(Premium) Gist of The Hindu: November 2013

Premium - Gist of The Hindu: November 2013

NUCLEAR DETERRENCE IS OVERRATED

The Indian Navy has figured in three recent, global news items. The launch of the indigenously developed aircraft carrier, INS Vikrant , expected to be operational by 2018, makes India only the fifth country after the
United States, Russia, the United Kingdom and France to have such capability. The diesel-electric submarine Prime Minister Manmohan Singh and his wife, Gursharan Kaur, launched the 6,000- tonneArihant in Visakhapatnam on July 26, 2009.

In time, it was said, with a fleet of five nuclearpowered submarines and three to four aircraft carrier battle groups, a 35-squadron air force and land-based weapons systems, India would emerge as a major force in the Indian Ocean, from the Middle East to Southeast Asia.

The strategic rationale is to acquire and consolidate the three legs of land, air and seabased nuclear weapons to underpin the policy of nuclear deterrence. Unfortunately, however, the whole concept of nuclear deterrence is deeply flawed.

Desensitised

Nuclear weapons are uniquely destructive and hence uniquely threatening to our common security. There is a compelling need to challenge and overcome the reigning complacency on the nuclear risks and dangers, to sensitise policy communities to the urgency and gravity of nuclear threats and the availability of non-nuclear alternatives as anchors of national and international security.

Limited India-Pakistan war

The putative security benefits of nuclear deterrence have to be assessed against the real risks, costs and constraints, including human and system errors. Modelling by atmospheric scientists shows that a limited, regional India- Pakistan nuclear war using 50 Hiroshima-size bombs each would, in addition to direct blast, heat and radiation deaths, severely disrupt global food production and markets and cause a nuclear warinduced
famine that kills up to a billion people around the world.

The extra caution induced by the bomb means that the subcontinent’s nuclearisation raised the threshold of tolerance of Pakistan’s hostile mischief, like provocations on the Line of Control and cover for cross-border terrorism. Yet, India did not need to buy deterrence against China. The best available evidence shows that China’s nuclear weapons, doctrine, posture and deployment patterns are designed neither to coerce others nor to fight a nuclear war with the expectation of winning, but solely to counter any attempt at nuclear blackmail.

The role of nuclear weapons in having preserved the long peace of the Cold War is debatable. How do we assess the relative weight and potency of nuclear weapons, west European integration, and west European democratisation as explanatory variables in that long peace? There is no evidence that either side had the intention to attack but was deterred from doing so by the other side’s nuclear weapons. Moscow’s dramatic territorial expansion across eastern Europe behind Soviet Red Army lines took place in the years of U.S. atomic monopoly, 1945–49. Conversely, the Soviet Union imploded after, although not because of, gaining strategic parity.

Historical Evidence

To those who nonetheless profess faith in the essential logic of nuclear deterrence, a simple question: are you prepared to prove your faith by supporting the acquisition of nuclear weapons by Iran in order to contribute to the peace and stability of the Middle East, which presently has only one nuclear-armed state?

It is equally contestable that nuclear weapons buy immunity for small states against attack by the powerful. The biggest elements of caution in attacking North Korea — if anyone has such intention — lies in uncertainty about how China would respond, followed by worries about the Democratic People’s Republic of Korea’s conventional capability to hit populated parts of South Korea. Pyongyang’s puny arsenal of useable nuclear weapons is a distant third factor in the deterrence calculus. Against the contestable claims of utility, there is considerable historical evidence that we averted a nuclear catastrophe during the Cold War as much owing to good luck as wise management. The 1962 Cuban missile crisis is the most graphic example of this. Australia’s most respected strategic analyst, former Deputy Defence Secretary Paul Dibb, argues that Moscow and Washington also came close to a nuclear war in 1983. Frighteningly, Washington was not even aware of this scare at the time and any nuclear war then would have used much more destructive firepower than in 1962.

