The Washington PostDemocracy Dies in Darkness

India’s 1.6 million new coronavirus cases in the past week are breaking its health system

Critics blame the Modi government’s pandemic decision-making

A health worker talks to a woman in a quarantine center for covid-19 patients, in New Delhi on Tuesday. (Manish Swarup/AP)
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Four months ago, Indian Prime Minister Narendra Modi declared victory over the coronavirus pandemic. Now the country is in a new covid-19 crisis, with more than 250,000 new confirmed infections daily. India has now overtaken Brazil, with the second-highest number of confirmed cases worldwide.

The actual number of cases may be much higher — testing lags are increasingly common, and some states have curtailed coronavirus testing. Similarly, official numbers report a seven-day average of around 1,300 deaths per day, but undercounting and misclassification of deaths is rampant. Long delays and price-gouging at crematoriums — amid reports of makeshift cremations on sidewalks — suggest the death counts are far higher than reported.

The Modi government faces public criticism for allowing political rallies and religious gatherings. There has been little official focus on further investments in either the country’s health infrastructure or vaccine production capacity. Domestic politics factor into India’s covid crisis in these ways.

The health-care system is completely overwhelmed

India is in the midst of a public health crisis. Hospitals across the country have no available beds or ventilators. Social media feeds show videos of long lines of ambulances outside hospitals and massive queues of people trying to procure drugs at pharmacies. On Tuesday, Delhi hospitals announced they had only a few hours of oxygen left.

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Public health experts blame the government for failing to meet its promises on boosting oxygen supplies. Many assumed the PM-Cares fund — the Prime Minister’s Citizen Assistance and Relief in Emergency Situations Fund, created at the start of the pandemic to solicit donations from citizens — would help in relief efforts.

On-site oxygen generation plants for hospitals, providing a piped supply, were slated to be financed by this fund. A year later, this public health infrastructure is still missing. Details of this $1.3 billion fund, however, remain shrouded in mystery amid allegations of lack of transparency.

The world’s largest vaccine producer faces an acute domestic shortage

India administered more than 3 million vaccine doses per day through much of April, one of the world’s largest vaccine rollouts. This included both the AstraZeneca vaccine (manufactured and branded in India as Covishield) and to a much smaller extent, India’s own vaccine, Covaxin. But last week vaccine centers ran out of doses and shut down across 10 states, including in India’s financial capital, Mumbai.

The Modi government faced strong criticism at home for exporting more than 65 million doses to 90 countries. Last week, with cases increasing exponentially, India halted exports of Covishield. But these vaccine supplies are also an essential part of supply of COVAX — the WHO initiative to provide vaccines to low-income countries. This halt in India’s COVAX commitments probably will increase inequalities in global vaccine distribution.

The Serum Institute of India, which is manufacturing Covishield vaccines, says it lacks the capacity to produce the required 800 million doses to vaccinate the country’s population. The institute asked for government assistance to support its stretched capacity, but to little avail. CEO Adar Poonawalla even tweeted directly to President Biden, urging him to lift an embargo on raw materials required for India’s vaccine production.

Vaccine prices may be out of reach

On Monday, the Indian government declared anyone over the age of 18 would be eligible for coronavirus vaccines, effective May 1. It also announced measures for liberalizing vaccine sales and deregulating vaccine prices.

But millions of India’s poor cannot afford unsubsidized vaccine costs. Despite promises of free vaccines for the first 300 million vulnerable people, around 800 million people in India live on less than $3.10 per day.

The burden of procuring vaccines has shifted to states, private hospitals and industrial establishments. These entities have been advised to buy vaccines directly from manufacturers at market prices, with no cap.

Superspreader religious gatherings probably will worsen the crisis

Last week, millions of Hindu pilgrims headed to the Maha Kumbh Mela for a five-day pilgrimage, held in the state of Uttarakhand. Over 1,700 devotees tested positive, and the festival itself lacked adequate coronavirus protocols.

Uttarakhand is seeing record-high covid cases, and 11 percent of devotees leaving the festival by train have tested positive. Many in India criticized the Modi government for permitting the festival and even facilitating travel for devotees from all across the country.

The lack of public health concern also stands in stark contrast to the government’s handling of a much smaller Muslim religious congregation last year, which resulted in several charges being brought against attendees. The incident led to increased communal backlash against Muslims across the country. This year’s court-mandated restrictions on Ramadan prayer congregations in Mumbai and Delhi also demonstrate inconsistent government guidance on religious gatherings.

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Election rallies are also adding to the surge of cases

India’s latest covid-19 spike coincides with legislative assembly elections in four states and one union territory during April. In West Bengal, the elections will take place in an unprecedented eight phases, allowing parties to sequentially move across districts and campaign in person.

Crowds at election rallies, though, are ignoring all covid-19 guidelines. To deter infections at public rallies, the current ruling party in West Bengal, All India Trinamool Congress (TMC), has proposed combining the final three phases of the elections.

The ruling Bharatiya Janata Party (BJP) is particularly focused on flipping West Bengal — and Modi has personally held large election rallies and praised the massive turnouts. Faced with mounting criticism, BJP announced this week that it will cancel large public rallies and only allow gatherings with 500 people.

New lockdowns create another migrant crisis

The surge in cases has led to lockdowns across multiple cities, triggering a second wave of internal migration. Thousands of migrant laborers in these cities are crowding bus and railway stations, trying to return home. But for many, their destinations are probably poorly equipped to handle testing, quarantining and providing health-care support for covid-19 patients.

A year after the national lockdown in India, the country faces an even bigger challenge with sharply rising cases and deaths — and a migration and health infrastructure crisis that could hurt India’s most vulnerable populations.

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Suparna Chaudhry is an assistant professor of international affairs at Lewis & Clark College.

Shubha Kamala Prasad is a Max Weber Fellow at European University Institute.

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