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Analysis

(USA/India) After the foundational agreements: An agenda for US-India defense and security cooperation (Joshua T. White, Brookings)

After the foundational agreements: An agenda for US-India defense and security cooperation

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Analysis

(India) India’s top court asks Modi gov’t to put farm laws ‘on hold’ (Al Jazeera)

India’s Supreme Court says Prime Minister Narendra Modi’s government should pause the implementation of the three farm laws passed recently while the concerns of the farmers, protesting for more than a month against the legislations, are heard.

https://www.aljazeera.com/news/2021/1/11/indias-top-court-asks-modi-govt-to-put-farm-laws-on-hold

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(UK/India) Are the UK and India Finally Getting Serious About Each Other? (Walter Ladwig, RUSI)

With the political focus in the UK dominated by both Brexit and the coronavirus pandemic, Prime Minister Boris Johnson may appear to be a surprising choice for India to select as chief guest at its Republic Day Parade later this month. This honour has long been used as a diplomatic signal by New Delhi to indicate a country which it considers of growing importance, but ties with London have been underwhelming for years.

The same pandemic which demanded Johnson’s attention also precluded his attendance in Delhi. Nonetheless, the British swiftly reciprocated India’s heightened attention. Johnson has invited Prime Minister Narendra Modi to attend the G7 summit in the UK in June and named Deputy National Security Adviser Alex Ellis as the next high commissioner to India. Taken together, these developments hint that after years of inattention, the UK and India may finally undertake a concerted effort to deepen their bilateral partnership.

UNREQUITED ATTENTION

For the past two decades, successive UK governments have sought a closer relationship with India, but these feelings were rarely reciprocated. The UK’s perceived softness on Pakistan-sponsored terrorism and London’s concerted effort to make China the anchor of post-Brexit economic policy suggested a lack of congruence with India’s strategic priorities. When combined with a belief that the UK was peripheral to geopolitical developments in the Indo-Pacific, New Delhi instead prioritised traditional partners like Russia and France or their expanding strategic ties with the US.

Recent changes in UK policy, however, have altered Indian assessments. The UK has co-sponsored efforts at the UN to designate the leader of the Pakistan-based Kashmiri extremist group Jaish-e-Mohammed as a ‘global terrorist’ as well as to name and shame Pakistan for failing to prevent the financing of terrorism. Johnson’s government is actively seeking to reduce economic exposure to China and prevent future Chinese involvement in its critical infrastructure as exemplified by the decision to ban Huawei equipment from the country’s 5G network.

Plans for the UK’s post-EU foreign policy indicate a significant ‘tilt’ towards the Indo-Pacific. ‘Global Britain’ hopes to play a meaningful role east of Suez by joining regional free trade agreements in Asia and increasing the Royal Navy’s presence, in addition to deepening ties with partners in the Persian Gulf, Southeast Asia and beyond. Together with the relaxation of UK visa restrictions that will benefit Indian students and high-skilled workers, these changes suggest there is more scope for improvement in UK–India ties than in the past.

BROADER STRATEGIC PARTNERSHIPS

At the same time, the Modi administration has a greater appreciation of the value of strategic partnerships with like-minded European countries. As the confrontation between the US and China has grown, India has deepened its cooperation with democratic middle powers in Asia like Australia and Japan. Similar attention is now being given to countries like the UK, who can contribute to a collective effort to help build a resilient order in the Indo-Pacific. The need to develop such relationships has been given even more urgency by India’s protracted border standoff with China that erupted into deadly violence last June.

The UK’s attractiveness to India lies in the fact that it is, in cricket terms, a solid ‘all-rounder’. Although the UK may not be India’s number one partner for trade, defence hardware or political cooperation, it is one of the few countries besides the US that is important in every single one of these dimensions.

The fact that both the UK and Indian governments want to upgrade their partnership is no small development, but translating this desire into action will require significant effort across a range of policy areas.

CHALLENGES AND NEW VENUES

Economics typically provides the foundation for enduring cooperation; however, the UK–India trade relationship is anemic. Neither country is a leading export market for the other, and hopes for a free trade agreement face too many political obstacles to be likely in the near term.

