The Hindu Gist - 6th November, 2026
1 . Danger in the sewer: India must eliminate situations that lead to sewer cleaning deaths
Continuing Sewer Cleaning Deaths: Four workers recently died while cleaning a hotel’s food-waste chamber in Ujjain, Madhya Pradesh. Parliament and National Commission for Safai Karamcharis data indicate 859 deaths (2014–25), 498 (2019–mid-2026), 332 across 18 States/UTs (2021–26) and 1,350 (1993–2025). The Safai Karamchari Andolan has repeatedly alleged under-reporting of such fatalities, suggesting that the actual scale may be higher.
Legal Framework and Implementation Gap: The Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013 distinguishes manual scavenging from hazardous sewer and septic tank cleaning, where workers remain exposed to noxious gases. In Safai Karamchari Andolan (2014) and Dr. Balram Singh v. Union of India (2023), the Supreme Court strengthened safeguards, restricted outsourced contracts requiring sewer entry and enhanced compensation to ₹30 lakh per worker. In 2025, it directed an end to manual sewer cleaning in four metropolitan cities, followed by notices to 15 Chief Secretaries in 2026 for non-compliance. Despite the government’s claim since 2021 that manual removal of excreta from insanitary latrines has been eliminated, sewer-cleaning deaths continue, while the claim has weakened the urgency of inspections of municipal bodies and private establishments.
Institutional Failures and the Need to Eliminate Hazardous Working Conditions
- Continued violation of safeguards: Private contractors and municipal bodies continue to violate restrictions on manual cleaning under the 2013 Act and its Rules.
- Evasion of accountability: Contractors evade liability by employing undocumented daily-wage workers, making it difficult to establish responsibility and ensure compensation.
- Caste-based occupational vulnerability: Workers from historically marginalised castes remain disproportionately represented in sanitation occupations, exposing them to hazardous working conditions and social exclusion.
- Employment formalisation and social security: Eliminating sewer-cleaning deaths requires formalising workers’ employment and improving access to social security across caste lines.
- NAMASTE implementation gap: The National Action for Mechanised Sanitation Ecosystem (NAMASTE) continues to face a significant gap between its stated objectives and actual outcomes.
- Flawed administrative approach: Although NAMASTE is centred on urban local bodies, its implementation difficulties reflect a fundamental policy error of the State — maximising administrative assistance rather than minimising situations that could lead to worker deaths.
- Shift from assistance to prevention: Distributing safety kits and providing administrative support cannot substitute for eliminating hazardous human entry into sewers and septic tanks. The priority must be to prevent the circumstances that expose workers to fatal risks.
2. A Middle Power Moment in a Fragmenting World
The weakening of the post-war international order and intensifying great-power rivalry have created opportunities for middle powers to exercise greater influence. Countries such as India, Brazil, Japan and South Africa are seeking to shape global governance through economic capabilities, diplomatic agility, coalition-building and strategic autonomy.
The Middle Power Profile and Changing Global Order
- Characteristics of middle powers: They possess significant regional influence, growing economic capabilities, credible diplomatic networks and political autonomy. Their influence relies more on coalition-building, agenda-setting and diplomatic engagement than coercion.
- Emerging middle powers: India, Brazil, Canada, Egypt, South Africa, Japan, Indonesia, Türkiye, Mexico and Germany represent this category. South Korea, the Netherlands, UAE, Nigeria and Qatar may also qualify in particular contexts.
- Common aspirations: Middle powers are not a monolith, but share the belief that the existing global order does not adequately reflect their aspirations or growing agency. They seek a greater role in shaping international affairs.
- Crisis of global governance: Institutions established after the Second World War have not evolved with changes in global power. The UN Security Council continues to reflect the power structure of 1945, weakening its legitimacy through inadequate representation and inconsistent adherence to international law.
- Institutional reforms: Middle powers seek a more equitable distribution of voice and influence in global institutions. They favour reforms that make the international order more representative while preserving its ability to restrain power and sustain cooperation.
