"India's Struggle Against COVID" with Professor Manu Bhagavan

April 26, 2021

Professor Manu Bhagavan of Hunter College and The Graduate Center, discusses "India's Struggle Against COVID" on the International Horizons podcast.

How did India go from declaring victory over COVID in January to being the world’s hotspot three months later? As one of the largest pharmaceutical and vaccine producers in the world, did India focus too much on vaccine diplomacy and too little on internal vaccination efforts? How has India’s regional competition with China affected how this plays out?

Manu Bhagavan, professor of history, human rights, and public policy at Hunter College and The Graduate Center, CUNY, talks to Ralph Bunche Institute Director John Torpey about how India reached its current crisis point and what other problems face India on the international stage. 

Subscribe to International Horizons on Apple PodcastsSpotify or Soundcloud. Read the transcript of this episode.

An edited excerpt of the transcript follows. 

John Torpey:  So we're hearing some worrisome news out of India in regard to the pandemic of late. It's had now more COVID cases in a single day than the United States has had in its COVID experience. Although, of course, India is four times larger than the U.S. in population terms. Still, things have definitely been getting worse in India. And what's happening there is leading the larger series of surge of cases around the world. So can you tell us what's going on?

Manu Bhagavan: Sure. Well, as you just indicated, India is in the midst of a COVID surge. According to experts, this is India's second major surge of COVID. For which, it appears, it was utterly unprepared. 

So just a quick rundown of where things stand at the moment. As of yesterday, India was running over 300,000 new cases per day. And those numbers are increasing with each day, and over 2,000 deaths per day. However, again, as you pointed out, by percentage terms, compared with the United States this is overall lower considering the size of India's population. But these are reported numbers and experts have concluded that there is severe underreporting or misreporting throughout the country.

The actual figures could be as great as anywhere as 10 to 20 times as great as the stated figures. So for example, Time magazine ran an estimate that potentially as high as 400 million people are currently infected in the country or about one-third. But I'd say we can sort of talk about a range of projected cases using reported plus unreported of somewhere in the range of about one-fifth to one-third of the population currently being infected. 

John Torpey Sounds pretty serious. And I've also seen reports to the effect, basically saying something that happened, apparently, a year or so ago as well in the early days of the pandemic, and that is that significant numbers of people who were essentially migrant workers in the cities were concerned about the lockdowns. 

[Prime Minister Narendra] Modi’s initial lockdown in March-April last year was very famously very severe. And a lot of people just fled to the countryside because they were afraid they would be without a way of surviving, essentially, if they didn't go back to the families that they had left behind in the countryside. 

Of course, the problem with this in epidemic terms is that they may be taking the virus back with them to their villages and to the countryside from which they came. So, can you say a little bit about, I mean, it seems like a kind of very important case of the kinds of economic effects that these shutdowns and lockdowns have on populations in the world that don't have a lot of economic alternatives. So how would you say this has affected the economy and the wellbeing, leaving aside kind of the pandemic itself. How have the government responses affected the population of India?

Manu Bhagavan: Well, the news overall is bleak. Before I answer that, I think I should just give a little bit more setup, which is that, India during the first wave, its initial response when COVID first came out was, as you just indicated, to impose a draconian lockdown nationwide. And that came with very little notice. So part of the problem with the lockdown was not so much just that there was a lockdown, but how it was done within what timeframe, and how much flexibility or understanding people were given and what mechanisms were put in place to address various communities’ kinds of needs; which varied from community to community, depending on what kind of access they had. 

The result of that was that, as you've indicated, there was a migrant labor crisis. And they were the ones who were primarily affected, that is to say, people from rural countryside, come and work in the cities. And when the lockdown was imposed, they had nowhere to go. And so they tried to flee back to their villages, they wound up packing train stations, they couldn't get on the trains, and then they congregated there, creating super spreader events, and then eventually took the virus back to the villages. And that made the first wave worse than it should have been or needed to be. 

