Will India be able to avert a third wave of the coronavirus pandemic?

Print edition : September 10, 2021

People waiting for the jab outside a vaccination centre in Mumbai on August 19. Photo: RAFIQ MAQBOOL/AP

The downward trajectory of the second wave has slowed down to imperceptible levels, a worrying trend in a context where the numbers are rising again around the world.

When Soumya Swaminathan, Chief Scientist, World Health Organisation, recently emphasised that there was no clear and definite way of predicting whether and when India would get a third COVID-19 wave, reports in the media reported her as also saying that it was not likely to be like the second wave. She apparently suggested that more localised outbreaks springing up from time to time were the more likely possibilities that India should expect as the future trajectory of the pandemic. She also cautioned that India should not let down its guard.

This expectation of a tepid third wave in India comes against a background of an increasing trend globally in the number of confirmed COVID cases and the number of deaths since the last week of June and the second week of July respectively. Intriguingly, even in the United States both these numbers have been rising.

Worrying Global Backdrop

At close to 1,14,000, the test-confirmed cases per million of the population since the beginning of the pandemic in the U.S. is almost five times greater than that of India. At 60 per cent, the proportion of its population that has received at least one vaccine shot is almost twice the proportion in India. At 50 per cent, the proportion of the population fully vaccinated in the U.S. is over five times the level in India. Going by these numbers, the proportion of the population in the U.S. immunised by either infection or vaccination should be much greater than in India. Yet, the U.S. is now reporting a seven-day average of close to 1,40,000 cases daily and the daily death toll is hovering around the 1,000 mark; per head of population, these are like the official numbers India had at the peak of its second wave.

Of course, the U.S. has seen worse periods in the past, but there is no guarantee that the current rising trend will reverse before previous peaks are attained. Moreover, less than two months ago the U.S. numbers had looked better than at any point of time since April 2020. This initially suggested that the transition from Donald Trump to Joe Biden would prove to be the harbinger of a decisive and pleasant turnaround. But that has not been the case.

The U.S., however, only serves as an important illustration of a more general phenomenon. The point is that wherever the COVID-19 pandemic has not been suppressed very early and has been allowed to spread widely in the population at least once, it has proved to be resilient and turned endemic. It seems to come back in wave after wave even in the face of widespread vaccination. Even Israel, which has administered 144 vaccine doses per 100 of its population, is currently experiencing a rising trend in cases and its daily numbers are already approaching the previous peak levels.

Also read: The fall and rise of COVID numbers

That India would be an exception to this larger pattern simply because its sero-survey has shown 67 per cent of the population carrying antibodies may be a misreading of the data. That Soumya Swaminathan did not intend to suggest this is indicated by her insistence that India should not let down its guard. India’s high seroprevalence levels despite a relatively limited spread of vaccination should therefore be seen primarily as evidence of how ineffective its epidemic control measures have been rather than as a source of comfort.

Second Wave Still Ongoing

The evidence in any case indicates that India’s second wave is far from over. The data between July 12 and August 15 show that the COVID-19 story in India has ‘settled down’ for now into a relatively stable situation. The numbers of cases, deaths and also vaccinations seem to remain similar week after week, moving neither up nor down in any prominent fashion (see Table).

The number of cases is still more than three times the numbers reported at the beginning of the second wave in the week ending on February 14. The number of weekly confirmed deaths is still over five times the number in the week ending on February 14. This is a “stability” one would not want to see; it indicates that the downward trajectory of the second wave has slowed down to an almost imperceptible level. More than 100 days have passed since the peak in daily cases on May 6. In this period, over 10.83 million Indians have been confirmed to have contracted COVID-19 and nearly 1.99 lakh have been officially recorded as having died from the disease.

Not every part of the country is, of course, showing the same situation. A large number of States constituting a contiguous region in northern and western India—Bihar, Jharkhand, Chhattisgarh, Madhya Pradesh, Uttar Pradesh, Uttarakhand, Delhi, Haryana, Punjab, Rajasthan and Gujarat—are reporting daily/weekly case numbers that are lower than at the beginning of the second wave. The complete opposite is the case with another contiguous region beginning from Maharashtra and Goa in western India, encompassing all the Southern States (Karnataka, Kerala, Tamil Nadu, Andhra Pradesh and Telangana), the eastern States of Odisha and West Bengal, and stretching to the north-eastern States (Assam, Manipur, Meghalaya, Mizoram, Nagaland, Arunachal Pradesh, Sikkim and Tripura); likewise in Himachal Pradesh, Jammu and Kashmir and Ladakh.

