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EFSAS Commentary

India’s COVID-19 crisis and some of its international dimensions


India is in the midst of a devastating and tragic COVID-19-induced humanitarian crisis of a magnitude that it has never before experienced in the 75 years since its independence from British colonial rule. The last time the country witnessed hundreds of thousands of people getting afflicted by a deathly virus every day, and a level of suffering comparable to today’s, was during the Spanish Flu in the late 1910s and early 1920s. Indian Prime Minister Narendra Modi described the second wave of COVID-19 as a “storm that has shaken the country”. At the time of writing, close to 18 million Indians have contracted the virus and well over 200,000 have died of it, as per official figures. The daily number of infections and deaths has been well over 300,000 and 2000 respectively for the last 10 days, with each new day invariably surpassing the previous day’s figures. The numbers for 28 April stood at over 350,000 infected and 3500 dead. As high as these numbers may sound, they do not even begin to convey the scale of the human tragedy that has been unfolding across the length and breadth of the vast, densely populated country that after wresting itself out of centuries of colonial exploitation had just begun to pull large swathes of its population, in their millions, out of poverty and into the middle-class.

With such a large number of people contracting the disease, India’s health infrastructure has come under unfathomable strain. To bring in some perspective, the health infrastructure of even a world leader such as the United States (US), which possesses far greater resources and a highly developed health system, was severely stretched as that country went through multiple waves of the pandemic. Severe challenges are also being faced by the kin of India’s COVID-19 victims due to the exponentially high number of daily deaths, which are several times what existing crematoriums and cemeteries are geared to handle. This has fed the harrowing scenes that are coming out of the country, and are likely to keep showing up on television and computer screens across the world over the coming days and weeks. India looks like a war zone where people are losing their lives to the invisible enemy.

Business Insider reported that public-health experts have been pointing out four factors that have caused the second wave of India’s COVID-19 outbreak to spiral beyond all expectations: rapidly spreading variants of the virus, an increase in social gatherings, a slow vaccine rollout, and an ill-prepared healthcare system. The experts identified rapidly spreading COVID-19 variants as perhaps the biggest culprit. One in particular, B.1.617, has a “double mutation” that may help it evade antibodies generated in response to vaccines or previous infections. Scientists say the variant shows early hallmarks of being more transmissible than the original strain. Prabhat Jha, an epidemiologist at the University of Toronto, said that “This new variant seems more infectious, seems to grab younger people, and seems to have really driven the numbers up”. Scientists have also recently identified a variant, B.1.618, in the state of West Bengal that has three key mutations. Another variant in Bangalore, B.1.36, carries a mutation that has been associated with COVID-19 re-infections. In Brazil, the only country that today has a comparable daily COVID-19 casualty figure of over 2000, the surge has also been linked to a more contagious variant of COVID-19 that has been discovered in the country.

Many believe that the situation in India may have been different had the invisible enemy's potential for destruction not been underestimated. India’s unexpected but remarkable success in taming its first wave of COVID-19 last year, leading to the country’s figures for infection and fatalities reducing to a trickle by the time 2021 came around, bred a sense of complacency in the population. This happened even as stories of suffering and loss brought about by an explosion of cases in the US, the United Kingdom (UK), Brazil and other countries dominated the media narrative. As Krutika Kuppalli, assistant professor at the Medical University of South Carolina put it, “Unfortunately, the narrative that played out about how well India did caused a false sense of security”.

This was also acknowledged by K. Vijay Raghavan, Principal Scientific Advisor to the Indian government, when he said in an interview with The Indian Express daily that “There were major efforts by central and state governments in ramping up hospital and healthcare infrastructure during the first wave… But as that wave declined, so perhaps did the sense of urgency to get this completed”. He added, “Everyone had been emphasizing that until most are vaccinated, we must follow COVID – appropriate behaviour. Perhaps we got used to hearing this too often. It is not easy to be observant for so long, but this is literally a matter of life and death”. He pointed out that everyone had been caught by surprise at the intensity of second wave, saying “While we were all aware of second waves in other countries, we now had vaccines at hand, and, there were no indications from modeling exercises that suggested the scale of the surge that what we are seeing. So, it became a race to vaccinate as many as we could, while also maintaining COVID – appropriate behaviour. Doing the former takes time. We slackened on the latter”. Measures such as face masks, physical distancing and restrictions on large gatherings needed to be strictly enforced and abided by, but were not.