The picture is comparatively rosier when it comes to investment. The UK is a leading source of foreign direct investment (FDI) in India as its businesses have put more than $30 billion into the country over the past decade. Notwithstanding high-profile investments such as the Tata Group’s acquisition of Jaguar Land Rover, India is not a top-10 source of FDI for the UK by value. An investment treaty could help deepen the financial ties between the two countries, improving access for UK firms and enticing more Indian companies to invest in the UK.

Although India and the UK declared their relationship to be a ‘comprehensive strategic partnership’ 16 years ago, they lack a regular strategic dialogue between their respective defence ministers of the sort that New Delhi has with a number of other states. Indeed, the two countries’ defence chiefs have not met since 2017, which raises questions about the degree of high-level support for closer defence ties. Addressing this lacuna, as well as reaching an agreement on government-to-government defence sales, should be a key priority for Johnson’s visit. The latter will enhance the competitiveness of UK firms in meeting India’s need for fighter planes, submarines, aircraft carriers and perhaps even naval nuclear propulsion, all of which will enhance the capacity of the Indian armed forces.

Maritime cooperation in the Indo-Pacific is a concrete means for the two countries to put their strategic partnership into action since the UK and India have a shared interest in safeguarding the region’s sea lanes and bolstering a rules-based regional order. In particular, the two countries have longstanding partnerships and strategic equities in the western Indian Ocean region stretching from Mumbai to the Persian Gulf. Not only does this part of the world provide energy resources to much of the globe, but it also contains a number of small states who lack the ability to counter piracy, environmental challenges and other non-traditional security threats in their waters. Thus, there is both an opportunity and a need for the UK and India to cooperate in providing security, promoting development and enhancing sustainability in this region.

The ongoing collaboration between the UK and India on a COVID-19 vaccine – which was developed in the UK at Oxford University and will be produced en masse at India’s Serum Institute – highlights the importance of science and research to their bilateral relationship. Both India and the UK are world-leading innovation hubs, and in the digital era, cooperation in areas like renewable energy, artificial intelligence and health technology could become as important to their relationship as economic and defence ties. Capitalising on this potential will require enabling greater mobility for both talent and companies across the UK–India tech corridor.

After years of neglect, both the UK and India are getting serious about their bilateral relationship. Each country stands to gain from tapping the other’s strengths in areas like education, research, defence and technology. Though they will not agree on every single foreign policy issue, close cooperation between India and the UK is mutually beneficial and has the potential to shape events in the Indo-Pacific in positive ways.

The challenge at hand for both governments is to finally demonstrate Modi’s assertion that a UK–India partnership is an ‘unbeatable combination’.

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(India/Inequalities/Faith) Using Participatory Action Research Methodologies for Engaging and Researching with Religious Minorities in Contexts of Intersecting Inequalities (Sowmyaa Bharadwaj, Joanna Howard, Pradeep Narayanan, IDS)

Using Participatory Action Research Methodologies for Engaging and Researching with Religious Minorities in Contexts of Intersecting Inequalities

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(India) Avoid privileging public sector over private sector in space (Kartik Bommakanti, ORF)

The Modi government made a significant decision in May 2020 to permit private sector participation in the space industry. The key to realising the promise of Indian private enterprise involvement in the Indian space sector is avoiding the pitfalls that come with the Indian State’s proclivity to privilege ISRO’s monopoly over space science and space technology. To be sure, there has always been some level of private sector involvement in the space sector. For instance, companies such as Larsen and Toubro (L&T) and Walchandnagar industries have provided critical manufacturing support to ISRO’s Space Launch Vehicle (SLV) programme. However, this private sector’s involvement has been through sub-contractual agreements with ISRO.

Indeed, recent claims that In-Space, ISRO’s and the Department of Space (DoS) regulator, may not end up creating a level-playing between various private sector companies, but may privilege a few enterprises over others is to some extent valid, but overstated. Rather, the concern should be over ISRO potentially monopolising space-related Research and Development (R&D) and production, rather than fostering true competition through its regulator In-Space. The risk of the Modi government’s initiative of liberating the space sector by lifting fetters on the private sector’s participation in a whole range of space activities will, if not outrightly be undone, be slowed down by ISRO’s bureaucratic interest in retaining a large chunk of space-related R&D and production work under its control.

