India Is a Warning

The world’s largest vaccine producer is struggling to overcome its latest COVID-19 surge—and that’s everyone’s problem.

India considered itself to be “in the endgame” of the pandemic just a few weeks ago. Now it is the global epicenter. The country recently surpassed the devastating milestone of more than 345,000 new COVID-19 cases in a single day, the biggest total recorded globally since the pandemic began.

What is taking place in India isn’t so much a wave as it is a wall: Charts showing the country’s infection rate and death toll, which has also reached record numbers in the country, depict curves that have shot up into vertical lines. Public-health experts aren’t optimistic that they will slope down anytime soon.

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, a supply now constrained by India’s domestic obligations. Meanwhile, the coronavirus is mutating. Reports of double- and even triple-mutant strains of the virus, which experts fear could be driving the country’s latest surge, have prompted concerns that what has started in India won’t end there. Despite efforts to restrict the spread of India’s new COVID-19 variant, called B.1.167, it has already been identified in at least 10 countries, including the United States and Britain.

If ever there were a time for intervention, it would be now. But world leaders, who have so far only paid lip service to the need for global cooperation, have mostly been preoccupied by their own internal situations. Although this approach may have served vaccine-rich countries such as the U.S. so far, India could prove its limits.

How did India, which merely a month ago thought it had seen the worst of the pandemic, get to this point? Michael Kugelman, the deputy director of the Asia program at the Washington, D.C.–based Wilson Center, told me the answer comes down to a “perfect storm” of factors that includes new and existing variants (and a lack of robust genomic sequencing to track them), a continuous stream of widely attended political rallies and religious gatherings (with no social distancing or mask wearing), and a general complacency on the part of the Indian government, which was slow to respond to a crisis in which it had prematurely claimed victory.

The result has been overwhelmed hospitals, depleted oxygen supplies, morgues that have run out of space, and crematoria that are melting from near-constant use. The country surpassed 2,000 deaths a day last week—and those are just the cases that have been recorded. This time next month, that figure could rise to as high as 4,500 daily deaths, Bhramar Mukherjee, a biostatician and epidemiologist at the University of Michigan who is tracking the situation in India, told me. Others warn that it could get as high as 5,500. Though the projections vary, the conclusions are largely the same. “All the arrows are pointing to real darkness,” Mukherjee said.

The situation has become so dire that the Pune-based Serum Institute, the manufacturer of the AstraZeneca vaccine and a major contributor to the COVAX initiative to provide doses to low- and middle-income countries, said it will not be able to meet its international commitments amid India’s domestic shortage. Once considered the pharmacy of the world, India is now being forced to import doses.

None of the Indian government’s missteps absolve the world from caring about what happens to the country, nor should they. Beyond the obvious moral reasons are practical ones too. As I have repeatedly written before, 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. Though virtually every known variant, including those from Britain, Brazil, and South Africa, has been identified in India, in some states the Indian strain has become the most prevalent.

“It’s very similar to what we saw in Manaus,” Christina Pagel, the director of clinical operational research at University College London, told me, referring to the badly hit Brazilian city. She noted that “it’s not a coincidence that these variants are arising in populations that have developed immunity through infection.”

Read: The Brazil variant is exposing the world’s vulnerability

Then there’s the issue of vaccine supply. India’s role as a major pharmaceutical producer has been spotlighted during the pandemic; it has provided 20 percent of the world’s generic drugs as well as more than 60 percent of the world’s COVID-19 vaccines, despite having inoculated just 1 percent of its own population. The country has the capacity to manufacture 70 million doses a month, but even with all of those doses directed toward its domestic needs, they’re not enough to meet the overwhelming demand. At present, India is administering some 3 million doses a day. To protect its population of 1.4 billion, Mukherjee said that rate would need to increase threefold.

Donating doses directly to countries that need them, including India, is a nonstarter for many countries. Most of those that have vaccines don’t have enough of them, and those with an immense surplus, such as the United States, aren’t yet confident enough in their supply to part with the excess.

But these countries can help in other ways. The first is by lifting export controls on the raw materials that are used to produce vaccines. This is what the CEO of the Serum Institute has asked of the Biden administration weeks ago. On Sunday, the U.S. government heeded the request, announcing that it would look to immediately provide the raw materials necessary to help India produce the AstraZeneca vaccine, locally known as Covishield, as well as other medical supplies. The British and German governments also pledged their support.

Another option is for countries to support the appeal, put forward by India and South Africa, for the World Trade Organization to temporarily relax patent rights related to COVID-19 vaccines and treatments so that they can be manufactured, without fear of being sued, by countries that are still struggling to inoculate their populations. More than 70 former world leaders and 100 Nobel Prize laureates have appealed to the Biden administration to back the waiver, as have several U.S. lawmakers. “If we want to restore America’s global leadership in the post-Trump era, we should help other countries access the technical know-how they need to manufacture their own vaccines to fight COVID-19,” Senator Chris Murphy, one of the 10 Democratic senators who have called on the Biden administration to back the effort, told me in a statement. “It’s an easy, effective way for the United States to help.”

There is a host of other ways for countries to help, irrespective of their resources. Assisting India with its sequencing is one option. Donating the oxygen the country so desperately needs is another.

Though mass vaccination has provided an off-ramp from the pandemic for some countries, India is a stark reminder that, for many others, a long road lies ahead. The world is on track to record more COVID-19 deaths this year than it did in 2020. The risks of allowing current outbreaks to ravage places such as India aren’t limited to those countries alone. Emerging variants and further delays to more equitable vaccine distribution stand to affect everyone, including vaccinated populations. India’s problem is the world’s problem.



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