The World

Submerging Nations

Once, we talked about the First and Third Worlds. Today, it’s the vaxxed and unvaxxed.

On the left, people dine outside without masks in New York's Bryant Park. On the right, people in India wait in line for vaccines, wearing masks and face shields, one person turning as if to look at the photo of New York City.
New York City and New Delhi on May 4. Photo illustration by Slate. Photos by Spencer Platt/Getty Images and Prakash Singh/AFP via Getty Images.

Last month, I walked down to a nearby drugstore, a Duane Reade on John Street in lower Manhattan, paused for the doors to slide open, and entered the First World. Beyond shining aisles of pet food and pantyhose, a pharmacist seated me in front of a shelf of Tums and slipped a shot of the Pfizer vaccine in my arm. Stick around for 15 minutes, the pharmacist said, just in case you have a reaction, which nobody does—and it was done.

Advertisement

I marveled at the ease of it. I’d brought an expired ID, but it hadn’t mattered. I had registered in minutes, and paid nothing, and could pick up orange juice on my way out. On the in-store radio, Paula Abdul sang, “Rush, rush … I want to see you free with me,” and I felt myself admitted, just like that, into a new free world: the vaccinated world.

Advertisement
Advertisement
Advertisement

Sudden events had brought me, in late May, to New York City from my home in New Delhi. From a locked-down city being savaged by its second wave of the coronavirus, I’d flown to a place where people had their masks off and sat at tables on the sidewalk wearing only light layers, drinking Negronis. Online, I found a menu of vaccines, “high-status” or basic, and places to get them, practical or whimsical: J&J shots under the belly of the blue whale at the American Museum of Natural History, or Pfizer at the drugstore down the street.

Advertisement

Soon my arm had a tacky red band-aid on it, stamped with a white W, the logo of the retail chain. It looked like a bag of frozen chicken breasts, I thought. How weird, and how American, to receive a miracle injection between shelves of diet energy drinks and microwaveable pork rinds. How appropriate, too, since the shots were already excess inventory here, dangled before the public like basement bargains: And get the chance to win … a full college scholarship! A million dollars. A shotgun.

In India, by contrast, if you were younger than 45, getting even a single shot was like getting through a needle’s eye. We had fallen for a delusion, and now we were paying for it. After a mild first wave, Indians were led to believe that we were “naturally” inoculated against COVID, an idea encouraged by the government of Prime Minister Narendra Modi. Since vaccination need not be a priority, his party stayed occupied with other grand designs: controversial agricultural laws, steamrolled through Parliament despite mass protests; a monumental building project, refashioning imperial New Delhi; and schemes to swing a state election in West Bengal, where Modi’s party had staked its image as an unstoppable national force.

Advertisement
Advertisement
Advertisement

In 2020, Modi had promised to meet the pandemic under a motto of “self-reliance.” India is among the world’s major vaccine manufacturers, and his intention was to rely exclusively on domestic production. But it soon became clear that the task of vaccinating a billion Indians would only move once hitched to his cult of personality and its train of nationalist bluster.

By the start of 2021, India had neither allowed its citizens to import their own vaccines nor placed an order for a single dose. The Serum Institute, a private firm that had struck its own deal with AstraZeneca, also found its own clients overseas and proceeded to export the majority of its doses to other developing countries. By the end of March, India had ordered only 35 million doses for its population of 1.4 billion. And then the mirage of immunity began to waver, and then it was gone.

Advertisement

Back in April, my days had been haunted by scenes I had read in books of history, of societies being destroyed by epidemics—smallpox in Native American villages, or cholera among refugees escaping Burma in World War II. These were extreme comparisons. But in private homes all around me, in my friends’ homes, the outlines of those historical scenes kept appearing.

Advertisement

On the news, the images from Delhi were all of hospitals and crematoria, places you could park a camera and record the meltdown. Nobody I knew was watching the news. Some days, my partner and I sat at our laptops, trying to work, but looking up every hour just to say a new name, which meant that person was dead. Mostly, we worried over friends whose families were sick, and we listened over the phone to their private unraveling.

Advertisement

There was no hope of getting a hospital bed. The highest forms of privilege were being flexed to get them, and failing. On April 29, a retired diplomat—formerly India’s ambassador to Algeria—died in the parking lot of a major hospital in the National Capital Region, five hours into his wait for admission. There was no oxygen to bring home; even hospitals were on Twitter, calling out for anyone to help with supplies. And increasingly, there was no specialist you could talk to, no way to fill a prescription, only dozens of hopeless phone numbers and registries, vestiges of a working state. Soon India had more new infections each day than the rest of the world combined.

Advertisement

On the phone, my friend said: My mother is sick, and I can look after her. But now my father and I have both tested positive too. What happens if I get sick, and can’t care for her? What if we find one hospital bed, but need two? Who will come and help? I didn’t know. Relatives withdrew—they couldn’t risk coming over, they had their own parents, and no hope of hospital care.

Advertisement

Behind a shaky wall of mutual aid and volunteerism, solidarity was growing strained. Now, to step out to the aid of the sick and abandoned was to risk becoming one of the sick and abandoned. Which is where the haunting outline appeared—of condemned peoples in the past who encountered new, bewildering plagues, and only knew they had to keep caring for one another, and kept bringing water and tending fevers, as each one felled another.

And those who were responsible stood by and watched.

It had been a while since I’d felt culture shock arriving in the United States, but I felt it now, and dwelt on it: the luxurious safety of the vaccinated world. I met a friend in the park and heard about his date night, which involved a subway ride to Bushwick, sharing a vape at a bar, going home and sleeping with a stranger. The sex was risky and experimental, but what shocked me: You took the subway? It was all beginning again: commerce, commutes, cocktails alfresco, the quickening beats of lifestyle in a city rising from its bed.

