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    A Year On, the Clean India Mission Falls Short

    Research amidst the COVID-19 pandemic has shown that the virus is transmitted through wastewater. This makes it crucial to revisit the goals of India’s ambitious Swachh Bharat Mission (Clean India Mission, or SBM) that came to a close almost exactly a year ago. While there were substantial improvements made in toilet coverage, a lack of data clarity muddies an understanding of exactly how large these improvements were across the country. According to government estimates, national sanitation coverage was 51% in 2014 when SBM began and reached 78% in 2018, less than a year prior to the end of the program. While this certainly shows progress — the national average was just under 26% in 1999 — no one would think to take these numbers and simply round up to 100%.  

    But at the close of the SBM last fall, this is exactly what Prime Minister Narendra Modi did. Speaking to a crowd, Modi proclaimed that India was now completely open defecation free (ODF), with sanitation coverage reported by the SBM portal as 100% in rural areas and, inexplicably, 105% in urban areas. From the start of the 2014 campaign, the central government maintained that in just five short years, India would be ODF. Despite the gains made, a singular focus on meeting steep targets in a very short amount of time seems to have put Modi in a tight spot by the time October 2019 rolled around. 

    Caste Politics Overshadow Sanitation Issues in India

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    The gaps have been, at times, glaring. News reports from established outlets all over the country reported open defecation in areas that were already recorded as ODF. A 2018 study by the Rice Institute estimated an open defecation rate of 44%, meaning nearly half of the sampled population was still engaging in the practice hardly a year before SBM ended. In urban areas the picture looks a bit better: 95% of urban households access an improved toilet. But this includes community toilets, which may be used by hundreds of other families and are often plagued with maintenance, hygiene and safety issues. Furthermore, one survey from 18 states identified over 48,000 manual scavengers still cleaning “dry” toilets which do not discharge into sewer lines.

    Social Pressure-Cooker

    What explains these inconsistencies? The use of shame-based tactics to stop open defecation, alongside a rush to meet ODF goals, have built up a pressure-cooker environment. The SBM has continued prior national efforts that deemphasized technical solutions and focused heavily on strategies to encourage behavior change at the local level. One such strategy is Community-Led Total Sanitation (CLTS), which hinges on “triggering” disgust and extreme emotions among community members to spur the abandonment of open defecation. Despite some concerns about shame-based approaches, the SBM continued with the CLTS Foundation and others as implementation partners.

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    But open defecation is an issue that needs more than short-term emotional reactions. The longstanding practice is mired in cultural tradition, casteist taboos and environmental factors, among others. Some reasons people give for it is that they do not wish to empty a pit themselves, that it is considered more hygienic to defecate further away from the home — certainly reasonable considering how few poor Indian homes have running water — or that community toilets are dirty and unsafe, so squatting in a quiet area nearby is actually preferable.

    In the SBM environment, people who have not built a toilet, for whatever reason, are highly likely to experience retaliation for continuing to defecate in the open. Because Indian culture is quite collective — the actions of one person are seen to have radiating effects on the family and community — sometimes social pressure can play a role in nudging behavior change. However, this is a slippery slope. In India’s highly unequal society, characterized by stark gender and caste-based hierarchies amidst a wide array of languages and ethnicities, such strategies have the potential to be misused, with large social costs.

    There is ample evidence to show this. In June 2017, Zafar Hussein, a local community leader agitating against the eviction of his settlement in Rajasthan, was allegedly beaten to death by local officials for trying to stop officials from taking photographs of women defecating in the open. His death was reported by multiple outlets. In other areas of Maharashtra, people have been followed by a loud band, jailed or fined for defecating in the open.

    Walls of shame have been instituted by local village councils onto which the names and photographs of people defecating openly are be pasted. These individuals were often removed from eligibility for local government programs. The previously mentioned Rice Institute study also recorded coercion and threats of the loss of government rations as a way to bring down open defecation rates. Notably, the study found that Dalits and Adivasis were the most likely to face such behaviors. India’s Health Ministry has publicly denounced the results of the Rice survey. But in September last year, weeks before Modi’s ODF declaration, two young Dalit children were beaten to death in their village in Madhya Pradesh for defecating in the open.