Thus, if ISRO and the Modi government are to make good on their endeavour to give the Indian space programme more dynamism and efficiency by involving the Indian private industry, they will need to avoid the course successive Indian governments have taken with regards to Indian industry’s participation in the defence sector. Without competition, India’s defence industrial sector has tended to stagnate or produce very few gains for the Indian armed forces. Despite frequent pledges to do so, there is a substantial empirical record to show that governments have failed to live up to the commitment of creating a level playing field between the private sector and public sector in defence. Contracts for warship construction is a case in point where governments, including the current, have frequently privileged public sector shipyards as opposed to private sector shipyards.

To be sure, ISRO is not completely encumbered by the challenges and problems bedeviling the performance of India’s defence industry, such as poor product quality and weak and untimely delivery. One reason is principally is due to the level of autonomy the space agency has enjoyed and the latitude to work in accordance with stringent timelines for delivery. This is in part due to the nature of the tasks and the missions that ISRO has to fulfill as opposed to the State-run Defence Research and Development Organisation (DRDO) and its subsidiaries. After all, the late Chairman of ISRO U.R. Rao observed many years ago, “Any programme or development of ISRO is not to compete with any country but for our requirement.” The statement is pregnant with the fact that neither time pressures nor pursuit of competitive advantage has constrained the ISRO. It has given the agency the latitude to pursue the development of the indigenous cryogenic upper stage at leisure and in the absence of competitive pressure. Nevertheless, there is a converse disadvantage in pursuing development over extended timelines. Take the cryogenic rocket programme. It took ISRO years to successfully develop the cryogenic upper stage of the Geosynchronous Launch Vehicle (GSLV). Even so, it has not matched the advanced space-faring countries in developing a cryogenic engine that can consistently send payloads of over three tonnes to Geostationary orbit (GTO). Indeed, notwithstanding progress with the GSLV Mark III in sending 2-2.5 tonne payloads, the Indian space programme is still dependent on Arianne rockets to launch its large communication satellites. Ultimately, ISRO has not been under enormous pressure to bring launch costs down for its heaviest payloads. Private sector involvement in rocket technology is an imperative for India. Take the case of the Falcon 9 rocket built by Space Exploration Technologies Corporation or Space X, a private company, which has broken the duopoly of Arianespace and United Alliance in the launch vehicle segment demonstrating clearly the importance of the private enterprise’s involvement and competition in successful launch vehicle development.

However, with the advent of private sector participation, the challenge for ISRO and the DoS will and should be as an enabler of fair competition and not simply as a regulator. Guarding against the temptation of statist developmental efforts in the space sector will be a key test for the Modi government’s and for ISRO’s scientific bureaucracy, if India is realise the full potential of private and commercial participation in the space sector in the coming decade. Unlike the cryogenic engine programme, which has been exclusively an in-house R&D effort, the slew of other developmental initiatives that are underway will potentially benefit from private sector involvement, such as the Reusable Launch Vehicle (RLV) programme, the Small Satellite Launch Vehicle (SSLV), which has already witnessed some start-ups conducting in-house development and satellite technology development.

If ISRO and the Modi government, including its successor follow through on their privatisation effort, there are enormous possibilities for the Indian space programme and the space industry in general. India could witness a substantial boom for space science; technology and industry bringing dynamism in the form entrepreneurial energy and productivity over the course of the 2020s. Consequently, it could help overcome delays by expediting solutions to complex technical challenges, which hitherto, atleast in some areas, have been the result of confining space science, technology and industry to a state-led undertaking. If India can limit its deeply entrenched statist instincts and let private sector participation thrive, it will also attract greater levels of foreign investment and capital flows from Venture Capitalists (VCs) and collaboration with overseas space start-ups and companies.

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(India) What India should know about non-state actors, counterterrorism and asymmetric warfare (Kabir Taneja, ORF)

The Chief of the Indian Air Force, Air Chief Marshal R.K.S. Bhaduria, while recently addressing a webinar on India’s national security challenges and the role of air power, highlighted the challenges posed by rapid progression in technological innovations coupled with lower costs, leading to disruptions in how threats and warfare are now being perceived. The Air Chief specifically highlighted the potency of these technological disruptions in the hands of non-state actors, increasing their capabilities of achieving disproportionate effects in a conflict theatre.

It is the non-state actors and their incorporation of technology that has started to cause tremors in the foundations of how warfare has been viewed and broached.