- Norm-shaping role: Middle powers are moving beyond being rule-takers, although they are not yet rule-makers in the classical sense. They increasingly influence issue-specific areas such as climate justice, equitable trade, development and technology access for the Global South.
- Strategic autonomy: Their diplomacy is generally pragmatic, non-ideological and multi-vector, allowing them to engage with different powers without permanent alignment.
Expanding Room for Middle-Power Action
- Great-power rivalry: The repositioning of the U.S. and growing assertiveness of China and Russia have created opportunities as well as constraints for middle powers.
- Weakening multilateralism: Erosion of great-power consensus, paralysis of multilateral institutions and fragmentation of global supply chains have increased uncertainty and restricted collective action.
- Coalition-building and mediation: Middle powers can convene issue-based coalitions, mediate conflicts where great powers are distrusted and bring countries together around shared challenges.
- Shaping global norms: They can influence digital governance, climate finance, health security and development cooperation. Their engagement with both the West and the Global South provides significant diplomatic leverage.
- Illustrative initiatives: India’s G20 leadership in 2023, Brazil’s climate diplomacy, South Africa’s global health and vaccine-equity initiatives, and Germany’s engagement with the Indo-Pacific demonstrate their expanding role.
- Shared vision: Despite differing priorities, middle powers seek an international system that reflects contemporary geopolitical realities rather than the power structures of 1945.
Demand for Cooperation and India’s Strategic Choices
- Declining global leadership: The weakening of uncontested global leadership and dispersion of economic and technological capabilities have increased the need for collective action.
- Cooperation across geopolitical divides: The Quad, BRICS, IMEC, Belt and Road Initiative (BRI) and International North-South Transport Corridor (INSTC) demonstrate cooperation involving middle powers and established powers.
- India’s multi-alignment: India’s engagement with multiple partners reflects its preference for advantageous relationships and preservation of strategic autonomy.
- Divergent perceptions of China: Brazil and Indonesia may view China primarily as an economic engine, whereas India’s concerns are rooted in unresolved border tensions. This requires context-specific foreign-policy choices.
- Strategic balancing: India’s relations with the U.S. and Russia reflect the need to maintain multiple partnerships. Political uncertainty following U.S. midterm elections adds further unpredictability to Washington’s international posture.
- Limitations of middle powers: They remain more vulnerable than superpowers to economic shocks, which can constrain their international influence.
- Role in the emerging order: Middle powers are not expected to replace great powers. Their role is to mediate, moderate and innovate, acting as stabilisers and sustaining cooperation in an increasingly fragmented world.
3. Are lower MRPs on cancer drugs translating into affordable care?
The National Pharmaceutical Pricing Authority (NPPA) has capped trade margins on 137 non-scheduled anti-cancer drugs, reducing the prices of nearly 900 medicine brands by approximately 70%–93%. However, the reduction in Maximum Retail Prices (MRPs) does not necessarily translate into equivalent savings for patients. Of the 1,024 brands examined, nearly 45.4% recorded price reductions of more than 50%, while 19.6% saw reductions exceeding 70% and only 0.8% exceeded 90%. The absolute reduction is important: only 16.5% of brands recorded reductions exceeding ₹12,000. Moreover, medicines such as Ribociclib and Pembrolizumab have not witnessed comparable price reductions, highlighting the limitations of trade-margin rationalisation in addressing the high cost of newer cancer treatments.
Regulation of Trade Margins and Pharmaceutical Pricing: Trade-margin rationalisation can reduce excessive margins across the pharmaceutical supply chain, but it does not necessarily address the underlying cost of medicines. Unlike telecommunications, healthcare lacks a comparable mechanism for regulating charges across its supply chain. The NPPA has powers under the Essential Commodities Act to require price disclosures and regulate margins, which can be used more effectively to improve transparency. However, pharmaceutical companies also require opportunities to recover substantial investments in research and development. Therefore, price regulation must balance affordability with incentives for innovation. Patients should also be informed about quality-assured generic alternatives before being prescribed expensive branded medicines.