    Numbers, Strategies and Health Equity

    These debates over sanitation data are not merely academic exercises. They have real, material impacts on people. In some ways, the above tragedies are not surprising. If a hasty approach is taken toward declaring areas ODF, it follows that any activity hinting that this claim is not matched by reality will be quashed. Despite this, the Bill and Melinda Gates Foundation bestowed the Global Goalkeeper Award upon Modi last year. It is surprising that one of the largest, most influential health organizations in the world, committed to facts and data, accepted without question the Indian prime minister’s claims, failing to consider all the evidence to the contrary.

    So what is the solution? Certainly, the answer is not to give up on sanitation programming as the need remains great. There are several organizations on the ground that have successfully integrated mobilization with communities, technical expertise and a sustained presence through which people are not merely pressured to stop a practice but meaningfully guided toward an alternative and given the facts and tools to integrate that alternative into their lives.

    However, this takes a more long-term presence, a less single-minded focus on quick targets, a commitment toward waste management infrastructure besides just toilets, and a willingness to meet people where they are. Further, the same people who have fallen through the gaps in the SBM are those with a lot to lose during the current pandemic: the rural poor, slum-dwellers, sanitation workers, manual laborers and migrants. Brutal crackdowns against those who kept working amidst India’s COVID-19 lockdown illustrate that retaliation cannot continue to be a solution when reality does not match the official word. Amidst the pandemic, sanitation infrastructure and the transparency of data surrounding it are necessities that cannot afford to wait.

    The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy. More

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    Global report: Trump wrongly claims Covid affects 'virtually' no young people

    As the United States’ coronavirus death toll edged closer to 200,000, US president Donald Trump claimed falsely at a rally in Ohio that the country’s fatality rate was “among the lowest in the world” and that the virus has “virtually” no effect on young people.Speaking in the town of Swanton, Trump said: “It affects elderly people. Elderly people with heart problems and other problems. If they have other problems that’s what it really affects, that’s it,” he claimed. “You know in some states, thousands of people – nobody young.”“Take your hat off to the young, because they have a hell of an immune system. But it affects virtually nobody. It’s an amazing thing. By the way, open your schools.”Trump also claimed that the United States had “among the lowest case-fatality rates of any country in the world.” The US ranks 53rd highest out of 195 countries in the world with a case-fatality rate of 2.9%, according to Johns Hopkins University. It is the 11th worst on deaths per 100,000 people, at 60.98.At least 199,815 Americans are known to have died since the start of the pandemic, according to Johns Hopkins, which relies on official government data. With the worst death toll in the world, the US accounts for one in five coronavirus-related fatalities worldwide. Just under one in every 1,600 Americans has died in the pandemic.In August, the World Health Organization warned that young people were becoming the primary drivers of the spread of coronavirus in many countries.Meanwhile, in Europe, stocks posted their worst fall in three months on Monday as fears of a second wave hit travel and leisure shares, while banks tumbled on reports of about $2tn-worth of potentially suspect transfers by leading lenders. Pubs, bars and restaurants in England will have to shut by 10pm from Thursday under new nationwide restrictions to halt an “exponential” rise in coronavirus cases.Boris Johnson is expected to make an address to the nation on Tuesday setting out the new measures. With cases doubling every week across the UK and a second wave expected to last up to six months, health officials are said to have advised the government over the weekend to “move hard and fast”. There could be up to 50,000 new coronavirus cases a day in Britain by the middle of October if the pandemic continues at its current pace, the country’s chief scientific adviser warned. Scotland is also expected to announce new restrictions on Tuesday.The Czech Republic prime minister, Andrej Babis, admitted on Monday that his government had made a mistake when it eased restrictions over the summer. “Even I got carried away by the coming summer and the general mood. That was a mistake I don’t want to make again,” the billionaire populist said in a televised speech.After fending off much of the pandemic earlier in the year with timely steps, including mandatory face masks outdoors, the government lifted most measures before the summer holidays.The Czech Republic registered a record high of 3,130 coronavirus cases on Thursday last week, almost matching the total for the whole of March, although testing capacity was low at the start of the pandemic.In other developments:There are 31.2m coronavirus cases worldwide, according to Johns Hopkins, and 963,068 people have died over the course of the pandemic so far.
    New Zealand recorded no new cases of Covid-19 on Tuesday, as restrictions on much of the country were entirely removed, and measures imposed on Auckland, the largest city, were due to ease further. There was no recorded community spread of the virus in the rest of New Zealand, where the government has now lifted all physical distancing restrictions and limits on gatherings.
    Mexico surpassed 700,000 confirmed cases on Monday after the health ministry reported 2,917 new confirmed cases in the Latin American country, bringing the total to 700,580 as well as a cumulative death toll of 73,697. More

