The World

India’s COVID Surge Affects the Entire World

The subcontinent was set to vaccinate dozens of other nations. Then its own outbreak spiraled out of control.

Many people sit close together in line in an open-air vaccination site
A vaccination center in Mumbai, India, on Friday. Sujit Jaiswal/AFP via Getty Images

On Friday, India reached a record of 217,000 COVID-19 infections in 24 hours, far outpacing any other country (and likely still undercounting the total, considering the subcontinent’s long-inadequate testing regime). This week, it surpassed Brazil as the second-most-infected country in the world, and is now only behind the United States in total infection and death rates. Reports of packed hospitals, low oxygen supply, overflowing crematoriums, and the spread of multiple variants abound. As alarming as this is for India itself, the increased global demand for vaccines and the deadly new variants developing within the country pose grave dangers for the rest of the world as well.

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The easily transmissible B.1.1.7 strain, which originated in the United Kingdom, took root in the subcontinent as it has elsewhere—but it’s not the only variant of its kind, or even the most worrying. According to data from Johns Hopkins, in the first half of April, the state of Maharashtra not only had the single biggest cluster of new cases within the country, but within the entire Asian continent. Much of this is due to a so-called double mutant, which in India consists of both the easily transmissible strain first found in Brazil and South Africa as well as another mutation that helps the virus sidestep the body’s immune system. Neeraj Kaushik, a professor at the National Institute of Technology, mentioned other troubling features of the variant in a report for the Delhi Police, noting that the variant was infecting younger people, spreading faster among families and groups, avoiding detection in certain tests, and causing new symptoms. The National Institute of Virology in Pune studied hundreds of Maharashtra virus samples from January through March and found that 61 percent of them matched the characteristics of this double mutant. Initially, this mutation had been downplayed by both the state and national governments, despite the fact that it was first detected back in December; on Tuesday, Maharashtra’s chief minister kicked off a 15-day period where only “essential services” would function, though he took care not to refer to it as a lockdown, and also dispatched police to enforce safety measures.

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Meanwhile, stories from last year’s pandemic impact are merely repeating themselves. Infections are spreading in other parts of India, like Karnataka and Madhya Pradesh, and states like Rajasthan and Uttar Pradesh have either laid down new curfews or extended already-existing curfew hours; Delhi, the single most devastated metropolis, has shut down several business operations, including restaurants, and is also installing a curfew this weekend. Urban low-wage and domestic laborers, cut off from their livelihoods, are leaving in large numbers for their families’ remote villages, very possibly bringing the virus with them. Members of the Lancet COVID-19 Commission Task Force on Public Health are repeatedly urging Indians to take extra safety measures, stating that “vaccines won’t be enough” in the face of variants. Last week, New Zealand banned visitors from India, claiming that the surge it had recently seen at its border (i.e., 23 cases) was spurred mostly by 17 Indian travelers. Other countries have not forbidden flights from India yet, but it could happen soon.

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Less than four months ago, the administration of Prime Minister Narendra Modi had declared victory over the pandemic and got to work on what’s been projected to be the world’s largest vaccination campaign, approving the manufacture and use of the British AstraZeneca vaccine (branded in India as Covishield) as well as India’s own vaccine, Covaxin, crafted by domestic drugmaker Bharat Biotech. World Trade Organization intellectual property regulations still prevent India from producing generic forms of approved, branded vaccines—a baffling decision for many reasons, not least because the country’s cheap, effective generics are among its biggest exports—yet the country was still determined to not just vaccinate its native population but also give vaccines to its neighbors and allies. This was planned in large part as a counter to geopolitical rival China’s global vaccine distribution campaign. The United States was also happy to partner with India for the purpose of speeding up manufacturing and distribution.

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In the first few months of 2021, the vaccine program did seem a startling success, even as COVID cases started to trickle upward (and were subsequently downplayed by the government). By this week, India claimed to have already distributed more than 100 million individual domestic vaccine doses—an impressive number that still wouldn’t even account for 8 percent of India’s population, not to mention that only 11 million people by this point have been fully vaccinated (all the currently available vaccines in India require two shots). The country’s External Affairs Ministry also claimed that, as of Friday, it had exported more than 65 million vaccines to at least 90 countries, mostly to developing nations that have struggled to obtain vaccines.

