058. Open Letter To WHO On Pentavalent Vaccine Related Deaths In India

Open letter To WHO On Pentavalent Vaccine-Related Deaths In India

Pentavalent vaccine was introduced in two states of India last year by the World Health Organization (WHO). Several alleged deaths occurring due to the vaccine, prompted the All India Drug Action Network to write to WHO asking for a re-evaluation of the introduction of the vaccine.

By All-India Drug Action Network

To: 

Dr. Margaret Chan,
The Director General,
World Health Organization, 

Geneva

Dear Dr Margaret Chan,

All India Drug Action Network (AIDAN) is a network of not-for-profit civil society organizations that has been campaigning and working for rational use of medicines, largely in the Indian context. We have written to you in the past. We would like to bring your attention to the Pentavalent (DPT + Hib + Hepatitis B) vaccine related deaths in India.

According to the Brighton classification of ‘Adverse Events Following Immunization’ (AEFI), re-challenge and recurrence of symptoms in the individual is needed for classification of AEFI as ‘certainly related to vaccine’. Such re-challenge is impossible if in the first instance, AEFI results in death. In the absence of proof from a re-challenge experiment, deaths caused by vaccines can only be classified as ‘probably related to vaccine or possibly related’ to the immunization.

As you would know, there have been several Pentavalent vaccine related deaths in Sri Lanka, Bhutan and Pakistan. Using the WHO approved classification of AEFI many of these deaths are ‘probably related to the immunization’ because no alternate cause for the adverse events has been found. However an expert panel looking at the deaths in Sri Lanka deleted ‘probably related’ and ‘possibly related’ from the classification of Brighton for purposes of their evaluation report, and then certified that the vaccines were ‘unlikely to be due to the vaccines’. This report (Expert Panel Report 23 December 2008 Sri Lanka) is available on the World Wide Web.

One by one the WHO has de-listed a number of brands of pre-qualified Pentavalent vaccine, but the problem has refused to go away. Pentavalent vaccine was introduced in two states in India on 14th December and 17th December 2011, to evaluate the safety of the vaccine in India.

According to an affidavit filed in the Kerala High Court by the Government of Kerala India, there have been four deaths in less than two months since it was introduced in the public health system. For your information the full text of the submission by Kerala government can be accessed here.

The reactions in India suggest that the cause of the problem is unrelated to the brand or manufacturer or lot of the vaccine. It appears to be a form of ‘hypersensitivity reaction’ as described in the post mortem report on one of the children in Kerala.

The vaccine can be administered to many patients without problems and there is no available method at present to predict which infant will react adversely.

The US FDA has pointed out that vaccines are aimed mostly at healthy individuals for prevention of diseases to which an individual may never be exposed. Unlike conventional drug treatments meant for the management of existing disease, in prophylaxis with vaccines, safety is of paramount importance. Vaccines that frequently and unpredictably cause death of healthy children cannot be recommended.

Pentavalent vaccine is at present recommended by WHO and its introduction is supported by Global Alliance on Vaccines and Immunization (GAVI) funds. Given these circumstances the WHO needs to re-evaluate the recommendations. We propose to copy this letter to countries supporting the GAVI initiative so that they may be able to initiate action in a responsible manner.

Looking forward to your early action in the regard.


1. Dr Jacob Puliyel, Drug Action Forum– Karnataka (DAF-K), New Delhi

2. Dr Mira Shiva, Medico Friend Circle, New Delhi

3. Dr Gopal Dabade, DAF-K, Dharwad

4. Mr Srinivasan. S, LOCOST, Vadodara

5. Mr Naveen Thomas, Headstreams, Bangalore

6. Mr Prasanna Saligram, AID India, Bangalore

7. Dr Anurag Bhargava, JSS, Chattisagarh

March 12, 2012.


Republished here on public interest by courtesy of All-India Drug Action Network

Links:

Pentavalent Vaccines Promoted by WHO Despite Deaths of Healthy Children – Part I, Asia

http://www.dadychery.org/2012/05/01/pentavalent-vaccines-promoted-by-who-despite-deaths/

Tags:

Kerala Health News, Health Research Online, Public Health Kerala, Health News, Kerala Health Service, India Health, Health Department, pentavalent vaccines, Antigen, Paediatric disease, Infant death,

057. Kerala’s Everyday Drink Of Vaccine Cocktails

Kerala’s Everyday Drink Of Vaccine Cocktails

India serves up costly cocktail of vaccines

By Ranjit Devraj

Source: Inter Press Service News Agency,
New Delhi, India.
Saturday, November 9, 2013.