While the Air Chief cautioned regarding the use of drones by both non-state actors and small states — the latter being highlighted arguably due to the recent Nagorno-Karabkh conflict between Azerbeijan and Armenia where drones played a critical role, specifically for the Azeris as the conflict zone became a parade for smaller, cheaper drones to prove their mettle. The Armenians, meanwhile, armed with older Soviet-era equipment often found themselves fighting an invisible enemy. It is the non-state actors and their incorporation of technology that has started to cause tremors in the foundations of how warfare has been viewed and broached.

Asymmetric warfare, CT and COIN

The Air Chief’s warning of the increasing threat of asymmetric warfare comes on the back of a slew of global and domestic developments in this field. An observable increase in small drones in and around the Line of Control in Kashmir may have finally forced the Indian security establishment to operationalise policies to counter a steady adoption of asymmetric warfare strategies, both from a state and counterterrorism level, including off-the-shelf purchases of counter-drone technologies from countries such as Israel. In fact, the use of such asymmetric tactics is not just visible in Kashmir, but also in heartland regions where the Naxal insurgency has a hold. In November 2019, it was reported that Maoists, for the first time, flew a drone above a CRPF camp in the violent Bastar region, highlighting a new phase of threat for counterinsurgency (COIN) operations to deal with on the internal security front.

However, from a counterterrorism and COIN perspective, technology such as crude armed drones, often piggybacking on quadcopters bought off any local toy store or online retailer and kitted out locally to carry crude bombs, narcotics, weapons and so on, have been operational in theatres such as Iraq and Syria, developed by terror groups like the so-called Islamic State (ISIS or Daesh). In fact, ISIS reportedly had its own small fleet of Do-It-Yourself (DIY) crude armed drones employed with home-made IEDs, and the group had a system in place for operators to log in their operations, like a formalised military. The innovation scale tips even beyond quadcopters, with drones outrightly built from scraps, operating both as drones with powered motors and gliders alike, showcasing an aptitude for not just modding but building crude drones from scratch.

From a counterterrorism and COIN perspective, technology such as crude armed drones, often piggybacking on quadcopters bought off any local toy store or online retailer and kitted out locally to carry crude bombs, narcotics, weapons and so on, have been operational in theatres such as Iraq and Syria, developed by terror groups like the so-called Islamic State (ISIS or Daesh).

The use of armed crude drones can be traced back to 2016, when ISIS-linked fighters killed two Peshmerga fighters and badly wounded two French soldiers in the Kurdistan region of northern Iraq via a booby-trapped drone. It is interesting to note here that these crude drones have also evolved since. The 2016 example mentioned above was that of a drone which crash landed and exploded when picked up by the Peshmerga fighters after being intercepted. Since then, these crude drones used by non-state actors have evolved, from both versions — that fly into targets and explode; and those that have been installed with makeshift pully systems that allows the drone to drop crude IEDs onto targets, record the same via a camera for propaganda value, and return home. These images and videos, released by ISIS’s voracious online propaganda ecosystem, made it into most living rooms around the world, on how in the midst of the world’s major conflict zone, the group was inventing, evolving, funding and challenging the might of the Western armed forces.

However, since 2016, this idea of using cheap yet effective technology available off-the-shelf, and difficult to monitor or regulate, has expanded beyond ISIS. To put this in perspective, in 2018, Venezuelan president Nicolas Maduro survived an assassination attempt involving an explosive drone.

Since 2016, this idea of using cheap yet effective technology available off-the-shelf, and difficult to monitor or regulate, has expanded beyond ISIS.

According to a study by New America, a US based think-tank, non-state actors ranging from Boko Haram in Nigeria and the Cartel De Jalisco Nueva Generacion (CJNG) in Mexico to the Taliban in Afghanistan and Hamas across the Middle East region have used drones in one way or another since 2016. In September 2019, two major Saudi Arabian oil refineries were hit by drone attacks that were claimed by Yemen’s Houthi rebels. Oddly, historically, the use of remote-control aircraft for attacks by a non-state actor, perhaps, can be traced back to 1993, when Japan’s erstwhile extremist cult known as Aum Shinrikyo acquired a Soviet-era helicopter and planned to operate it via remote control (as a drone, in today’s language) in a failed attempt to release toxic Sarin gas by air.

