Context

India has signed a protocol amending the Double Taxation Avoidance Agreement (DTAA) with Mauritius to plug treaty abuse for tax evasion or avoidance.

Amended India Mauritius Tax Treaty – Key Highlights

• The amended pact has included the Principal Purpose Test (PPT), which essentially lays out the condition that the tax benefits under the treaty will not be applicable if it is established that obtaining that duty benefit was the principal purpose of any transaction or arrangement.
• Mauritius has been a preferred jurisdiction for investments in India due to the non-taxability of capital gains from the sale of shares in Indian companies until 2016.
• Mauritius remains India’s fourth largest source of FPI investments, after the US, Singapore, and Luxembourg. FPI investment from Mauritius stood at Rs 4.19 lakh crore at the end of March 2024.

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About Double Taxation Avoidance Agreement (DTAA)

A Double Taxation Avoidance Agreement (DTAA) is a pact signed by two nations that encourages capital investment, trade in goods and services, and other economic activities between the two nations by preventing International Double Taxation.

• Depending on the types of businesses/holdings that citizens of one country have in another, the DTAA may either cover all types of income or may focus on a particular type of income.

Benefits of Double Taxation Avoidance Agreement (DTAA):

• Deduction: Taxpayers can claim the taxes paid to foreign governments as a deduction in the country of residence.
• Exemption: Tax relief under this method can be claimed in any one of the two countries.
• Tax credit: Tax relief under this method can be claimed in the country of residence.

Significance: 

The recent amendment India Mauritius Tax Treatyreflects India’s intent to align with global efforts against treaty abuse, particularly under the BEPS framework.

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Context

Recently, Indian Space Research Organisation (ISRO) attained a significant milestone in space debris reduction, stating that its PSLV-C58/XPoSat mission left Zero debris in Earth’s orbit.

PSLV Accomplishes Zero Orbital Debris Mission

• ISRO achieved this milestone by repurposing the last stage i.e. 4th stage of the PSLV, into the PSLV Orbital Experimental Module-3 (POEM-3), effectively transforming it into an orbital station.

PSLV Orbital Experimental Module-3 (POEM-3)

• It is a three-axis altitude-controlled platform with power generation and telemetry & telecommand capability for supporting payloads.
• Developed by: Vikram Sarabhai Space Centre (VSSC)
• POEM-3’s Accomplishments
  • In the PSLV C-58 mission, POEM-3 successfully deployed the XPoSat satellite in a 650 km orbit.
  • Subsequently, the fourth stage of the PSLV/POEM-3 was maneuvered to a 350 km circular orbit before re-entering Earth’s atmosphere upon completion of its payload objectives.

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Significance of POEM-3’s Achievement

• Technological Innovation: It demonstrates commitment to innovative space debris management and sustainable exploration solutions. 
  • ISRO’s accomplishment is crucial in light of the growing concern over space debris. 
• Environmental Impact and Safety: POEM-3’s re-entry minimized space debris accumulation, preserving the space environment. 
  • With a rising number of objects in space, the risk of collisions and the creation of further debris, known as the ‘Kessler syndrome,’ poses a significant threat to space assets.
  • Therefore it will help address concerns over satellite and debris proliferation, especially in low Earth orbit (LEO).
• Global Recognition: Knowledge Sharing Insights from POEM-3’s mission outcomes are valuable for international space agencies and other similar organizations.

International Regulatory Framework

• Currently there are no specific international laws addressing debris in Low Earth Orbit (LEO), most space-faring nations adhere to Space Debris Mitigation Guidelines 2002, endorsed by the United Nations in 2007. 
• Efforts by Various Space Agencies:  
  • NASA Orbital debris program since 1979.
  • ESA: Zero debris charter with the goal of achieving zero space debris by 2030.
  • Japan: Commercial Removal of Debris Demonstration (CRD2) and
  • China: Debris Removal through spacecraft with solar sails.
  • ISRO: Project Netra, for early warning systems in space to detect debris &  hazards to Indian satellites.
  • Apart from the POEM missions, ISRO has set up a Space Situational Awareness Control Centre to protect its high-value assets from close approaches and collisions with inactive satellites, pieces of orbiting objects, and even near-earth asteroids.

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Context

Global Trade Body ‘WTO’ in its recently released Bi-annual report “Global Trade Outlook and Statistics” says global trade will pick up in 2024 but downward risks remain.

WTO Global Trade Outlook and Statistics Report: Key Highlights

• World Merchandise Trade volume: It is projected to grow 2.6% in 2024 and 3.3% in 2025, following a larger-than-expected decline of -1.2% in 2023. 
  • By the end of 2023, merchandise trade volume was up 6.3% compared to 2019. Commercial services also increased, with annual US$ values up 21% between 2019 and 2023. 
  • India’s share of global goods exports was 1.8% in 2023 and imports was 2.8%.
• World Real GDP Growth at market exchange rates: It is slowed from 3.1% in 2022 to 2.7% in 2023 but is expected to remain mostly stable over the next two years at 2.6% in 2024 and 2.7% in 2025. 
  • linked to inflationary pressures: The contrast between the steady growth of GDP and the slowdown in merchandise trade volume is linked to inflationary pressures, which had a downward effect on consumption of trade-intensive goods.

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• US Dollar Value of Merchandise Counterbalanced by Commercial Services Trade: 
  • The US dollar value of global merchandise trade dropped by 5% to US$ 24.01 trillion. However, this decline was largely counterbalanced by a robust 9% increase in commercial services trade, reaching US$ 7.54 trillion. 
  • In global commercial services, India’s share in exports is seen 4.4% in 2023 at $344 billion, up 11% on-year whereas imports is seen as 3.4% at flat at $247 billion.
  • Reasons Behind the Shift: The decrease in merchandise exports can be attributed in part to the declining prices of commodities like oil and gas. Conversely, the upsurge in commercial services trade was fueled by the resurgence of international travel and the booming market for digitally delivered services.
• Digitally Delivered Services:
  • India is now 4th largest exporter of Digitally Delivered Services (India’s share rose to 6% in 2023 from 4.4% in 2019)and reached $257 billion in 2023 in the World, marking a 17% increase compared to the previous year.
  • This growth outpaced that of Germany and China, which saw 4% growth each.
• Future Outlook: In 2024 and 2025, inflation is expected to gradually abate, allowing real incomes to grow again in advanced economies, boosting consumption of manufactured goods. 
  • A recovery of demand for tradable goods in 2024 is already evident. This is related to an increase in household consumption linked to improved income prospects. 