Now, that said, India's whole experience with COVID has been extremely unique. So its first wave, which ran roughly until September of 2020, was less than many projections had expected, significantly less. And then, all of a sudden, in September or October, starting around October of 2020, the numbers simply plummeted. And then India became an epidemiological mystery; nobody really could come up with a real explanation. And subsequently, until this point, nobody has yet as well, which is that COVID seemed to miraculously disappear. 

All kinds of explanations have been put forward: maybe it was the youth of the population; maybe it was exposure to other kinds of disease; maybe it was immune systems which were pumped up from other pathogens. It could have to do with low obesity rates. Anyway, all kinds of things were postulated as to the explanation as to why India's numbers were so low. 

But whatever the explanations were, there was story after story in the international press. By January, the Indian Prime Minister, Narendra Modi, sort of started chest thumping, and claiming that India had defeated COVID with its rigorous proposals and policies. And that the country had a lot to be proud of; not only had it defeated COVID, but that it was unique in the world, and that it had engaged national resources against the virus. And then people basically let their guard down. 

Oh, I left out one important claim for the drop in the virus, which was there was a heavy mask mandate in the country, and people were adopting that significantly. After January of 2021, people let their guard down; they stopped wearing masks, they stopped social distancing, and they started large congregations again. And then on top of that, it's election season, and there was a religious festival. And all of this combined has led to where we are right now. 

In terms of economic impact, India has an extremely young population, and that young population needs jobs. So one of the bigger crises that the country had been facing pre-pandemic was how do you create jobs for so many people? And how do you sustain it, because they're so young?

So you have to invest in all kinds of ways, and you have to create public and private sector positions to accommodate that many people. And there was a lot of controversy about what the government was doing to sort of spur that kind of growth. But subsequently -- there were certain issues, obviously; there was a great deal of wealth generation in the country and has been for years, a number of people have moved out of poverty growing the middle class. 

And so these were some success stories. There was also some overt changes in cities' infrastructure, between cities and so on. But subsequently, from the pandemic, not only do we see a sluggish economy, but we see people falling out of the middle class in huge numbers, like one-third of the middle class has moved back into poverty in the last year or so.

John Torpey: As a result of COVID?

Manu Bhagavan: Yeah, well, as a result of COVID. And you multiply this by the previous lack of investment in jobs, or preparation for these kinds of things. And the country has set back significantly. 

Now, I will say that some economic forecasts had projected that with the economic stimulus in the United States that India was one of the countries that was set to benefit in some ways from a global resurgence starting this summer. But right now, that no longer looks really viable. I mean, I'd say that the country is set back significantly.

John Torpey: That's unfortunate. So one question is, how is the vaccine rollout going? My understanding is that the target number is something like 300 million, which is, of course, only less than a quarter of the population. And the point that you make about the youthfulness of the Indian population, I think, is also an important one. 

It was conjectured early on, in the pandemic, that Africa because of the relative youthfulness of its population might emerge relatively unscathed. I'm not sure exactly whether people think that's actually been the case or not. I'm trying to get somebody from the Africa CDC to talk about what's going on there, who just put out an article in The Lancet on this. 

But in any case, how's the vaccine rollout going? Not so well, I gather? And are there the kinds of age restrictions that we have in the United States and European countries? Or how is it, you know, being organized?

Manu Bhagavan: India is one of the largest pharmaceutical and vaccine producers in the world, thanks predominantly to what's called the Serum Institute of India, which is based in the western part of the country out of the city of Pune in the state of Maharashtra. That isn't the only place, but that's one of the largest producers. And Serum Institute has contracted with a number of places to produce vaccines for India as well as for much of the rest of the world. India was expected to produce 60% of the vaccine for the rest of the world. 

Serum Institute in particular was contracted with AstraZeneca to produce the Oxford vaccine, the local brand name for it is Covishield in India. In addition, India indigenously developed its own vaccine “Covaxin." And the trials for that also looked very good; that it was a highly efficacious vaccine. 

