GP SOURCES.

Host-parasite relationships
In the context of communicable disease, the host-parasite relationship
must be considered not only with respect to the individual host-parasite
interaction but also in terms of the interrelationship between the host and
parasite populations, as well as those of any other host species involved.
Most pathogenic bacteria are obligate parasites; that is, they are found only
in association with their hosts. Some, such
as staphylococci and streptococci, can proliferate outside the body of the
host in nutritive materials infected from host sources. Within the tissues of
the host, these organisms set up local infections that spread throughout the
body. Still other bacteria, such as the glanders bacillus (Burkholderia
mallei) and the gonococci, meningococci, and pneumococci, are more
closely adapted parasites, capable of multiplying outside the body of the
host only under the artificial conditions of the laboratory. All these
microorganisms have complete cell structures and metabolic capabilities.

A greater degree of dependence on the host is shown

by rickettsiae and viruses. Rickettsiae are microorganisms that have
the cell structure of bacteria. They exhibit a small degree of
metabolic activity outside cells, but they cannot grow in the absence
of host tissue. The ultimate in parasitism, however, is that of the
viruses, which have no conventional cell structure and consist only
of a nucleic acid (either DNA or RNA) wrapped in a
protective protein coat. Viruses are obligatory intracellular
parasites, capable of multiplying only within the cells of the host,
and they have no independent metabolic activity of their own. The
genetic information that directs the synthesis of virus materials and
certain enzymes enters the host cell, parasitizes its chemical
processes, and directs them toward the synthesis of new virus
elements.

These various degrees of parasitism suggest that the host-parasite

relationship is subject to continuing evolutionary change.
The adaptation of the microorganism to its parasitic existence, in
this view, is accompanied by progressive loss in metabolic
capability, with eventual complete physiological dependence of the
parasite on the host.

 Air pollution is responsible for the deaths of around 7 million

people each year — and 91% of the global population is
exposed to air that exceeds the limits on pollution levels set by
the World Health Organization (WHO).
 Fine particulate matter is a key source of air pollution. This can
be directly produced or indirectly produced when other
pollutants react to chemicals in the atmosphere.
 In a new study, researchers highlight another type of pollutant,
called anthropogenic secondary organic aerosols (ASOAs),
which also react with other pollutants.
 The researchers show that ASOAs are likely to significantly
contribute to mortality associated with air pollution.
In a new study, a team of scientists has shown that an under-researched
type of pollution, ASOAs, make a significant contribution to air pollution
mortality.

For the researchers, their findings, published in the journal Atmospheric

Chemistry and Physics, highlight the need for greater focus on these types
of aerosols and the need for further research into how, when, and where
they react with other pollutants to cause air pollution.

Fine particulate matter

According to the WHO, about 7 millionTrusted Source people die each year
due to air pollution. The organization also reports that over 90% of the
world’s population breathes air that exceeds the WHO’s safety standards
for air pollution.
Researchers have found that fine particulate matter is a leading cause of
this pollution — and that deaths due to fine particulate matter have
increased from 3.5 million per year in 1990 to 4.2 million per year in 2015.

According to the Environmental Protection Agency, fine particulate matter

can be caused directly or indirectly. Some direct sources of fine particulate
matter include fires and construction sites.

Indirect sources include chemicals such as nitrogen oxides and sulfur

dioxide, which can be emitted from the burning of fossil fuels and react with
other chemicals in the atmosphere to produce fine particulate matter.

ASOAs
One type of chemical that can contribute to the formation of fine particulate
matter are ASOAs. Previously, research has shown that these chemicals
— found in inks, cleaning products, adhesives, and paints, for example —
are a major source of volatile organic compounds that contribute to fine
particulate matter.

Speaking to Medical News Today, Dr. Benjamin A. Nault, from the Center
for Aerosol and Cloud Chemistry, at Aerodyne Research Inc., in Billerica,
MA, and a lead author of the research, defined ASOAs as “particulate
matter that is formed through [the] chemistry of organic compounds emitted
from human activities.”

“These human activities include driving vehicles (emissions from tailpipes),

cooking (charcoal emissions), heating (charcoal or wood), and volatile
chemical products […] such as paint, adhesives, inks, cleaners, asphalt,
etc. Some examples of these organic compounds include benzene,
toluene, and xylenes.”

In their study, the researchers wanted to further confirm the role that
ASOAs play in fine particulate matter pollution.
Dr. Nault told MNT that determining the amount of ASOAs is crucial to this.

“Particulate matter can be broadly classified as either primary or

secondary. Primary particulate matter is particulate matter that is directly
emitted from a source — think about the black smoke you may see coming
out of a diesel vehicle or the smoke you see from a campfire or forest fire.”

“Secondary particulate matter is particulate matter that is produced by

emissions that have undergone chemistry in the atmosphere — think about
the sulfur dioxide that is emitted from coal fire plants that leads to acid
rain,” Dr. Nault added.

“Due to this chemistry, secondary particulate matter can be more

challenging to regulate, as you have to know both the emissions and the
chemistry that leads to the particulate matter that is being observed and
that can lead to health impacts. The secondary organic aerosol is one of
the most difficult to regulate, as it is estimated that there are [thousands] of
organic gases in the atmosphere from various emissions.”

“Once these emissions enter the atmosphere, they can undergo rapid
chemistry, which (a) allows them to become particulate matter but (b) can
make it more challenging to trace that compound to an emission source.
This combination of emissions and chemistry has led to a large effort from
the research community to be able to understand secondary organic
aerosol production and how it may impact human health,” explained Dr.
Nault.

“However, many studies have typically not [been] able to predict the
amount of secondary organic aerosol that has been observed. Our
research was able to predict the amount of secondary organic aerosol for
various cities and different emissions around the world, providing
confidence that we could start investigating how secondary organic aerosol
impacts human health.”

According to Dr. Brian McDonald, of the National Oceanic and Atmospheric

Administration Chemical Sciences Laboratory, in Boulder, CO, and a co-
author of the study, “What’s new here is that we are showing this is an
issue in cities on three continents, North America, Europe, and East Asia.”

According to Dr. Nault, “The older idea was that to reduce premature
mortality, you should target coal-fired power plants or the transportation
sector.”

“Yes, these are important, but [we are] showing that if [you are] not
getting at the cleaning and painting products and other everyday
chemicals, then [you are] not getting at a major source.”

Strong correlation
The researchers found a strong correlation between the production of
ASOAs and volatile organic compounds, which react in the atmosphere to
create fine particulate matter.

Using the models, the researchers estimate that ASOAs cause

between 340,000 and 900,000 premature deaths each year. According
to Dr. Nault, “[That is] more than [10] times as many deaths as
previously estimated.”

While regulations on air pollution emission have increased over time,

ASOAs have seen relatively little regulation.

Speaking to MNT, Prof. Jose-Luis Jimenez, of the Cooperative Institute for

Research in Environmental Sciences, at the University of Colorado
Boulder, and a corresponding author of the study, said, “The key problem is
that the importance of ASOAs for mortality has not been recognized.”

“Previous studies concluded that the impact was small, and therefore, there
was no urgency to regulate the chemicals that are most important to create
ASOAs. Our research shows that the impact is quite large, and this
recognition is the first step towards regulation. Then there is a need for
research that provides more detail on the specific products and chemicals
that are most important and to develop regulations to address these
sources.”

“It is similar to the way ozone pollution has been regulated: First, it was
recognized as a problem in Los Angeles in the 1950s and 1960s and
started to be regulated. As more was learned about the chemistry that led
to ozone pollution, the regulations were more targeted and effective. But
ozone pollution is still a problem in many places (for example, in Colorado
this summer), as these pollutants are difficult to reduce to low levels and
need continuing efforts.”

Future research
Speaking to MNT, Dr. Nault said that to develop the findings of the present
study, more research needs to be done globally, and that a more detailed
understanding of the makeup of ASOAs and fine particulate matter is
needed.

“This research is just a starting point for [a] better [understanding of]
secondary organic aerosol in urban areas and how it directly impacts
human health. A big first area that needs to be added to this research is
more observations around the world, especially throughout Central and
South America, throughout Africa, and throughout Central, South, and
Southeast Asia.”

“We generally expect similar results [to what] we found in this research;
however, this data would provide valuable insight into what the emissions
are in these regions, whether trends we found in our research holds in
these areas, and what the health impacts from [ASOAs] may be in these
regions.”

