The second wave of COVID-19 has devastated India. Death and despair has engulfed families, with the coronavirus spreading like wildfire. Healthcare infrastructure is on the brink and the mood nationwide is one of anxiety and worry.
We spoke with Dr Vikram Patel, The Pershing Square Professor of Global Health in the Blavatnik Institute's Department of Global Health and Social Medicine at Harvard Medical School.
Why is the second wave of infections so ferocious in India?
Vikram Patel: First of all, the second surge is no surprise. It was observed in every other country of the world. It was also observed 100 years ago when the first influenza virus epidemic killed millions of people in India. So, in terms of history, this is no surprise at all.
And the reasons for it being fierce are primarily because we became increasingly complacent at the level of population and the government. I remember, around the month of January, hardly any one was wearing masks.
Then, mass congregations like Kumbh and the election rallies were big contributing factors in spreading the virus. The fact is that we let our guard down and now we have an extremely infectious variant that has mutated. I read reports that this new variant was identified as early as October last year.
Unfortunately, the horse has bolted and even masking by all people and a massive increase in vaccination coverage will have a limited impact on the inevitable cycle of death and despair
So, complacency at many levels is the main cause?
A combination of things worked. The exponential spread of the second wave in India has parallels with what has been observed in Brazil in recent months.
A systematic analysis of the Brazilian experience, published in the journal Science, has concluded that while no single factor can explain this terrible surge, a failure on the part of government to implement a timely, equitable, consistent, science-informed and coordinated policy across sectors - early in the wave - has been a major contributor.
If such a systematic analysis was done in India, I believe we would come to a similar conclusion. But, unfortunately, the horse has bolted and even masking by all people and a massive increase in vaccination coverage will have a limited impact on the inevitable cycle of death and despair.
A large number of Indians weren’t affected so the virus found a fertile ground. Also, its possible that the immunity that was acquired may have declined with time. As it does. Or, it may be less effective against the new variants. If that’s the case then even if you were infected, it may not protect you against the new variants.
I don’t understand our government’s policy and goals. It is quite different from, say America, where I am right now, or UK, where the goal is to have maximum coverage in the shortest possible time.
For example, I don’t understand the rationale for controlling the distribution of vaccines and exporting vaccines when we had a billion people to vaccinate. Only the government can explain the reasoning behind it. But, I believe one of the possible reasoning was, as I and some others were lulled into believing, that we had achieved some degree of herd immunity.
A statewide survey in Karnataka last September showed that half the people were found positive. I think there was a feeling - I was among them who felt - that there was some degree of herd immunity in population. Actually, we were completely wrong!
I think that created complacency. We thought maybe we don’t need that much of vaccination because so much of our population is naturally vaccinated. Also, remember that there was a period when people were not turning up at vaccination centres.
Even we saw vaccines being junked or wasted. People thought it is all gone, why worry? Why take a risk with a vaccine which is authorised in the emergency way? The process of vaccine trials was doubted. Once these kinds of doubts were seeded in someone’s minds, they began to ask why should I take the vaccine, especially when the infection seems to have vanished.
How do you see the new mutant and its impacts?
The most urgent need of the hour is genome sequencing. These variants mutate over time and become more infectious and try to avert the immune system of the body, particularly the coronavirus family. The influenza virus mutates, so the flu vaccine is re-engineered every couple of years because the virus mutates and no longer responds to the previous version of the vaccine.
Very little information is coming out from the government. But India was slow to start the genome sequencing and there is not enough money. By the way, India has all the leading technologies. Human resource is not an issue. The issue is political will, leadership and guidance to the scientists.
Was it possible to and viable to vaccinate everybody in India within 2-3 months?
It’s not about money. We didn’t have the doses. You don’t need to vaccinate everybody, first of all. We need to vaccinate up to 60% to 70% of people over the age of 18. That translates into 1.2 billion doses. We don’t have that volume right now.
The surge is taking a toll on young Indians. Do you agree?
That’s my extreme worry. The young people of India are hit the hardest. Due to Covid they are undergoing tremendous stress. There was hope to open the schools and colleges but everything is shut again. The need to socialise has also suffered. Those fresh out of colleges were looking for jobs.
They are affected as the jobs have evaporated. I thought the resilience will come back, economy would revive and people will bounce back. But, the second wave is really the straw that broke the camel's back.
The second wave could last for three months. Only saving grace is that already many people have been impacted who might develop immunity.
In these dark times what has upset you the most?
The locking down of the marginalised upsets me the most. They form the majority of our country. The upper classes that includes scientists, academics, policymakers and bureaucrats have colluded with each other to protect their interests at the cost of the poor.
The best example of it is the first lockdown. We celebrated the lockdown that essentially meant that more than half of our country went hungry.
Pandemics happen in every part of the world. Most governments do struggle. We can’t blame the government of India as the only one that has failed. What has shocked me is that Covid virus has exposed the deep feudal class system in India. That’s more difficult to fix. You may fix the virus but how do you fix lack of empathy in this country?