• Potential Challenges: Risks to the forecast are on the downside due to current geopolitical tensions and policy uncertainty. 
  • Conflict in the Middle East has diverted sea shipments between Europe and Asia while tensions elsewhere could lead to trade fragmentation. 
  • Rising protectionism is another risk that could undermine the recovery of trade in 2024 and 2025.

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Context

The Adjudicating Authority under the Prevention of Money Laundering Act, 2002 (PMLA) confirmed the attachment of assets worth Rs 751.9 crore belonging to a political party-promoted National Herald newspaper.

Role of the Adjudicating Authority

• Section 5 of the PMLA: It provides for the attachment of any property that is suspected to have been acquired with the proceeds of crime in a case of any offense that is listed in the schedule of the law. 
• Provisional attachment order: It  is valid for a period of 180 days within which the Adjudicating Authority (appointed by the central government) must confirm the attachment, failing which the property is automatically released from attachment.
  • The accused can continue to enjoy the property until the Adjudicating Authority confirms the attachment, after which the ED has the power to claim possession.

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What Happens After the Adjudicating Authority Confirms the Attachment?

• Once ED claims possessions, the property shall remain out of bounds for the owner until the trial is completed.
  • Following final confirmation, in case of a residential property, the ED will ask the owner to vacate the premises along with his belongings, and will take over possession.
• Case  of a conviction:  The trial court may order confiscation of the attached property, and vest the rights to the property with the central government.
• Right to Appeal: The accused can challenge the Adjudicating Authority’s confirmation order at the PMLA’s Appellate Tribunal within 45 days. If the Appellate Tribunal too confirms the order, the accused can file a plea in the High Court, and so on.

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Context

The Indian Institute of Technology Bombay (IIT-B) has taken initiative to create patient-centric cancer therapy in India. Their focus is on developing accessible CAR-T cell therapy.

• CDSCO approved the first CAR-T cell therapy in October 2023.
  • This therapy is intended to treat relapsed or refractory B-lymphomas and B-Acute Lymphoblastic Leukemia (B-ALL), where other treatments have failed.

About Chimeric Antigen Receptor Or CAR-T Cell Therapy

• CAR-T cell therapy is a type of cancer treatment that modifies a patient’s immune cells to target cancer cells more effectively.
• Process of CAR-T Cell Therapy:
  • T cells are derived from bone marrow stem cells and are essential components of the immune system responsible for defending the body against infections.
    • These cells are a type of white blood cell
    • It is extracted through a procedure called leukapheresis.
    • These T cells are then modified in a laboratory to express proteins called chimeric antigen receptors (CARs).

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• • • • The CAR has different parts that help it recognize cancer cell antigens and activate the immune system.
      • Each CAR stretches across the cell membrane, with parts outside and inside the cell.
        • Outside, there are fragments of antibodies made in the lab. 
          • It is chosen because they stick well to the target.
        • Inside, there are two components that send signals when the receptor meets an antigen.
    • The gene that makes the CAR is artificially created in the laboratory.
      • They then use a carrier called a vector to deliver this gene into the patient’s T-cells. 
        • Viral vectors, like lentiviral vectors, are often used in this process. 
  • The modified T cells are then multiplied in the lab before being infused back into the patient’s body.
  • The patient usually undergoes chemotherapy before receiving the CAR-T cells. 

FDA Approval:

• The FDA has given the green light to six CAR-T cell therapies so far.
• Four of these therapies are aimed at a protein called CD19 found on the surface of leukemia and lymphoma cells.
• NexCAR19: Similarities and Differences:
  • NexCAR19 shares similarities with these therapies as it also targets CD19.
    • NexCAR19 is a CAR-T therapy developed in India.
  • Difference between US-developed therapies and NexCAR19.
    • In the US, CAR-T cell therapies use antibody fragments from mice.
    • NexCAR19, on the other hand, has human proteins mixed with the mouse antibodies, making it more ‘human-like.’
      • Objective: This modification aims to enhance the therapy’s safety profile and effectiveness.

Applications of  CAR-T cell therapy

It is mainly used for certain types of blood cancers:

• B-cell acute lymphoblastic leukemia (ALL).
• Diffuse large B-cell lymphoma.
• Follicular lymphoma.
• High-grade B-cell lymphoma.
• Mantle cell lymphoma
• Multiple myeloma.
• Primary mediastinal large B-cell lymphoma.

Risks of CAR-T cell therapy

• Cytokine Release Syndrome (CRS): This is the most common side effect and involves an intense inflammatory response. 
  • This can cause Fever, Chills, Fatigue, Muscle aches, Nausea and vomiting, Difficulty breathing, Low blood pressure
  • In severe cases, it can be life-threatening.
• Neurotoxicity: It can affect the nervous system and cause Confusion, Tremors, Seizures, Difficulty speaking. Loss of coordination. 
• Increased Risk of Infections: CAR-T therapy weakens the immune system, making it harder for the body to fight off infections. This is especially concerning because many patients receiving CAR-T therapy are already battling cancer.
• Low Blood Cell Counts: Treatment can decrease the production of important blood cells, leading to Fatigue, Increased risk of bleeding, Higher chance of infection. 