Cancer Care Beyond Drug Prices: The financial burden of cancer extends beyond medicines to diagnostics, surgery, travel and follow-up care. A study estimates average cancer treatment expenditure at approximately ₹4.1 lakh, nearly 80% of which is paid out of pocket. Although Ayushman Bharat provides health coverage of ₹5 lakh, this may not be sufficient for every cancer patient. Insurance coverage remains fragmented, covering only part of the treatment cost. The disparity in outcomes is also evident: nearly 90% of women diagnosed with breast cancer survive at least five years in high-income countries, compared with approximately 65.5% in India. The proposed policy response includes a dedicated national mission for cancer prevention and treatment, standard treatment protocols, specialised cancer facilities, second-opinion arrangements, more transparent drug-price regulation and strategic public procurement to negotiate lower prices.
4. Removing the Odds Between Safety and Freedom
Internet Access, Fundamental Rights and Constitutional Balance
- Right to Internet access: In the proceedings in Just Rights for Children Alliance v. S. Harish, the Supreme Court recognised the right to access and use the Internet as a fundamental right under Article 21 read with Article 19(1)(a). It held that children, irrespective of age, enjoy these constitutional rights and that measures for online safety should target harmful material and those responsible for it, rather than deny children Internet access altogether.
- Authority-liberty coordination: Reasonable restrictions must balance individual freedoms with social interests. The exercise of State authority should protect children without unnecessarily curtailing their constitutional liberties.
- Internet as a learning tool: Digital technologies expand access to information, educational resources and opportunities, while enabling children to develop skills, express opinions and connect across geographical boundaries.
- Judicial recognition of digital rights: In Anuradha Bhasin v. Union of India (2020), the Court recognised the protection of Internet-based speech and trade under Articles 19(1)(a) and 19(1)(g). In Pragya Prasun v. Union of India (2025), it recognised digital access as part of equality and accessibility rights, including for persons with disabilities.
Online Safety and Age-Appropriate Safeguards
- Online vulnerabilities: Internet access also exposes children to cyberbullying, harassment, privacy violations and fraudulent content, making appropriate safeguards necessary for their well-being.
- International and State-level restrictions: Countries including Australia, Brazil, China, Indonesia, Malaysia and the UAE have introduced age-based social media restrictions. In India, Andhra Pradesh and Karnataka have considered screen-time restrictions, while Bihar has banned social media use in schools.
- Shared responsibility: Online safety requires coordinated efforts involving parents, government, educational institutions and service providers. Age-appropriate boundaries and awareness of online risks can help children make informed decisions.
- Balancing freedom and safety: Blanket restrictions may deprive children of educational and developmental opportunities. The emphasis should be on restricting harmful content, promoting responsible use and adopting preventive safeguards rather than curbing Internet access itself.
5 . How Do Tokamaks Work to Make Nuclear Fusion Possible?
Nuclear fusion research aims to reproduce the process through which the Sun generates energy by combining light atomic nuclei. Tokamaks use powerful magnetic fields to confine superhot plasma and enable fusion reactions. Despite technological advances, engineering challenges involving plasma containment, energy requirements and reactor materials remain significant, and no tokamak has yet generated net energy for commercial power.
Working Principle and Scientific Challenges of Tokamak Fusion
- Tokamak design: A tokamak is a device that uses magnetic fields to confine plasma inside a ring-shaped vacuum chamber. Plasma consists of charged particles formed when gas is heated to extremely high temperatures, separating electrons from atomic nuclei.
- Fusion fuel: Nuclear fusion research primarily uses isotopes of hydrogen such as deuterium and tritium. These combine to form helium, releasing energy and producing neutrons.
- Magnetic confinement: Charged particles spiral around magnetic field lines. A tokamak uses strong magnetic fields to prevent plasma from touching the reactor walls, as contact would cool and contaminate it, preventing fusion.