“Further, a better understanding of what is actually being emitted from

these volatile chemical products, products that are used in everyday usage,
is needed to better understand how [they] impact indoor and outdoor air
quality and how these volatile chemical products [may be] similar or
different for different regions around the world.”

“Finally, we use total particulate matter to describe the health effects from
this pollution; however, we would think that certain material in the
particulate matter would be worse for health effects. Continued research in
understanding what is actually in particulate matter, including [ASOAs], and
what material leads to the health effects can lead to better emissions
standards and improved health.”

Individual choices
Dr. Nault said that as an individual, using cleaner modes of transport,
avoiding the use of solid fuels, and purchasing low emission products can
make a difference to how much we contribute to air pollution.

“Transportation is still an important source of ASOAs and particulate

matter. So, making sure that your vehicle is well tuned and taken care of
ensures reduced emissions. If possible, using mass transportation or
cycling will overall reduce this contribution further, as [having] fewer
[individual] cars in urban areas will improve emissions.”

Air pollution consists of small particles that can be natural or artificial.

The range of possible pollutants means that air pollution can affect people
both outdoors and indoors.

Outdoor air pollution consists of:

 particles from burning coal and gas

 harmful gases, such as nitrogen oxides or sulfur dioxide
 tobacco smoke
  ground-level ozone

Indoor air pollution consists of:

 household chemicals
 harmful gases, such as carbon monoxide or radon
 building materials, such as lead or asbestos
 pollen
 mold
 tobacco smoke

According to the World Health Organization (WHO), the pollutants that

pose the highest riskTrusted Source to a person’s health are:

 particulate matter (particle pollutants), which comprises suspended

solids and liquid droplets
 nitrogen dioxide
 sulfur dioxide
 ozone

Short-term exposure
Short-term exposure to air pollution, such as ground-level ozone, can affect
the respiratory system because the majorityTrusted Source of the
pollutants enter the body through a person’s airways.

Short-term exposure to air pollution may lead to respiratory infections and

reduced lung function. It may also aggravate asthma in people with this
condition.

Exposure to sulfur dioxide may cause damage to the eyes and respiratory
tract, as well as irritating the skin.
Long-term exposure
Research into the long-term health problems that air pollution can cause is
ongoing. Research has linked air pollution to serious health problems,
adverse birth outcomes, and even premature death.

Chronic obstructive pulmonary disease

Exposure to particle pollutants may cause chronic obstructive pulmonary

disease (COPD). According to the WHO, air pollution causes 43%Trusted
Source of COPD cases and deaths worldwide.

COPD is a group of diseases that cause breathing-related difficulties, such

as emphysema and chronic bronchitis. These diseases block the airways
and make it difficult for a person to breathe.

There is no cure for COPD, but treatment can help reduce symptoms and
improve quality of life.

Lung cancer

According to the WHO, air pollution causes 29%Trusted Source of all lung

cancer cases and deaths.

Particle pollutants are likely to contribute to this figure significantlyTrusted

Source as their small size allows them to reach the lower respiratory tract.

Cardiovascular disease

Research shows that living in an area with higher levels of air pollution may
increase the risk of death from stroke. Air pollution may trigger stroke
and heart attacks.
A 2018 reviewTrusted Source notes that the Global Burden of Disease
Study estimated air pollution to be responsible for 19% of cardiovascular
deaths in 2015. It was also the cause of about 21% of deaths due to stroke
and 24% of deaths from coronary heart disease

Health effects from specific

pollutants
According to research by the International Agency for Research on Cancer,
outdoor air pollution is a carcinogen, meaning that it may cause cancer.

Polluted air contains separate particles and chemicals, each of which has a
different effect on health.

Particle pollutants

Particle pollutants consist of a combination of different particles in the air.

Due to the small size of these particles, they can reach the lungs and raise
the risk of lung and heart disease.

They may also cause a worsening of symptoms in people with asthma.

Ground-level ozone

Pollutants react with sunlight to create ground-level ozone. Smog consists

largely of ozone and is a key trigger of asthma symptoms.

Carbon monoxide

According to a 2016 articleTrusted Source, if the levels of carbon monoxide

are lower than 2%, this gas does not appear to affect a person’s health.
However, if the levels are higher than 40%, carbon monoxide may be fatal.

The symptoms of carbon monoxide poisoning may include:

 weakness
 dizziness
 chest pain
 vomiting
 confusion
 a headache

If a person suspects that they are experiencing carbon monoxide

poisoning, they should move to an area with fresh air and seek immediate
medical help.

Sulfur dioxide

Sulfur dioxide is a byproduct of burning fossil fuels, such as coal and oil.

It can cause eye irritation and make a person more vulnerable to

developing respiratory tract infections, as well as cardiovascular disease.

Nitrogen dioxide

Nitrogen dioxide is present in vehicle exhaust emissions. Gas and

kerosene heaters and stoves also produce large amounts of this gas.

Exposure to nitrogen dioxide may lead to respiratory infections. Typically,

inhaling nitrogen dioxide causes wheezing or coughing, but it may also lead
to headaches, throat irritation, chest pain, and fever.

How can we reduce exposure?

People can reduce their exposure to air pollutants by limiting the amount of
time that they spend in areas with poor air quality. It is important to be
aware of possible air pollutants both outdoors and indoors.

Outdoor air pollution

Governments, businesses, and individuals can all help in minimizing air

pollution. Reducing emissions from vehicles and the levels of pollutants in
the atmosphere may improve the quality of the air.

A person can also check the current air quality by using the AirNow
website. This government service monitors air quality across the United
States.

The site provides information on air pollution levels, which it color codes
according to their potential effect on health. If the rating is orange or above,
people can help protect their health by:

 avoiding walking beside busy roads

 exercising for less time outdoors or using an indoor venue instead
 staying indoors until air quality improves

Indoor air pollution

A person can reduce indoor air pollution by ensuring that buildings are
clean and ventilated.

Dust, mold, and pollen may all increase the risk of respiratory problems.

Radon gas can build up in homes that developers built on land that has
uranium deposits. Radon gas can cause lung cancer.
A person can check for radon in the home by using a radon test kit.
Alternatively, they can hire a professional to take this measurement for
them.

Radon test kits are available to purchase in stores and online.

A person can use a carbon monoxide detector to monitor the carbon

monoxide levels in their home or workplace.

Carbon monoxide detectors are available to purchase in stores and online.

Summary
Air pollution can be harmful to a person’s health. It may cause respiratory
and cardiovascular conditions.

A person can reduce the likelihood of health problems by checking the air
quality in their local areas and being aware of any existing health
conditions.

Carbon monoxide can be fatal. If a person thinks that they have carbon
monoxide poisoning, they should get into fresh air and seek medical help
immediately.

What are the effects of

climate change on health?
A new study evaluating health data over the
past 20 years finds that a spectrum of health
conditions are adversely affected by climate
change.

Both the extent and cause of climate change remains a controversial area
of debate.

According to polling over the past 2 decades, two thirds of Americans

believe that climate change is occurring, with about 40% of these believing
that humans are the cause, and about half believing climate change will
pose a serious threat in their lifetimes.

But the authors of the new study – from the Global Health Institute,
University of Wisconsin-Madison – say the consensus is that fossil fuel
combustion and tropical deforestation contribute to climate change. Health,
the researchers add, is inextricably linked to climate change.

The authors gathered data from 56 medical journal articles investigating the
health impact of climate change and looked at air temperature data from
the National Oceanic and Atmospheric Administration National Climate
Data Center. The researchers averaged data over 13 climate models.

The researchers say their results show that many American cities will
experience more frequent extreme heat days by 2050. This means that
cities such as New York and Milwaukee may have, on average, three times
as many days hotter than 90°F.

What health conditions may be

affected by climate change?
More frequent days of extreme heat means that many health concerns will
be exacerbated, such as:
  Respiratory disorders, including those made worse by fine particular
pollutants (such as asthma and allergic diseases)
 Infectious diseases, including insect-transmitted diseases and water-
borne diseases (such as childhood gastrointestinal diseases)
 Food insecurity, including reduced crop yields and an increase in
plant diseases
 Mental health disorders, such as post-traumatic stress
disorder and depression, that are associated with natural disasters.

In the study, the authors argue that substantial health and economic
benefits may be associated with reduced combustion of fossil fuel:

“Accounting for co-benefits may document that reducing greenhouse

emission yields net economic benefits, that labor productivity increases,
and that health system costs are reduced. Co-benefits can provide
policymakers with additional incentives, beyond those of curtailing climate
change, to reduce the emissions of both carbon dioxide and short-lived
climate pollutants.”