Ignoring widespread concern over the safety, efficacy and cost of pentavalent vaccines, India’s central health ministry has, this month, approved inclusion of the prophylactic cocktail in the universal immunization programme in seven of its provinces.

Pentavalent vaccine doses, a cocktail of five antigens in a single shot, confers immunity against five paediatric diseases – diphtheria, pertussis, tetanus, hepatitis B and haemophilus influenza type b (Hib), with the last one considered particularly problematic by some experts.

Pentavalents, produced by several manufacturers and promoted by the Global Alliance on Vaccines and Immunization (GAVI), has had a history of causing adverse reactions and deaths in India’s neighbouring countries like Bhutan, Sri Lanka and Pakistan.

In 2010, the National Technical Advisory Group on Immunization (NTAGI), a body of experts selected by the Indian government, recommended limited introduction of pentavalents in southern Kerala and Tamil Nadu and evaluation of results over a year before extension to other states.

Pentavalents were launched in Kerala and Tamil Nadu in December 2011, but the results were not encouraging. Kerala recorded four infant deaths following vaccination, with symptoms similar to what were seen in other South Asian countries.

Public health activists in Kerala, a state with 100 percent literacy and human development indices similar to those of advanced Western countries, quickly filed a public interest litigation (PIL) in the Kerala High Court asking for intervention in having the programme called off and a return to the existing health plan.

But despite infant deaths and two pending PILs (with yet another being heard in the Delhi High Court) against pentavalents, the health ministry announced on Apr. 16 that pentavalents would be introduced in five more states – Gujarat, Haryana, Karnataka, Goa, Jammu and Kashmir and Puducherry in October.

In making the decision, the government overlooked the NTAGI, which has not even been convened since August 2010 when the body suggested limited introduction to Kerala and Tamil Nadu as the two states have good adverse event following immunization systems.

“Going by what we have seen in the neighbouring countries and now in the state of Kerala, pentavalents can, without warning, cause children (to suffer) hypersensitivity reactions and death,”

Jacob Puliyel, an eminent paediatrician at St. Stephen’s hospital in New Delhi and member of the NTAGI, told IPS. Puliyel likened the situation to penicillin sensitivity and said it bordered on criminality to be administering pentavalents without first testing a child for hypersensitivity. “Every child that is being given a dose of pentavalent vaccine is a potential victim of the adverse reaction,” he said.

Puliyel was among the many eminent physicians and public health activists in India who wrote to World Health Organization (WHO) director-general Margaret Chan on Apr. 3 asking the health body to “re-evaluate” its recommendation of pentavalent vaccines on the grounds of safety.

Another signatory, Dr Meera Shiva, an expert on pharmaceutical drugs attached to the voluntary Medico Friends Circle, told IPS that WHO had to de-list a number of brands of ‘pre-qualified’ pentavalent vaccine, “but adverse reactions persist and we have surely not heard the last of them.”

The letter to Chan, written under the aegis of the All-India Drug Action Network, an umbrella of public health activist groups, suggested that the cause of the vaccination- related deaths was likely to be “hypersensitivity reaction as described in the post mortem report on one of the children (who died) in Kerala.”

“Unlike conventional drug treatments meant for the management of existing diseases, in prophylaxis with vaccines, safety is of paramount importance. Vaccines that frequently and unpredictably cause the death of healthy children cannot be recommended,” the letter to Chan said.

Policy analysts specializing in vaccines said they were dismayed at the move to approve pentavalents in as many as seven of India’s states, which account for 340 million of India’s 1.2 billion people.

“Pentavalents are a test case for India’s new policy on vaccines that is in keeping with liberalization and openly favours pharmaceutical majors at the cost of India’s public sector vaccine units,” said Madhavi Yennapu, a scientist who specializes in vaccines at the central government’s National Institute of Science, Technology and Development Studies.

Twenty of India’s 23 public sector vaccination units, once the mainstay of the country’s immunization programme, have been shut down one after another over the last four years on the grounds that the quality of their products was suspect.

Yennapu pointed to the draft National Vaccination Policy, released last year, for clues on why the government has not made any serious attempt to revive the vaccine- manufacturing units by enforcing quality standards, for instance.

