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Editorials/Opinions Analysis For UPSC 06 January 2024

  1. Drug war: On use of antibiotics and antimicrobial resistance
  2. Striking fear: On hit-and-run accident cases and Section 106 of the Bharatiya Nyaya Sanhita


Background

The adage “prevention is better than cure” holds valuable wisdom in medicine. However, blindly wielding this principle, particularly in the form of prophylactic antibiotic use, risks undermining the very purpose of treating patients – their recovery. This concern becomes even more dire when considering the rise of antimicrobial resistance (AMR), a phenomenon where pathogens evolve to evade the very drugs designed to combat them.

Relevance

  • GS3 – Science and technology- developments and their applications and effects in everyday life.
  • GS2 – Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

Main Exam Question:

Critically analyze the challenges posed by rising antimicrobial resistance (AMR) in India, citing evidence from the recent “First Multicentric Point Prevalence Survey of Antibiotic Use.” Suggest concrete solutions to combat AMR and ensure responsible antibiotic use for the future of healthcare.

In Reports

The recent “First Multicentric Point Prevalence Survey of Antibiotic Use at 20 NAC-NET Sites India 2021-22”conducted by the National Centre for Disease Control paints a worrying picture.

  • The survey reveals that in over 70% of cases across hospitals in 15 states and 2 union territories, patients received antibiotics. But the truly alarming statistic is that 55% of these prescriptions were purely prophylactic, not to treat existing infections.
  • Only 45% of antibiotic use targeted active infections, and an even smaller 6% were based on specific bacterial identification.

AMR Explained:

  • Pathogens are microorganisms like bacteria, viruses, and fungi that can cause disease.
  • Over time, through mutations and genetic exchange, these pathogens can develop resistance to the drugs designed to kill them. This is antimicrobial resistance (AMR).
  • Resistant pathogens become difficult or impossible to treat, leading to longer illnesses, increased healthcare costs, and even death.

Prophylactic Antibiotic Use: A Double-Edged Sword

  • Prevents infections in high-risk situations: Used before surgery, dental procedures, or in immunocompromised individuals to prevent post-operative or opportunistic infections.
  • Reduces infection rates in specific scenarios: Can be effective in certain situations like preventing recurrent urinary tract infections or traveler’s diarrhea.
  • Contributes to AMR: Unnecessary use accelerates the development of resistant bacteria, threatening effective treatment of future infections.
  • Increases potential for side effects: Antibiotics can disrupt gut flora, cause allergic reactions, and contribute to antibiotic-associated diarrhea.
  • Misuse is widespread: The recent survey highlights the issue of over-prescription and lack of bacterial identification for prophylactic use
The Dangers of Misuse and Overuse:
  • The survey’s findings highlight the rampant misuse and overuse of antibiotics, contributing to the rapid rise of AMR. This accelerates the evolution of resistant pathogens, putting a question mark on the efficacy of these vital drugs.
  • The World Health Organization (WHO) estimates that AMR was responsible for 1.27 million deaths globally in 2019 and contributed to 4.95 million deaths.
  • AMR jeopardizes not only infection treatment but also other medical procedures like surgery, cesarean sections, and cancer chemotherapy, which rely on effective antibiotics to prevent complications.
The Role of Players:
  • Doctors: Responsible for prescribing antibiotics judiciously, based on specific bacterial identification and only when necessary.
  • Government: Needs to enforce regulations on antibiotic use, invest in research, and ensure access to effective drugs.
  • Patients: Must understand the dangers of unnecessary antibiotic use and practice patience when seeking treatment.

Way forward

Infectious disease specialists and critical care experts have long sounded the alarm on AMR, advocating for rational antibiotic prescription practices. Curbing the non-therapeutic use of antibiotics in both humans and animals is crucial. Addressing the research and development pipeline crisis for new antibiotics is essential to stay ahead of evolving pathogens. Equitable access to new and existing antibiotics globally is another critical aspect.



Context:

India grapples with the grim reality of being one of the world’s leading nations in road fatalities, with over 1.5 lakh lives lost annually. Among these tragedies, hit-and-run accidents stand out for their callous disregard for human life and potential for prolonged agony for victims’ families. This context sheds light on the recent controversy surrounding Section 106 of the Bharatiya Nyaya Sanhita (BNS), the proposed new criminal code, and its proposed harsher penalties for such cases.

Relevance:

  • GS2 – Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
  • GS4 – ethical concerns and dilemmas in government and private institutions; laws, rules, regulations, and conscience as sources of ethical guidance

Main Exam Question

Critically analyze the proposed provision of the BNS regarding harsher penalties for hit-and-run accidents. Consider the ethical and practical implications of the increased sentence, along with alternative approaches to addressing road safety. In your answer, discuss the need for balancing justice with fairness and ensuring effective implementation of the law.

Understanding the Law:

Section 106 replaces the existing Section 304A of the Indian Penal Code (IPC), which dealt with causing death by rash or negligent act. While the IPC capped the penalty at two years, the BNS significantly escalates it. Key provisions include:

  • Increased base penalty: Up to five years imprisonment for causing death due to rash or negligent driving.
  • Hit-and-run clause: Failure to report the accident can lead to extended imprisonment of up to 10 years and a fine.
  • Reduced liability for medical professionals: This clause, unrelated to hit-and-run, creates a separate two-year maximum sentence for registered medical practitioners in case of death during a medical procedure.
Driver Concerns and Protests:

The proposed harsher penalties, particularly the hit-and-run clause, have triggered anxiety and protests among truck drivers. Their anxieties stem from several factors:

  • Fear of lynching: In India, mob violence against suspected drivers involved in accidents is sadly not uncommon.
  • Potential for accidental non-reporting: Drivers argue that accidents can occur due to sudden mechanical failures or medical emergencies, leading to unintentional delay in reporting.
  • Lack of awareness and access to legal support: Many drivers, especially from rural areas, may not be fully aware of the new law or have access to legal guidance in case of an accident.

The Debate on Proportionality:

The proposed law ignites a vital debate on the balance between justice and fairness:

  • Justice for victims: Proponents argue that harsher penalties serve as a deterrent and ensure accountability for negligence that costs lives.
  • Fairness for drivers: Critics question the necessity of such steep sentences, especially considering the role of factors like poor road infrastructure and mechanical failures in some accidents. They argue that such harsh punishments could incentivize concealing accidents due to fear, which wouldn’t benefit victim families.

Beyond Penalties: A Comprehensive Approach:

The editorial rightly emphasizes that focusing solely on increased penalties misses the bigger picture. To truly address road safety, a comprehensive strategy is crucial:

  • Infrastructure improvements: Upgrading roads, addressing black spots, and implementing better signage are essential to prevent accidents at the source.
  • Driver training and licensing: Effective training programs and stricter licensing procedures can raise awareness and ensure responsible driving practices.
  • Public awareness campaigns: Educating the public about road safety rules and responsible behavior can encourage a culture of respect and caution on the roads.
  • Effective enforcement: Stringent implementation of traffic laws and swift action against reckless driving are crucial deterrents.

Way forward

The debate surrounding Section 106 highlights the need for a nuanced approach to tackling hit-and-run accidents. While justice for victims is paramount, simply increasing penalties without addressing underlying issues like infrastructure and driver training might create unintended consequences. Finding a balance between justice and fairness, and implementing a comprehensive safety strategy, is key to saving lives and building a safer road ecosystem for all.


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