The authors add that because climate change may have important
implications for the health of the world’s population, it is important that high-
quality research “and responsible, informed debate needs to continue.
However, given that evidence over the past 20 years suggests that climate
change can be associated with adverse health outcomes, strategies to
reduce climate change and avert the related adverse effects are
necessary.”

In a linked editorial, JAMA‘s editor-in-chief Dr. Howard Bauchner and

executive editor Dr. Phil B. Fontanarosa write that the gains in well-being in
the 20th century occurred because of large efforts to improve public health.

“Today, in the early part of the 21st century,” they write, “it is critical
to recognize that climate change poses the same threat to health as
the lack of sanitation, clean water, and pollution did in the early 20th
century. Understanding and characterizing this threat and educating
the medical community, public, and policy makers are crucial if the
health of the world’s population is to continue to improve during the
latter half of the 21st century.”

Across India, public health services have been understaffed

and under-resourced

India has never spent more than 2% of its GDP on healthcare. And
healthcare facilities across the country straddle different levels of
efficiency and sufficiency. The impact of COVID-19 has shaken even
States like Kerala and Tamil Nadu that traditionally did well in the area of
healthcare. In a discussion moderated by Ramya Kannan, public health
experts Abhay Shukla and T. Sundararaman discuss whether healthcare
for all can be a fundamental right. Edited excerpts:

The COVID-19 epidemic has been unprecedented in its

impact on society. While we can argue that no country in
the world can actually be fully prepared to handle an
emergency, do you think the time is ripe to push the
agenda of healthcare as a fundamental right for all
citizens ?
Abhay Shukla: I would say that one of the most positive impacts of this
otherwise very damaging epidemic has been that it has opened the eyes of
people to the importance of universal and robust public health services and
the need for everybody to be covered by quality healthcare, or for health
services to be accessible to everyone. And this epidemic, because it has
been concentrated in large cities and has also affected the middle class, has
become a matter of high priority.

So, this is a ripe time to actually take forward the agenda of right to
healthcare and because the right to healthcare, if it is to be real, it always
has to be universal. In that sense, right to healthcare is very much on the
agenda and I think we all need to push for that.

T. Sundararaman: Yeah, so, in some sense, this notion of right as different

from a commodity that can be purchased on the market must be made. In
classical economic terms, this is a public good, it is a good with a very
high degree of externality. So perhaps you can get away politically by not
providing healthcare for a lot of our population. Or if you believe the
theory that it is enough to provide them a minimalist healthcare, the rest is
left to the markets. But here, you actually have paid a huge price for doing
so. Everybody has, but the poor have paid the most. Because, at some
point, there is a huge amount of the cost of this whole pandemic, total lack
of preparedness for it and that it can strike everybody. And it doesn’t affect
only health, but all sectors of the economy.

The idea was that if we give immunisation and some antenatal care, that’s
enough, but that’s not the case. We need very good disease surveillance,
we need an integrated primary care system that can deliver in the field. We
need tertiary care with the most sophisticated of ventilators. And we need
surge capacity, meaning we need an excess redundant capacity that can
take care of any health emergency that happens.

During the pandemic, there has been a great deal of

imagination in dispensing healthcare and stretching the
limits to cover as many people as possible, more than
before. Does this give you hope that India can deliver
quality healthcare for all? And what range would be
sufficient as a percentage of GDP?
Abhay Shukla: So, if we see the situation today across the country,
despite the fact that public health services [have been] historically
understaffed, under-resourced, [and don’t have] sufficient number of
doctors and other resources, they have really stretched themselves to meet
the challenge of the COVID-19 epidemic. And I would say reasonably
creditably. And in States such as Kerala of course, public health services
have done a remarkable job of containing the spread of the epidemic,
especially through their primary healthcare activities.

So, what we are seeing is that until now in the public imagination, at least
the middle-class imagination, the model of healthcare has been [of] large
private hospitals. And generally, public health services, especially primary
healthcare, have been kind of invisible and mostly neglected.
But now, we are seeing with the COVID-19 epidemic a completely
different kind of situation coming forth. And, the public imagination is
also beginning to change.

So, this is leading to, or it can lead to, a change in people’s perception and
it can lead to a rejuvenation of public health services, because political will
flows from the public. And, if the public takes a greater interest, then
obviously, governments also have to respond.

If this trend continues even after the epidemic has died down, then there’s
no reason why we cannot achieve access to quality healthcare for everyone
in the coming 5-10 years in most States across the country. And, as for a
budget, around 3-4% of the GDP for public healthcare, and publicly
organised healthcare, would be a good starting point for putting in place at
least a basic kind of universal healthcare (UHC) system.

T. Sundararaman: So, I think the pandemic is still, in India, in an early

stage, and it will play out. I am concerned about the way our country
handled the economic crisis. In the West, for example, lockdown means a
huge burden on the state because you have complete social security
commitments, unemployment benefits to give, but over here, there is a lot
of relief being distributed, but it is just not the same. On the other hand,
much of the burden is shifted to the poor.

Similarly, in healthcare, there are States whose main approach has been to
re-purpose existing hospitals providing comprehensive, tertiary, secondary
healthcare for COVID-19. And the patients that are therefore pushed out
because of this, have to either seek care in the unaffordable private sector.
And, I don’t think our democracy has yet reached that stage of maturity or
robustness where we are able to say “Oh, you need to build new hospitals,
you need to create extra beds,” like China, or Spain did. You just can’t use
the public system as residual care. But in India, we need to be much more
articulate about human rights and the fundamental issue, or else this
burden will get unfairly pushed on to people. The ₹15,000 crore allotment
for the health sector that was sanctioned, along with the first lockdown, is
a welcome step. My only point is that much more was needed in the
routine annual budget of this year, and over the past four years.
And I am worried that, as July approaches, it might slowly spread into the
hinterland. This is the way the Spanish Flu started in India. It started as an
all-Bombay problem from the ships. It was in Bombay for a long time,
then spread slowly through the country, and then you had all places
affected.

I hope that at some point the government does get into strengthening the
public services because the private institutes are not even offering care,
many of them are preferring to stay shut till the worst of the pandemic is
over.

Both of you seem to have experience with drafting

universal healthcare policies. Professor Sundaram and
Dr. Shukla, I believe you worked on the draft proposal of
healthcare for all for the government. And Dr. Shukla,
you’ve done some work on this in Maharashtra. Can
elaborate on what constitutes a universal healthcare
policy?
T. Sundararaman: I think there are three big issues that in our last effort
held us back. And I think we need to have a closure on all these three
issues before we can actually go ahead. On the first, I think it is an easy
one, that the right to health and the right to healthcare are different things.
The right to healthcare is enforceable in a certain way, but in this context,
the right to healthcare is something that should be done immediately.

In doing so, there is one fundamental issue. Healthcare is a State subject.

Should we make it a Central subject, because then the Central money will
flow? But even the response to this pandemic shows that actually that
doesn’t work.

Well, for many of these decisions the States have to take, and they need a
high degree of cooperation. So, whereas the Centre and the States must
have an agreement on the funding, a lot of it will need to remain a State
subject. Definitely, one of the problems is inherently constitutional — but
it should not lead to over-centralisation. And the third issue is of course,
the most fundamental one. You have to put your money where your mouth
is, you have to actually get the resources that are required for it and that
requires a transfer of resources. Again, a transfer of resources without
populist shaming or saying that you are giving subsidies. We have to
recognise that if you want a metric of equal health quality, you need to
invest more on the healthcare of the poor, the middle class, the upper class,
the ruling privileged persons will have to pay a price.

Abhay Shukla: About the issue of universal healthcare, we need a system

for universal healthcare, which is a complement to the right to healthcare
kind of scenario. A group of public health experts and health activists in
Maharashtra has over the last three years, developed a framework that...
could be achieved in the next five years, and in a very realistic kind of
scenario. So, this is not a pipe dream, it is something which is possible
provided that there is political will for it.

But to develop this kind of a system, there are a few constraints which we
need to overcome. Right now, we have a fragmented health system. We
have one health system for the poor, another for the middle class and
another for the rich and the super rich. What we need to do is to move
from this fractured system towards a single healthcare system for
everyone.

So, even after the epidemic has receded, the idea that the government can
regulate private hospitals, harness them in public interest will remain, and
I think that opportunity, which is being opened up in the period of the
COVID-19, should not be lost. It has to continue till we reach a system of
universal healthcare, which involves regulated private providers.