The new policy demands that the “risk of manufacturing vaccines by private manufacturers must be cushioned by assistance from (the) government” and suggests that it be made mandatory for the government to support vaccine producers with advance market commitments (AMCs).

Madhavi explained that AMCs provide guaranteed markets for a vaccine even before trials are conducted, with the government committed to paying a supporting minimum price.

“Even if the vaccine turns out to be less efficacious than the existing one the government must honour the AMC by buying the new vaccine at the agreed price.

“This means that AMC funds must be deposited with the World Bank ahead of vaccine delivery by countries that GAVI is supposed to be helping with the introduction of new vaccines,”

Madhavi told IPS:

“Naturally, GAVI would be looking at large countries like India, Brazil and China to provide the AMCs.” For a country like India, what is important is to “see how many vaccines are needed to prevent how many deaths and at what cost, rather than throw out tried and tested vaccines in favour of a cocktail (pentavalent) which not only has doubtful advantages but has been shown to cause adverse reactions,” Madhavi said. According to Madhavi, there is no hard scientific evidence to show that India needs the Hib vaccine .“It is clearly piggybacking on other vaccines and the public made to pay for it.” The existing diphtheria, tetanus, pertussis (DPT) vaccine costs about 30 cents for all the doses needed to immunize a child, while immunization with pentavalents will cost more than 10 dollars. “We need to ask ourselves if introducing the new vaccine is really worth all the public money being spent on it,” Madhavi said.

Republished here on public interest by courtesy of Inter Press Services

Source: INTER PRESS SERVICE News Agency
Saturday, November 9, 2013

Tags: Kerala Health News, Health Research Online, Public Health Kerala, Health News, Kerala Health Service, India Health, Health Department, pentavalent vaccines, Antigen, Paediatric disease, Infant death,

056. Kerala Health Department Severely Accused By CAG On Account Of Sickle Cell Anaemia

Kerala Health Department Severely Accused By CAG On Account Of Sickle Cell Anaemia

Comptroller and Auditor General of India raps Kerala health department

Sickle Cell Anaemia is an inherited disease characterized by red blood cells that assuming a sickle shape making normal life difficult in later stages of the sickness

Press Trust Of India, Thiruvananthapuram
June 22, 2014

The Comptroller and Auditor General (CAG) has expressed concern over the failure of the public health system in Kerala to tackle the prevalence of sickle cell anaemia among the tribal population in Wayanad, home to nearly 31 per cent of Adivasi communities in the state.

According to a recent CAG report, out of the 85 per cent of tribal population screened by health authorities in the district, a total of 706 persons were found to be affected with the disease while 6,992 showed its traits.

Quoting a survey by the National Rural Health Mission (NRHM) from 2007-08 to 2012-13, it said as many as 312 of those suffering from the "life-long inherited disease" were in the age group of 18-40 and 262 in the school-going age of 5-17.

Sickle Cell Anaemia is an inherited disease characterized by red blood cells that assuming a sickle shape making normal life difficult in later stages of the sickness.

The NRHM had recommended grant of incentives to the school going students to continue their studies and for preferential treatment and temporary and contract jobs to those patients in the age group of 18-40, it said. However, the government and district administration did not initiate steps to implement this, the report said. The report also found fault with the state health department for not completing the disease screening to cover the entire tribal population in the region.

"No special efforts have been made by the Health Department to extend help to the identified patients to lead a normal life," it added.

Republished here on public interest by courtesy of Business Standard Dot Com

Link: http://www.business-standard.com/article/economy-policy/cag-raps-kerala-health-department-114062200709_1.html

Tags: Kerala Health News, Health Research Online, Public Health Kerala, Health News, Kerala Health Service, India Health, Health Department, Sickle Cell Anaemia, CAG, NRHM, Adivasi, Wayanad, Tribal

050. Who Were Behind The Abandoned Health Observatory Surveillance Project Of Kerala?

Who Were Behind The Abandoned Health Observatory Surveillance Project Of Kerala?