- Magnetic field configuration: A ring-shaped magnetic field alone is insufficient because the field becomes stronger on the inner side than the outer side, causing plasma particles to drift. An additional magnetic field twists the field lines into a helix, helping prevent this drift and confine plasma.
- Plasma heating: Electric currents induced in the plasma, along with external heating systems, raise its temperature to the levels required for fusion. The plasma must remain sufficiently hot and confined long enough for fusion reactions to occur.
- Energy generation: Deuterium-tritium fusion releases approximately 6 MeV of energy, with about 80% carried by neutrons and 20% by helium nuclei. The neutrons transfer their energy to a surrounding blanket, generating heat that can be used to produce steam and drive a turbine.
- Tritium breeding: The reactor blanket contains lithium, which reacts with fusion neutrons to produce tritium. Since tritium is rare and radioactive, breeding it within the reactor is important for sustaining the fuel supply.
Global Progress, Engineering Limitations and India’s Tokamak Programme
- Scientific origins: The tokamak concept was developed in the Soviet Union in the early 1950s, particularly through the work of physicists Igor Tamm and Andrei Sakharov. Experimental work subsequently advanced at the Kurchatov Institute in Moscow.
- ITER project: The International Thermonuclear Experimental Reactor (ITER) is the world’s largest tokamak experiment, involving seven members — China, the European Union, India, Japan, South Korea, Russia and the United States. It aims to demonstrate the scientific and technological feasibility of fusion energy.
- ITER’s limitations: The project has faced delays, rising costs and engineering challenges. Its revised schedule envisages deuterium-tritium operations in 2039, with an estimated additional cost of €5 billion. ITER is a physics experiment and is not designed to convert fusion heat into electricity.
- China’s EAST tokamak: China’s Experimental Advanced Superconducting Tokamak (EAST) sustained high-confinement plasma for 1,066 seconds in January 2025, demonstrating progress in maintaining plasma stability and temperature.
- India’s tokamak programme: India’s two main machines are:
- SST-1: The Steady State Superconducting Tokamak, developed by the Institute for Plasma Research (IPR), Gandhinagar.
- ADITYA: India’s first tokamak, which began operations in 1989 and was rebuilt as ADITYA-U in 2016, resuming operations in 2017. India also participates in ITER and manufactures components for it.
- Indigenous private-sector development: Bengaluru-based Pranos Fusion has developed PRAGYA, described as India’s first privately developed compact tokamak. It is an experimental platform intended to develop capabilities in plasma control and magnetic confinement, rather than generate commercial electricity.
- Alternative approaches: Fusion research also explores inertial confinement, where powerful lasers compress a tiny fuel pellet, and magnetised target fusion, which combines magnetic confinement with compression. Germany’s Wendelstein 7-X is another example of magnetic confinement using a stellarator configuration.
- Commercialisation challenge: No tokamak has yet generated net energy for commercial electricity. Achieving sustained plasma confinement, managing reactor materials, breeding tritium and overcoming high construction and operational costs remain major technological challenges.
The Indian Express Gist - 6th November, 2026
1 . National belonging, contested & enlarged
Immigration, Racial Exclusion and the Expansion of American Democracy
- Historical contradiction: America’s political identity has evolved through a continuing tension between racial exclusion and democratic inclusion. Waves of hostility towards immigrants have repeatedly been followed by their gradual acceptance into the national mainstream.
- Immigration reforms: The Immigration Act of 1924 sharply restricted Asian immigration, while the 1965 immigration reforms opened the way for large-scale migration from India and other Asian countries.
- Capacity for inclusion: America’s ability to absorb outsiders and elevate them to positions of public authority has remained an important feature of its political history.
- Changing political representation: The proportion of racial and ethnic minorities in the U.S. Congress increased from approximately 12% in 2000 to 26% in 2024.
- Indian-American representation: Five Indian-Americans secured election to the House of Representatives, with a sixth awaiting the final count. At least 30 Indian-Americans won State legislature elections, including 15 women.