The Election Commission of India, the independent Constitutional body entrusted with the delicate task of conducting elections across India, has come in for criticism, including from a High Court, for allowing political parties to hold mammoth rallies in the 5 states that have just finished voting yesterday. These rallies were organized even as the virus raged and spread. The government of the Indian state of Uttarakhand, similarly, has faced flak for encouraging Hindu devotees to congregate in numbers for a dip in the holy Ganges on the occasion of the Kumbh festival that is held every 12 years. Millions turned up. The election rallies and religious gatherings, as much as the overall laxity that the people displayed, would certainly have been among the factors that contributed to the worsening of the crisis. The time for case studies, fault finding, and blame affixing, however, is certainly not now. India’s COVID-19 crisis is only going to get worse before it gets better again. For the Indian government and the people of India, the only national priority at the moment ought to be to repel the second wave of COVID-19 by utilizing every asset and resource that is available. Attention also needs to be directed towards doing the utmost to ameliorate the tragic pains and losses of the people, especially the poorest among them. The time for stock taking will come, as it must when a disaster of this scale occurs, but only when the war against COVID-19 is won, as it inevitably will be, and a semblance of normalcy is back. Till then it should not be allowed to become a distraction.

There are some interesting international dimensions to the crisis in India. Some Indian analysts have been critical of the country’s decision to share millions of doses of vaccines produced by it, as well as a large quantum of COVID-19 medication, mainly to less developed countries but also some very affluent ones across the world when these countries were in dire need of these. The critics opined that India should rather have prioritized its domestic population. This is a point of view that owes a lot to hindsight, and it chooses to disregard the sense of satisfaction and pride that most Indians felt at their country being in a position to help those less fortunate than themselves in their time of desperate need. The critics also failed to take into account that at the time the exports were approved, India had successfully confronted its first wave of COVID-19 and was reporting almost as few daily cases as The Netherlands was. India has a population of 1.3 billion as against 17.28 million of The Netherlands. India’s generosity, which came at a juncture when the more affluent countries were possessively guarding their medical assets for their own country people, had earned it high praise from the World Health Organization (WHO) and world leaders. It is also increasingly being quoted by the likes of President Joe Biden of the US and Prince Charles of the UK as a reason why India needs to be extended all help to overcome its own difficult time.

Gratitude for past help is, however, not the only reason why the international community needs to prioritize assisting India in overcoming its fight against COVID-19. India is home to the world's biggest vaccine manufacturer – the Serum Institute of India – which has been a major source of the Oxford-AstraZeneca vaccine that it produces for the United Nations (UN)-backed COVAX scheme to provide vaccines to low and middle-income countries. As The Atlantic observed in an article titled ‘Why the World Should Worry About India’, “India’s outbreak is an enormous tragedy for its own people, but it’s also a catastrophe for the rest of the world. Ninety-two developing nations rely on India, home to the Serum Institute, the world’s largest vaccine maker, for the doses to protect their own populations”. Till India’s own surge subsides, drawing from the examples of the US and the UK that used rapid and widespread vaccinations to quell their out of control COVID-19 outbreaks, it is more likely to concentrate on vaccinating its own population than on exporting this critical asset. The sooner India feels better about its overall COVID-19 situation, the faster the vital vaccination programme for the rest of the developing countries is likely to proceed.

The Indian surge is also significant for the international community because the higher the number of COVID-19 cases a country has, the more likely it is that new variants will emerge. That is because every single infection gives the virus a chance to evolve and a major concern is that mutations could arise that render the presently available vaccines ineffective. The article in The Atlantic noted that “uncontrolled outbreaks anywhere pose a threat everywhere, including vaccine-rich countries such as the United States. Perhaps the biggest concern right now, in India and elsewhere, is the threat posed by more transmissible variants and their potential ability to overcome vaccine immunity”. Dr. Soumya Swaminathan, the WHO’s chief scientist, therefore, pointed out that the outbreak in India was not just a crisis for that country, but for the whole world. “The virus doesn't respect borders, or nationalities, or age, or sex or religion. And what’s playing out in India now unfortunately has been played out in other countries”, she said. Even Stéphane Bancel, the chief executive officer of Moderna Inc., told reporters that “We are fighting a virus that is not standing still. If you think about the variants that are emerging, the UK, Brazil, South Africa and now we are hearing about the double mutant variant in India, there are more appearing everywhere. I’m worried deeply about the next six months”.

