Just a few months ago, our health minister sanguinely led us to believe we had overcome Covid-19, triumphantly declaring that “India has flattened the Covid graph.” Three months later those words ring hollow as India is at a crisis point, its health infrastructure deficiencies ruthlessly exposed.
Hospital beds are impossible to come by even for the rich and powerful who find to their horror that wealth and status pose no obstacle to the SARS-CoV-2 virus. Oxygen shortages and rationing, overflowing graveyards and crematoriums are not just nightmare scenarios from a dystopian future but very real, even in the country’s financial nerve centre, Mumbai. Essential drugs (and some deemed “essential”), like redeliver and tocilizumab, are impossible to get even at black market rates, and the number of cases across the country reached a tragic global milestone with 3,12,731 new infections recorded in a single day (1 in every 7 globally) taking India’s tally to 15 million cases with a death toll of 1,80,000.
What are the reasons for this disaster? Here are the four that I believe are most relevant.
Complacency: Indians let down their collective guard. Instead of being bombarded with messages exhorting us to be vigilant, we heard self-congratulatory declarations of victory from our leaders, now cruelly exposed as mere self-assured hubris. Let’s be honest, we seemed to be doing well at the start of the year, not because of any great public health strategy but merely due to “luck” and the virus biding its time. And then the bad just got worse.
A different variant: It is apparent to experts that the new strain in circulation is caused by a variant, far more infectious than the initial strain. Yet we still have no clear indication of the genotype of the strain(s) currently in circulation because we have performed gene sequencing on a paltry 0.1% of our cases. The UK, by contrast, seems to have scored a convincing victory against the virus, partly because of the £20 million committed to daily sequencing of the virus across the country.
A slow vaccine rollout: India’s vaccine rollout proceeded at a glacial pace without any sense of urgency. Only 4.5% of India’s population have been vaccinated as of April 20, which means we are a full 600 days away from reaching herd immunity (70% of the population vaccinated).
Despite India being touted as the “vaccine superpower of the world” we are faced with the frightening spectacle of vaccine shortages, with several vaccine centres reporting very limited stock. The Centre seems to have got its calculations hopelessly wrong if we had the largesse to distribute vaccines to neighbouring countries despite facing a deficit at home. Crowded vaccine centres with people jostling for their turn before stocks finish are common – I’m convinced many people to acquire Covid at crowded vaccine centres, coming down with symptoms a few days after their first dose.
This results in vaccines getting a bad name when in reality neutralising antibodies build up two weeks after the second dose. Our innate inability to socially distance, not the vaccine, is to blame. Vaccine hesitancy is also to blame. The unchecked spread of misinformation – “death by WhatsApp” – is also responsible for Indians’ wariness about the vaccine.
Political miscalculation: Allowing rallies and large election meetings without any checks, permitting crowds of several hundreds of thousands to gather en masse for the Kumbh Mela strike one as heinously inappropriate. Religious sentiments, nepotism and crowd-pleasing sadly trump basic public health principles and common sense in India.
And so we see history repeat itself both as tragedy and farce, oblivious to the lessons we should have learnt from the first wave. We witness the same kneejerk reaction yet again, with lockdowns and streams of returning migrants who will almost certainly seed this strain of virus across the hinterlands of the country. We witness yet again the pathetic unpreparedness that has come to characterise India’s Covid response.
It’s not too late, however. We must roll out vaccines on a war footing, spending whatever it takes on their production, mobilisation, distribution and injection. Vaccines are the only way out of this dark tunnel – to all adults above the age of 20, as quickly as possible. Vaccines at every GP clinic, school and village square. We’re not yet sure if vaccines conclusively prevent us from getting infections or from passing them on, but they indisputably prevent those infections from being severe enough to need hospitalisation or ICU.
This will keep away the floods of admissions at our hospital gates, allowing overworked doctors and stretched healthcare centres the chance to recoup. Vaccine developers will have their work cut out to ensure their vaccines keep up with variant strains. ICMR needs to invest in large nationwide sequencing studies to determine which vaccines work best against prevailing variants. Indeed the battle between vaccines and variants is likely to be long and hard and for humanity’s sake, the former must win.
Let us invest in many vaccines from every reliable source possible so that no Indian goes unvaccinated. We need to fight the false messages of the anti-vaccine lobby with clear and easy to follow pro-vaccine messages, endorsed by celebrities and public figures. Even more crucially, let’s have the discipline to mask up and avoid all social gatherings for the foreseeable future. Till vaccines are universal, and probably long after, let’s not underestimate the vital importance of the humble but well-fitting mask, hand washing and social distancing as public health measures par excellence.