The covid-19 crisis in India is a massive setback for the entire world. The scale of the nation’s surge is a warning not only for its neighboring countries, which are also experiencing sharp increases in cases, but also for countries around the globe. If we do not heed this warning and work on vaccine equity, we risk a forever pandemic with long-term cycles of lockdowns, economic damage and constant fear.
India is reporting more than 380,000 cases and 3,500 deaths daily. Both are underestimates. The Indian health-care system is completely overwhelmed. It is impossible to find hospital beds. Supplies such as oxygen are incredibly scarce, and there is a huge backlog with diagnostic testing. Many people with sick family members and friends in India — including us — are checking in on them. This time around, younger people are sick and, as is always the case, the poor are hit the hardest.
The devastating second wave in India is the result of a perfect storm: a failure to plan for a second wave; premature relaxation of public health measures; large gatherings; insufficient vaccination coverage; and newer variants such as B.1.1.7 and B.1.617 that are highly transmissible and potentially more severe.
India has 95,000 intensive care beds and 48,000 ventilators. By mid-May, it is projected that the country will need 340,000 beds and more than 700,000 ventilators. Rural India has few of these and is already hit hard. India needs the global community’s support to survive this crisis.
Even as India struggles to get the second wave under control, cases are surging among India’s neighbors, including Nepal, Pakistan, Bangladesh and Sri Lanka. While the exact variant driving the new surges among India’s neighbors is unclear, the B.1.617 variant has already spread to more than 18 countries.
The Indian subcontinent is not OK pic.twitter.com/D9eByNvMLj
— Madhu Pai, MD, PhD (@paimadhu) April 28, 2021
Other countries in South Asia have far less resources and medical infrastructure compared with India. Nepal, for example, has 1,486 ICU beds and 634 ventilators , and Nepal’s health ministry is anticipating a need to treat 15,000 ICU patients by July. Bangladesh, home to 163 million people, has only 1,134 covid-19 ICU beds. Pakistan, the fifth-largest country in the world, has fewer than 4,000 ventilators. India’s neighbors can ill afford the kind of devastation India is experiencing.
Vaccination coverage in these countries is too low to prevent surges. Pakistan, Bangladesh and Nepal have vaccinated 1 percent, 3.5 percent and 7 percent of their populations, respectively, with a single dose. And vaccination numbers are not likely to ramp up soon, given that India is now prioritizing domestic vaccination efforts. India’s vaccine supply to Covax, the World Health Organization’s initiative to send vaccines to developing countries, is now in jeopardy.
Another truly frightening scenario is the spread of the more transmissible and lethal variants to low-income countries, especially on the South American and African continents. The uncontrolled outbreak in Brazil (driven by the aggressive P.1 variant) has already posed a threat for many South American countries.
Most countries in Africa have limited health infrastructure and cannot possibly deal with the severe disease typical of the newer variants. As the variant that emerged in South Africa has shown, the continent has limited capacity for such surges. It is estimated that there are fewer than 2,000 ventilators across 41 African countries. Ten African countries have none at all.
Only about 2 percent of the vaccine doses administered to date globally have been in Africa, and poorer countries might not be vaccinated until 2024. The entire continent is therefore highly vulnerable to the newer variants that are causing havoc in Asia and South America. If African leaders and the general public give up on public health measures, they might see the kind of devastating surge that South Asia is experiencing. No country is safe.
It has become painfully clear that newer variants of the virus have transformed the nature of this pandemic. We cannot just vaccinate rich countries and hope that we will be safe. The only way to end this pandemic is to end it everywhere. Otherwise, we will forever play whack-a-mole with a constantly mutating virus.
History will not be kind to us if we do not ensure global access to covid-19 vaccines. The rollout of highly effective vaccines in record time is one of the greatest triumphs of science. But the hoarding of vaccines and roadblocks around sharing raw materials and information on how to make these vaccines globally will be seen as our biggest strategic mistake.
Global leaders must collaborate, waive intellectual property rights, share technology, and allow and support more countries to manufacture vaccines. Sharing of the mRNA vaccine recipe is critical, since these vaccines can be quickly redesigned to keep up with the newer variants.
India is a cautionary tale for the world. It is proof that we cannot fight this pandemic country by country. By the time we put out one fire, we will have to fight another. World leaders must think beyond their borders and do the right thing for all of humanity.
Madhukar Pai is a professor of epidemiology and global health at McGill University. Manu Prakash is an associate professor of bioengineering at Stanford University’s Center for Innovation in Global Health.