- Broader democratic participation: The election of Abdul El-Sayed, son of Egyptian immigrants, as America’s first Muslim senator, the re-election of Somali-American Ilhan Omar, and electoral victories of African-American candidates demonstrate the expanding possibilities of political inclusion.
- Emergence of immigrant leadership: Zohran Mamdani, born in Uganda to parents of Indian origin, became New York’s first Muslim and South Asian mayor in January 2026. Indian-born Nithya Raman defeated incumbent Karen Bass in the November 2026 election to become the mayor of Los Angeles.
- Persistence of racial prejudice: The resurgence of anti-Indian rhetoric within sections of the MAGA movement demonstrates that economic success and the model minority perception do not make immigrant communities immune to racial hostility.
National Belonging, Political Identity and Implications for India
- Contested national identity: National belonging is continuously shaped by the tension between exclusion and inclusion. America’s experience demonstrates how democratic participation can progressively enlarge the idea of who belongs to the nation.
- Indian parallel: Hostility towards outsiders is not unique to America. India’s history includes ‘sons of the soil’ movements, while caste and religious prejudice also influence its politics and society.
- Political loyalties of the diaspora: Indian-American political loyalties are primarily towards the United States, and their political views reflect the diversity of American politics.
- Changing diaspora perspectives: As the Indian-American community expands, differences in its members’ positions on India’s policies towards the United States are also likely to increase.
- Implications for Indian diplomacy: New Delhi should not automatically assume that Indian-origin political leaders will support Indian government positions. Their support must be earned, as with that of other American citizens.
- Avoid sweeping judgments: India must recognise both America’s history of racial and religious prejudice and its demonstrated capacity to welcome outsiders and enable their political advancement.
2. Why India’s rejection of a TB drug patent matters
India’s rejection of a patent application for the BPaL tuberculosis drug combination marks an important step towards promoting generic competition and affordable treatment for drug-resistant TB. The decision highlights the balance between pharmaceutical patent protection, prevention of evergreening and the public health imperative of ensuring access to essential medicines.
Patent Rejection and Access to Drug-resistant TB Treatment
- Patent rejection: The Indian Patent Office rejected a patent application filed by the US-based Global Alliance for TB Drug Development (TB Alliance) for the combination of Bedaquiline, Pretomanid and Linezolid (BPaL). This opens the possibility of generic manufacturers producing the combination in India, increasing competition and potentially reducing prices.
- Pre-grant opposition: The application faced two pre-grant oppositions in 2020 under India’s patent framework. These were filed by Eldred Tellis of Sankalp Rehabilitation Trust and Ganesh Acharya, supported by Lawyers Collective and Médecins Sans Frontières Access Campaign, and by the Delhi Network of Positive People (DNP+) with support from Third World Network.
- Preventing evergreening: The decision challenges the practice of evergreening, whereby pharmaceutical companies seek additional patents for minor modifications or new formulations of existing medicines to extend market exclusivity and delay generic competition.
- Earlier patent decisions: The ruling follows earlier refusals concerning bedaquiline’s salt form (2023), paediatric formulation (2024), long-acting injectable and the newer BPaL combination.
- BPaL treatment regimen: Recommended by the World Health Organization (WHO) for eligible patients with drug-resistant TB, BPaL is a six-month, all-oral treatment combining Bedaquiline (B), Pretomanid (Pa) and Linezolid (L). The BPaLM regimen additionally includes Moxifloxacin (M).
- Treatment effectiveness: BPaLM has recorded a treatment success rate of approximately 89%, compared with 52–75% for standard regimens. More than 15,000 patients have already started BPaLM treatment under India’s National TB Programme.
- Public health relevance: India has the world’s highest TB burden, accounting for nearly a quarter of global cases. Its TB incidence stood at 187 cases per 100,000 population in 2024. Affordable access to shorter treatment regimens is particularly important for patients with multidrug-resistant and rifampicin-resistant TB.
Affordable Medicines, Generic Competition and Regulatory Challenges
- Reduction in treatment costs: Increased generic competition can make treatment more affordable. A six-month BPaLM treatment course costs approximately $284, compared with $588 in 2022.