Prof. Sundararaman, can you weigh in on the private

healthcare angle? Clearly, the private healthcare sector,
which was all powerful, has sort of stepped back to play
a supportive role in COVID-19. Does this mean the role
of the private healthcare sector in India may actually
change in future?
T. Sundararaman: Even the Prime Minister’s health insurance scheme
[allowing people to access insurance cover for treatment in private
hospitals] has been such a failure today. It is only the high-charging
patients without insurance cover that are using the private sector.
 Today, it is the public system, with all its problems, that has risen to the
occasion. So, in this sense, even the ‘worst public health States’ have stood
by the people. But it doesn’t mean that the private sector has no role. We
need for the private sector, a much clearer regulatory regime and ways of
contracting that are useful and it is most important that they supplement,
not substitute, the strengths of the state.

T. Sundararaman is former executive director, National Health Systems

Resource Centre; Abhay Shukla is the national convener of Jan Swasthya
Abhiyan

Gulabo lay her head in my lap, pleading, “Bhaiyaji, mujhe bacha lo!” (Brother, please save
me!), and soon after took her last breath. Just two days ago, I had freed her and her family
from intergenerational bondage at a brick kiln in Mahendragarh, Haryana. She died of severe
tuberculosis and malnutrition. Overcome by anger and grief after I had cremated Gulabo’s
body, I walked up the road till I reached the chamber of the erstwhile senior judge of the
Supreme Court of India, Justice P N Bhagwati.
Two years after this meeting, the landmark judicial order of 1984 in Bandhua Mukti Morcha
v. Union of India established that with respect to workers, the constitutional right to life is
inclusive of the right to health. At the time, I served as the general secretary of Bandhua
Mukti Morcha. Justice Bhagwati was moved by the plight of Gulabo and many others in
situations similar to slavery, and brought to light the limitations of the country’s healthcare
systems to serve its poorest.
This reality is starker today. Forty years after Gulabo, innumerable children are still dying
from lack of healthcare. Amidst the pandemic, the frantic cries for oxygen, hospital beds,
medicine and even a place to cremate their own, laid bare our failure to extend dignity in both
life and death. Now, compound this with the loss of income, debt, food insecurity, and
illiteracy. That is the situation of lakhs of families in India today. That said, the most
profound loss is of people’s faith in the ability of the country’s healthcare system to protect
them. It is the primary responsibility of elected representatives to reinstate this faith.
The right to equality guaranteed under Article 15 upholds non-discrimination on the basis
religion, race, caste, gender, place of birth, etc. However, the dismal investment in public
health for decades has made healthcare a privilege available to a few. The constitutional right
to health is critical to breaking discriminatory structures that will otherwise continue to
perpetuate inequality in all spheres of life, including education, opportunity, wealth, and
social mobility.
The judicial interpretation of the right to life and liberty under Article 21 in several
judgments as inclusive of health was crucial, but has its limitations. The universal access to
healthcare is now as achievable as it is indispensable. The rights of people are not stagnant,
and must evolve as the country evolves. Ayushman Bharat is an ambitious scheme with great
potential, but there is a difference between a rights and a service-delivery model of
development. If health is a fundamental right, it will give a spine to the entire health
ecosystem, empower doctors and healthcare workers, and ensure transparency, inclusivity,
and accountability. Moreover, it will pave the way for special legislation, capable institutions,
increased budgets, medical training and research, wellness and prevention, and outreach of
services; thereby instilling immense confidence and positivity amongst the citizens.
The right to education too had long been upheld as implicit to the right to life before the
constitutional amendment that established it as fundamental in its own right. Now, the
primary school enrolment rate is over 95 per cent, a target believed to be impossible 15 years
ago. While there is much left to attain in terms of quality of education, learning outcomes,
infrastructure, teacher education, and social parity, the progress is measurable. When it comes
to healthcare, however, entire life-savings of families are lost if even one member falls
seriously ill. This is unacceptable.
We need a fundamental shift in our approach to healthcare. Instead of viewing it as spending,
we have to see it as a high-yield investment that can considerably cut down future out-of-
pocket costs and also increase output. The evidence is before us today. As we scramble to
deal with a monumental health crisis with a crumbling healthcare system, we are witnessing
its grave economic impact. If the current healthcare model does not change, we risk finding
our children in the same situation.
Our collective suffering can be translated into long-lasting change. In the past few weeks, I
have written to urge the Prime Minister, and every Member of Parliament to consider this
recommendation. Many MPs have come forward in unity. The universal access to healthcare
is now as achievable as it is indispensable.
This is the time for a constitutional amendment to make health a fundamental right. India is
facing a defining moment in its history, and our children will pay the price for our choices
today. At this point, I am reminded of Gandhiji’s talisman: “Whenever you are in doubt, or
when the self becomes too much with you, apply the following test. Recall the face of the
poorest and the weakest man (woman) whom you may have seen, and ask yourself, if the step
you contemplate is going to be of any use to him (her).” Let this be our guiding light.
The writer is a Nobel laureate

How to Spot Real and Fake

News
Critically Appraising Information
When Alice scrolls through her social media feed, she's stopped in her
tracks by the news that her company is about to be bought out by its
biggest rival. She quickly posts a response, shares the story with her
contacts, and emails it to her team so that they can discuss it later.

But then Alice has a troubling thought. What if the story wasn't true? What
if she just shared a "fake news" story? After all, she didn't check the
source.

If she has been a victim of fake news, and then added to the rumor mill
herself, how will people ever trust her again?

Fortunately, there's lots you can do to avoid making the same mistake as
Alice. In this article and video, we explore how you can separate fake
news from the truth.

What Is Fake News?

There are two kinds of fake news:

1. Stories that aren't true. These are entirely invented stories designed to make
people believe something false, to buy a certain product, or to visit a certain
website.
2. Stories that have some truth, but aren't 100 percent accurate. For example,
a journalist quotes only part of what a politician says, giving a false impression
of their meaning. Again, this can be deliberate, to convince readers of a certain
viewpoint, or it can be the result of an innocent mistake. Either way, it quickly
attracts an audience and can become entrenched as an "urban myth."
Note:
To confuse matters further, there are also people who claim that factually
accurate stories are fake news, just because they don't agree with them or
find them uncomfortable.

Where Does Fake News Come From?

Fake news is nothing new. But, what is new is how easy it's become to
share information – both true and false – on a massive scale.

Social media platforms allow almost anyone to publish their thoughts or

share stories to the world. The trouble is, most people don't check the
source of the material that they view online before they share it, which can
lead to fake news spreading quickly or even "going viral."

At the same time, it's become harder to identify the original source of news
stories, which can make it difficult to assess their accuracy.

This has led to a flood of fake news. In fact, one study found that more than
25 percent of Americans visited a fake news website in a six-week period
during the 2016 U.S. presidential election
But, not all fake news stories are found online. Co-workers who gossip by
the water cooler or while browsing print publications that fail to check their
facts, for example, are also guilty of spreading misinformation, even if
inadvertently.

The Impact of Fake News in the Workplace

Research shows that 59 percent of people are concerned about the effect
that fake news has in the workplace, and with good reason!
For example, some people might start to believe that they no longer need
evidence to back up their arguments. Others start to mistrust information all
together. They stop listening to industry reports, and disengage from official
workplace communication, slowing their professional growth and
development. Ultimately, this can damage an organization's learning
culture.

Fake news can affect behavior, too. It encourages people to invent

excuses, to dismiss others' ideas, to exaggerate the truth, and to spread
rumors. This can create divided, anxious workplaces where people are
cynical and unsure of who to trust.
They might even begin to mistrust you if they believe that authority figures
have lied to them, or that the information that they are working with is
suspect. This can sap people of the curiosity, enthusiasm and ambition that
they need to collaborate and to be successful.
Misinformation and fake news can also harm your business. Invented
reviews of your products or inaccurate financial updates, for example, can
do serious reputational damage .

Six Ways to Spot Fake News

Separating fact from fiction accurately can seem daunting. But getting to
the truth is always worth the effort – even if it's not what you want to hear!
Use these six steps to weed out the truth from the lies:

1. Develop a Critical Mindset

One of the main reasons fake news is such a big issue is that it is often
believable, so it's easy to get caught out. Much fake news is also written to
create "shock value," that is, a strong instinctive reaction such as fear or
anger.