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    Succession creator Jesse Armstrong criticises Trump and Johnson at Emmys

    The Succession creator, Jesse Armstrong, used his Emmy acceptance speech to attack Boris Johnson and Donald Trump for their “crummy” response to coronavirus, and also the media moguls who do so much to keep them in power.Armstrong’s HBO show, telling the story of a billionaire media tycoon and his dysfunctional, warring family, was one of the big winners at the ceremony on Sunday. It won seven awards, including outstanding drama, which Armstrong accepted from a hotel room in London.He said it was sad not to be able to share the success with colleagues in the US. “Being robbed of the opportunity to spend time with our peers, maybe I’d like to do a couple of un-thankyous,” he said.“Un-thankyou to the virus, for keeping us all apart this year. Un-thankyou to President Trump for his crummy and uncoordinated response. Un-thankyou to Boris Johnson and his government for doing the same in my country.“Un-thankyou to all the nationalist and quasi-nationalist governments in the world who are exactly the opposite of what we need right now. And un-thankyou to the media moguls who do so much to keep them in power. So un-thankyou!”Armstrong is one of Britain’s most celebrated comedy writers, having co-created Peep Show and Fresh Meat in the UK as well as having been on the writing team for The Thick of It.Succession’s seven wins came from 18 nominations and included the best actor award for Jeremy Strong, who plays the eldest son, Kendall Roy. His success meant that Brian Cox, who plays the patriarch and was nominated in the same category, missed out on a prize that bookmakers had made him odds-on to win.Cox was one of many British and Irish actors to miss out. Olivia Colman (The Crown) and Jodie Comer (Killing Eve) were thwarted in their category when Zendaya made history by becoming the youngest person to win in the best actress drama lead category for Euphoria.Also missing out were Helena Bonham Carter (The Crown), Fiona Shaw (Killing Eve), Matthew Macfadyen (Succession), Harriet Walter (Succession), Jeremy Irons (Watchmen), Paul Mescal (Normal People), Andrew Scott (Black Mirror), Dev Patel (Modern Love) and Phoebe Waller-Bridge for her guest appearance on Saturday Night Live.Aside from Succession the big winners were HBO’s Watchmen, shown in the UK on Sky Atlantic, and the Canadian sitcom Schitt’s Creek, which, since it went on Netflix, has steadily and quietly become a huge feelgood hit. The sixth and final season of the show swept the board in the comedy categories, a feat not even achieved by shows such as Frasier and Modern Family.It won seven Emmys with acting wins for the show’s stars Eugene Levy, Dan Levy, Catherine O’Hara and Annie Murphy. Appearing in the ceremony’s virtual backstage area Dan Levy, its co-creator and showrunner, discussed the possibility of Schitt’s Creek returning as a movie.“Here’s the thing – some people have been asking that,” he said. “If there is an idea that pops into my head and worthy of these wonderful people, it has to be really freaking good at this point.”Other winners included Last Week Tonight with John Oliver, the Birmingham-born writer and comedian who started out on the UK standup circuit before achieving success in the US.RuPaul’s Drag Race, which has spawned a Bafta-nominated British version on the BBC, won the reality competition award.The virtual awards ceremony, hosted by Jimmy Kimmel – “welcome to the Pandemmys” – will go down as one of the oddest in the Emmys’ 72-year history with prizes delivered to winners, often in their homes, by people in hazmat tuxedos.The dress code was “come as you are”, with the suggested option of designer pyjamas. Hardly any of the stars went down that route, although Jane Lynch, in a very smart top, revealed she was also wearing sweatpants.A number of actors used the event to express support for the Black Lives Matter movement, including Regina King, who won the limited series lead actress award for Watchmen. She wore a T-shirt that honoured the police shooting victim Breonna Taylor and used her speech to remind people of the importance of voting.Later she explained why wearing the T-shirt was important. “The cops still haven’t been held accountable,” she said.“She represents just decades, hundreds of years of violence against Black bodies. Wearing Breonna’s likeness and representing her and her family and the stories that we were exploring, presenting and holding a mirror up to on Watchmen, it felt appropriate to represent with Breonna Taylor.” More