Developing counter measures

Deterring these new threats, specifically in the hands of terror groups and other non-state actors, has not been easy. The drones modded and used by such groups, which include models made for far simpler reasons such as photography and film making, are products that are considered to be everyday items available from duty-free shops at airports to large technology retail outlets. In fact, according to investigations conducted by Conflict Armament Research (CAR), India was one of the country’s listed (along with China, Lebanon, Turkey, Uzbekistan and Kuwait) from where some of these drones were procured, most likely through online retailers. In one instance, a drone purchased in India in August 2016, and activated in the UK in October of that year, was found in Tal Afar, Iraq. This highlights that the time scale between purchase and use is short.

While India has embarked for tighter control of manufacturing and usage of civilian drones, the fact remains that regulating global supply chains of not only products, but components is an immensely difficult task. For example, previously, components including fuses and detonating cords manufactured by Indian companies were found in IEDs manufactured by ISIS. The manufacturers revealed that they often do not know who the final buyer is, and it is increasingly becoming difficult thanks to online markets to find out whether the buyer is genuine or not.

Of course, the challenge always emits from the fact that technology always does, and always will, outpace policy.

Creating regulations and financial obstacles to tackle this kind of ‘technology transfer’ may be futile and committing to creating kinetic and tactical counter measures against these new threats by pitting technology against technology is arguably a better option to go with. Of course, the challenge always emits from the fact that technology always does, and always will, outpace policy. Nonetheless, this sort of challenge has also garnered innovative responses against increasing asymmetric threats from terror groups. The French, for example, started to train eagles to take out crude drones, albeit to limited success. On a more tactical and organised level, the US Army has adapted more aggressively against these threats.

The US Army setup its Asymmetric Warfare Group (AWG) back in 2006, during the peak of its ‘war against terror’ campaigns in Afghanistan and Iraq. Meaning, that the US had a head start in this regard, as far as thinking beyond the box is concerned. This, however, is not surprising considering the expansive operational theatres the US military operates in the Middle East and beyond. This operational history gave the US Army a much more realistic agenda to develop systems to ward off ‘alternative’ threats. The success of the AWG was recently documented by Capt. T.S. Allen, Maj. Kyle Brown and Dr Jonathan Askonas, who highlighted how the US Army out-innovated the ISIS drones. Allen, Brown and Askonas highlight how the US Army studied, recognised and acted on these new threats, stripping down ISIS’s drones’ program both theoretically and practically, coming to innovation-based conclusions, and integrating their findings into US Army training methodologies.

The Asymmetric Warfare Group (AWG) is a good blueprint to study for a country such as India and could become another point of cooperation between Washington DC and New Delhi.

This expansive explanation first and foremost gives an insightful look on how to conceptualise an asymmetric threat which lies beyond threats that are both obvious and bookish, keeping current and future ‘crude-tech’ innovations in mind that could possibly be co-opted by non-state actors. The success of the AWG, perhaps, is on offer today due to the announcement made in October 2019 that the US Army will shut down the unit by September of this year. Nonetheless, the AWG is a good blueprint to study for a country such as India and could become another point of cooperation between Washington DC and New Delhi.

Conclusion 

India’s defence procurement, which largely relies on purchases made on the very day they need to be utilised, is currently integrating both traditional drone technologies pushed through by the Ladakh crisis with China and counter mechanisms to use of small drones by non-state (often supported by a state in India’s case) actors via counter-drone technologies from the likes of Israel.

It is imperative for India to remember that fighting DIY and crude armed technologies could well be more difficult to achieve than traditional warfare. Militarising a camera drone used to make YouTube videos by an influencer is as convoluted an act as it sounds, and it requires a special set of thinking caps to tackle it both granularly and strategically. The long-held idea that drones such as the MQ-9 Reaper, armed with Hellfire missiles and having a Hollywood-like kill list in its coffers is a pony trick that only the US can master at this point of time as far as counterterror operations are concerned. Recognising that technologies are not exclusive anymore to warfare is the thought deterrence that India’s national security czars should internalise. New Delhi’s security thinking should move forward keeping these new mantras in mind while designing counterterror and COIN strategies for the next decade.

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(India/China) China confirms a lost Chinese soldier was found by India, calling for immediate return (Liu Xin and Zhao Yusha, Global Times)

China confirmed a lost Chinese soldier in the border areas was found by India and called for an immediate return of the soldier, according to China’s frontier forces on Saturday.