Compared to the sophistication and reliability of the command and control systems of the two Cold War rivals, those of some of the contemporary nuclear-armed states are dangerously frail and brittle. Nor do nuclear
weapons buy defence on the cheap: the Arihant cannot substitute for the loss of theSindhurakshak . They can lead to the creation of a national security state with a premium on governmental secretiveness and reduced public accountability. In terms of opportunity costs, heavy military expenditure amounts to stealing from the poor. Nuclear weapons do not help to combat India’s real threats of Maoist insurgency, terrorism, poverty, illiteracy, malnutrition and corruption. Across the border especially, there is the added risk of proliferation to extremist elements through leakage, theft, state collapse and state capture.

NPT

  • The Nuclear Non-proliferation Treaty (NPT) has kept the nuclear nightmare at bay for 45 years. The number of countries with nuclear weapons is still, just, in single digit.
  • There has been substantial progress in reducing the numbers of nuclear warheads.
  • But the threat is still acute with a combined stockpile of 17,000 nuclear weapons, 2,000 of them on high alert.
  • The NPT’s three-way bargain between non-proliferation, disarmament and peaceful uses is under strain. The Conference on Disarmament cannot agree on a work plan.
  • The Comprehensive Test-Ban Treaty has not entered into force. Negotiations on a fissile materials cut-off treaty are no nearer to starting. The export control regime was damaged by the India–U.S. civil nuclear agreement.

CO2 EFFECT: FOCUS ON MARINE FAUNA

The oceans absorb more than a quarter of carbon dioxide in the atmosphere, which dissolves in the water to form carbonic acid. This way, the oceans act as a carbon dioxide sink. However, as the amount of greenhouse gas increases in the atmosphere, so does the amount of carbonic acid in the waters, leading to ocean acidification (OA).

  • The studies have found varying levels of adaptability among different organisms. Scientists from the Helmholtz Centre for Polar and Marine Research have found that corals and echinoderms (like starfish) face endangerment and extinction, respectively, by 2100.

  • Their findings are more pertinent because they are based on the same emission scenarios used by the Intergovernmental Panel on Climate Change (IPCC) to prepare its Fifth Assessment Report, due out in September.
  • Corals spend their entire life in one place and cannot efficiently compensate for higher acidity as they lack the necessary physiological mechanisms.

  • These organisms also secrete calcium carbonate to create the most productive ecosystems known: coral reefs. Higher OA and warmer climes could interfere with the formation of reefs, with the scientists believing they could face extinction by the end of the century.

INDIA’S TB CONTROL

  • Tuberculosis is very much in the news, but for all the wrong reasons — a shortage of drugs; increasing multi-drug and extensive drug resistance (MDR, XDR), making treatment both cumbersome and expensive; total drug
    resistance (TDR) as a veritable death warrant; popularly used serological tests for diagnosis being declared worse than useless, and a government order for mandatory case notification.

  • Private practitioners are legally authorised to treat TB, but without qualitycheck mechanisms.
  • They often bypass the prescribed treatment protocol, while MDR, XDR and TDR result from non-protocol drug treatment.
  • India pioneered TB control among developing nations.

  • A national TB control project was launched in 1962. With BCG vaccination as the main intervention, there was an air of expectancy that it would protect against TB. Free TB treatment was included to create goodwill in the community, with public-private partnership (PPP). When “directly observed treatment, short course” (DOTS) became popular, PPP was neglected — a fatal flaw in TB control. In 2012, India’s golden jubilee year of TB control, the World Health Organization (WHO) named India the worst performer among developing nations, with 17 per cent of the global population carrying 26 per cent of the global TB burden.

BCG vaccination

  • India’s TB control pioneers P.V. Benjamin and Frimodt-Moller introduced the mass BCG vaccination in the hope that it would protect against infection by TB bacilli.

  • Preventing infection is key to disease control. BCG manufacturing began in Chennai and an extensive vaccine trial was launched in Chengalpattu district, Tamil Nadu, to measure its protective efficacy. In 1978, the Expanded Programme on Immunisation took over BCG vaccination.

  • In 1979, preliminary results of a 15-yearlong BCG trial showed no protection against infection by TB bacilli. The disappointing results were much debated, and ignored by the then TB control leadership. In 1999, the final results, which were published in the Indian Journal of Medical Research , confirmed that the TB control project had lost the tool of primary prevention.