So on the face of it, India looked like it was positioned to do very well. It also has a long history of vaccine rollout and successfully vaccinating huge numbers of people. So in this interim period, where it looked like COVID was defeated, and India was set to do all of this with vaccine production, people really grew very proud of the country. 

The prime minister sort of played up on that. They engaged in what's called vaccine diplomacy. They started shipping doses of vaccines to all kinds of other countries around the world who needed it; it was an act of generosity, and it was also an act of diplomacy, strategic diplomacy. And then the bottom came out. 

So originally, the vaccine rollout was targeted at the elderly population as it was elsewhere in the world. And then they dropped the age limit to 45. That's where it stands currently and those with certain kinds of conditions.

But the vaccine rollout was sluggish from the beginning, in part because people believe that the pandemic was over so they didn't see any rush any need to go get it. “Covaxin," the indigenous vaccine, initially, the data regarding "Covaxin" was opaque. So people's confidence in exactly what it was or whether they would be mandated to get that was a bit low. And even with “Covishield," people sort of had questions. So all of that combined with the fact that they thought that the pandemic was over led to a sort of sluggish response to receiving the vaccine; much slower than expected. 

The prime minister did get vaccinated on camera. And that helped a little bit. But by and large, people responded slowly, and there wasn't a designated campaign to really sort of get this going fast enough.

As of right now, about 10% of the population have received one dose of the vaccine, at least one dose, but only about 2% or a little over 2% are fully vaccinated. These are grim numbers. And now we have got a whole set of other problems. 

So now, there appears to be a vaccine shortage. The country has announced that they'll expand the age cap so that by May the 1st, everyone 18 and older will be able to get the vaccine when they wish. But the problem is that, as I said, there's a vaccine shortage, and no one understands exactly where the things are magically going to come from in time. 

This time, the Center has decentralized vaccine purchasing to the states. That's leading to competition between states and raises questions about the ultimate cost of what the shots will be in the various states. So people claim that the current government is playing politics; it certainly appears that they very well might be. And so how they mitigate this is still up in the air. The plan originally was that the vaccine would be free for everyone at all government clinics, and would cost no more than a small capped price at any private clinic. But subsequently, we don't know where things stand right now.

John Torpey: Is there a vaccine hesitancy problem?

Manu Bhagavan: It doesn't seem like that's a problem right now. I think people are sort of desperately ready for a vaccine shot. But at the moment, the bigger problem appears to be in production. Now Adar Poonawalla, who is the guy who runs Serum Institute, said that there's a two part problem having to do with the United States, essentially, which is that India needs some raw materials in order to be able to produce more vaccine.

Now this sort of has gotten confused in the press; people have concluded this means all vaccines. I think he's clarified very recently that “Covishield," the Oxford vaccine, can continue to be produced. But there's another vaccine in lineup, the "Novavax" vaccine. And for that they need more raw materials from the United States. 

The Defense Production Act in the United States, I think, is what's causing the problem, which is that U.S. production has to be prioritized; U.S. needs have to be prioritized through that. So they're trying to work this out in a way where people can get the necessary stuff to India. 

The other problem has to do with additional vaccines. The U.S., for example, is sitting on a stockpile of AstraZeneca vaccine, which we're highly unlikely to use. And so that's something that could be sort of shipped out over there. And then there's smaller things like Remdesivir, oxygen, PPE; these are things the country is in desperate need of again. It has indigenous manufacturing capacity, but right now the need is grossly outstripping its manufacturing capacity.

John Torpey: Right. Well, hopefully that'll get addressed soon. And hopefully, the flow of vaccines to the other parts of the world will also get ramped up. We did a podcast a couple of months ago, about the importance of getting the whole world vaccinated. [The podcast] was based on a conversation we had with a couple of Turkish economists who had been involved in studying the economic consequences of that not happening; and they're bad for us, as well as for those parts of the world where the people do not get vaccinated.