People have been left to die outside of the hospital they cannot get into, due to lack of beds and facilities. Hospitals around India are reporting dying patients because of oxygen shortages. Few incidents happened; oxygen tanks leaked, and fire broke out in a hospital ward. Doctors and health workers are exhausted, overwhelmed by sudden increase of patients. They are having traumatic experiences as they must make life and death decision and turn away patient in the fact that people are dying who could otherwise be safe. The Indian Medical Association (IMA) reported that 747 doctors have died of Covid-19, the highest number were from Tamil Nadu (89 deaths), West Bengal (80 deaths) and Maharashtra (74 deaths). Healthcare workers are over-worked not only during their working time at the hospitals but also supervising many patients that stay at home without proper medical supplies. Healthcare systems are on the brink of collapse.
India’s swift decision to have two-months-long national lock-down to contain the first wave has sparked a huge exodus of millions of migrant workers who headed home to their villages and put about 100 million people out of work in a matter of days. As an impact, about 230 million Indians fell into poverty with women and children bear most of the brunt. After the first wave, the government was relaxing health protocol and allowing sport-social-religious gathering turn into ‘super-spreader events.’ Thousands or millions of peoples allowed to have gathered in one place without social distancing and mask-wearing. The impact of that decision is devastating.
The government of India ignored warnings from the Indian SARS-COV-2 Genetics Consortium (INSACOG) about the new variant of B.1.617 first detected in early March 2021. Different with the first wave, this time India is faced with a ‘double mutation’ variant of the Covid-19 which is attacking younger populations with severe infections. There are growing fears about the spread of infections to rural areas where health infrastructure is limited or not exist. In the countryside, people die at home without medical attention and these deaths are vastly unreported. The second wave of Covid-19 crisis is expected to add 75 million people more to poverty with incomes of less than 2 USD a day.
As the health system becomes inaccessible, people desperately turn to social media searching for oxygen, ventilators, plasma donations and medical supplies for their loves one to survive. Civil society turns into activists by helping each other through sharing information on social media, verifying news, providing oxygen, medical supplies, and food for free. However, criticism on how the government is handling the crisis is not permitted on social media. Unsurprisingly, the social media companies like Twitter, Facebook and Instagram have been requested to remove all posts criticizing the Government of India. For these social media companies, access to the huge India’ market with 400 million users is more important than the rights of the Indian people for free speech.
The response of various Indian states to Covid-19 will differ as the poorest states have the weakest capacity to deliver health services. Some states will be in far worse shape than others. Maharashtra state is one of the states that has been hit hardest by Covid-19. Over 17.975 health workers have been infected with Covid-19, and 175 have died. According to experts, there are several reasons why Maharashtra recorded the highest number of cases. First, Maharashtra state has the 2nd biggest population in India. Secondly, Maharashtra has more densely populated cities caused by urbanization, like Bombay, the Nation’s financial hub. Third, the new variant of B.1.617 was first detected in early March 2021 in Maharashtra. Fourth, Maharashtra has relatively better Covid-19 recorded tests than other states. Fifth, after the first wave, the government allowed ‘super-spreader events’ where thousands or even millions of peoples participating without respecting health protocols. And lastly, the vaccine roll-out is slow across India.
This ‘vaccine nationalism’ is a very bad policy as it is self-defeating while it opens the possibility of new more-life-threatening variants of Covid-19 mutation to emerge somewhere in a poorer country. It is very risky to rely on production of vaccine from only a few manufacturers to supply vaccine to the rest of the world when cases of pandemic occur. Therefore, we welcomed the support of US and EU to waive the vaccine intellectual property (IP) rights proposed by the government of India and South Africa. It would allow other countries with the manufacturing capacity to produce and scale up production of Covid-19 vaccines. We expect there is not even one country among the 164 members of WTO which will vote against a waiver, because then that initiative would fail.