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    Oleandrin: Trump allies pitch extract from poisonous plant to fight Covid

    Allies of Donald Trump have promoted a plant extract called oleandrin to people seeking to ward off Covid-19. The plant the extract is derived from, oleander, is poisonous and there is no proof the compound is either safe or effective to treat or prevent Covid-19, experts say.But unlike other unproven and potentially dangerous Covid-19 “cures” pitched by Donald Trump and his supporters, including the prescription antimalarial hydroxychloroquine, experts fear this compound could easily reach the public as a dietary supplement.“Supplements are like snake oil, in the sense they are not regulated by the FDA,” said Martin Ronis, a professor in Louisiana State University’s department of pharmacology and experimental therapeutics, referring to the US Food and Drug Administration.While pharmaceutical companies must show the FDA drugs are safe before they go to market, dietary supplements are considered “food” in the US and thus must be proven unsafe before they are removed from the market. Because of this regulatory structure, Ronis said it would be possible for the company behind the plant compound – Texas-based Phoenix Biotechnology – to bring the extract to market.“You can essentially make all kinds of apocryphal claims about supplements,” said Ronis. One of Phoenix’s board members is Mike Lindell, a prominent Trump backer, pitchman, and CEO of MyPillow. Lindell chairs Trump’s re-election effort in Minnesota.While Lindell has pitched Phoenix’s plant extract as a coronavirus cure on TV and to the president’s coronavirus taskforce, the company also quietly received $5m in funding from an undisclosed investor, patented its extract for use in Covid-19, and promoted an early study in monkey cells as proof of efficacy – an assertion one of the study’s own authors denies.Lindell told the TV host Greg Kelly, an anchor on the conservative Newsmax network: “I started using it myself and giving it to friends and family who tested positive.”The interview was one of several television appearances about oleandrin and is prominently displayed on the company’s website. “Is he allowed to do that?” Kelly laughed as he asked his other guest, Andrew Whitney, the vice-chairman and fellow director of Phoenix Biotechnology.“Well, I’m doing it as well,” Whitney replied, “and so is everyone else at the company, because we believe in the product, Greg. We know it works.” Phoenix Biotechnology did not respond to an emailed request for an interview.The Washington Post has reported that Whitney has visited Trump in the White House and pitched oleandrin to him.Oleandrin has not been approved to treat any medical disorder. The supplements industry has also opposed introducing oleandrin to the market.“The unanimous opinion is that this is a stupid idea and no one should allow an oleander supplement to get close to their mouth,” ​said Loren Israelsen, president of the United Natural Products Alliance, in a statement to a trade publication.Phoenix Biotechnology has released only one study on oleandrin’s use against Covid-19. The study was published in what is called a “pre-print”, which means it is not peer-reviewed. Two of the authors had a financial stake in Phoenix Biotechnology. The study, called an “in vitro” study, examined oleandrin’s effect on monkey cells in the laboratory.Pharmaceutical companies looking for FDA approval typically take drugs through a long pipeline of testing including in pre-clinical trials, in non-human primates, and then in a series of clinical trials testing for safety and dosing, leading up to a double-blind, placebo-controlled randomized trial for efficacy.If Phoenix sought approval for its product, the pre-print it published would represent a concept for potential study at the very beginning of this pipeline. The median cost of bringing a drug to market is $985m, according to a recent study in the Journal of the American Medical Association. Most new drugs fail.Phoenix has conducted two clinical trials for safety of oleandrin in cancer treatment, but both were small. Phoenix proposed providing oleandrin in what appears to be a liquid, according to its website.Although Whitney said in his interview with Kelly that Phoenix has researched oleandrin for “25 years”, the earliest research related to the company appears to be from 2002. Phoenix was incorporated in 2003, according to a press release.Phoenix received a patent for its extraction process in 2005, and in that time it has sponsored research at several institutions, including University of Texas San Antonio, the MD Anderson Cancer Center and Duke University.The company appears to be moving ahead in its efforts to monetize oleandrin. The “pre-print” was published on 15 July. The company filed for patents in the US on 18 July and earlier in Australia. The American patent was reportedly granted on 29 July, and Phoenix told the US Securities and Exchange Commission it received $5m from a single, unnamed investor on 7 August. More