Due to darkness and complicated geography, a Chinese soldier went missing on the China-India border early Friday morning. China informed India as soon as the incident occurred, and sought help from the Indian side. After two hours of searching, the soldier was found, said the frontier force. The Indian side is waiting for the order to return the soldier, the People’s Liberation Army Daily reported on Saturday.

India should return the soldier immediately, to help de-escalating of the border tension between the two countries, and uphold regional stability, the statement said.

Indian media reported that a Chinese soldier was apprehended by Indian troops near the south bank of Pangong Tso Lake in Ladakh on Friday.

China’s front forces also denounced certain Indian media’s hyping of the incident.

China and India are working on the situation of a Chinese soldier who lost his way in the China-India border area, sources close to the matter told the Global Times.

Qian Feng, Director of the Research Department at the National Strategy Institute at Tsinghua University, told the Global Times that instances of soldiers from both sides getting lost along the LAC is not unusual considering the numbers of Chinese and Indian soldiers stationed along the border.

There were previous occasions when soldiers from both sides lost their way and crossed the border.

In October, a PLA soldier went missing while helping a herdsman find his yak along the China-India border. After China asked India to help in the search, India later notified China that a missing person from China had been found and would be returned to China after a medical exam.

Qian said that previously, there were fewer soldiers stationed in these areas in severe winters. But currently, both India and China have increased their garrisons after several stand-offs.

Given the mature mechanism between China and India, India would return the lost Chinese soldier once they found him. If necessary, they would also offer medical care or other humanitarian assistance to him if he has been injured.

“The Indian side may also interrogate Chinese soldiers and examine whether they have carried  equipment, maps or other items that may lead to suspicions of prying into Indian military intelligence,’ Qian said.

Qian noted that whether the Indian military would return the lost Chinese soldier timely would be the touchstone for whether India is still willing to act in accordance with the agreement reached by the two sides through previous talks.

“India may not detain the soldier for a long time since it would be seen as destructive to the previous consensus on solving problems via diplomatic channels. Any incident would stimulate the already tense situation along the border,” Qian said.

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(India/China) India apprehends Chinese soldier at disputed border region (Al Jazeera)

The Indian army has captured a Chinese soldier in the remote Ladakh region where the two countries are locked in a months-long military standoff along their disputed mountainous border.

It was the second detention on the high-altitude border since the pitched battles in June in which 20 Indian soldiers and an unknown number of Chinese troops were killed.

An army statement on Saturday said the Chinese soldier was taken into custody on Friday for transgressing into the Indian side in an area south of Pangong Tso lake.

“The PLA [People’s Liberation Army] soldier is being dealt with as per laid down procedures and circumstances under which he had crossed the LAC [Line of Actual Control],’’ the statement said.

There was no immediate confirmation or comment from China.

A high-altitude standoff between the Asian giants began in early May with a fierce brawl and exploded into hand-to-hand combat with clubs, stones and fists on June 15 that left 20 Indian soldiers dead. China is believed to also have had casualties, but has not given any details.

Both sides have since poured tens of thousands of troops and heavy weaponry into the tension zone in the Ladakh region, currently in the grip of freezing winter temperatures.

India and China have disputed their frontier for seven decades and fought a brief war in 1962. The two sides blame each other for the current standoff.

The neighbours have held several rounds of disengagement talks but failed to ease the military buildup.

India’s foreign ministry said on Friday the two sides have agreed to a new round of talks between senior commanders.

“In the meantime, both sides have maintained communication at the ground level to avoid any misunderstandings and misjudgements,” it said in a statement.

Indian and Chinese soldiers often lose their way in the disputed Himalayan region.

In October, India detained another Chinese soldier in Ladakh’s Demchok area, but he was freed after he was found to have strayed across the de facto border.

In September, China released five Indian nationals who went missing from the eastern state of Arunachal Pradesh amid simmering tensions between the two countries. The five men were hunters.

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(India) CoWIN app for vaccine, telemedicine: 2021 is the turning point for India’s healthcare through AI (Shoba Suri, ORF)

Even though we have lost 2020 to the pandemic, there is hope in 2021. The pandemic has impacted both lives and livelihood causing healthcare challenges, economic recession and humanitarian crisis. A lot has also evolved through the year, incredible advances in technology, digital health, governance, and humanity. From the “new normal” to a “new future,” nations are looking at restoring health, restarting economy and rebuilding resilient societies.