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Challenges Before CAR-T Therapy Implementation in India

• Limited access to primary healthcare:  Primary healthcare facilities are a challenge in many parts of India. 
  • This can be a barrier for patients considering CAR-T therapy, as this therapy requires close monitoring and management by specialists throughout the process.
• Concentration of cancer treatment facilities:  Cancer treatment facilities, especially those equipped for advanced therapies like CAR-T, are concentrated in metropolitan areas.
  • This can create a disparity for patients in remote locations who may not be able to easily access the therapy or the required follow-up care.
• Infrastructure for managing side effects: CAR-T therapy has various side effects, particularly cytokine release syndrome (CRS). Therefore, it requires intensive care support. 
  • However, the limited availability of such facilities in some areas could be a challenge.
• Immunocompromised patients: CAR-T therapy itself can leave patients immunocompromised, making them more susceptible to infections.  India’s healthcare system may not be universally equipped to handle such cases effectively, especially in areas with limited resources.
• High Cost: Even though NexCAR19 is a more affordable option compared to similar treatments abroad, it remains expensive for many Indian patients, ranging from ₹40 to 45 lakh. 
  • There are multiple aspects that contribute to the high cost of NexCAR19 production. These include Labor expenses, Logistics, Materials, Facility costs, Marketing, distribution, and intellectual property development. 

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Context

India has been elected to several key bodies at the United Nations.

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Jagjit Pavadia Re-elected to International Narcotics Control Board (INCB)

Jagjit Pavadia was re-elected for a third term to the International Narcotics Control Board (INCB) after garnering the highest number of votes from March 2025-2030.

• Elections to ECOSOC: The UN Economic and Social Council (ECOSOC) held elections to fill vacancies in 17 of its subsidiary bodies. These vacancies were filled through election by acclamation, secret ballot and nomination.
• Elections by Acclamation: India was also elected by acclamation to:
  • Commission on the Status of Women for the term 2025-2029

• Executive Board of the United Nations Children’s Fund for the term 2025-2027 Executive Board of the United Nations Development Programme, the United Nations Population Fund and the United Nations Office for Project Services for 2025-2027
• Executive Board of the United Nations Entity for Gender Equality and the Empowerment of Women for the 2025-2027 term
• Executive Board of the World Food Programme for the 2025-2027 term.

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About International Narcotics Control Board (INCB)

• Genesis: Established in 1968, the Narcotics Control Board (INCB) is the independent and quasi-judicial monitoring body for the implementation of the United Nations international drug control conventions.
• Members: It consists of 13 members who are elected by the Economic and Social Council and who serve in their personal capacity, not as government representatives. 
  • Three members with medical, pharmacological or pharmaceutical experience are elected from a list of persons nominated by the World Health Organization (WHO).
  • 10 members are elected from a list of persons nominated by Governments.
• Mandate: To ensure that adequate supplies of drugs are available for medical and scientific uses and that the diversion of drugs from licit sources to illicit channels does not occur.
  • International Narcotics Control Board (INCB) also monitors Governments’ control over chemicals used in the illicit manufacture of drugs and assists them in preventing the diversion of those chemicals into illicit traffic.

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Context

The government has heightened security focus on the strategic Andaman and Nicobar Islands (ANI).

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Why are Andaman and Nicobar Islands key to Indo-Pacific Security?

• Military Infrastructure Upgrade: The military infrastructure upgrade is undergoing in the Andaman and Nicobar Islands (ANI), with revamped airfields and jetties, additional logistics and storage facilities, a habitat for troops, and a robust surveillance infrastructure. 
• Container Transhipment Terminal: The Centre is also working to construct a container transhipment terminal alongside associated infrastructure to support traffic and operations.
• Objective Behind Infrastructure Upgradation: The enhancement of security infrastructure is part of a comprehensive strategy aimed at:
  • Transforming the Andaman and Nicobar Islands into a formidable maritime stronghold and fostering cooperation with maritime neighbors. 
  • It could serve as a platform for cooperative maritime endeavors like aircraft and submarine search and rescue missions.
  • It will facilitate deployment of additional military forces, and facilities for larger and more warships, aircraft, missile batteries and troops.
• Chinese Increasing Influence: This is being done amid Chinese attempts to expand its influence in the region, which includes the construction of a military facility at Myanmar’s Coco Islands lying 55 km north of Andaman and Nicobar Islands (ANI).

Andaman and Nicobar Islands (ANI)

• Group of Islands: The Andaman and Nicobar Islands (ANI) consists of two groups of islands, the Andaman Islands and the Nicobar Islands, covering an area of 8,249 sq km.
  • The entire island chain consists of 836 islands, including islets and rocky outcrops, of which some 38 are permanently inhabited.
• Governance: The islands are governed as a single Union Territory by the Central Government of India through the Andaman Nicobar Administration.
• Integrated Tri-service Command: The Andaman and Nicobar Islands is home to India’s only integrated tri-service command of the armed forces, the Andaman and Nicobar Command (ANC), responsible for maritime surveillance and enhancing India’s strategic presence in the eastern Indian Ocean.

Andaman and Nicobar Islands (ANI) As Key to Indo-Pacific Security

• Strategic Location and Maritime Chokepoints:  Situated at the entrance of the Strait of Malacca, the long chain of Andaman and Nicobar Islands (ANI) connects one of the world’s most crucial trade chokepoints.
  • They offer India the capability to monitor traffic flow from the South China Sea (Pacific Ocean) to the Andaman Sea (Indian Ocean).
• Proximity to Key Maritime Routes and Shipping Lanes:  The ANI commands a position over one of the world’s most frequented sea lanes. 

