Case Method
pick-up & drop for local travel from pre-defined locations in Delhi.
approach involving lectures, in-class exercises, interactive
discussions and audio-video. The participants will get an Female participants are encouraged to apply and given preference
opportunity to plan and design Decentralised Wastewater Treatment in full / part fellowships.
System (DWWTs) as part of ‘Do It Yourself’ – group exercise. Note: Only shortlisted candidates will be informed

TRAINING COORDINATOR TRAINING DIRECTOR

JYOTI PARSAD, PROGRAMME OFFICER - WATER PROGRAMME SURESH KUMAR ROHILLA, SENIOR DIRECTOR, CSE
MOBILE: +91 8559838864 ACADEMIC DIRECTOR, SCHOOL OF WATER & WASTE, AAETI
EMAIL: JYOTI.PARSAD@CSEINDIA.ORG EMAIL: SROHILLA@CSEINDIA.ORG

CLICK HERE TO REGISTER

59Decentralised Wastewater Treatment and Local Reuse.indd 59 09/12/21 11:52 AM

 R.N.I. NO. 53588/92 POSTAL REGN. NO. DL(S)-17/3109/2021-2023
ISSN 0971-8079. Licensed to Post without Pre-payment U(SE)-44/2021-2023 at Lodhi Road HO,
New Delhi-110003. Published on 14-15 every month. POSTED ON: 16-17 of the same fortnight, Total pages: 60

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