This means it's essential that you keep your emotional response to such
stories in check. Instead, approach what you see and hear rationally
and critically .
Ask yourself, "Why has this story been written? Is it to persuade me of a
certain viewpoint? Is it selling me a particular product? Or is it trying to get
me to click through to another website? Am I being triggered?"

2. Check the Source

If you come across a story from a source that you've never heard of before,
do some digging!

Check the web address for the page you're reading. Spelling errors in
company names, or strange-sounding extensions like ".infonet" and ".offer,"
rather than ".com" or ".co.uk," may mean that the source is suspect.

Whether or not the author or publisher is familiar, stop to consider their

reputation and professional experience. Are they known for
their expertise  on the matter? Or do they tend to exaggerate?
Be aware that people who spread fake news and "alternative facts"
sometimes create web pages, newspaper mockups, or "doctored" images
that look official, but aren't. So, if you see a suspicious post that looks like
it's from the World Health Organization (WHO), for example, check the
WHO's own site to verify that it's really there.

Remember, even if you got the story from your best friend, this gives it no
extra authority – they likely didn't follow these steps themselves before
forwarding!

Tip:
Trusted online fact-checking sites like Snopes can help you to verify
stories that sound too good to be true.

3. See Who Else Is Reporting the Story

Has anyone else picked up on the story? What do other sources say about
it?

Avoid leaping to the conclusion that all main stream media (MSM) output is
fake. This can be as unwise as following every rumor or conspiracy theory.

Professional global news agencies such as Reuters, CNN and the BBC
have rigorous editorial guidelines and extensive networks of highly trained
reporters, so are a good place to start. But no one is unbiased, and anyone
can make a mistake, so keep looking.

4. Examine the Evidence

A credible news story will include plenty of facts – quotes from experts,
survey data and official statistics, for example. Or detailed, consistent and
corroborated eye-witness accounts from people on the scene. If these are
missing, question it!

Does the evidence prove that something definitely happened? Or, have the
facts been selected or "twisted" to back up a particular viewpoint?

5. Don't Take Images at Face Value

Modern editing software has made it easy for people to create fake images
that look real. In fact, research shows that only half of us can tell when
images are fake. However, there are some warning signs you can look out
for. Strange shadows on the image, for example, or jagged edges around a
figure.
Images can also be 100 percent accurate but used in the wrong context.
For example, photos of litter covering a beach could be from a different
beach or from 10 years ago, not the recent alleged event.

You can use tools such as Google Reverse Image Search to check where an
image originated and whether it has been altered.

6. Check That it "Sounds Right"

Finally, use your common sense! Bear in mind that fake news is designed
to "feed" your biases, hopes or fears.

For example, it's unlikely that your favorite designer brand is giving away a
million free dresses to people who turn up to its stores. Equally, just
because your colleague believes that two married co-workers are having
an affair, doesn't mean it's true.

Tip:
Some stories that you'll encounter will sound "wrong," but won't
necessarily be fake news. They could be intentional satire or something
that comes from a humorous website, like The Onion or The Daily Mash,
for example.
Warning:
If these tips suggest that the information that you are about to pass on is
fake, partial or malicious, avoid sharing it with others – even if you're
inviting them to check it. Doing so could lead to rumors spreading and
may harm your professional credibility.

Test Your Knowledge

Now it's time to put what you've learned into practice! Below are five recent
news stories. But, can you tell which ones are true and which are false?
Click on the links next to each to find out.

1. "John McCain Photographed Alongside Osama Bin Laden." Real or

Fake?
2. "California Governor to Relocate Veterans Cemetery to Make Way for
Affordable Housing." Real or Fake?
3. "New Species of Deadly Spider Kills Five in U.S." Real or Fake?
4. "Firefighters Forced to Buy More Expensive Data Package During
Wildfire." Real or Fake?
5. "President Trump's Personal Lawyer Tweets that Hillary Clinton Will Get
'Free Room and Board' in Prison." Real or Fake?
Key Points
Fake news refers to deliberate untruths, or stories that contain some truth
but which aren't completely accurate, by accident or design.

Some people also claim that truthful stories are "fake news," just because
they don't agree with them. This can lead to the dangerous ignoring of vital
advice.

Fake news can have a negative impact on workplace behavior. For

example, by damaging learning culture, and causing rumor and mistrust to
spread. So, it's vital to know how to separate the real from the fake. You
can do this by following these six steps:
1. Develop a critical mindset.
2. Check the source.
3. See who else is reporting the story.
4. Examine the evidence.
5. Don't take images at face value.
6. Check that it "sounds right."

A source is credible when it is trustworthy. Sometimes it is hard to determine

whether 'credible' sources are trustworthy or not, as voicing an opinion or
presenting false information as fact without any credentials or proof is easy
for anyone, especially online.

Sources can often appear credible even when there is little evidence to support
them - just think of the many pseudoscience-based articles that go viral on social
media sites. Here are a few points to consider when evaluating sources for
credibility:
Be skeptical

Just because something is presented as a fact, it doesn't mean that it is.

Question everything, books, articles, and websites can all be unreliable
sources.

Examine the source's and author's credentials and

affiliations

Always research the background of any resources you are considering

using for your paper. Consider the author's credentials and affiliations
during your search for sources, are they associated with a certain special
interest group or another biased source of funding? Can the author/source
be biased because of certain views and affiliations?

Evaluate what sources are cited by the author

Unless the author is analyzing their own data, their information came from
somewhere. Beware if the author doesn't list academic sources. Always
review the type of sources listed and make sure they stand up to scrutiny.

Make sure the source is up-to-date

Nowadays, due to the speed at which technology moves, information and

reliable sites go out-of-date quickly. Make sure that your source is still
relevant and applicable and comes from a trustworthy author.

Check the endorsements and reviews that the source

received

You can read reviews of books printed or on the websites of online book
retailers. You can find reviews of larger reputable websites. Some smaller
 sources, like journal articles, might not have reviews readily available, but
you can check if the authors are authoritative sources in their field.

Check if the publisher of the source is reputable

Large publishers or reputable magazines and journals will thoroughly check

the facts of the information they are distributing, which makes these sources
pretty safe. This is especially true if the source in question comes from peer-
reviewed journals or other scholarly databases.

Some of the other source-evaluation methods you can use include investigating
the types of sources the author decided to use. Credible journal articles will have
more source credibility than personal blogs, for example. This is because journal
articles are created by academics that hold the proper credentials and have to
make use of reputable sources in order to get through peer-review.

Pieces that are public opinion or opinion pieces do not hold up to the same
standard as academic writing. Even news articles can be biased sources; in
the past few years, fake news has become widespread in online search
engines. Major newspapers have fallen prey to this in recent years.

Make sure the source does not use loaded or vague

terms to support itself

Beware of sources that use vague terms like "recent studies show", or "many
people believe", without backing up these claims with citations. Online
sources are notorious for this - remember that their ultimate goal is to
maximize their readership and not to produce scholarly, peer-reviewed
articles.

Also, beware of buzzwords playing on the readers' emotions. Many internet

sources will use misleading titles in order to draw in readers, even if they are
non-credible sources.
Beware of bias

Always evaluate if the source presents clear and unbiased information, or if it

aims at persuading you to take on a specific point of view. A source written from
a specific point of view may still be credible, but it can limit the coverage of a
topic to a particular side of a debate. It's always better to make use of sources
that show both sides of the story.
Many academic papers have to give an overview of the other scholarly articles
they used as citations.

#1 Handle & Prepare Food Safely

Food can carry germs. Wash hands, utensils, and surfaces often when preparing
any food, especially raw meat. Always wash fruits and vegetables. Cook and keep
foods at proper temperatures. Don’t leave food out – refrigerate promptly.

#2 Wash Hands Often

One of the most important healthy habits to prevent the spread of germs is to clean
your hands.  Our hands can carry germs, so it is important to wash them often, even
if they don’t look dirty.

When to Wash Your Hands

Make sure to clean your hands before and after:

 Using the bathroom or changing diapers

 Eating
 Cooking or serving food
 Treating a cut or wound
 Contact with a sick person

 Putting on and removing protective equipment like a face mask

Clean your hands after these actions:

 Coughing, sneezing, or blowing your nose

  Touching another person’s hands or touching an animal or pet

 Handling garbage

Touching frequently touched areas (doorknobs) or contaminated items (dirty laundry

or dishes).