• • This positioning allows India to oversee the movement from the South China Sea (Pacific Ocean) to the Andaman Sea (Indian Ocean) through the Strait of Malacca. 
  • Nearly 70,000 1,20,000 ships sailing through the Indian Ocean pass-through the Strait of Malacca and the neighbouring Six Degrees channel. 
• Potential for Power Projection and Maritime Domain Awareness:  Port Blair, the capital of these islands, is just 20 nautical miles away from Myanmar, and the southern point, known as Indira Point, is 90 nautical miles away from Indonesia. 
  • Hence this should help India counter China’s ‘String of Pearls’ strategy due to its closeness to the ‘Strait of Malacca’ chokehold.
• Proximity to  Southeast Asia: The Andaman and Nicobar Islands are located close to Southeast Asia (and the Association of SouthEast Asian Nation countries) which are central to the country’s Indo-Pacific vision. 
  • The Coordinated Patrol (CORPAT) exercises as well as the multinational MILAN exercise, help not only in realizing India’s Act East policy but also its Act Indo-Pacific policies. 
• Counterbalancing the Chinese Influence: The increasing Chinese influence in the littoral states using the “string of pearls” strategy can be counterbalanced by India’s push towards developing ANI using the ‘SAGAR MALA‘ initiative and Act East Policy.
• Surveillance and Power Projection: Andaman and Nicobar Islands could provide multiple military operations for India to keep the busiest sea lanes under surveillance and for power projection.
  • It will enhance India’s underwater maritime domain awareness in this region, like the US-Japan “Fish Hook” SOSUS network in the South China Sea and the Indian Ocean Rim. 
  • This is a significant part of controlling, monitoring the Chinese influence, and tracking the movements of Chinese submarines in the deep Indo-Pacific region.
• Net Security Provider: India can leverage the potential of these islands to protect its own interests and enhance its image as the ‘net security provider’ in the region.
• Important Fulcrum of Indo-Pacific: The Andaman and Nicobar Islands is at the intersection of the Indian Ocean, the South China Sea, and the Pacific Ocean, an important fulcrum of the Indo-Pacific’s strategic concept.

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Challenges in Andaman and Nicobar Islands’s Strategic Development

• Vulnerability of Choke Points: Maritime choke points constitute critical vulnerabilities for world trade and commerce, as visible from the severe disruption and rerouting of shipping caused by the Houthi attacks in the Red Sea.
• China’s Expansion: As part of its Maritime Silk Road initiative, China has been funding and executing new ports and modernizing existing ports in many countries along the IOR. Ex-It developed new bases at Gwadar and Djibouti.
  • The Trilateral Highway Project in Myanmar, Hambantota port at Sri Lanka, which is under ninety-nine years of lease under China, is the classic example of China’s Debt Trap Diplomacy. 
• Untapped Potential of Andaman and Nicobar Islands (ANI): Despite the presence of all three services, the ANC has yet to realize its potential.  The command has limited assets and presence in comparison to a theater-level presence of a joint command. 
  • While it has the potential to be the forward operating base for all of India’s engagements with Southeast Asia, it mainly acts as a logistical facility for deployments of India’s Eastern Naval Command to East and Southeast Asia. 
• Slow Pace of Development: Internet connectivity is reported to be erratic. Road building, airstrip construction, and even the building of jetties have been slow or nonexistent.
• Vulnerability to Non-state Actors: The absence of a human presence on hundreds of these islands has made them vulnerable to narcotics smuggling, intrusion by foreign vessels, and other incursions.
• Remote Location: Few companies are willing to work on the islands because of the distance and cost. 
  • For some materials, importing from Indonesia would be far cheaper and more cost-effective than sending shipments from the Indian mainland.
• Developmental Challenges: Developing these islands carries massive environmental, sustainability, and tribal welfare challenges. 
  • There is an island-wide restriction on clearing land for development, and 94.68 per cent of the islands are under forest cover. 
  • The presence of indigenous tribes on the islands has also restricted commercial activities and development in tribal areas.

Government Interventions for Development of Andaman and Nicobar Islands (ANI)

• National Remote Sensing Centre (NRSC): The NRSC, based in Hyderabad, manages satellite data processing and disaster management. 
  • The government has requested the NRSC to increase resources for satellite image analysis and data dissemination for 55 inhabited islands in ANI and Lakshadweep.
• Multi-Agency Maritime Security Group (MAMSG) meeting: The Ministry of Home Affairs recently organized a MAMSG meeting to discuss surveillance of uninhabited islands.
• Modern Hangar and Dispersal system: They were inaugurated at INS Utkrosh in Port Blair. 
• Precision Approach Radar (PAR): It was inaugurated at INS Utkrosh to enable accurate horizontal and vertical guidance to land an aircraft safely in low visibility conditions.
• NITI Aayog’s Holistic Development Program for the islands: It aims to provide a framework for developing a new ‘greenfield city’ with a diverse and robust economy based on maritime services and tourism.
• Maritime Hub: In 2015, the government announced an INR 100,000 million plan to develop the islands into the country’s first maritime hub. 
• • It aims to develop facilities, such as telecommunications, electricity, and water, which will help build and expand strategic capabilities.
• Declining Protectionism:  In 2019, a new Island Coastal Regulation Zone Notification was promulgated, allowing land reclamation for ports, harbours and jetties. 
• Maritime Exercises: ANC conducts joint maritime exercises such as the Singapore-India Maritime Bilateral Exercise and Coordinated Patrols with Myanmar, Thailand and Indonesia.
• Expanding Naval Presence: Following the Ladakh stand-off with China in May 2020, India is expediting plans for stationing additional forces, warships, aircraft, and missile batteries in the Andaman and Nicobar Islands (ANI). 
  • There have also been reports of naval air stations INS BAAZ and INS KOHASSA expanding their support operations.

