Tue. Jan 18th, 2022

The second wave of the pandemic that has battered India raises many questions for which policy makers don’t yet have good answers. But they all depend, in large measure, on a single factor: the Indian government ramping up a so far lackluster vaccination program to protect against a potentially devastating third wave of infections.

Can the Indian economy bounce back quickly or will it languish for an extended period? Many livelihoods hinge on a sustained reopening. The Pew Research Center estimates that last year’s (milder) first wave of Covid drove 75 million Indians to poverty. This includes 32 million who dropped out of the middle class, more than half of the 54 million world-wide who suffered this misfortune amid the pandemic. And damage to Asia’s third-largest economy affects the region more broadly.

Can India, the world’s largest vaccine manufacturer, still play an outsize role in inoculating the developing world while it struggles to deliver vaccines to its own population? As of Wednesday, India had fully inoculated only 3% of its population. About 11.3% have received at least one dose of vaccine. By banning exports, the government has already leaned on the Serum Institute of India, the world’s largest vaccine manufacturer, to redirect for domestic use 140 million doses of the Covid-19 vaccine earmarked for the World Health Organization’s Covax initiative. The Serum Institute was supposed to supply about 1.1 billion doses of vaccine to Covax. That goal now appears fantastical.

Will India be a viable competitor to China for influence in Asia and beyond? On Wednesday, China delivered 500,000 donated doses of its Sinopharm Covid vaccine to Sri Lanka, adding to the 600,000 doses it delivered in March. Taking advantage of India’s disarray, Beijing has also supplied vaccines to Bangladesh, Nepal and the Maldives, countries New Delhi has long regarded as part of its sphere of influence.

Will Prime Minister

Narendra Modi’s

popularity—pummeled by his spectacular mishandling of the pandemic—recover? According to pollster Morning Consult, Mr. Modi’s approval rating has fallen to 64%, still high compared with other world leaders, but much lower than before. His net approval has fallen 20 points since the start of April. Last week an Indian pollster, CVoter, found that for the first time since Mr. Modi took office seven years ago voters dissatisfied with his performance outnumber those who are satisfied.

While many variables will affect the ultimate answers to these questions, the principal one will be the government’s response to the pandemic.

For now it looks as if the second wave of the pandemic is receding almost as quickly as it rose. On Wednesday India recorded around 211,000 cases, roughly half of its peak of about 414,000 cases on May 6. Officially recorded deaths remain high—3,800 on Wednesday—though down from a peak of 4,500 on May 18. India has been the epicenter of the pandemic since early April, so improvements there contribute disproportionately to the global Covid count. On Wednesday the world recorded around 561,000 cases, down from a peak of 906,000 on April 28.

Not everyone believes this apparent good news. Experts agree that India grossly undercounts cases and deaths. In a phone interview,

Bhramar Mukherjee,

a biostatistician at the University of Michigan, estimates that the true death rate in India’s second wave may be four to six times the official count. She points out that seroprevalence studies after the first wave showed that India’s official count had captured as few as 1 in 16 cases.

Skeptics argue that the lower official numbers may be explained by the pandemic largely migrating to the rural hinterland of some of India’s poorest and most populous states—including Bihar, Uttar Pradesh and West Bengal—where testing is uncommon. State governments may even suppress data in some cases.

The daily death count remains high in part because deaths lag cases, but also because other factors are stretching hospital capacity. In addition to Covid and everyday diseases and injuries, Indian doctors are fighting a deadly epidemic of “black fungus” thought to be caused by the overprescription of steroids and a high prevalence of diabetes.

The gut-wrenching images coming out of India also make it easy to disbelieve talk of improvement. It’s hard to feel optimistic when you see shallow mass graves on the banks of the Ganges River and corpses floating in its water, a patient gasping for breath as he is wheeled to a distant hospital on a vegetable cart, crematoria bursting with 30 to 40 times their usual traffic,

Facebook

walls and

Twitter

timelines plastered with condolences.

Still, conditions really do seem to be improving. Though Ms. Mukherjee says official Indian figures are “gross underestimates,” relative changes in the Covid positivity rate and the effective reproduction number, R—the rate of virus transmission—can reliably measure decline. Moreover, the sheer scale of the pandemic means that hundreds of millions of Indians have likely been infected already, even if only a fraction of them were reported in official figures. There are fewer people left for the virus to infect and from whom it can spread and mutate.

What must India do next? In a phone interview,

Anup Malani,

a health economist at the University of Chicago, suggests that the government strategy rest on three prongs: seroprevalence surveys to determine the population’s true immunity, genome sequencing to detect mutant viruses quickly and an accelerated vaccination program to give the virus less room to mutate in a way that makes it vaccine-resistant.

The Modi government bungled India’s response to the second wave. A lot rides on whether it manages to do better this time around.

Evidence that the coronavirus may have escaped from the Wuhan Institute of Virology catches up to Fauci and other Wuhan Covid deniers, despite suspicious facts that have been apparent from the start. Image: Johannes Eisele/AFP via Getty Images

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By rahul