By Special Correspondent
Kerala Health Research Online

The first news report to mention Kerala Health Observatory And Basic Surveillance Project was by The Hindu National Daily published on 23 January 2013 which involved Health Secretary Rajeev Sadanandan saying: ‘The State Health Department is putting in place a Health Observatory formulated by the department to track the morbidity and mortality pattern in the State through a survey, covering 2.3 lakh households or a population of 10 lakh covering all panchayats. It is one of the largest armies in the world to track all health-related data. The project is taken up by the Health Department, with technical support from the Population Health Research Institute of McMaster University, Canada under formal technical collaboration, supervised and supported academically by the Achutha Menon Centre for Health Science Studies, Health Action by People, and the Department of Community Medicine at the Medical College. McMaster University will assist in data management and analysis as the State has little experience in handling such mammoth studies. The proposal is to pilot the project in April, by surveying data from two clusters of 55 households each in urban and rural areas in all districts. Health workers will visit the designated areas and administer the questionnaires prepared by a team of experts. The questionnaire will be pre-loaded in a tablet PC so that the health workers need not spend more than 20 minutes in a household for data collection. Personal information on all members in a family will be collected. The tablet is GPRS-enabled so that the supervisors can determine if the health workers are entering the data from the field. The data will be uploaded in a server to be maintained here, ‘a Health official’ said. The training for health workers for administering the questionnaire through tablets will begin in February. The pilot is expected to be completed in a month after which the project will be formally launched. The 28 tablet PCs to be used for the pilot study will be provided by McMaster University. A proposal for supplying tablet PCs to health workers for their field work is being taken up with the IT Department.’

The second news article to come up was what the Times of India published on 18 March 2013, ‘Canadian Expertise To Create Database Of Diseases’, which further revealed that NRHM would fund the survey and the diseases caused due to extensive use of alcohol and tobacco, the food habits of the people, the rate of obesity and its reasons, the rate of prevalence of diabetes and blood pressure, the diseases caused due to lack of exercises and the reasons behind the deaths occurring in the state, would be investigated.

For one full year nothing was heard of this project in news media though everything was happening with the project. It was on 23 March 2014 that Times of India printed Kerala’s Opposition Leader Mr. V. S. Achuthanandan’s allegations on this project, under the heading ‘V S Says Govt. Clarification On Drug Tests Misleading.’ We must note that, by this time, the words Basic and Surveillance had dropped out of the title of the project and we know why. They are dreadful words, attracting the attention of vigilant inquisitors. The news article said, according to Mr. Achuthanandan, ‘the government’s clarification on allegations of drug experiments on citizens was misleading, health minister had not denied receiving money for the survey conducted among 1,540 families across the state for a Canadian organization, the minister had only said that the health department has not accepted any remuneration for the survey and the minister has yet to clarify how an NGO received money instead and why such an initiative was undertaken without the permission of the Government of India or the Indian Council of Medical Research. The Opposition Leader also alleged that a memorandum of understanding signed between Kerala Health Observatory and Population Health Research Institute of Canada had led to handing over of lifestyle and health details of people of the state to the Canadian organization, the health minister and former health secretary Rajeev Sadanandan were involved in the matter, and that the Head of the Department of Community Medicine, Mr. Vijaya Kumar, was receiving the remuneration through a non-government organization of which he is the secretary.’

The New Indian Express also on 21 March 2014 reiterated this allegation of the Opposition Leader that ‘the State Government is conducting dangerous drug trials on people in collaboration with the Canadian Government, people were being treated like guinea pigs by the State Government project Kerala Health Observatory and the Population Health Research Institute in Canada and that under the guise of this experiment, the Canadian Government was being gifted details about the lifestyle and health of the people of Kerala. He also alleged that the Health Department assigned five health inspectors and nurses for this job for over the past one year. Under the agreement signed between the Kerala Government and the PHRI, this is not merely an observation programme, but a scheme to intervene in the health status. This means, drug tests could also be a part of it. It is understood that data collected from 1,540 households in the 14 districts have been transferred to the Canadian Government. He said this is not just illegal and immoral, but also a source of corruption and demanded the State Government to clarify as to what exactly the Kerala Health Observatory Project is. The government should explain whether the subjects were informed that the data would be handed over to Canada and whether the scheme had the clearance of the Union Health Ministry. It should be explained as to how the remuneration is being paid to the organization ‘Health Action by People’. The government should also explain whether drug tests have been conducted on people, he said. 

