Prime Minister Narendra Modi launched the National Sickle Cell Anaemia Elimination Mission from Shahdol, Madhya Pradesh, with the aim of eradicating sickle cell disease as a public health issue by 2047. Having witnessed the severe impact of this disease during his time as Chief Minister of Gujarat, where it poses a major public health challenge, Mr. Modi's government is now working to address it nationwide. This article outlines the opportunities for further progress in tackling the disease.

Challenges in India

• India has the second-highest burden of sickle cell disease globally, with over a million people affected, primarily in the tribal regions of Odisha, Jharkhand, Chhattisgarh, Madhya Pradesh, and Maharashtra.
• Sickle cell disease is caused by a genetic mutation; children are at risk of developing the disease if both parents carry the trait. While healthy individuals have disc-shaped red blood cells, those with sickle cell disease have crescent-shaped cells that shorten life expectancy (to around 40 years) and cause numerous health issues like sickle cell anaemia, recurrent infections, and organ damage.
• In addition to physical challenges, patients often face social stigma, being considered "genetically inferior" or even subjected to superstitions linking the disease to divine punishment or black magic. This can limit their social and marital opportunities.
• The Mission, launched in 2023, has placed the government's focus on addressing sickle cell disease. A nationwide screening initiative is underway, and hydroxyurea, a key medication for managing the disease, has been added to the essential medicines list, improving accessibility. However, significant challenges remain.
• Current estimates indicate that only 18% of sickle cell patients in India receive regular treatment. This is due to high dropout rates at various stages, from screening to diagnosis and treatment adherence.
• The biggest barriers are at the diagnosis and treatment stages. Many patients delay seeking proper medical help due to the stigma and often turn to traditional healers, who misdiagnose the condition. While the public healthcare system has strong diagnostic capabilities, tribal communities have historically distrusted it, leading to fewer people getting tested.
• The second major issue is treatment adherence. There is no permanent cure for sickle cell disease, and while gene therapy holds potential, it is likely to remain unaffordable for most patients. In the meantime, hydroxyurea, an affordable treatment, is effective when administered consistently.
• However, access to medication is inconsistent, with patients often facing stock shortages or long distances to collect their prescriptions. In some areas, patients must travel over 200 kilometers for treatment. Additionally, many patients lack access to crucial vaccinations that help prevent infections and improve their quality of life.
• To build on the Mission's early progress, addressing these challenges is key. First, efforts to reduce stigma and build trust in public health services are essential. Targeted media campaigns could dispel myths specific to different regions and communities, drawing on successful public health campaigns against polio and HIV. Reducing stigma could also lead to better disclosure of sickle cell carrier status, lowering the number of children born with the disease.
• Second, increasing newborn screening in high-risk areas could help catch cases earlier, as it is a cost-effective approach with significant benefits.
• Third, ensuring that essential medications and adherence support are easily accessible at local health centers is vital. Specialized centers for treating complications should also be established at the district or divisional level.
• Fourth, improving vaccination coverage for sickle cell patients, possibly through catch-up programs, would help reduce infections and enhance their quality of life.
• Fifth, health services in tribal areas need to be strengthened, with funding and operational strategies tailored to the unique challenges of these regions.
• Finally, more research is needed to better understand the disease in India and develop new treatments. Philanthropists and civil society organizations can play a crucial role in collaborating with the government at both the central and state levels to drive progress

India’s Semiconductor Push

For Preliminary Examination:  Current events of national and international importance

For Mains Examination: GS II & III - India's Semiconductor Push, Science & technology

Context:

Semiconductors are emerging as the “new oil”, as they are used in nearly all electronic devices. Countries are competing to secure a portion of the manufacturing and supply network

What are the challenges associated with the manufacturing of semiconductors in India?

Key takeaways:

Most modern semiconductors are integrated circuits, commonly known as 'chips.' These are small electronic circuits made up of transistors, diodes, capacitors, resistors, and their interconnections. Primarily composed of silicon, semiconductors contain millions or billions of transistors, which function like tiny electrical switches that turn on and off to process data such as images, radio waves, and sounds. Semiconductors are vital for electronic devices, supporting advancements in fields such as communication, computing, healthcare, military systems, transportation, clean energy, and more. Their design and production are highly intricate, providing the core functionality for electronic devices to process, store, and transmit data.

India is aiming to establish itself as a key player in the semiconductor supply chain, but the industry faces several challenges:

• Capital-Intensive Nature: The semiconductor industry requires substantial capital investment. According to a report by the Semiconductor Industry Association, R&D consumes 22% of annual semiconductor sales, while capital expenditure accounts for 26%. This makes semiconductor fabrication highly capital-intensive with significant barriers to entry.

• Limited Access to Technology: The industry is dominated by a few countries and companies, such as Taiwan and South Korea, which together account for around 80% of global chip manufacturing. Additionally, only one company, ASML from the Netherlands, produces the extreme ultraviolet lithography (EUV) machines necessary for creating advanced chips, making it a nearly closed ecosystem with high entry barriers.

• Manufacturing Complexity: Semiconductor production is a highly complex process, with between 500 and 1,500 steps involved in the creation of semiconductor wafers. This process requires a wide range of inputs, including silicon wafers, various chemicals, and essential infrastructure such as clean water and uninterrupted power supply.

• Shortage of Skilled Talent: While India excels as a hub for design engineers working for major chip companies, it lacks a skilled workforce for operating the fabrication plants' factory floors.

• Limited R&D in Semiconductors: India also lags in original semiconductor design research, which is critical for shaping the future of chip technology.

• Concerns Among Major Players: Key players in the global semiconductor industry have expressed concerns about the stability of policies within India’s semiconductor sector

Follow Up Question

1.Which of the following statements regarding semiconductors is/are correct?

1. Semiconductors are primarily composed of silicon and consist of millions or billions of transistors.
2. Taiwan and South Korea account for more than 80% of the global semiconductor manufacturing capacity.
3. Extreme Ultraviolet (EUV) lithography devices used for manufacturing advanced semiconductors are produced by multiple companies globally.

Select the correct answer using the code given below:

A. 1 and 2 only
B. 1 and 3 only
C. 2 and 3 only
D. 1, 2, and 3