The catastrophe unfolding in India appears to be the worst-case scenario that many feared from the Covid-19 pandemic: unable to find sufficient hospital beds, access to tests, medicines or oxygen, the country of 1.4 billion is sinking beneath the weight of infections.
The two opposed assumptions of the global response to coronavirus – wealthy countries in the west prioritising vaccines for their own need in one camp, and the argument led by the World Health Organization for global vaccine equality in the other – are also failing to hold as the scale of the crisis in India points to an urgent need to prioritise the response there.
With the global supply of vaccines unlikely to pick up until the end of this year, what is required now is international leadership and a recognition that, despite the best intentions of the World Health Organization and the vaccine-sharing Covax initiative to fairly distribute jabs, the pandemic may require a period of more focused firefighting where difficult and sometimes unpopular decisions need to be made.
That will require countries to look beyond their own health crises to see that the pandemic could still get much worse without intervention. Experts have repeatedly warned that allowing the virus to circulate unchecked increases the risk that dangerous new strains will emerge and prolong the pandemic.
Models already exist for what could be done, including George W Bush’s initiative to fight Aids in Africa under the president’s Emergency plan for Aids relief and the 2014 global response to Ebola in West Africa, which was seen as an international priority.
The reality is that the magical thinking displayed by the Indian prime minister Narendra Modi’s government – which claimed the pandemic was in its “endgame” in March as the country careened towards a second wave of infections – was not much different from the mistakes of other leaders, including the former US president Donald Trump, who thought the virus would simply disappear, or the mistaken boosterism of the UK prime minister, Boris Johnson.
What is different in India – a country with a fragile health system and even weaker surveillance – is the huge possibility for harm locally and globally, perhaps on a scale not yet seen in the pandemic.
India has also dramatised the danger of an atomised approach in the global response to coronavirus.
The world’s biggest producer of vaccines, the Serum Institute of India, was supposed to supply doses under the Covax scheme to poorer nations, mostly in Africa. Doses have now been diverted for India’s needs, which is itself has struggled to acquire material for vaccine production from the US.
As a consequence of the crisis, this month India shipped just 1.2m doses abroad compared with 64m in the three months prior.
China, which has heavily pushed its own version of vaccine diplomacy, has already moved to fill that vacuum. Wang Wenbin, a spokesperson for the Chinese foreign ministry, said that “China is willing to provide the necessary support and help” to India, though he did not detail specific information. The UK government is to airlift 495 oxygen concentrators, which can extract oxygen from the air when hospital systems have run out, 120 non-invasive ventilators and 20 manual ventilators to Delhi, with Germany also likely to send an oxygen generator and other aid.
But what India needs immediately is supplies for its vaccine factories, currently held up by US export restrictions, and tools, such as genomic sequencing, to identify and control existing and emerging variants.
One hopeful sign is that the US has promised to “rapidly deploy” aid to healthcare workers in India, where there has been a fourth consecutive day of world-record Covid case numbers.
The US said it was in high-level talks to deploy extra help to Indian healthcare workers and that it was gravely concerned about the situation there.
Dr Anthony Fauci, the US’s top infectious diseases expert, said on Sunday several measures are being considered, including sending over oxygen supplies, tests, drug treatments and personal protective equipment.
“Bottom line, it’s a terrible situation that’s going on in India and other lower middle-income countries, and there is more we can do,” he said.