Ashish K. Jha is dean of the Brown University School of Public Health.
What happens next will have large implications both for South Asia and for the world. It is time for the United States, the world’s oldest democracy, to come to the aid of this key global ally. Here are three critical things it can and must do:
First, support India’s public health response. India’s testing infrastructure is not adequate to keep up with the level of infections across the nation. The United States has done well scaling up testing capacity, and given that it now has an excess supply of testing kits, it can easily send some to India. The United States can work with India to develop a strategy for how best to deploy those tests. People infected with the virus do most of the spreading early in their disease course, and testing them during that time period, often before they have symptoms, is critical to controlling the outbreak. With limited testing capacity, India is primarily testing symptomatic people long after they’ve finished spreading it to others, which has little impact on controlling the disease.
Beyond testing, India would benefit from high-quality personal protective equipment to protect its front-line clinicians and to support high-quality mask-wearing for its general population. As the United States builds up its capacity here, it can work with U.S. manufacturers to send India its high-quality masks.
Second, bolster India’s capacity to treat covid-19 patients. India’s health system is on the verge of collapse. Many hospitals already have run out of beds, and the situation is likely to get much worse before it gets better. The United States should work closely with Indian counterparts to establish field hospitals.
Beyond beds, India desperately needs supplies, most urgently oxygen. The Modi government recently announced its intention to buy 50,000 metric tons of liquid oxygen. It might not be enough. The United States has production capacity and can help get more oxygen delivered to India.
India is also running out of key medicines for sick patients, including sedatives needed for patients on ventilators. Remdesivir, used to treat covid-19, is in short supply as well. Fortunately, the drug most helpful in severe disease, dexamethasone, is widely available in India, but given significant rates of counterfeit and substandard medicines in India, the United States may be able to help ensure adequate supplies of high-quality dexamethasone. The United States also has ample stockpiles of monoclonal antibodies, which have yet to be widely used here. These treatments are most effective early in the disease course, so the Food and Drug Administration should work with Indian drug regulators to determine whether and how they could be best used in India.
Finally, boost India’s vaccine supplies. The Biden administration must clear the path to sending our excess supply of vaccines to India and other countries in crisis. India is currently vaccinating around 2 million to 3 million people per day, similar to daily records in the United States, but inadequate in a population four times our size. India has so far managed to vaccinate only about 10 percent of its population.
The United States has, according to some estimates, at least 30 million unused doses of the AstraZeneca vaccine that the FDA has not yet authorized. Given declining rates of vaccination among Americans, they seem unlikely to ever see domestic use. We should lend them to India now. Further, we should develop a plan to send excess supplies of Pfizer, Moderna and Johnson & Johnson vaccines abroad. The Serum Institute of India, the world’s largest manufacturer of vaccine doses, reported last week that it was unable to ramp up production due to U.S. export controls on raw materials. President Biden invoked the Defense Production Act and an associated export embargo in February to focus on domestic production. Given that we now have more vaccines than we need, it is time to lift this embargo so that India can produce the vaccines it badly needs.
India is in a crisis. The United States has strategic interests in helping India weather the pandemic; it is also the right thing to do. Only the United States has the capacity, resources and technical know-how to bend the curve of India’s catastrophic second wave of disease. The faster we assist our ally, the more lives will be saved. One democracy coming to the aid of another in this time of crisis is exactly what the world needs now. It will be good for India. It will be good for the United States. And it will make the world a safer place.