How to Wash Hands with Soap and Water

1. Wet hands and apply soap.
2. Rub hands for at least 20 seconds. Scrub all surfaces.
3. Rinse hands.

4. Dry hands with a clean cloth or paper towel. If in a public place, use the paper
towel to turn off the faucet. Then, throw in the trash.

*When helping a child, wash their hands first, and then your own.

How to Clean Hands with Hand Sanitizer

1. Use hand sanitizer if soap and water are not available and if your hands do
not look dirty. To be effective, hand sanitizer must have at least 60% alcohol
content.
2. Apply hand sanitizer to both hands.

3. Rub hands covering all surfaces until dry. If your hands dry before 10 seconds
you did not use enough. Apply more and repeat.
*Although not as effective as washing one’s hands with soap and water or using
hand sanitizer, pre-moistened cleansing towelettes with at least 60% alcohol content
can be an alternative.

#3 Clean & Disinfect Commonly Used Surfaces

Germs can live on surfaces. Cleaning with soap and water is usually enough.
However, you should disinfect your bathroom and kitchen regularly. Disinfect other
areas if someone in the house is ill. You can use an EPA certified disinfectant (look
for the EPA registration number on the label) or a bleach solution.

#4 Cough and Sneeze into a Tissue or Your Sleeve

If you are sick, the air that comes out of your mouth when you cough or sneeze may
contain germs. Someone close by can breathe in your air, or touch a surface
contaminated with your germs, and become ill. Cough or sneeze into a tissue or your
shirt sleeve-not into your hands. Remember to throw away the tissue and wash your
hands. You can wear a face mask when you are sick with a cough or sneezing
illness
#5 Don’t Share Personal Items
Avoid sharing personal items that can’t be disinfected, like toothbrushes and razors,
or sharing towels between washes. Needles should never be shared, should only be
used once, and then thrown away properly.

#6 Get Vaccinated
Vaccines can prevent many infectious diseases. You should get some vaccinations
in childhood, some as an adult, and some for special situations like pregnancy and
travel. Make sure you and your family are up-to-date on your vaccinations. If your
regular doctor does not offer the vaccine you need

#7 Avoid Touching Wild Animals

You and your pets should avoid touching wild animals which can carry germs that
cause infectious diseases. If you are bitten, talk to your doctor. Make sure that your
pet’s vaccinations are up-to-date.

#8 Stay Home When Sick

When you are sick, stay home and rest. You will get well sooner, and will not spread
germs.

What is vaccination?

Vaccination is a simple, safe, and effective way of protecting you against harmful
diseases, before you come into contact with them. It uses your body’s natural
defenses to build resistance to specific infections and makes your immune system
stronger.

Vaccines train your immune system to create antibodies, just as it does when it’s
exposed to a disease. However, because vaccines contain only killed or weakened
forms of germs like viruses or bacteria, they do not cause the disease or put you at
risk of its complications.

Most vaccines are given by an injection, but some are given orally (by mouth) or
sprayed into the nose.
How does a vaccine work?

Vaccines reduce risks of getting a disease by working with your body’s natural
defenses to build protection. When you get a vaccine, your immune system
responds. It:

 Recognizes the invading germ, such as the virus or bacteria.

  Produces antibodies. Antibodies are proteins produced naturally by the
immune system to fight disease.
 Remembers the disease and how to fight it. If you are then exposed to the
germ in the future, your immune system can quickly destroy it before you
become unwell.

The vaccine is therefore a safe and clever way to produce an immune response in
the body, without causing illness.

Our immune systems are designed to remember. Once exposed to one or more
doses of a vaccine, we typically remain protected against a disease for years,
decades or even a lifetime. This is what makes vaccines so effective. Rather than
treating a disease after it occurs, vaccines prevent us in the first instance from
getting sick.

When should I get vaccinated (or vaccinate my child)?

Vaccines protect us throughout life and at different ages, from birth to childhood, as
teenagers and into old age. In most countries you will be given a vaccination card
that tells you what vaccines you or your child have had and when the next vaccines
or booster doses are due. It is important to make sure that all these vaccines are up
to date.

If we delay vaccination, we are at risk of getting seriously sick. If we wait until we

think we may be exposed to a serious illness – like during a disease outbreak – there
may not be enough time for the vaccine to work and to receive all the recommended
doses.

If you have missed any recommended vaccinations for you or your child, talk to your
healthcare worker about catching up.

Why should I get vaccinated?

Without vaccines, we are at risk of serious illness and disability from diseases like
measles, meningitis, pneumonia, tetanus and polio. Many of these diseases can be
life-threatening. WHO estimates that childhood vaccines alone save over 4 million
lives every year.
Although some diseases may have become uncommon, the germs that cause them
continue to circulate in some or all parts of the world. In today’s world, infectious
diseases can easily cross borders, and infect anyone who is not protected

Two key reasons to get vaccinated are to protect ourselves and to protect those
around us. Because not everyone can be vaccinated – including very young babies,
those who are seriously ill or have certain allergies – they depend on others being
vaccinated to ensure they are also safe from vaccine-preventable diseases.

What diseases do vaccines prevent?

Vaccines protect against many different diseases, including:

 Cervical cancer
 Cholera
 COVID-19
 Diphtheria
 Ebola virus disease
 Hepatitis B
 Influenza
 Japanese encephalitis
 Measles
 Meningitis
 Mumps
 Pertussis
 Pneumonia
 Polio
 Rabies
 Rotavirus
 Rubella
 Tetanus
 Typhoid
 Varicella
 Yellow fever

Some other vaccines are currently under development or being piloted, including
those that protect against Zika virus or malaria, but are not yet widely available
globally.

Not all of these vaccinations may be needed in your country. Some may only be
given prior to travel, in areas of risk, or to people in high-risk occupations. Talk to
your healthcare worker to find out what vaccinations are needed for you and your
family.

Who can get vaccinated?

Nearly everyone can get vaccinated. However, because of some medical conditions,
some people should not get certain vaccines, or should wait before getting them.
These conditions can include:

 Chronic illnesses or treatments (like chemotherapy) that affect the immune

system;
 Severe and life-threatening allergies to vaccine ingredients, which are very
rare;
 If you have severe illness and a high fever on the day of vaccination.

These factors often vary for each vaccine. If you’re not sure if you or your child
should get a particular vaccine, talk to your health worker. They can help you make
an informed choice about vaccination for you or your child.

What is in a vaccine?

All the ingredients of a vaccine play an important role in ensuring a vaccine is safe
and effective. Some of these include:

 The antigen. This is a killed or weakened form of a virus or bacteria, which

trains our bodies to recognize and fight the disease if we encounter it in the
future.
 Adjuvants, which help to boost our immune response. This means they help
vaccines to work better.
 Preservatives, which ensure a vaccine stays effective.
 Stabilisers, which protect the vaccine during storage and transportation.

Vaccine ingredients can look unfamiliar when they are listed on a label. However,
many of the components used in vaccines occur naturally in the body, in the
environment, and in the foods we eat. All of the ingredients in vaccines – as well as
the vaccines themselves - are thoroughly tested and monitored to ensure they are
safe.

Why does vaccination start at such a young age?

Young children can be exposed to diseases in their daily life from many different
places and people, and this can put them at serious risk. The WHO-recommended
vaccination schedule is designed to protect infants and young children as early as
possible. Infants and young children are often at the greatest risk from diseases
because their immune systems are not yet fully developed, and their bodies are less
able to fight off infection. It is therefore very important that children are vaccinated
against diseases at the recommended time.

Are vaccines safe?

Vaccination is safe and side effects from a vaccine are usually minor and temporary,
such as a sore arm or mild fever. More serious side effects are possible, but
extremely rare.

Any licensed vaccine is rigorously tested across multiple phases of trials before it is
approved for use, and regularly reassessed once it is introduced. Scientists are also
constantly monitoring information from several sources for any sign that a vaccine
may cause health risks.

Remember, you are far more likely to be seriously injured by a vaccine-preventable

disease than by a vaccine. For example, tetanus can cause extreme pain, muscle
spasms (lockjaw) and blood clots, measles can cause encephalitis (an infection of
the brain) and blindness. Many vaccine-preventable diseases can even result in
death. The benefits of vaccination greatly outweigh the risks, and many more
illnesses and deaths would occur without vaccines.

More information about vaccine safety and development is available here.

I didn't vaccinate my child at the recommended time. Is it too late to catch up?

For most vaccines, it’s never too late to catch up. Talk to your healthcare worker
about how to get any missed vaccination doses for yourself or your child.

Are there side effects from vaccines?