Way Forward

• Maintaining Comprehensive Maritime Domain Awareness (MDA): MDA through the ANI is critical, especially in monitoring sub-surface vessels. 
  • This could be done by utilizing a variety of networked assets such as radars, aircraft, satellites, and unmanned vehicles. . 
• Anti-submarine Warfare Capability: The frequent passages of People’s Liberation Army Navy (PLAN) warships, submarines, and research/intelligence-gathering vessels in these waters suggest a sustained Chinese naval presence, including nuclear attack submarines. 
  • This necessitates the Indian Navy to maintain a significant anti-submarine warfare capability in the region.
• Upgrading Communications Infrastructure:  India should upgrade the islands’ communications infrastructure and integrate it with MDA facilities on the mainland. 
  • The current infrastructure is poor and cannot sustain a coherent surveillance strategy. 
• Enhancing Military Infrastructure: There is an urgent need to enhance the islands’ intelligence, surveillance, and reconnaissance cover to utilize their potential fully.
  • The islands are home to modest military assets and infrastructure with tremendous potential, though underutilised. 
• Encouraging Migration: There is a need to consider encouraging migration from the land and opening up some of the strategically located uninhabited islands to tourism. 
  • This would give India a more robust physical footprint and help the country track the movement of vessels and people.
• Cooperation with Strategic Partners:  India must collaborate with its partners, which have specific expertise in this area to advance its development vision. 
  • For example, India and Japan are building infrastructure and connectivity corridors in the Indian Ocean, including the Asia-Africa Growth corridor. These initiatives provide an opportunity to develop many civilian projects on the islands, like ports and highways. 
  • Port visits by the US, Japan, Australia, France or the UK can lead to further graded cooperation in the dimensions in the ANI between India and its key strategic partners.
• Engagement with ASEAN: There lies an opportunity to make ANI an important element of the “Act East Policy” of engaging with countries in the region east of India.
• Utilizing Act East Policy: India needs to focus on the holistic development of these islands through strategic investments and increasing military strength in the Andaman and Nicobar Islands to counter China.

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Conclusion

As the Indo-Pacific region gains increasing significance and concerns regarding China’s assertive behaviour increase, the international community is uniting to collaborate and ensure the safe conduct of trade in this area. The ANI, therefore, will help India to occupy centre stage in the Global maritime strategy in the years to come.

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Context

A study by researchers at Hyderabad, revealed that around 70-80% of people who visit an eye hospital can benefit from teleconsultations, because the severity of their problems did not need attention at a hospital. 

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About Telemedicine

• Telemedicine is the remote delivery of healthcare services, including consultations and medical diagnostics, over telecommunications infrastructure, allowing patients to access medical care without the need to travel physically.
• This modern healthcare approach leverages digital information and communication technologies, to provide clinical support across distances.
• Telemedicine has emerged as a viable alternative to in-person consultations with doctors in many contexts because it saves patients time and expenses, which can be considerable if they are located in remote areas and/or are not well to do.

Different Types of Telemedicine Services

• Teleophthalmology: Focuses on eye care and enables patients to consult with ophthalmologists via digital platforms.
• Teledermatology: Remote diagnosis and treatment of skin conditions.
• Telepsychiatry: Deals with mental health issues, providing psychiatric assessments, therapy sessions, and medication management remotely. 
• Teleradiology: Involves transmitting radiological patient images, such as X-rays, CT scans, and MRIs, from one location to another for the purposes of sharing studies.
• Telecardiology: Enables cardiac care to be provided through remote monitoring and consultation. 
• Telepathology: Involves the practice of pathology at a distance. It uses technology to facilitate the transmission of pathology image-rich data for diagnosis, education, and research. 
• Telepediatrics: Allows pediatricians to consult with children and their parents remotely.
• Tele Orthopedics: Provides consultations related to orthopedic conditions.
• Tele-rehabilitation: Aims at improving the physical and psychological rehabilitation process for patients.
• Tele-urgent Care: Tele-urgent care services allow patients to receive immediate consultation for acute but non-life-threatening conditions.

Evolution of Telemedicine

• Early Developments:

  • ISRO’s Telemedicine Pilot (2001): ISRO launched its Telemedicine Pilot Project connecting Chennai’s Apollo Hospital with the Apollo Rural Hospital in Andhra Pradesh.
  • Establishment of Telemedicine Networks:By the mid-2000s, several states, including Kerala and Tamil Nadu, started developing their telemedicine networks, often supported by ISRO’s satellite connectivity.

• Expansion and Integration:

  • National Telemedicine Taskforce (2005): The Ministry of Health and Family Welfare established the National Telemedicine Taskforce under the Health Information Technology Board to expand telemedicine across India. It led to the formulation of guidelines and standards for telemedicine practices in India.
  • Public-Private Partnerships: Collaborations between government entities and private sector players expanded the reach and technological base of telemedicine services.

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• Policy Support and Regulation:

  • Telemedicine Practice Guidelines (2020): COVID-19 accelerated the need for telemedicine services, prompting the government to release the “Telemedicine Practice Guidelines” in March 2020.
    • These guidelines legally enabled registered medical practitioners to provide healthcare using telecommunication and information technologies.
  • Digital India Initiative: As part of the broader Digital India initiative, significant emphasis was placed on enhancing digital infrastructure that supports telehealth services. 

• Recent Development:

  • Integration with Ayushman Bharat Digital Mission (ABDM): Telemedicine services have been integrated with the ABDM, aiming to create a digital health ecosystem under the National Health Authority.
  • COVID-19 Pandemic significantly boosted the use of telemedicine as lockdowns and the risk of infection made traditional visits challenging. It became a critical tool in managing healthcare during the pandemic, with a sharp increase in both service providers and users.

Key Elements Propelling the Telemedicine Industry’s Expansion

• Healthcare necessity: Chronic diseases are affecting more and more people worldwide. Furthermore, the requirement of healthcare at home has risen due to the geriatric population.
• Technological advancement: Expansion of telehealth solutions is also impacted by prevalence of mobile devices across all age groups and on-demand healthcare apps.
• Easy Diagnosis for patients: Patients are constantly looking for care that is accessible and convenient. Running a telemedicine E Clinic can therefore aid in the timely diagnosis of patients. 
• Patient retention: Besides drawing in new patients, it also enables current patients to regularly receive remote checks and guidance.