The Hindu National Daily, on 31 March 2014 reported, in a different tone, that ‘the Opposition Leader’s recent criticism of the so-called drug trials conducted as part of the Kerala Health Observatory Project has caught many public health activists by surprise. Many officials in the health department wonder what caused the octogenarian leader to suddenly raise the issue’ when Health Minister had announced in the Assembly sometime ago that the project, which never involved any drug trial, had been shelved, the minister having had also clarified that the project, sought to be conducted in association with the Canada-based Population Health Research Institute, involved only collecting details on the morbidity and mortality patterns with regard to the high prevalence non-communicable diseases in the Kerala population and advisory body comprising of top health officials and well-known academics and public health activists having overseen the entire exercise, the findings of which having not handed over to any foreign entity.’ According to this news paper, ‘many officials wondered privately whether the Leader of the Opposition had been briefed wrongly about the project by sections not disposed well towards such Health Department initiatives, since allegations regarding drug trials have always been a politically sensitive topic in Kerala.’

We, readers of all these news articles, will now have a few questions of our own in our minds which will have to be answered by the government and a few names printed on our conscience which we ourselves have to clear. The most relevant questions which spring up in our minds have already been asked by the Opposition Leader. The names which trouble us, which we ourselves have to clear, are Kerala Health Observatory Project, Government of Kerala Health Department, National Rural Health Mission, Medical College Department of Community Medicine, Population Health Research Institute Canada and McMaster University Canada, Health Action by People, Achutha Menon Centre for Health Science Studies, Trivandrum and a few names which come up when we search internet for Kerala Health Observatory Project. 

Kerala Health Observatory and Basic Surveillance Project

To tell the truth, the name Kerala Health Observatory Project does not come up anywhere, associated with any credible research institutions. Only news is there, cultivated, planted or officially released. It exists nowhere. It has left behind only paper trails- vouchers, letters, cheques- all conveniently shelved now, to be opened only when an investigation starts or a judicial court summons. It left no electronic trail. Searching the internet with the key words kerala-health-observatory-project leads to nowhere, or to whatever is only there (See the picture below). It leads to the names of only two ladies. Everyone escaped clean, except two young ladies whose names are left there alone on the broad sky of internet for all to view. One is a consultant whose Linked In profile shows she is engaged by Health Action by People since April 2010 as Consultant, holding the responsibility of coordinating their international study funded by McMaster University and other responsibilities including searching out funding options for their research projects. The website of Health Action by People also shows her name. The other is that of a Computer Assistant in the Medical College Hospital, Trivandrum whose Linked In profile also claims she has been associated with Kerala Health Observatory Project. Medical College Authorities do not have Computer Assistants on their pay rolls except those, if any, appointed on daily wages basis by Hospital Development Committee. None of the other governmental and non-governmental organizations’ digital fronts mention anything about this project. Even after questions having been raised by prominent legislators, health minister having answered questions and reputed news papers having reported grave allegations, it is inconceivable that electronic searches for this project lead only to two young women who did not think it prudent and wise to keep back from publicly associating their names to a project which was doomed to be abandoned and hushed up later.

Health Action by People

Health Action by People started near Mutharamman Kovil, Pettah and then moved to near Medical College, Trivandrum. It was founded by the prominent Dr. C.R.Soman of Trivandrum, the late health visionary of Kerala. He was a professor at Medical College, Trivandrum, noted as a trainer of health workers in the state. After his demise, Dr. Raman Kutty, a professor at Achutha Menon Rsearch Centre became its Chairman. Dr. K.Vijayakumar, Professor of Community Medicine at Medical College, Trivandrum is its Secretary. They have two professors from the Achutha Menon Centre in their Executive Council, including the Chairman, and four professors from the Medical College, Trivandrum, including the Secretary. They do have a Dr. Rajasree Gopinath as Consultant. When they say they are committed to serving the people in the field of health and that their organization is led by a group of professionals sharing a common vision and ideal, why should we unbelieve?

