PM IAS JUNE 14 EDITORIAL ANALYSIS

Editorial 1 : Rapid, diagnostic test for UTIs may help stem super bug crisis

Context

The PA-100 AST System from Sysmex Astrego is a high-tech, transformative, rapid, point-of-care test for UTIs (Urinary Tract Infection).

Superbug crisis

• Rational use of antibiotics — choosing the appropriate antibiotic for the correct patient at the optimal time — is fundamental to saving lives and combating the superbug crisis.
• Rapid diagnostics are poised to be crucial in this effort.
• The crisis is imminent: Antibiotic-resistant infections killed nearly 1.3 million people globally in 2019 and are on course to cause 10 million deaths a year by 2050, outstripping cancer.
• The global economy may lose $ 4 trillion by 2030 and up to $ 100 trillion by 2050 due to the AMR crisis.

PA-100 AST System

• Most advanced tests in medical practice today are PCR-based, but the PA-100 AST System from Sysmex Astrego has developed a transformative technology based on a phenotypic test.
• This test identifies the bacteria causing the urinary tract infection and performs antibiotic susceptibility testing (AST) to determine the effective antibiotic for the specific patient in under 45 minutes.
• The test uses a single-use cartridge, the size of a smart phone. Less than half a millilitre of the urine is added to this cartridge.
• Bacteria in the urine are trapped in over 10,000 microfluidic traps in parallel arrays and exposed to five different antibiotics at five different concentrations.
• The cartridge is inserted into a reader instrument the size of a shoe box, where bacterial growth is monitored by phase-contrast imaging.
• The reader provides a report , “sensitive” or “resistant” for each antibiotic in 30-45 minutes. This supports doctors and health workers in their clinical decision making at the point of care, and opens up the significant possibility of previously “retired” first-line antibiotics coming back into use for the majority of patients.
• Accurate, rapid diagnosis of bacterial infections that helps doctors and health workers manage and target antibiotics, will slow the development and spread of antibiotic resistant infections, improve healthcare and potentially save millions of lives.
• The test represents a huge advance over the current turnaround time of 2–3 days. The test will help doctors prescribe the right antibiotic at the right time, rather than waiting for 3 days and resorting to an empirical antibiotic prescription.
• The test can be performed in a doctor’s clinic rather than sending the urine sample to a laboratory.
• When a patient with symptoms of a urinary infection visits a doctor, if the new technology is used , the doctor will know within 45 minutes ,whether the patient has urinary infection or not and if there is an infection for which antibiotics will work.
• The test is transformative, accurate, and affordable for patients worldwide.

The current way of diagnosis

• Currently, there are two types of tests available to diagnose urinary infections.
• The first one is the urine dipstick test that can be done as a point-of-care test.
• Point-of-care diagnostic tests are tests that can be performed in the clinic, emergency departments, hospital wards, or pharmacy counters, without the need to send the sample to a laboratory.
• The advantage of the dipstick is that results are available in a couple of minutes, which helps doctors decide whether to start antibiotics or not.
• Unfortunately, accuracy is not more than 50–60%. Even if the doctor carries out a dipstick despite its limitations, the test doesn’t help the doctor choose the right antibiotic.
• For this, the urine sample must be sent to the laboratory for culture. The culture results take a minimum of 2–3 days. But the doctor cannot wait 2–3 days to start an antibiotic.
• So, even if the doctor sends a urine sample for culture, they still have to start an antibiotic empirically, based on educated guesswork, before the culture results are ready.
• By this time, the patient has already completed a full or half course of antibiotics.
• Such blind antibiotic prescriptions are a major cause of the antibiotic resistance crisis, especially in countries like India.
• Currently urinary tract infection management in most cases is based on a 50/50 rationale. Only 50% of patients with symptoms of urinary infection have an actual infection, and the accuracy of a urine dipstick is 50–60%.
• In India, every year, millions of patients with urinary tract infections visit doctors or pharmacies seeking treatment. These infections result in significant loss of life, burden the healthcare system, and have a socio-economic impact.
• Hence, rapid and accurate point-of-care tests for urinary tract infection can save millions of lives worldwide, especially in India.