The 11 States reporting lower numbers at present, however, have always tended to under-report cases. Though they account for almost 55 per cent of the Indian population, their contribution to the cumulative total in test-confirmed cases since the beginning of the pandemic has been less than 30 per cent. Yet the Indian Council of Medical Research (ICMR) found the highest levels of seroprevalence among their populations, despite many of them lagging behind in vaccination.

Widespread Immunity: Myth or Reality?

It can perhaps be argued that even if by default rather than by design, States that are home to the bulk of the Indian population, many with a relatively poorer health infrastructure, are now protected because the virus has already touched large parts of their populace and imparted to them something like herd immunity. It could be additionally presumed that any residual shortage in the requirement for herd immunity will be taken care of by vaccination, and vaccination may cover their entire populations before the existing immunity wears off. Going by this logic, these States are not likely to see a third wave any time soon.

Also read: False positivity amidst declining second wave

It could be further argued that parts of the country that have been more successful in slowing down the virus but are showing, as a result, higher incidence of the infection at present, will also perhaps achieve the same situation over the next few months, aided by a good vaccination performance. Yet, the U.S. experience shows how tenuous such assumptions can be, and there are in fact many conditions on which the expected outcome depends.

The experience of the U.S. and others reinforces the well-established scientific view that no country is safe until everyone is safe. Indeed, the gross global inequalities in vaccination may be one of the important reasons for rising numbers even in highly vaccinated countries. One response to this has been the plan to give booster shots to those who have been given two doses. The plan has drawn the ire of the World Health Organisation as it may aggravate the problem. As the epidemic gets prolonged and sustains its worldwide spread, the risk of new and more infectious variants of the virus emerging, which can also reduce the efficacy of vaccines, increases. In such a situation the completion of India’s current vaccination programme will not be sufficient to guarantee foolproof protection for its population.

Moreover, India continues to face a difficult trade-off between the objectives of vaccinating its own population and that of contributing to the global battle against the pandemic. What is in India’s “national interest” remains apparently a debatable question. Organisations such as the WHO have never compared India’s decision to ban exports of vaccines with the actions of the advanced countries when they similarly prioritised vaccination of their own populations. India’s economic status as a lower-middle-income country and the devastation produced by the second wave (which was when the ban came into force) were of course contributory factors. However, an additional factor was the underlying structural constraints that the WHO could not possibly comment on, but which was the result of the lack of foresight and planning on the part of the Indian government. This was the eminently avoidable problem of inadequate capacity in India to produce vaccines. India and the world are paying a heavy price for this critical policy failure of the Narendra Modi government in the one area where India had the potential to play a leading role in the global battle against the pandemic. As a consequence, India is both a contributor to and a victim of the global inequality in vaccination.

Nearly 45 per cent of India’s adult population (31.72 per cent of the total population) had received at least one dose by August 18, 2021. Less than 10 per cent of the population, or under 14 per cent of adults, have been fully vaccinated. These are still below the world averages of 31.96 per cent and 24.01 per cent respectively, according to the data provided by Our World in Data. On August 18, the seven-day average of the number of vaccine doses administered daily per 100 persons was 0.4, below the world average of 0.45 and significantly lower than the Asian average of 0.56. These numbers expose the limits of both the scale and the speed of India’s vaccination programme, which the government propaganda machinery continues to showcase as a colossal and unparalleled achievement.

Also read: Fourth ICMR sero-survey results

With the countrywide vaccination doses administered “stabilising” at somewhere between 35 and 37 million a week, India is only on track to add around 700 million (70 crore) jabs to its vaccination tally in the 19 weeks or so remaining in 2021. However, there are 52 crore Indians still waiting to receive their first dose and another 28 crore whose second dose is pending. Thus, almost half of the remaining balance will not be covered by 70 crore doses.

As the weeks and months pass, the Indian government’s pandemic response remains stuck in a groove, reduced to a kind of routine activity. Nothing much changes in either the actual practice of the policy or the propaganda on it. Notwithstanding the official statements about the need to remain cautious, the propaganda is clearly contributing to lulling the country into a false sense of security and a belief yet again that the worst is past us. But with each passing day, the reality is that the danger is only increasing. It is luck alone that India now relies on to avert being struck by lightning once again.

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