Government of Kerala, Health Department and National Rural Health Mission

Government of Kerala through its health minister has admitted that an agreement was signed between the Canadian Organization and the Government which along with everything else was shelved after a time. It has not yet revealed who in Kerala were involved and how much money was spent on this project before its shelving. Also it has yet to answer the specific questions raised by the Opposition Leader of Kerala. The Health Department did involve itself in this project by deputing staff, if they did depute. This department has to answer who were deputed to do what, when and where and what their financial commitments were and who gave them the authority to depute personnel, spend money, collect people’s data and hand over it. The people of Kerala know well about the activities of NRHM. It is a central agency housed in the state, working with a lot of money, living a lavish life like kings and accounting to no one. The central government directed NRHM to create websites and post every activity including daily expenditure so that people can evaluate how they spend public money, following continuous allegations of misappropriation of money were reported from all states. They were even directed to post the names of who work where on which day so that people may check. They totally disobeyed this for fear of peoples’ interfering and public comments in websites. That is why it is said they account to no one and live like kings. Their websites have a few photos of persons, a few telephone numbers, a few links here and there and no information. Whatever is there is available in any government diary. Every dubious project which springs up in Kerala in the name of health is financed by this agency, if it has ‘considerations’. Every ambitious educated entrepreneur set out to make quick money come up with projects for this agency, for they do not provide links in their website to projects undertaken or amounts spent on each. If they are funded by the government of Kerala in any project, the government will not have details of this money once it leaves government coffers. If someone asks details from the government under the Right To Information Act about the money they gave, the government will say details are available only with the NRHM and not with them! In this particular case of Kerala Health Observation and Surveillance Project too, as reported, it was NRHM who was to finance (or distribute money to?) this survey, no wonder. Every unaccountable spending is now delegated to NRHM. Man, even defense establishments are now accountable to people! 

Achutha Menon Centre for Health Science Studies, Trivandrum

The Achutha Menon Centre for Health Science Studies is the Health Sciences wing of the Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum. They train professionals in health research and health policies. Government of India recognized this wing of Sree Chithra as a Centre of Excellence for public health training.  The AMCHSS does have an ongoing research project, the Principal Investigator of which being Dr.V.Ramankutty: Prevalence Of Type II Diabetes In A Rural Community. The path to this project is: Home > About SCTIMST > Organisation > AMCHSS > Projects > List of Ongoing Projects- 12. Apart from this, they mention nothing about any research project undertaken with Canadian partnership or assistance. They do have visiting faculties from abroad and an affiliated WHO Fellowship Programme and there might be Canadian citizens among the scholars who have come and gone, but their official website has zero information on Kerala Health Observatory Project. Perhaps, their name was unnecessarily dragged into this by those who came up with this project. One of their professors, Dr.V.Raman Kutty, is also the chairman of Health Action by People in Trivandrum, incidentally. And another of their professors is in their Executive Council also.

Population Health Research Institute in Canada

The Population Health Research Institute (PHRI) was founded in 1999 as a joint Institute of Hamilton Health Sciences Corporation and McMaster University. Their declared research programs include studying the causes and prevention of cardiovascular diseases, diabetes, obesity, vascular complications, and stroke. They have a global team of collaborators with researchers from eighty countries in six continents, including North America, Africa, Asia Pacific, Europe, Middle East and Latin/South America, according to their public relations. Their Lead Investigators are noted as Dr. Salim Yusuf, D.Phil, FRCP, Canada, Professor of Medicine at McMaster University, Director of the Population Health Research Institute, and Vice-President of Research and Chief Scientific Officer at Hamilton Health Sciences and Dr. Clara Chow, a post-doctoral research fellow.

But their official website does not have information on any projects undertaken in Kerala. In European standards, with the strict European Information Commissioners, if they do not have anything to display on Kerala, it clearly means they do not have any official deal with Kerala. If there does exist a connection, it is personal and out of office. It is very easy nowadays for someone to sign Memorandums of Understanding and mislead institutions, if there is someone in that institution who is prepared to turn head the other way in return for favours once received or offered. 

So, we have to assume that the name of the PHRI was either unnecessarily dragged into this project to boost project profile and secure government support and finance, or the PHRI withdrew from partnering with the project, on wise second thoughts. News reports say that they only intended to provide guidance and expertise, not finance. The PHRI which has undertaken so many research studies in so many countries is unlikely to sign genuine agreements officially and withdraw from them if the projects are feasible, viable, legal and righteous in their evaluation. Then who did sign the agreement for them? Did they sign it with Health Action by People or with the Government of Kerala? What were the terms of this agreement?

We know whoever approved, promoted and travelled along with this project and claimed it as their own has now disowned it, like they do to a leper. The involved establishments did spend money, depute personnel, collect data, hand it over and everything else associated with carrying out a project like this. It was, we can guess, brought forward by private persons, who got eminent institutions and scientific personalities involved, got politicians to speak for them and get favour from government, until it became a government project with government funding. We can also guess it violated so many principles inviolable where two countries, a state government, and sensitive data of people are involved. It all started in 2013 and ended in 2014 within just one year, the same period when people with guts in Kerala were playing with state politicians and bureaucrats and technocrats like playing with dolls and puppets and got projects approved and purses un-stringed. We have seen so many scams not to wonder. Why did the Kerala Government actually abandon this project and shelf it suddenly?