Conclusion

The Longitude Prize on AMR intends to incentivise the creation of new diagnostic tests that in a matter of minutes, can identify whether an infection is bacterial and, if so, the right antibiotic to prescribe to slow the spread of antibiotic resistant infections.

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Editorial 2 : Do coalition governments slow down the economic reforms agenda?

Introduction

Until the 2014 Lok Sabha elections, India had had coalition governments for 21 years. Fitch had stated that coalition politics and a weakened mandate for the National Democratic Alliance (NDA) could make it challenging to pass legislation on the more ambitious parts of the reform agenda.

Do coalition governments end up making too many policy concessions?

• This question is based on two assumptions which need to be cleared. First, that single-party governments are the natural order of things and multi-party governments are an aberration and will therefore have undesirable consequences. Comparative studies show that this is not necessarily true.
• Second, that a single-party government behaves as a unitary actor.
•  Once we remove these two assumptions, we will see that differences between coalitions and single-party governments have actually reduce.
• There will always be competing ideas and interests and as a consequence, we are likely to see policy compromises and bargains in both.
• The only difference, perhaps, is that in multi-party governments, much of it (compromises) takes place in the public, so in a way they are more transparent.
• So far, India’s experience with coalition governments has not been bad. There have been checks and balances which have helped governments work better as compared to single-party governments.
• Economic growth requires reform. We often believe that reform requires decisiveness, and that decisiveness, in turn, requires a single-party majority government.
• But it is more complicated than that, since the form of government is just one of the many factors influencing economic growth.
• On the question of social policy reforms, earlier coalition governments, despite their rhetorical commitment to a more social democratic agenda, actually had quite a few setbacks.
• If you have to negotiate and bargain and compromise in order to settle on a policy, it is true that there can be multiple veto points that coalition partners can exercise.
• There is a strong consensus for weak reform. But the fact that parties are engaging in negotiations means that there is less radical change and there is more policy stability that facilitates investments over the longer term.
• The fewest checks and balances are seen under single-party majority governments. That could lead to rather unpropitious policy decisions.

Past performance on the economic agenda

• There has actually been a great deal of continuity between governments and their policies, and one has not seen any major reversals.
• Policy change has been gradual and incremental since 1991. Public bargaining between parties signals that different viewpoints are being heard and accommodated.
• Coalitions over a period of time have institutionalised certain decision-making mechanisms which accommodate different voices.
• When it comes to reforms, coalition governments have worked better. In contrast, in a single-party government, there have been decisions, such as the farm laws, which were taken without getting everyone on board.
• Institutions that are meant to facilitate and promote Centre-State relations are more activated in coalition governments.
• That is unsurprising because the allies are often regional parties. You have a more informed policy-making process even if it might be more turbulent.

Role of state governments

• The role of State governments is higher in a national coalition. When Prime Minister Narendra Modi first took power, he pledged to strengthen Indian federalism by embracing a concept of “cooperative federalism”.
• The government also accepted the 14th Finance Commission’s recommendations to increase the State governments’ share of the divisible pool of taxes.
• But over the last decade, the Centre’s share of revenue increased because of the introduction of special cesses which were not part of the divisible pool.
• Second, the Planning Commission was abolished. It was a flawed institution, but it did provide an institutional space for negotiation.
• There is also a greater control over social welfare benefits and their packaging as directly coming from the Union government. That is what is fueling a lot of the discontent.
• Moreover, The division of taxes between the Centre and State is a complex problem. The amount of funds available to the States is also a function of the way in which the economy is functioning.
• When the economy does well, there will be more to go around, and vice-versa.
• At the same time, we also need to take into account, for instance, the regional and income disparities between States.
• And then there is the vertical imbalance between the Centre and the States.
• Another source of tension is with regard to sharing of taxes under GST.
• The goods that were taxed at a higher rate in the pre-GST regime was put under a lower bracket, so there was a decline in revenue for the States.
• The number of commodities that were taxed at a higher rate under the pre-GST regime was reduced. Overall, the GST architecture does not favour the States.

Conclusion

The only possible difference would be the pace of decisions. This also depends on how the decisions are taken and the mechanisms that are used. That might give us a clue to whether economic reforms get stalled or economic reforms are taken forward.