  • In 2000, the Indian Academy of Pediatrics called for a major redesign of TB control, with alternative tactics to prevent infection and treat infection before it caused disease. WHO’s 2012 Annual Report on TB confirmed India’s failure. DOTS saves lives from TB mortality, but has failed to control TB.

Infection in the Air

TB bacilli spread through the air we breathe in; everyone is at risk of infection. After infection, the majority remains well, but the bacilli stay alive, latent or dormant in body tissues for life. Some 10 per cent will develop TB disease some time in adult life. When disease pathology is in the lungs (pulmonary TB), the bacilli have an easy escape route to the environment. Thus, lung TB is the critical link in the chain of transmission — coughing and spitting allow the bacilli to contaminate the air, and others breathe them in.

In young children, infection can rapidly lead to disease, called childhood TB, which can be serious and life-threatening. BCG fails to protect against infection by TB bacilli, but protects against infection progressing to childhood TB. Thus, universal neonatal BCG vaccination saves thousands of lives and huge costs for diagnosis and treatment. Childhood TB is not infectious; so, treating childhood TB has no role in TB control.

The chances of infection with TB bacilli increase with time and infection prevalence increases with age. In India, about 15 per cent are infected by 15 years of age; 40-60 per cent by 40 years. Among them, a few develop lung TB due to various “risk factors.” They cough/spit out billions of TB bacilli. One way to control TB is by treating everyone with lung TB very early on to break the transmission chain. This is theory; a person with lung TB is infective for many weeks and would have already infected children in contact by the time his sputum is tested and found positive. More often than not, the stable door is shut after the horse has bolted. Yet, if all are treated, over a period of time, the infection rate might decline. Strangely, the target is to treat only 70 per cent with DOTS. WHO estimates that only half of lung TB patients get DOTS. This way, TB cannot be controlled in India. Without PPP, all cases cannot be treated according to protocol.

A Public Health Emergency

The TB control pioneers designed free treatment in the public and private sectors. After all, if the government cannot provide a safe environment for children to grow up in without getting exposed to TB bacilli, the least it should do is to offer free care. They designed a district TB treatment model under PPP. TB control is a Central government project, while health care is a State subject. The private sector has grown enormously. The TB control project has failed to address the yawning gap between private sector health care and TB control.

In the 1980s, AIDS entered India; HIV infection is a major risk factor of TB. Diabetes, another factor, is increasing in India. Poverty and nutritional deficiencies are additional factors. A project review in 1990 confirmed India’s failure to control TB. The Revised National TB Control Programme (RNTCP) using DOTS was launched in 1993, the year WHO declared TB a global emergency. Nationwide expansion of RNTCP took 13 years as the government saw no TB emergency in India.

For those fortunate enough to receive DOTS, the cure rate is high. Their death rate is markedly reduced. For those with extrapulmonary TB, a sputum test will not help in diagnosis. RNTCP is not interested in them as
they do not spread TB bacilli. So, the project illustrates incomplete health care and inadequate public health.

As a Right

“Control” is a defined term in epidemiology — the disease burden should be reduced to a pre-stated level, within a stipulated period of time, and proven to be due to intervention and because of a “secular trend.” As socio-economic status increases, TB should decline even without specific interventions — that is a “secular trend.” RNTCP has not set control targets in terms of a time frame and disease burden. It is not measuring a
secular trend. Thus, the “control” in RNTCP is not epidemiologically sound.

A critical method of TB control, practised in countries with public health infrastructure, is to detect and treat infected children so that the latent bacilli are killed and children removed from the infected pool. They will not develop pulmonary TB as adults. This move is feasible in India, but requires a redesigned TB control strategy. Both interventions, DOTS and treatment of latent infection, must be dovetailed for effective TB control.

Poverty leads to TB and TB worsens poverty. Poverty alleviation requires TB control. The annual economic loss to India on account of uncontrolled TB was assessed by the government at $23.7 billion, while RNTCP’s budget is only $200 million. A redesigned RNTCP deserves at least $1 billion. TB control is at once a humanitarian service, human rights entitlement and investment in socio-economic development. The RNTCP leadership has to get back to the drawing board to redesign TB control.

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