Patent waiving of IP Rights is just a first step. The fact is producing and distributing vaccine is complicated and takes time. We basically cannot wait for months or years before those patent waivers give impact for boosting global vaccine productions. What we need urgently is boosting production capacity of existing manufacturers and reducing restrictions on the export of vaccine and raw materials to make them. Equitable access to vaccines for all people and a global vaccination strategy will lead to global herd immunity.
As the crisis deepened, international aid is coming from around the world, sending vaccine, oxygen, medicines, diagnostic tests, protective gears, etc. It is helpful, but too little, too late. It is becoming clear that what happened in India is not only catastrophic to India, but also to the rest of the world. As distribution of vaccine being halted, we will be expecting outbreaks to happen soon in other countries. Imagine if the virus reached a state like Myanmar. This country has a very poor health system affected by years of armed conflict and violence. With 1.600 km porous border, thousands of internally displaced persons and political refugees from Chin state of Myanmar flee and seek safe havens in the Mizoram and Manipur districts of India.
What is already obvious is the spill-over of the virus to Nepal. Six provinces of Nepal share a porous border of about 1.850 km with 5 states of India, mainly Uttar Pradesh and Bihar. An estimated 6 million Nepalese live and work in India. With sudden increase of cases up to 9.000 a day, the fragile health system of Nepal is on the brink to collapse. 2 out of 5 people tested now return positive. More than 3.500 peoples have died, and 400 of them in the past 2 weeks alone. Nepal is just two weeks behind India towards similar catastrophe. Closing the borders is too little too late, as Pakistan, Bangladesh and Sri Lanka are also reporting spikes of cases. Very soon the center of global Covid-19 cases will move to South Asia.
Along with the raise of cases in India, more and more countries decided to close its border for peoples coming from India. Discrimination against Indian peoples is increasing in many countries. The government of Australia has taken disproportionate and very punitive laws, which criminalize their own citizens coming or returning home from India. This policy is obviously racists against India-Australians people and civil society organizations should pressure the government of Australia to immediately withdraw this policy.
The worst has yet to come for India. India urgently needs to provide oxygen for patients, roll out vaccines, build temporary hospitals, isolation center and vaccine centers in a short period of time, while providing proper personal protective equipment and safe environment for health workers. People must know that the current vaccine should be seen as preventive measures rather than treatment, which means that those people who were vaccinated can still be infected by the virus and infect others. Research at this point only demonstrated that the vaccine alleviates the symptoms, which is already a huge step forward. Scientist do not know yet for how long the current vaccines will maintain antibody immune system against Covid-19. Therefore, people must respect and implement health protocols everywhere, anytime. Hopefully, anti-viral medicine and booster vaccines that can anticipate new variants and serve to stimulate the immune system to recognize a new variant in a longer lasting period can be developed.
Health has never been a major issue in the general election in India. However, the Covid-19 pandemic should change this . It is now time to raise health care as a prominent campaign. Healthcare spending in India remains just a little over 1% of the Gross Domestic Product, as opposed to the National health Policy which stipulates 2,5%. The budgetary allocation on healthcare as percentage share of the total budget remains at 1,98%. It is the responsibility of the government to ensure the health of the people by providing universal quality healthcare which is accessible and affordable. We should make sure that government manifesto regarding health do not end up mere rhetoric and window dressing. The government must involve people in policy development of the healthcare system, its monitoring and evaluation, because health has always been the primary concern of people. All people have equal rights to universal quality healthcare.
The longer the virus can spread rampant in India, the more people it will infect and the more likely it is that further mutations will emerge. Many people do not yet realize the severity of what lies ahead. What happens in India is vital to what will happen next to the world. While the UK variant was detected in January in the northern state of Punjab, the Indian variant B.1.617 has now reached at least 17 countries. The battle against Covid-19 seems to be a long one. The India case is an alarming reminder of how the virus can spike when precautions are lifted and health protocol ignored. Unless we keep being cautious and learn from experiences like the one from India, we cannot win this battle.