Given these concerns that were starkly evident to the experts and were publicly articulated by them, the tardiness of the US and its many affluent allies in the West in responding to the humanitarian disaster that was sweeping across India is surprising and inexplicable. Admittedly, COVID-19 has hit the West hard too, and each region was looking after itself first in these difficult times, but even after learning of the scale of devastation that was sweeping through India for several days, the West had remained nonplussed.

It actually took Chinese offers of assistance to India, even if they were wisely spurned by the latter, to wake the US up. The Chinese offers were followed by a barrage of articles in the Chinese State-owned media that highlighted the unreliability of the US as a partner and suggested that India would be better off by joining the Chinese camp. US State Department spokesperson Ned Price had said on 23 April, when the crisis in India was already full-blown, that the US would not lift the ban on raw materials being requested for by India to produce COVID-19 vaccines because it was “not only in our interest to see Americans vaccinated, it’s in the interests of the rest of the world to see Americans vaccinated”. Just 3 days of Chinese media bombardment later, Biden suddenly recalled the urgent export of hydroxychloroquine by India to the US during the early pandemic and tweeted, “India was there for us and we will be there for them” after he had assured PM Modi over the phone that the US would do everything it could to help India. Since then, several countries have pledged to assist India with medicines, supplies of oxygen and raw materials for vaccines, but the need in India is immediate.

It has been 4 days since Biden’s assurance, and while there has been a lot of talk in the media about the help that the US was planning to extend, till the time of writing not a single item of assistance nor a single dose of the Oxford-AstraZeneca vaccine that the US has been hoarding in the tens of millions but not using, has reached India from the US. The ban on the raw materials urgently required by Indian vaccine makers has also not been removed. The plea by Doctors Without Borders to the US government that pharmaceutical companies be asked to “share technologies and know-how” with vaccine manufacturers across the world, as countries such as India and South Africa have also been demanding, has not yet been acceded to.

The view that India has been reticent in whole-heartedly joining the US-led efforts at containing China and that it has been fence-sitting has been rife in a section of the political dispensation not only in the US, but also in the European Union (EU). The lack of meaningful solidarity and concrete manifestations of assistance from the US and the EU even weeks after India descended into crisis should serve to explain to these sections why India has been hesitant to plunge deeper than neck-deep. Aparna Pande, director of the Initiative on the Future of India and South Asia at the Washington-based Hudson Institute, put it succinctly when she told Bloomberg that “The delay in US response to the humanitarian crisis unfolding in India is regrettable... What these incidents have ended up doing is reinforce the argument within India that strategic autonomy is the path to continue with, not further alignment with the US”. By not taking up China’s offers, India has sent a clear message to the US and the democratic West about which camp it favours. It is now the turn of the chosen camp to demonstrate that India has, indeed, opted for the right horse. As Aman Thakker, adjunct fellow at the Washington-based Center for Strategic and International Studies put it, while Biden’s slow response could have been better, the US still has time to salvage its reputation.

India will draw several lessons from the calamity that is plaguing it. Most of these will come later, when the incessant pressure to save lives and ensure medical infrastructure and supplies has eased. One lesson, however, is already clear. Reports from Pakistan suggest that it is also presently facing a particularly severe phase of COVID-19. An Al Jazeera report of 28 April said that Pakistan, over the preceding 24 hours, had suffered its deadliest day since the pandemic began last year. The Pakistani media had reported a day earlier that the country, which has been in the midst of a severe financial crisis for several years now, had only three weeks’ worth of wheat stock left. The bane of the India – Pakistan relationship has been that it has invariably taken tragedies to get them to begin meaningful conversations. The present humanitarian tragedy confronting the two countries ought to tell their leaderships in no uncertain terms that theirs are not nations and societies that can afford to waste scarce resources and energies on war and strife, death and destruction. The common people of both countries deserve better. The horrors of the tragedy inflicted by COVID-19 should not only inspire the two countries to bid adieu to their prolonged era of confrontation and war, it must also encourage them to rewire their entire architecture of governance to benefit their populations in ways way beyond what has been done thus far.

Finally, as a mark of respect for the hundreds of thousands of Indians who have lost their lives to COVID-19, India must assume its share of responsibility to drive the international community to name and chasten the country that had unleashed the deadly virus upon the world.