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Yet with the virus still wrecking the country, optimism about India’s recovery has dwindled, and systems are rapidly readjusting. Vaccine rollout has slowed amid the latest surges, putting further benchmarks (including that of vaccinating 250 million “priority people” by July) out of reach and portending a yearslong slog toward herd immunity. Last month, the government halted Covishield exports in order to prioritize the native population; on Tuesday, it announced that it would grant emergency approvals to vaccines being used in other countries, including Russia’s Sputnik V. India is also trying to obtain the Pfizer vaccine, which its government had shrugged off in January after it had refused to sign an indemnity bond—a deal other countries with Pfizer contracts have agreed to—that would have inoculated the company from potential lawsuits over side effects. Moderna appears reluctant to take its product to India, while Johnson & Johnson is in talks with India’s government for a deal on the one-shot vaccine, although its recent pause in the U.S. might spur further skepticism among vaccine-hesitant Indians.

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Meanwhile, regional vaccine reception is dependent on the national effort—and there, the rollout is increasingly flailing. At least 10 states have vaccine shortages in their areas, leading to vaccination sites closing down or turning people away; in turn, national leaders are denying that there is a shortage and instead are blaming the states for supposedly poor logistics. India’s Serum Institute, which is producing Covishield, has admitted publicly that its capacity is “very stressed.” Plus, Covaxin production is also bound to slow, in part due to lack of supply of a crucial ingredient sourced from the U.S.; as a result, states like Punjab are missing second doses for those who are on schedule to receive them. These logistical issues are compounding further troubles for Punjabi health officials, who already had trouble persuading vaccine-skeptical seniors to take the shots. And Indian vaccine hesitancy isn’t limited to old age: In other cities, poor urban laborers whose livelihoods were already affected by economic recession are shunning the vaccine, worrying that missing any time for work to get the shots will imperil their employment.

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All this was sadly foreseeable. After a messy stay-at-home order in spring 2020 that displaced tens of millions of people from their homes, India never mandated more such large-scale restrictions, and individual states often had to come up with their own responses, with successful results in certain regions and dire ones in others. Throughout the pandemic, Modi and his ideological acolytes have mainly done what they’ve done best over the past seven years: downplay problems, fuel culture wars, and fail to address the consequences of their own policies and statements.

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On Monday and Wednesday, 3 million maskless Hindus from across the nation gathered in tight crowds at the Ganga River to observe the Kumbh Mela holiday; hundreds of participants in Monday’s festivities have tested positive for the virus, and almost 200 devotees there were found to already have been positive when they reached the river. There is a notable contrast between the response from the Indian government and its ideological allies to this event and the reaction to Muslims who celebrated at religious events early on in the pandemic. Back in spring 2020, the hashtag #CoronaJihad dominated social media, and Muslims who’d held gatherings were disproportionately blamed for viral spread. Already, the Kumbh Mela case count far exceeds the numbers from Islamic observations, yet there will likely be no comparable uproar.

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Religious festivities aren’t the only crowds likely playing a part in viral spread: Local political elections are ramping up. The states of Assam, Kerala, and Tamil Nadu are set to hold elections through the end of the month, despite the lack of distancing in political rallies and tense skirmishes at poll sites. These very states are experiencing high case upticks, yet federal government officials are still prioritizing events in states like West Bengal, whose local elections are being perceived as a referendum on Modi’s conservative Bharatiya Janata Party.

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But it’s not just poor public examples that other countries have to fear from India—it’s also the supply of vaccines. India’s Covishield had become an essential part of COVAX, a World Health Organization–backed initiative to get vaccines to lower-income nations; by late March, India had supplied almost 30 million doses for COVAX’s use. With India keeping Covishield totally domestic for now, countries without strong manufacturing bases or health systems that benefited from India’s vaccine generosity will lose out, and the COVAX effort itself will have to slow down. Regions of the world with enhanced vaccine production capacity, including the U.S. and the European Union, remain stingy with vaccine sharing, while a Chinese government official recently cast doubt on the efficacy of his own country’s domestic and exported vaccines. Because of all this, more than 85 of the world’s poorest countries may not have sufficient vaccine access before 2023, according to the Economist. India’s vaccine generosity had helped plug the gap left by other heavyweights, but its domestic reprioritization may now have the unfortunate effect of putting dependent nations at higher risk for viral spread, economic shutdown, and variant emergence. Speaking of variants: Maharashtra’s double mutant has now been found in at least eight other countries. With the rapid global reach of the British, South African, and Brazilian variants, it likely won’t be long before India’s variant also establishes a deadly hold.

The pandemic is far from over in India. Rather, it’s become even more horrifying than before. The rest of the world can’t afford to ignore this.

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