Like any medicine, vaccines can cause mild side effects, such as a low-grade fever,
or pain or redness at the injection site. Mild reactions go away within a few days on
their own.

Severe or long-lasting side effects are extremely rare. Vaccines are continually
monitored for safety, to detect rare adverse events.

ow are vaccines developed and tested?

The most commonly used vaccines have been around for decades, with millions of
people receiving them safely every year. As with all medicines, every vaccine must
go through extensive and rigorous testing to ensure it is safe before it can be
introduced in a country.

An experimental vaccine is first tested in animals to evaluate its safety and potential
to prevent disease. It is then tested in human clinical trials, in three phases:

 In phase I, the vaccine is given to a small number of volunteers to assess its

safety, confirm it generates an immune response, and determine the right
dosage.

 In phase II, the vaccine is usually given hundreds of volunteers, who are
closely monitored for any side effects, to further assess its ability to generate
an immune response. In this phase, data are also collected whenever
possible on disease outcomes, but usually not in large enough numbers to
have a clear picture of the effect of the vaccine on disease. Participants in this
phase have the same characteristics (such as age and sex) as the people for
whom the vaccine is intended. In this phase, some volunteers receive the
vaccine and others do not, which allows comparisons to be made and
conclusions drawn about the vaccine.

 In phase III, the vaccine is given to thousands of volunteers – some of whom

receive the investigational vaccine, and some of whom do not, just like in
phase II trials. Data from both groups is carefully compared to see if the
vaccine is safe and effective against the disease it is designed to protect
against.

Once the results of clinical trials are available, a series of steps is required, including
reviews of efficacy, safety, and manufacturing for regulatory and public health policy
approvals, before a vaccine may be introduced into a national immunization
programme.

Following the introduction of a vaccine, close monitoring continues to detect any

unexpected adverse side effects and further assess effectiveness in the routine use
setting among even larger numbers of people to continue assessing how best to use
the vaccine for the greatest protective impact. More information about vaccine
development and safety is available here.
Can a child be given more than one vaccine at a time?

Scientific evidence shows that giving several vaccines at the same time has no
negative effect. Children are exposed to several hundred foreign substances that
trigger an immune response every day. The simple act of eating food introduces new
germs into the body, and numerous bacteria live in the mouth and nose.

When a combined vaccination is possible (e.g. for diphtheria, pertussis and tetanus),
this means fewer injections and reduces discomfort for the child. It also means that
your child is getting the right vaccine at the right time, to avoid the risk of contracting
a potentially deadly disease.

Is there a link between vaccines and autism?

There is  no evidence of any link between vaccines and autism or autistic disorders.
This has been demonstrated in many studies, conducted across very large
populations.

The 1998 study which raised concerns about a possible link between measles-
mumps-rubella (MMR) vaccine and autism was later found to be seriously flawed
and fraudulent. The paper was subsequently retracted by the journal that published
it, and the doctor that published it lost his medical license. Unfortunately, its
publication created fear that led to dropping immunization rates in some countries,
and subsequent outbreaks of these diseases.

We must all ensure we are taking steps to share only credible, scientific information
on vaccines, and the diseases they prevent.

Should my daughter get vaccinated against human papillomavirus (HPV)?

Virtually all cervical cancer cases start with a sexually transmitted HPV infection. If
given before exposure to the virus, vaccination offers the best protection against this
disease. Following vaccination, reductions of up to 90% in HPV infections in teenage
girls and young women have been demonstrated by studies conducted in Australia,
Belgium, Germany, New Zealand, Sweden, the United Kingdom and the United
States of America.

In studies, the HPV vaccine has been shown to be safe and effective. WHO
recommends that all girls aged 9–14 years receive 2 doses of the vaccine, alongside
cervical cancer screening later in life.
I still have questions about vaccination. What should I do?

If you have questions about vaccines be sure to talk to your healthcare worker. He or
she can provide you with science-based advice about vaccination for you and your
family, including the recommended vaccination schedule in your country.

When looking online for information about vaccines, be sure to consult only
trustworthy sources. To help you find them, WHO has reviewed and ‘certified’ many
websites across the world that provide only information based on reliable scientific
evidence and independent reviews by leading technical experts. These websites are
all members of the Vaccine Safety Net.

How does WHO help ensure vaccine safety?

WHO works to ensure that everyone, everywhere is protected by safe and effective
vaccines. To do this, we help countries set up rigorous safety systems for vaccines
and apply strict international standards to regulate them.

Together with scientists from around the world, WHO experts conduct ongoing
monitoring to make sure that vaccines continue to be safe. We also work with
partners to help countries investigate and communicate if potential issues of concern
arise.

Any unexpected adverse side effects that are reported to WHO are evaluated by an
independent group of experts called the Global Advisory Committee on Vaccine
Safety. 

Germs are all around us, both in our environment and in our bodies. When a person
is susceptible and they encounter a harmful organism, it can lead to disease and
death.

The body has many ways of defending itself against pathogens (disease-causing

organisms). Skin, mucus, and cilia (microscopic hairs that move debris away from
the lungs) all work as physical barriers to prevent pathogens from entering the body
in the first place. 

When a pathogen does infect the body, our body’s defences, called the immune
system, are triggered and the pathogen is attacked and destroyed or overcome.

The body's natural response

A pathogen is a bacterium, virus, parasite or fungus that can cause disease within
the body. Each pathogen is made up of several subparts, usually unique to that
specific pathogen and the disease it causes. The subpart of a pathogen that causes
the formation of antibodies is called an antigen. The antibodies produced in
response to the pathogen’s antigen are an important part of the immune system. You
can consider antibodies as the soldiers in your body’s defense system. Each
antibody, or soldier, in our system is trained to recognize one specific antigen. We
have thousands of different antibodies in our bodies. When the human body is
exposed to an antigen for the first time, it takes time for the immune system to
respond and produce antibodies specific to that antigen. 

In the meantime, the person is susceptible to becoming ill. 

Once the antigen-specific antibodies are produced, they work with the rest of the
immune system to destroy the pathogen and stop the disease. Antibodies to one
pathogen generally don’t protect against another pathogen except when two
pathogens are very similar to each other, like cousins. Once the body produces
antibodies in its primary response to an antigen, it also creates antibody-producing
memory cells, which remain alive even after the pathogen is defeated by the
antibodies. If the body is exposed to the same pathogen more than once, the
antibody response is much faster and more effective than the first time around
because the memory cells are at the ready to pump out antibodies against that
antigen.

This means that if the person is exposed to the dangerous pathogen in the future,
their immune system will be able to respond immediately, protecting against
disease. 

How vaccines help

Vaccines contain weakened or inactive parts of a particular organism (antigen) that
triggers an immune response within the body. Newer vaccines contain the blueprint
for producing antigens rather than the antigen itself. Regardless of whether the
vaccine is made up of the antigen itself or the blueprint so that the body will produce
the antigen, this weakened version will not cause the disease in the person receiving
the vaccine, but it will prompt their immune system to respond much as it would have
on its first reaction to the actual pathogen.
Some vaccines require multiple doses, given weeks or months apart. This is
sometimes needed to allow for the production of long-lived antibodies and
development of memory cells. In this way, the body is trained to fight the specific
disease-causing organism, building up memory of the pathogen so as to rapidly fight
it if and when exposed in the future.

Herd immunity
When someone is vaccinated, they are very likely to be protected against the
targeted disease. But not everyone can be vaccinated. People with underlying health
conditions that weaken their immune systems (such as cancer or HIV) or who have
severe allergies to some vaccine components may not be able to get vaccinated with
certain vaccines. These people can still be protected if they live in and amongst
others who are vaccinated. When a lot of people in a community are vaccinated the
pathogen has a hard time circulating because most of the people it encounters are
immune. So the more that others are vaccinated, the less likely people who are
unable to be protected by vaccines are at risk of even being exposed to the harmful
pathogens. This is called herd immunity.

This is especially important for those people who not only can’t be vaccinated but
may be more susceptible to the diseases we vaccinate against. No single vaccine
provides 100% protection, and herd immunity does not provide full protection to
those who cannot safely be vaccinated. But with herd immunity, these people will
have substantial protection, thanks to those around them being vaccinated.