Benefits of Telemedicine

• Bridge Gap Between Urban- Rural Healthcare: Telemedicine can improve access to healthcare services in remote and rural areas, where more than 70% of the Indian population resides.
• Step Towards Universal health coverage: Telemedicine can provide a full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course enabling universal health coverage.
• Cost Reduction: Telemedicine reduces the need for travel and physical infrastructure, which in turn cuts down healthcare costs significantly. 
  • A study published by the L.V. Prasad Eye Institute found that teleconsultations saved patients an average of INR 370 to INR 8,339 per visit in travel and related expenses.
• Decrease in Carbon Footprint: The same study from L.V. Prasad Eye Institute noted that teleconsultations resulted in 1,666 fewer kilometers of travel and a reduction of 176.6 kg of CO2 emissions per patient over three months, contributing significantly to environmental sustainability.
• Efficiency and Time Savings: Telemedicine allows for quicker consultations and follow-ups, which saves time for both patients and healthcare providers. 
  • A survey conducted across several telemedicine platforms in India reported that wait times for teleconsultations were typically less than 10 minutes.
• Enhanced Disease Management: Chronic diseases require ongoing care, and telemedicine facilitates regular monitoring and management without frequent hospital visits. 
  • For diabetic patients, telemedicine interventions have been shown to help in better glycemic control as patients can regularly consult their doctors for adjustments in their treatment plans.
• Expansion of Specialist Care: Many regions in India lack specialist doctors, particularly in fields such as psychiatry and endocrinology. Telemedicine has enabled access to these specialists without the need for patients to travel long distances. 
  • For instance, telepsychiatry has expanded rapidly, providing critical mental health services during the COVID-19 pandemic.
• Support for Health Crises: During the COVID-19 pandemic, telemedicine was pivotal in delivering healthcare while minimizing the risk of virus transmission. It supported the healthcare system by providing a means to triage and treat patients remotely, thus alleviating the burden on hospitals.

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Challenges Associated with Telemedicine

• Technological Barriers: A significant portion of India’s rural population lacks reliable internet access, which is crucial for effective telemedicine. 
  • According to a report by the Telecom Regulatory Authority of India (TRAI), as of 2020, only about 34% of rural India has broadband connectivity.
• Digital Literacy: Digital literacy remains low in many parts of India, particularly among older populations in rural areas. This affects the ability of patients to use telemedicine services effectively. 
  • A survey by the National Sample Survey Office (NSSO) found that only about 20% of Indian adults are digitally literate.
• Infrastructure and Equipment Availability: The lack of necessary medical equipment and infrastructure to support telemedicine, such as digital diagnostic tools, is another hurdle. This is especially true in primary healthcare centers in rural areas.
• Regulatory and Legal Issues: There are significant ambiguities in the legal framework governing telemedicine in India, particularly concerning liability, data protection, and cross-border issues. 
  • The “Telemedicine Practice Guidelines” of 2020 have started to address these, but many areas remain unregulated.
• Privacy and Data Security Concerns: Concerns about the security of patient data and privacy in telemedicine transactions are prominent, especially with the rise in cyber attacks. 
  • According to a study by a leading cybersecurity firm, healthcare breaches in India saw a 45% jump in 2020 alone.
• Cultural and Behavioral Barriers: A significant portion of the Indian population prefers in-person consultations over virtual ones, driven by cultural norms and the perceived value of physical doctor-patient interactions.
• Integration with Existing Healthcare Systems: Effectively integrating telemedicine with existing healthcare practices and systems poses a challenge, including issues with interoperability and standardization of electronic medical records (EMR).
• Quality of Care: Maintaining the quality of care through telemedicine, ensuring it matches that of in-person consultations, remains a concern, particularly with non-visual examinations and the potential for misdiagnosis.
• Fragmented Insurance Coverage: The coverage of telemedicine by health insurance policies is not comprehensive, which acts as a barrier to its utilization. Patients are less likely to opt for telemedicine options if they are not covered by their insurance plans

Regulatory Framework for Telemedicine in India

• Telemedicine Practice Guidelines, 2020: They provide a comprehensive framework for the practice of telemedicine, including norms for physician-patient interactions, management and treatment protocols, and the privacy and security of patient records.​.
• National Medical Commission Act, 2019: The act replaces the Indian Medical Council Act, 1956 and influences telemedicine particularly concerning the accreditation, ethical conduct, and professional standards expected from practitioners engaging in telemedicine​.
• Information Technology Act, 2000: This act underpins the legal framework for telemedicine as it relates to data protection and privacy. It outlines the obligations for properly handling and protecting electronic health records, which is crucial for maintaining patient confidentiality in telemedicine interactions.
• Drugs and Cosmetics Act, 1940 and Rules, 1945: While primarily regulating the standards for drugs and cosmetics in India, this act also impacts telemedicine especially in the prescription and distribution of medicines over telehealth platforms​.

Way Forward

• Bridging the Digital Divide: 

  • Infrastructure expansion: Investing in reliable internet connectivity, affordable devices, and digital literacy programs, particularly in rural areas and among vulnerable populations.
  • Local language support: Localizing digital health platforms and resources to ensure accessibility and inclusivity.
  • Developing user-friendly interfaces: Designing telemedicine platforms that are easy to use and accessible to people with varying levels of digital literacy.

• Strengthening the Regulatory Framework:

  • Developing clear and comprehensive regulations: Establishing data privacy standards, security protocols, and guidelines for data collection, storage, and sharing.
  • Promoting interoperability: Implementing standardized data formats and interoperability protocols to enable seamless data exchange between different healthcare systems.
  • Creating a robust regulatory body: Establishing a central authority responsible for overseeing the telemedicine ecosystem to ensure compliance with regulations..

• Fostering Innovation and Collaboration:

  • Promoting public-private partnerships: Encouraging collaboration between government, healthcare providers, technology companies, and research institutions to accelerate innovation in the field of telemedicine.
  • Supporting startups and entrepreneurs: Providing funding, mentorship, and infrastructure support to startups developing innovative telemedicine technologies.
  • Leveraging existing platforms: Integrating telemedicine solutions with existing healthcare infrastructure, such as public health facilities and community health centers.

• Building Capacity and Expertise:

• • Investing in training programs: Equipping healthcare professionals with the necessary skills and knowledge to use and manage telemedicine technologies effectively.
  • Encouraging knowledge sharing and collaboration: Fostering a culture of knowledge sharing and collaboration among stakeholders in the digital health ecosystem.

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Conclusion

Telemedicine can revolutionize the health industry and paves the way for Universal Health Coverage if the loopholes are effectively plugged.