Note: 

This is not the end of the article. We know more things will become public in near future. We will certainly report them here. This article will be updated. Please bookmark this page.

Links To News Articles:

The Hindu News Article Dated 23 January 2013

Times of India News Article Dated 18 March 2013

Times of India News Article Dated 23 March 2014  

New Indian Express News Article Dated 21 March 2014

The Hindu National Daily News Article Dated 31 March 2014





   

048. Health Director Post Permanently Reserved For Caste Candidates? Merit No Bar?

How Many Times Can Communal Reservation Be Sought For Government Promotions?

By Special Correspondent

How many times can a doctor seek communal reservation for departmental promotions in the Kerala Health Services Department which is supposed to be a department of specialists? No one in Kerala seems to know. Even those who know, fear about speaking aloud, for fear of angering extremely rich communal elements and alienating powerful politicians who enslave themselves to communal zealots for a few hundred thousand community votes. This issue of only communal candidates becoming Director of Health Services has been fuming in this department for more than a quarter century and qualified doctors in this department fear it would continue to be so the next century also. An Assistant Surgeon has to pass through the posts of Civil Surgeon, Deputy Director of Health Services and Additional Director of Health Services, to become a Director of Health Services. It is justifiable for a doctor to avail the benefit of communal reservation for once, for recruitment to the entry post of Assistant Surgeon or for one promotion. But availing the benefit of communal reservation for all levels is unbelievable among specialists in the world. If it happens regularly in each recruiting year, there will soon be a host of Additional Directors in the department within 15 years, all having enjoyed the benefit of reservation multiple times, ascending to the post of the super doctor, bypassing everyone not eligible to enjoy communal reservation. Every other qualified and brilliant doctor in the department, even after thirty years, will not have a chance. How they can become a Director is a Chinese mathematical puzzle which even the Abacus cannot solve. 

It was due to imbalance in the strength of several minority communities in the government due to long neglect by authorities and lack of resources for a good education, that the reservations bill was introduced in India which guaranteed recruitment of backward castes and communities into government posts, subject to a maximum of 50 percent of vacancies, the rest earmarked for merit. Later, orders from the highest law office in the country held that this reservation could be used only once in the entire service; if used for recruitment, it shall not be allowed for promotions; if was not sought for recruitment, it could be sought for promotion once. Recruitment to the post of the Director of Health Services is the finest example in Kerala of how a specialists’ department can allow merit to be overruled by communal factors, skillfully manipulate reservation to cent percent and bring down the efficacy and competency expected of the post. 

For the past three decades, Kerala Health Services has been helpless but to reserve this post for community and caste candidates. Seniority, service merit and academic qualifications are no consideration for recruitment to this post- the bare minimum is sufficient. The only question is, ‘do you have a reservation?’ The unusually brilliant in this department are tired. They are facing the dilemma of quitting joining private service or succumbing to communal powers and suffering the shame of working far below the incompetent. The main reason for brilliant doctors leaving this department and young ones not joining is this, and the unnecessary and illogical ban on home practice. Drive away the brilliant ones and make health service a haunt of inferior opportunists- that is what the government has only been able to achieve so far. 

One former Director of Health Services was recruited as Assistant Surgeon through special communal recruitment. While still under probation, was suspended for the death of a child and mother but still she managed to get promoted as Civil Surgeon Grade II through Special Recruitment.  While other doctors became Civil Surgeons Grade II in 13 years, she made it in 5 years. The same way she became Civil Surgeon Grade I. Then the posts of Deputy Director of Health Services and Additional Director of Health Services also were secured the same way and eventually the final one: five promotions using communal reservation! We will wonder who is there to acquiesce to demands for all these promotions and grant them too: it is those who already are there in government on the same communal and caste basis. Now, we know that the senior-most among the Additional Directors of Health Services only would be posted as the DHS. While a non-communal, doctor would take at least 30 years to become an Additional Director of Health Services, she could make it within 15 years. When she reached the final level, there was little competition there because these posts are limited in number and could be filled up only when a retirement vacancy arises. She naturally had to compete only against other reservation beneficiaries. And the seniority among them counted. So, now, we have a bunch of Additional Directors in the health services department- all recruited and promoted on the basis of community and caste, competing against each other for the post of the DHS. Our doctor anyway became the DHS, even though she had to retire without full charge of the DHS due to court’s intervention. 