Vaccinating not only protects yourself, but also protects those in the community who
are unable to be vaccinated. If you are able to, get vaccinated.

n the early 1900s, polio was a worldwide disease, paralysing hundreds of thousands
of people every year. By 1950, two effective vaccines against the disease had been
developed. But vaccination in some parts of the world was still not common enough
to stop the spread of polio, particularly in Africa. In the 1980s, a united worldwide
effort to eradicate polio from the planet began. Over many years and several
decades, polio vaccination, using routine immunization visits and mass vaccination
campaigns, has taken place in all continents. Millions of people, mostly children,
have been vaccinated and in August 2020, the African continent was certified wild
poliovirus free, joining all other parts of the world except Pakistan and Afghanistan,
where polio has not yet been eradicated.

Key facts
 Mental health is more than the absence of mental disorders.
 Mental health is an integral part of health; indeed, there is no health
without mental health.
 Mental health is determined by a range of socioeconomic, biological and
environmental factors.
 Cost-effective public health and intersectoral strategies and
interventions exist to promote, protect and restore mental health.

Mental health is an integral and essential component of health. The WHO

constitution states: "Health is a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity." An important implication of
this definition is that mental health is more than just the absence of mental disorders
or disabilities.

Mental health is a state of well-being in which an individual realizes his or her own
abilities, can cope with the normal stresses of life, can work productively and is able
to make a contribution to his or her community.

Mental health is fundamental to our collective and individual ability as humans to

think, emote, interact with each other, earn a living and enjoy life. On this basis, the
promotion, protection and restoration of mental health can be regarded as a vital
concern of individuals, communities and societies throughout the world.

Determinants of mental health

Multiple social, psychological, and biological factors determine the level of mental
health of a person at any point of time. For example, violence and persistent socio-
economic pressures are recognized risks to mental health. The clearest evidence is
associated with sexual violence.

Poor mental health is also associated with rapid social change, stressful work
conditions, gender discrimination, social exclusion, unhealthy lifestyle, physical ill-
health and human rights violations.

There are specific psychological and personality factors that make people vulnerable
to mental health problems. Biological risks include genetic factors.

Mental health promotion and protection

Mental health promotion involves actions that improve psychological well-being. 
This may involve creating an environment that supports mental health.

An environment that respects and protects basic civil, political, socio-economic and
cultural rights is fundamental to mental health. Without the security and freedom
provided by these rights, it is difficult to maintain a high level of mental health.

National mental health policies should be concerned both with mental disorders and,
with broader issues that promote mental health. Mental health promotion should be
mainstreamed into governmental and nongovernmental policies and programmes. In
addition to the health sector, it is essential to involve the education, labour, justice,
transport, environment, housing, and welfare sectors.

Specific ways to promote mental health include:

 early childhood interventions (e.g. providing a stable environment that is sensitive to

children’s health and nutritional needs, with protection from threats, opportunities for
early learning, and interactions that are responsive, emotionally supportive and
developmentally stimulating);
 support to children (e.g. life skills programmes, child and youth development
programmes);
 socio-economic empowerment of women (e.g. improving access to education and
microcredit schemes);
  social support for elderly populations (e.g. befriending initiatives, community and day
centres for the aged);
 programmes targeted at vulnerable people, including minorities, indigenous people,
migrants and people affected by conflicts and disasters (e.g. psycho-social
interventions after disasters);
 mental health promotional activities in schools (e.g. programmes involving supportive
ecological changes in schools);
 mental health interventions at work (e.g. stress prevention programmes);
 housing policies (e.g. housing improvement);
 ·violence prevention programmes (e.g. reducing availability of alcohol and access to
arms);
 community development programmes (e.g. integrated rural development);
 poverty reduction and social protection for the poor;
 anti-discrimination laws and campaigns;
 promotion of the rights, opportunities and care of individuals with mental disorders.

Mental health care and treatment

In the context of national efforts to develop and implement mental health policy, it is
vital to not only protect and promote the mental well-being of its citizens, but also
address the needs of persons with defined mental disorders.

Knowledge of what to do about the escalating burden of mental disorders has

improved substantially over the past decade. There is a growing body of evidence
demonstrating both the efficacy and cost-effectiveness of key interventions for
priority mental disorders in countries at different levels of economic development.
Examples of interventions that are cost-effective, feasible, and affordable include:

 treatment of depression with psychological treatment and, for moderate to severe

cases, antidepressant medicines;
 treatment of psychosis with antipsychotic medicines and psychosocial support;
 taxation of alcoholic beverages and restriction of their availability and marketing.

A range of effective measures also exists for the prevention of suicide, prevention
and treatment of mental disorders in children, prevention and treatment of dementia,
and treatment of substance-use disorders. The mental health Gap Action
Programme (mhGAP) has produced evidence based guidance for non-specialists to
enable them to better identify and manage a range of priority mental health
conditions.

WHO response
WHO supports governments in the goal of strengthening and promoting mental
health. WHO has evaluated evidence for promoting mental health and is working
with governments to disseminate this information and to integrate effective strategies
into policies and plans.

In 2013, the World Health Assembly approved a "Comprehensive Mental Health

Action Plan for 2013-2020". The Plan is a commitment by all WHO’s Member States
to take specific actions to improve mental health and to contribute to the attainment
of a set of global targets.

The Action Plan’s overall goal is to promote mental well-being, prevent mental
disorders, provide care, enhance recovery, promote human rights and reduce the
mortality, morbidity and disability for persons with mental disorders. It focuses on 4
key objectives to:

 strengthen effective leadership and governance for mental health;

 provide comprehensive, integrated and responsive mental health and social care
services in community-based settings;
 implement strategies for promotion and prevention in mental health; and
 strengthen information systems, evidence and research for mental health.

Particular emphasis is given in the Action Plan to the protection and promotion of
human rights, the strengthening and empowering of civil society and to the central
place of community-based care.

In order to achieve its objectives, the Action Plan proposes and requires clear
actions for governments, international partners and for WHO. Ministries of Health will
need to take a leadership role, and WHO will work with them and with international
and national partners, including civil society, to implement the plan. As there is no
action that fits all countries, each government will need to adapt the Action Plan to its
specific national circumstances.

It’s important to take care of yourself and get the most from life.
Below are 10 practical ways to look after your mental health.
Making simple changes to how you live doesn’t need to cost a
fortune or take up loads of time. Anyone can follow this advice.
Why not start today?

1. Talk about your feelings

Talking about your feelings can help you stay in good mental health and deal with times when
you feel troubled.
Tell me more...

2. Keep active
Regular exercise can boost your self-esteem and can help you concentrate, sleep, and feel
better. Exercise keeps the brain and your other vital organs healthy, and is also a significant
benefit towards improving your mental health.

Tell me more... 

3. Eat well
Your brain needs a mix of nutrients in order to stay healthy and function well, just like the other
organs in your body. A diet that’s good for your physical health is also good for your mental
health.

Tell me more...

4. Drink sensibly
We often drink alcohol to change our mood. Some people drink to deal with fear or loneliness,
but the effect is only temporary.

When the drink wears off, you feel worse because of the way the alcohol has affected your brain
and the rest of your body. Drinking is not a good way to manage difficult feelings.

Tell me more...

5. Keep in touch
There’s nothing better than catching up with someone face to face, but that’s not always
possible. You can also give them a call, drop them a note, or chat to them online instead. Keep
the lines of communication open: it’s good for you!

Tell me more...

6. Ask for help

None of us are superhuman. We all sometimes get tired or overwhelmed by how we feel or when
things don’t go to plan.

If things are getting too much for you and you feel you can’t cope, ask for help. Your family or
friends may be able to offer practical help or a listening ear.

Local services are there to help you.

Tell me more...
7. Take a break
A change of scene or a change of pace is good for your mental health.

It could be a five-minute pause from cleaning your kitchen, a half-hour lunch break at work, or a
weekend exploring somewhere new. A few minutes can be enough to de-stress you. Give
yourself some ‘me time’.

Tell me more...

8. Do something you’re good at

What do you love doing? What activities can you lose yourself in? What did you love doing in the
past?

Enjoying yourself can help beat stress. Doing an activity you enjoy probably means you’re good
at it, and achieving something boosts your self-esteem

Tell me more...

9. Accept who you are

We’re all different. It’s much healthier to accept that you’re unique than to wish you were more
like someone else. Feeling good about yourself boosts your confidence to learn new skills, visit
new places and make new friends. Good self-esteem helps you cope when life takes a difficult
turn.

Tell me more...

10. Care for others

‘Friends are really important… We help each other whenever we
can, so it’s a two-way street, and supporting them uplifts me.’
Caring for others is often an important part of keeping up relationships with people close to you.
It can even bring you closer together.