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Context

In recent years, the urgency of addressing climate change has become increasingly evident, propelling nations worldwide to commit to ambitious clean energy targets. Among these nations, India has emerged as a pioneer in sustainable development and climate action.

Right Against Climate Change Part of Equality and Right to Life – Supreme Court

• Recently, the Supreme Court has expanded the scope of fundamental rights to include “the right to be free from adverse effects of climate change.’’
• India has ranked 7th in a report, Climate Change Performance Index (CCPI) 2024, published on the sidelines of the COP28 in Dubai.
  • India is effectively in fourth position, as the first three ranks in the ‘very high’ performance category remained vacant.

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The Evolution of India’s Climate Policy

• Origin Of India’s Climate Policy: 

  • India’s commitment to climate action traces back to the inception of the National Committee for Environmental Planning and Coordination (NCEPC) in February 1972.
    • In 1972, then-Prime Minister Indira Gandhi addressed the Stockholm conference, outlining India’s climate stance as well as that of the global south.
  • In the 1990s, new policies emerged worldwide in many areas, including the environment. 
    • The 1992 Rio Summit saw the emergence of the United Nations Framework Convention on Climate Change (UNFCCC) and the Convention on Biological Diversity and Forest Principles. 
    • India has developed its policy response through missions and programmes to reduce its climate vulnerability. On 30th June 2008, the National Action Plan on Climate Change (NAPCC) was released. 
      • India’s climate policy has always been clear, consistent, and coordinated.
      • India’s efforts to address climate change are immediate, ambitious, and planned, covering every sector of its economy.

• Statute: 

• • After the Rio Summit, the climate change and biodiversity divisions in India’s then Ministry of Environment and Forests came to life slowly and steadily.

• India’s Climate Policy Vision: 

• • India’s climate policy is shaped by its vision of inclusive growth for all-round economic and social development, the eradication of poverty, a declining carbon budget, firm adherence to the foundational principles of the UNFCCC, and climate-friendly lifestyles.

Major Determinants of India’s Climate Policy

Here are the some key determinants of India’s Climate Policy; 

Government Initiatives and Actions Towards Climate Change Mitigation in India

Despite having historical cumulative emissions of less than 4% (1850-2019) and 1.9 tonnes of CO2 per capita emissions, India took many domestic and international actions to benefit the planet.

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India’s Initiatives & Actions for Climate Change Mitigation:

• Green Credit Program: At COP28, India felt its presence by introducing the Green Credits Program, transcending the commercial nature of carbon credits. 
  • Participants can earn Green Credits for a wide range of activities that promote environmental sustainability.
• Global Biofuel Alliance: Under India’s G20 presidency, the India-led initiative Global Biofuel Alliance was launched to promote sustainable biofuel usage, offer technical assistance to national biofuel programs worldwide, and enable the exchange of policy practices.
• International Solar Alliance (ISA): India established ISA with France in 2015 to attract $1 Tn of investment in solar projects by 2030 in solar-rich countries, thereby increasing access to clean energy. 
  • Consequently, this demonstrated India’s leadership abilities to leverage climate finance to drive sustainable growth and combat climate change.
• Panchamrit
  • Reach 500 GW Non-fossil energy capacity by 2030
  • 50% of its energy requirements from renewable energy by 2030
  • Reduction of total projected carbon emissions by 1 billion tonnes from now to 2030
  • Reduction of the carbon intensity of the economy by 45% by 2030, over 2005 levels
  • Achieving the target of net zero emissions by 2070
• Green Climate Fund (GCF): India’s involvement in the GCF, where it has pledged contributions and actively encourages G20 members and developed countries to increase their support. 
• National Action Plan on Climate Change (NAPCC): Launched in 2008 with eight missions, it has laid the ground for understanding climate change and acting on it. 
• State Action Plans on Climate Change (SAPCCs): Thirty-four Indian states and Union Territories have prepared SAPCCs consistent with the objectives of NAPCC. 
• National Solar Mission: Launched in 2010, its objective is to establish India as a global leader in solar energy, by creating the policy conditions for its diffusion across the country as quickly as possible.
• National Adaptation Fund on Climate Change (NAFCC): It was established in 2015 to meet the cost of adaptation to climate change for India’s State and Union Territories that are particularly vulnerable to its adverse effects.
• National Mission for Enhanced Energy Efficiency: It has been implemented since 2011 and aims to strengthen the energy efficiency market by creating a conducive regulatory and policy regime. It envisages fostering innovative and sustainable business models in the energy efficiency sector. 
• National Green Hydrogen Mission: This mission aims to accelerate the deployment of Green Hydrogen as a clean energy source and support the development of supply chains that can efficiently transport and distribute hydrogen.
• Nationally Determined Contributions (NDC): A climate action plan to cut emissions and adapt to climate impacts. 
  • In August 2022, India updated its NDC, according to which the target to reduce the emissions intensity of its GDP has been enhanced to 45% by 2030 from 2005 level, and the target on cumulative electric power installed capacity from non-fossil fuel-based energy resources has been enhanced to 50% by 2030.
• Common but Differentiated Responsibilities and Respective Capabilities (CBDR–RC): It is a principle within the United Nations Framework Convention on Climate Change (UNFCCC) that acknowledges the different capabilities and differing responsibilities of individual countries in addressing climate change.
  • India has been a consistently strong voice of the Global South for the CBDR-RC principle was developed largely through Indian interventions at the Rio Summit, 1992.
• Others: National Mission on Sustainable Habitat, National Water Mission, National Mission for Sustaining the Himalayan Ecosystem, National Mission for A Green India, National Mission for Sustainable Agriculture, National Mission on Strategic Knowledge for Climate Change, etc.