Advertisement

Back home, in our bunker in Delhi, my partner was bingeing on The Bold Type, a dream of millennial high life and officegoing in Manhattan. Now I was there, my real and virtual landscapes exchanged, the high life all around me, the pandemic on my phone. In Delhi, the lockdown was extended again. On Twitter, I see a photograph of hundreds of wooden pushcarts, the type rented out to hawk fruit or biscuits, stacked up by the roadside, motionless for weeks—and I can hear the hunger roar. I look up and watch bags of chicken pesto paninis being slung into dumpsters at sundown.

Advertisement
Advertisement
Advertisement

A sort of déjà vu crept into Indian headlines: For the first time in my adult life, India opened its hands for foreign aid. The disparity of hope between the countries felt vaguely familiar. I was born in a decade when we had terms for it: First World and Third World. In memories of early ’90s childhood, really nice things came out of suitcases with Pan Am tags on them. Later, nice things were still American, but were in the shops in the city center, thanks to new laws and purchasing power.

Advertisement

By the new millennium, even American jobs were available here, outsourced straight to my hometown. “Third World” was a passe and offensive concept. The term for us now was Emerging Nation, and we grew used to the First World panoply of nice things, imported but homegrown too, franchise but also boutique. None of that is gone, but it is impounded by the pandemic, to be returned in unknown condition, at an unknown date. Purchasing power means less if you can’t go out to eat, much less if you’re asphyxiating in a queue outside a hospital, and the queue won’t move.

I return from the First World to the Great Unvaxxed. India’s numbers had climbed to an unreal peak of over 400,000 new cases daily—the official figure, itself an undercount—and then began to drop, as the lockdowns finally took effect. By May 15, the Economist estimated, India had had a million excess deaths, since only the start of the year. By the time I got home, the infection had streamed off into the villages, where there are few nasal swabs, and where the health care system was never anything but broken.

Advertisement
Advertisement

The great “moral stain” of the AIDS pandemic, the scholar Zeynep Tufekci has observed, was that most of its victims died after lifesaving drugs were finally found. From 1995, thanks to combination antiretrovirals, also known as the “AIDS cocktail,” being HIV-positive ceased to be a terminal condition. But the great majority of AIDS deaths took place anyway, in the decade after, in India and sub-Saharan Africa, because the drugs were patented and priced far beyond Third World incomes. India has reprised this tragedy in 2021, allowing the majority of deaths to occur months after vaccines were at hand. Urban Indians, stunned by loss and abandonment, do not comprehend how much of that loss need never have happened.

Advertisement

The Indian government’s lethal dawdling and bravado—a form of vaccine hesitancy at the grandest scale—shifted only as the second wave smashed into Delhi. It then banned vaccine exports—a means to commandeer the Serum Institute’s full output, regardless of the firm’s prior obligations. Much of the cost of India’s mistakes has thus fallen on other Asian and African countries, which ordered millions of doses but were forced to turn to rich countries for handouts.

Advertisement

India promised, too, to allow imports of vaccines approved by foreign regulators. Inexplicably, it continues to stonewall Johnson & Johnson and Pfizer (a folly even more unforgivable since mRNA vaccines, like Pfizer’s, have been shown to have greater efficacy against the delta variant than locally produced, non-mRNA options). The first Pfizer shot went into a nurse’s arm on Long Island on Dec. 14. That is 200 days of lost time and lost lives.

Advertisement

In June, Delhi’s lockdown began to lift. Residents shuffled back into a semi-shuttered city with their single-shot semi-immunity and shot nerves. Everything is in limbo: It’s a toss-up whether our second shots or our third wave will reach us first. On May 15, 2.4 percent of Indias population was fully vaccinated; a month later, that figure had increased by only 1 percent. Each lost day increases the threat of new waves, new lockdowns, and a perennial cycle hobbling Indian lives. Behind the lag in immunization is a tail of economic, intellectual, and nutritional losses, likely to stretch into generations to come.

Advertisement

For many millions of Indians, our rise from Third World to “emerging” superpower economy has been a trick of words. For millions of others, though, the past 30 years have allowed an escape from generations of poverty, into a precarious but dreaming middle class. These dreams are coming undone. Back in March, the Pew Research Center estimated that the pandemic had already pushed 75 million Indians back into poverty. That estimate uses a per capita poverty line of $2 a day. In May, the Centre for Sustainable Employment, in Bengaluru, used a national minimum wage (representing a “decent standard of living”) and reached a heart-stopping figure of how many have fallen below it: 230 million. This great number rejoins a Submerging Nation, a place of many declining numbers—wages, savings, meals—and dwindling hope.

The dismal categories dividing the world had seemed to be behind us, but I see it pulling apart again, right beneath my feet. A version of me stands on either side. In New Delhi, I’m counting down the weeks until my partner’s shot. I hope my country moves quickly past its hubris and addled nationalism, and that the rich world moves quickly to meet us—which means sharing not just vaccine stocks, in charity, but also the means by which they can be internationally produced and equitably sustained. I worry that the amnesia that followed the AIDS cocktail, the tears and Pyrrhic relief of 1995, when a pandemic was ended but only for the rich world, could recur. In New York, I relish a summer night, sweet freedom, and the return of First World problems. I worry: Should I say “Nearly there,” when I’m only just leaving? Will I sweat into my jacket if I run three blocks from the subway? Is there anything else I’m forgetting?

Advertisement