During the past 25 years, the post of DHS has been reserved this way. And it is expected that it would be the same for the next 50 years also. Who will work at a place where caste and creed overrule brilliance and qualification? So our question arises, for Kerala government to answer: How many times can communal reservation be sought for promotions in the health department?

What the law states about availing reservation benefits multiple times:

The Supreme Court of India held that reservation of appointments or posts under Article 16(4) included promotions (in Akhil Bharatiya Soshit Karamchari Sangh (Railway) v. Union of India 1981, 1 SCC 246), which was later overruled and held that Reservations cannot be applied in promotions (in Indira Sawhney & Others v. Union of India. AIR 1993 SC 477).

77th Constitution amendment Art 16 (4 A) & 16 (4B) were introduced to make judgement as invalid but subsequent judgement in M. Nagraj & Others v. Union of India AIR 2007 SC 71 held the amendments constitutional. Those constitutional amendments do not alter structure of Art. 16(4). 

Roster-point promotees getting the benefit of accelerated promotion would not get consequential seniority and the seniority between the reserved category candidates and general candidates in promoted category shall be governed by their panel position. This was overruled and held that the date of continuous officiation has to be taken into account and if so, the roster- point promotees were entitled to the benefit of continuous officiation (Jagdish Lal and Others v. State of Haryana and Others (1997) 6 SCC 538) which was overruled again and held that held that roster promotions were meant only for the limited purpose of due representation of backward classes at various levels of service and therefore, such roster promotions did not confer consequential seniority to the roster point promotee (Ajitsingh Januja & Others v. State of Punjab AIR 1999 SC 3471; Jagdish Lal M G Badappanvar v. State of Karnataka 2001(2) SCC 666 : AIR 2001 SC 260) 

Relaxation of qualifying marks and standard of evaluation in matters of reservation in promotion was not permissible (S. Vinod Kumar v. Union of India 1996 6 SCC 580).

If the state wants to frame rules with regard to reservation in promotions and consequential seniority, it has to satisfy itself with quantifiable data that is there is backwardness, inadequacy of representation in public employment and overall administrative inefficiency, and unless such an exercise was undertaken by the state government, the rules in promotions and consequential seniority cannot be introduced. (Suraj Bhan Meena v. State of Rajasthan; M. Nagraj & Others v. Union of India AIR 2007 SC 71) Reservation in promotion is dependent on the inadequacy of representation of members of SC, ST and backward classes and subject to the condition of ascertaining whether such reservation was at all required, as no exercise was undertaken to acquire quantifiable data regarding in adequacy of representation. The Rajasthan High Court rightly quashed the notifications providing for consequential seniority and promotion to the members of SC and ST communities and held the same does not call for any interference. 

General observations and directives made by law courts are the following:

Backwardness and inadequacy of representation are the controlling/compelling reasons for the state to provide reservations, keeping in mind the overall efficiency of state administration. Government has to apply cadre strength as a unit in the operation of the roaster in order to ascertain whether a given class/group is adequately represented in the service. Roaster has to be post-specific with inbuilt concept of replacement and not vacancy based. If any authority thinks that for ensuring adequate representation of backward class or category it is necessary to provide for direct recruitment therein, it shall be open to do so. Backlog vacancies are to be treated as a distinct group and excluded from the ceiling limit of 50%. If a member from reserved category gets selected in general category, his selection will not be counted against the quota limit provided to his class and reserved category candidates are entitled to compete for the general category post. The reserved candidates are entitled to compete with the general candidates for promotion to the general post in their own right. On their selection, they are to be adjusted in the general post as per the roster and the reserved candidates should be adjusted in the points earmarked in the roster to the reserved candidates. Each post gets marked for the particular category of candidate to be appointed against it and any subsequent vacancy has to be filled by that category alone (replacement theory). (R K Sabharwal v. State of Punjab AIR 1995 SC 1371: (1995) 2 SCC 745). The operation of a roster, for filling the cadre-strength, by itself ensures that the reservation remains within the 50% limit.