India’s Achievements Towards Climate Change Mitigation – How is India Tackling Climate Change

• Decline in India’s Emission of Greenhouse Gases: India has been successfully decoupling its economic growth from greenhouse gas (GHG) emissions, reducing the emission intensity of its GDP by 33% between 2005 and 2019. 
• Increase in India’s Renewable Energy Capacity: India’s solar energy has increased by more than 26 times, and wind energy capacity has doubled in the last ten years.
  • It now has the fourth-largest installed wind capacity and the fifth-largest solar in the world. In November 2021, nine years ahead of schedule, it achieved a target of 40% installed electric capacity from non-fossil fuels and then increased the target to 50%.
• A World Leader: India is a world leader in climate action today. It has added two more C’s to India’s climate policy: confidence and convenient action.
  • India’s long-term low emissions development strategy to the UNFCCC showcases its belief in the multilateral process to achieve net zero by 2070. 
• Call for Sustainable Lifestyles: India and Sweden head ‘The Leadership Group for Industry Transition’. With the ‘Lifestyle for Environment’ movement, India shows that convenient actions are the only way possible and that India’s sustainable lifestyles are the way forward.
• Committed Actions: India is also unprecedentedly focused on providing basic services such as pucca housing, round-the-clock electricity, clean drinking water, universal health insurance, and clean cooking gas.
  • These are remarkable steps in the fight against climate change.

What Are the Challenges India Faces in Mitigating Climate Change?

• Technological Limitations: 

  • It impacts the development and implementation of effective climate change policies. 
    • While renewable energy technologies have advanced rapidly in recent years, carbon capture and storage technologies that could help mitigate emissions from existing infrastructure are still in the early stages of development and face technical challenges.
    • As per the World Economic Forum, the use of artificial intelligence (AI) can contribute to the fight against climate change. Existing AI systems include tools that predict weather, track icebergs and identify pollution. AI can also be used to improve agriculture and reduce its environmental impact.

• High Reliance on the Use of Coal: 

  • India is trying to meet its NDCs with clear long-term policies that promote renewable energy, but its heavy reliance on coal, along with oil and gas, is still meeting its growing energy needs.
    • Coal is the most essential and abundant fossil fuel in India, accounting for 55% of the country’s energy needs. 
    • As per the International Energy Agency, in 2022, with an annual production of 310 million tonnes and imports of almost 25 million tonnes, coal will provide one-third of the energy supply in India. 

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• Climate Finance: 

  • Transitioning to a low-carbon economy requires substantial investments in renewable energy, energy efficiency, infrastructure, and sustainable land use practices.
    • India needs substantial climate finance by 2050 to achieve its ambitious sustainability goals. An estimated US$10.1 trillion will be required to reach net zero by 2070 (World Bank).

• Difficulty in Prediction: 

  • Climate change is a multifaceted phenomenon, including greenhouse gas emissions, land use changes, industrial activities, and natural processes and their interconnectedness, which makes it difficult to predict the nature and impact of climate change.

• Overexploitation of Natural Resources: 

  • It has been clear that the problem of climate change in India results from developed countries’ overexploitation of natural resources. 
    • The US accounts for 27% of the world’s excess material use, followed by the EU (25%). 
    • Other rich countries, such as Australia, Canada, Japan, and Saudi Arabia, collectively contributed 22%. Due to resource overuse, China has also exceeded its sustainability limit by 15%.
    • Over the same period, 58 countries representing 3.6 billion people, including India, Indonesia, Pakistan, Nigeria, and Bangladesh, stayed within their sustainability limits. 

• A Balancing Dilemma: 

  • Balancing economic development with environmental sustainability is a delicate task for policymakers, especially in India and countries heavily reliant on fossil fuels.
    • As per the World Bank, climate change could push more than 100 million people into extreme poverty by 2030 by disrupting agriculture and fueling the spread of malaria and other diseases.
      • Socio-economic Concern: Vulnerable populations, such as low-income communities, indigenous peoples, and small island nations, face the severe impact of climate change effects. 

Way Forward to Climate Change Mitigation in India

• Regulation on Coal Usage: Coal, a major player in India’s energy sector, needs to be regulated. A shift towards green energy must be made to assist India in its renewable energy conversion goal. 
• Sustainable Management of Forests: Forests that are carbon sinks (help in Carbon sequestration) need sustainable management from cooperative efforts of local communities and government. 
  • Carbon sequestration also provides multiple benefits, such as biodiversity conservation, soil fertility improvement, water security, livelihood support, and disaster risk reduction.
• Long-term Targeted Policies: Financial, political, and policy leadership lies at the bottom of all the recommendations for climate change policy for India. Policies and actions should be taken while considering their long-term impacts.
  • Policymakers must develop policies addressing socio-economic disparities and ensuring equitable outcomes.
• A Collaborative Effort: Regional, state, national, and global involvements are the most effective keys for India to meet its aspirations of a climate-resilient planet and achieve long-term sustainable growth.
• Encouraging Innovation: Integrating technology-driven solutions such as remote sensing, IoT devices, and AI-based analytics can help combat climate challenges by maintaining the appropriate data and its computation.
  • Example: The Data in Climate Resilient Agriculture (DiCRA) platform, launched by the United Nations Development Programme and the Telangana government, uses Artificial Intelligence to improve food systems and security. 
    • The platform provides farmers with crucial data and analytics to combat the impact of climate change on their crops and livestock, enhancing their resilience and securing their livelihoods.
• Incorporate Climate Parameters into Tax Devolution Formula: The 16th Finance Commission can incorporate climate vulnerability and emission intensity as key parameters in the tax devolution formula.
  • It must become a key player in India’s climate readiness by aligning economic growth with environmental imperatives, supporting clean energy initiatives, and addressing regional climate challenges.
• More Investment: While reducing emissions is critical, it is equally important that we invest in technologies and infrastructure to help communities adapt to the crisis already at hand.
  • This is especially true for vulnerable communities in developing countries that are in dire need of investment in climate-resilient infrastructure, such as drought-resistant crops, flood protection systems, and early warning systems for extreme weather events.

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Conclusion

India recognises that development and environment are two sides of the same coin and must be considered together for holistic development. To solve a global problem like climate change, the world needs to believe in the age-old Indian ethos of ‘Vasudhaiva Kutumbakam’—One Earth, One World, and One Future. 

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