Experts criticise India's complacency over COVID-19
Authors: Anoo Bhuyan
Journal: The Lancet (2021)

Mass gatherings have been permitted as cases soar and patients die, while experts criticise a lack of planning and flexibility in the COVID-19 response. Anoo Bhuyan reports from New Delhi. India is battling a second wave of COVID-19, which has rapidly surpassed its first wave in 2020 in terms of the number of new cases and deaths per day. Currently, India has the second highest number of COVID-19 cases in the world after the USA. “The country is working day and night for hospitals, ventilators, and medicines”, said India's Prime Minister in his monthly national broadcast on April 25, 2021. India has been recording more than 300 000 cases of COVID-19 per day since April 21, up from 100 000 per day on April 4. These numbers eclipse India's previous highest number of new cases reported in a single day, at 97 860 cases on Sept 16, 2020. Health infrastructure has collapsed in several cities, with several state governments imposing curfews and lockdowns on movement, such as in the national capital New Delhi and in Maharashtra. State governments are scrambling to build up new infrastructure, making announcements this month about suddenly commencing the construction of new health facilities or oxygen plants. However, this frenetic activity comes in the middle of an ongoing and exponential rise in cases, whereas it should have come before, say experts. In early 2021, an opinion that India had overcome the pandemic and acquired herd immunity gained ground among policy makers, sections of the media, and the public, said Srinath Reddy, president of the Public Health Foundation of India. “Even sections of the scientific community propagated this view”, he added. The belief that there would be no second wave, says Reddy, was also spurred on by the desire to reopen society and revive economic growth. Although India saw a lull in cases in January and February of this year, March was a period of hectic public gatherings, sanctioned and even encouraged by public officials. Five states held elections this month, and many politicians, including India's prime minister and leaders of several parties, conducted hundreds of massive political rallies around India. Just 10 days ago, in an address at an election rally in West Bengal, India's Prime Minister Narendra Modi said he had never seen such huge crowds at a rally. Last month, he tweeted: “On my way to the massive party rally.” The Bharatiya Janata Party, to which he belongs, has been regularly publishing the location and timing of his various public rallies for people to attend. India's election commission, responsible for organising all elections, had repeatedly published notices threatening to act against politicians for their massive rallies and roadshows during the pandemic, but these notices have not amounted to much as the commission has not taken action against any political party for the crowded rallies. Only last week did they finally take their strongest action yet of banning political roadshows. However, the commission has still permitted public meetings by politicians, with the caveat that they be kept to under 500 attendees. Despite the pandemic and the risk of a major rise in cases, central and state governments also permitted the Hindu festival of Kumbh Mela to go ahead. Millions of Hindus turned up to the festival for prayers and a dip in the river Ganges, which is considered auspicious. The festival began on April 1, and was only called off by local authorities 17 days later. Local authorities reported nearly 2000 cases of COVID-19 detected among people who had come to participate in the festival. Fully opening society with unrestrained crowding, mass gatherings, large scale travel, and lack of personal protective measures such as masks “permitted the virus to move freely”, said Reddy. “Large mass gatherings should have been avoided”, he said. This action could have not only protected participants in these mass gatherings, but also prevented others from getting the wrong signal that the danger had fully passed. The most palpable and visceral crisis in the country currently is a shortage of oxygen in hospitals. “We are delivering oxygen cylinders to people's houses when they call us in an emergency”, said Harteerath Singh, a volunteer with Hemkunt Foundation in Delhi. Singh and a group of volunteers have about 200 oxygen cylinders, which they constantly get refilled from various vendors and deliver to people's homes around Delhi. Singh said they are currently finding it difficult to get any new cylinders or refill the ones they have because vendors everywhere are busy or out of stock themselves. Indian social media is awash with thousands of requests from all over the country of people asking if there are any oxygen cylinders or hospital beds with oxygen or ventilators available. India's daily production capacity for oxygen is 7127 metric tonnes and consumption is 3842 metric tonnes, according to Indian Government data released in early April. However a few days later, Max Hospital, a private hospital, approached a Delhi court to inform them about an oxygen shortage at their facility. During the hearing, the government is reported to have told the court that India's oxygen consumption was over 8000 metric tonnes per day by April 21. “I dread receiving calls from family or friends these days as mostly it is to seek help in finding a bed. In most cases I have failed”, Tweeted Indu Bhushan, a senior bureaucrat who was instrumental in setting up India's massive health insurance scheme in 2018. The central and state governments had scaled back some of the arrangements they had made for oxygen in hospitals after the first wave subsided. As COVID-19 numbers were waning, perhaps this was alright, said T Sundararaman, former dean of the School of Health System Studies at the Tata Institute of Social Sciences, but there was no “flexibility” in the system to ramp it up quickly as numbers rose again, he said. “The government did not plan for both peak and non-peak scenarios”, he said, which explains why there is not enough supply to meet the demand as India has hit yet another and a much higher peak. “The government needs to take responsibility for both production and logistics of distribution of this oxygen and cannot claim that there is enough supply or that supply is now being created, without also handling its distribution.” The Indian Government only announced on April 15 that it is looking to import 50 000 metric tonnes of medical oxygen. It has asked its foreign missions in different countries to find vendors who can supply medical oxygen to India. The EU will “do its utmost to mobilise assistance”, especially with regard to oxygen supply and medicines, according to Janez Lenarcic, the European Commissioner for Crisis Management. Similar messages of support have been made by officials in Germany and France. The Indian Government has also sent aircrafts to Singapore to airlift liquid oxygen containers and deliver them to India. The US Government issued a statement on April 25, 2021, saying that it will release raw materials that are needed for making COVID-19 vaccines to India, and that it is looking into how to send oxygen generation equipment “on an urgent basis”. However, the higher number of COVID-19 cases in India has also triggered foreign governments to be more cautious. The UK Government has banned visitors travelling from India from entering the UK, and the French Government has imposed a 10-day quarantine on any traveller from India entering France. The Indian Government has said that India's programme to give the COVID-19 vaccine is the “world's largest”. Indian companies are also manufacturing and exporting COVID-19 vaccines to the rest of the world. For example, Serum Institute of India is exporting the AstraZeneca COVID-19 vaccine, and several Indian companies are also manufacturing the Sputnik-V vaccine. However, despite manufacturing vaccines for other countries, India is facing a shortage of vaccines for its own programme. Some people who have received their first injection of the two vaccines in use in India (Covaxin and Covishield) have been unable to get their second dose as vaccination centres around the country are reporting an absence of replenishments. “It was all bad planning”, said Shahid Jameel, a virologist at Ashoka University in New Delhi. “India did not give sufficient orders to vaccine companies, to allow them to manufacture enough doses. Whereas other countries, which are taking vaccination seriously, had all given assured orders to vaccine manufacturers.” The Indian Government last declared on April 8 how much vaccine stock it had, when the health minister reported a stock of 24 million doses. As of April 26, the country has administered around 145 million doses, and has said that it intends to administer 500 million by July, 2021. However, the government has not given any data as to where and when the millions of vaccine shots needed for the targeted groups would be available. All the same, the government has announced that all adults older than 18 years will be able to get a COVID-19 vaccine, starting May 1, 2021. Despite this shortage, India is also continuing to export vaccines made commercially in India as donations and to WHO's COVAX Facility. “India's vaccine diplomacy and policy of exporting and donating vaccines was a good thing”, said Jameel. “But we underestimated our demand.”