- Expansion of treatment coverage: Lower medicine prices can enable the government to procure more treatment courses within the same budget, potentially expanding coverage under the National TB Elimination Programme (NTEP).
- Access beyond patent rejection: Removal of patent barriers does not automatically ensure affordable or universal availability. Actual access depends on generic manufacturers entering the market, quality-assured supplies and effective government procurement.
- Government responsibility: The Central Drugs Standard Control Organisation (CDSCO) has approved bedaquiline and pretomanid for use under NTEP. The government must ensure that every eligible patient diagnosed with rifampicin-resistant TB receives appropriate treatment.
- Patent approval vs drug regulatory approval: Patent approval determines exclusive intellectual property rights, whereas drug regulatory approval assesses whether a medicine can be marketed and used. Rejection of a patent application does not automatically grant regulatory approval to other manufacturers.
- Quality assurance: Generic medicines must meet the same quality and safety standards as reference medicines. Increased competition should not compromise pharmaceutical quality or patient safety.
- WHO prequalification: WHO prequalification provides an international assessment of the quality, safety and efficacy of medicines, while Indian drug regulators retain responsibility for domestic regulatory permissions.
- Balancing innovation and public health: Patent protection must be balanced against affordable access to essential medicines. Preventing frivolous secondary patents can promote competition while maintaining appropriate standards of quality, safety and efficacy.
3. India’s time will come. For now, it is a middle power in a bi-multipolar world
India’s Rise and the Limits of Its Global Position
- Economic transformation: India’s growth rate increased from 5% during 1950–80 to 6% during 1980–2010, exceeding 8% during 2003–10. This improved international perceptions of India and raised expectations of its ability to catch up with East Asian economies and China.
- Historical recognition: The Goldman Sachs BRIC report (2001) and Stephen P. Cohen’s India: Emerging Power (2001) recognised India’s growing economic and strategic potential.
- Democratic credentials: India’s identity as a post-colonial democratic nation, its support for anti-colonial movements and its plural, secular character contributed to its international stature, even when its economic capabilities were limited.
- Strategic autonomy: India’s ability to withstand sanctions imposed by the U.S., Japan and other countries following the 1998 nuclear tests demonstrated its resilience and willingness to assert its strategic interests.
- Gap between ambition and capability: Premature claims of economic and global leadership, including the unfulfilled $5-trillion economy target for 2020 and claims of becoming the world’s third-largest economy, have weakened the credibility of India’s rise.
- Viksit Bharat 2047: Achieving developed-country status by 2047 requires sustained economic growth of well above 8% annually over the next decade.
- China’s technological advantage: Between 2010 and 2025, China emerged not only as an economic power but also as a knowledge power, widening the gap in technological and economic capabilities.
- Domestic political challenges: Bigotry, majoritarianism and anti-intellectualism, alongside an excessive focus on electoral dominance, have undermined India’s democratic credentials and international image.
India’s Strategic Position in a Bi-multipolar World
- Emerging global order: The world is moving towards a bi-multipolar system, with the U.S. and China as the two dominant powers possessing global reach, alongside several middle powers.
- India as a middle power: India should recognise its present position as a middle power and developing country rather than prematurely projecting itself as a third major global power.
- Build middle-power partnerships: India should strengthen cooperation with Russia, the European Union, the UK, Japan, Brazil and South Africa, alongside other like-minded countries.
- Balance major-power relations: Both the U.S. and China pose strategic challenges for India. Neither should be treated as an uncomplicated partner or used as a weapon against the other. Maintaining stability in relations with both is essential.
- Independent foreign policy: India’s participation in the Quad and growing military engagement with the U.S. should not compromise its strategic autonomy or independent diplomatic voice.
- Global leadership through representation: India’s aspiration for a greater international role, including a place in the UN Security Council, requires it to articulate the concerns of weaker countries rather than merely seek the support of powerful nations.