India has made significant advances in health system and outcomes in the past decades. Despite this, India faced a huge burden on healthcare, mainly a result of low public investment. Further high out-of-pocket costs are driving millions to poverty and debt. The pandemic has disrupted health services and likely to increase mortality indirectly. But all is not bad.

India needs to step up its investment in healthcare services to sustain its economic growth as well as prepare for future public health emergencies.

The new mortality estimate shows a substantial decline in the under-five mortality rate for India, from 126 in 1990 to 34 in 2019. There was decline in both infant mortality rate (89 in 1990 to 28 in 2019) and neonatal mortality rate (57 in 1990 to 22 in 2019). However, the recent data from the National Family Health Survey-5 (NFHS-5) released for 22 states/Union Territories, indicates extreme trends in nutrition and health indicators. Data shows worsening trends in nutrition indicators (childhood stunting, wasting and underweight), and promising trends for indicators of health outcomes and health delivery system in most states. There is a significant decline in both infant mortality rate and under-five mortality rate across states. Vaccination coverage, an important indicator of public health shows considerable improvement in immunisation among children 12-23 months across states/UTs.

To sustain the current progress in health indicators calls for accelerated coverage of child health and nutrition services both at community and facility level. India needs to step up its investment in healthcare services to sustain its economic growth as well as prepare for future public health emergencies. The remedy to overcome India’s healthcare afflictions calls for the amalgamation of data, technology and collaboration. Here is an opportunity to redesign the health system and building resilience equipped to handle future pandemics without disrupting routine health services.

Key takeaways for 2021

India’s healthcare has seen significant digital transformation and calls for a holistic digital health ecosystem to improve health outcomes. The National Digital Health Mission to be rolled out in January 2021 will look at enabling more effective delivery of healthcare services and moving towards health to all. It promises to significantly contribute to achieving the Sustainable Development Goals related to health. Digital health makes healthcare more accessible.

The development of safe and effective vaccines is one thing, however, safety and efficacy, delivery dynamics, access and cost along with an effective communication strategy are equally important.

The government of India has chalked out a plan to deliver Covid-19 vaccine through a new digital platform ‘CoWIN’ beginning January 2021. The development of safe and effective vaccines is one thing, however, safety and efficacy, delivery dynamics, access and cost along with an effective communication strategy are equally important. Technology in healthcare plays a crucial role in resolving crisis and improve efficiency. The use of telemedicine — an enabler of healthcare access and affordability or artificial intelligence in pandemic detection, vaccine development, and facial recognition with masks etc. have greatly enhanced in the pandemic.

The Telemedicine Practice Guidelines issued jointly by the Ministry of Health and Family Welfare and NITI Aayog is timely and allows for remote consultation. India has surpassed in the use of AI in 2020 (70 percent) as compared to 2019 (62 percent), with 73 percent of healthcare and pharma companies adopting during the pandemic. AI can impact Indian healthcare by enabling access, enhance efficiency and enabling preliminary diagnosis.

Covid-19 has exposed the fragility of India’s healthcare system and the need to accelerate progress towards Universal Health Coverage (UHC). The recent launch of Reimagining India’s Health System — a Lancet Citizens’ Commission will layout the roadmap for achieving UHC in India. Healthcare is essential and fundamental to achieving sustainable development. The commission will work towards developing a citizen’s blueprint by 2022 for the implementation of UHC through a participatory and consultative process across India’s healthcare landscape.

The recent launch of Reimagining India’s Health System — a Lancet Citizens’ Commission will layout the roadmap for achieving UHC in India.

The pandemic has reversed the global health progress and nations have to work hard to bring it on track. The 10 ways to put global health issues on track in 2021 looks promising. India needs to strengthen its preparedness for pandemic and other emergencies, also tackling health inequalities, revitalise effort to tackle communicable diseases and prevent and treat non-communicable diseases, etc.

Vision 2035: Public Health Surveillance in India, a vision document by NITI Aayog and University of Manitoba is futuristic and provides insights to strengthen it’s health systems and services. It envisages predictive and responsive health surveillance — inclusive of prioritised, emerging, and re-emerging communicable and non-communicable diseases.

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