As life is attempting to return to normalcy in the US with 52% of the adult population receiving at least one dose of the Covid-19 vaccine and 35% of adults fully vaccinated on April 23, on the other side of the world, the lives of my friends and family in India have been struck with a paralysing sense of fear, anxiety, trauma and pain. The second surge of SARS-CoV-2 infections has a ferocity and a velocity that has never been seen before in this pandemic. In the last one month, daily new cases have gone up by roughly 8 times (from 40,000 to 315,000) and daily deaths have gone up by roughly 10 times (from 198 to 2,100). We are staring at a startling effective reproduction number of 1.6 nationally, with seven states having a 7-day average reproduction number above 2.0.
It is an enormous tidal wave that is ravaging my country of birth and we, unfortunately, have access to only picket fences to stop it. Many of us with a hyphenated identity across two continents, people of Indian origin living away from home tremble at the very sound of the phone ringing…is it a +91 number? Are our loved ones safe? If something happens to my octogenarian parents, will I be able to go through the travel restrictions to be by their side? Even in our safe inoculated first-world bubbles, there is no escape from this global pandemic.
Going from the personal to the population health level, the humanitarian crisis in India has ripple effects far beyond its borders. What happens in India affects the whole world in a number of ways. I will just share two compelling examples. As we can already appreciate, the more the virus spreads, the more it mutates. The UK variant is in Michigan, the Indian double mutant is in the UK: no one is safe until everyone is safe. The pandemic has taught us more emphatically than ever that our health is interconnected. The second example is through more obvious supply chain connections. Since India is one of the world’s largest vaccine producers, skyrocketing domestic demands for vaccines have already started to affect the immunisation plans of other countries.
We need to solidify our alliance with international partners to get through this catastrophe. This collaboration can take place in various direct and indirect ways, starting from negotiating supply of oxygen cylinders, pulse oximeters, medications, airlifting of oxygen generation plants to address the immediate crisis or through setting up a robust and scalable infrastructure for genomic sequencing integrated with epidemiologic surveillance. Some of these efforts are already underway. Sharing sequencing and individual level clinical and vaccination data in real time with global consortiums much more extensively and nimbly will help advance our understanding of the disease and the emerging variants. Assistance can be sought to secure shipments of rapid home self-tests for Covid-19, the one manufactured by Abbott is currently available in US retail stores. These tests are affordable, accurate and fast and will help us circumvent the RT-PCR testing bottleneck. Now that EUA has been granted to internationally approved vaccines, collaboration is needed to secure as many doses as quickly as possible.
Of critical importance is to strike a deal for one-shot vaccines due to the urgency and enormity of this exploding crisis and challenges with vaccine adherence in India. Global support towards enhancing infrastructure to scale up vaccine production in India, pressing pedal to the floor, will eventually help the whole world in managing the pandemic. The entire world should equally benefit from the astonishing science, technology and knowledge generated collectively in the last one year, not just the first world. It is undeniable that Covid-19 has underscored the glaring structural health inequities that exist around the world. The distribution of loss has not been equal, from Detroit to Dharavi, it is the most vulnerable who have suffered and are suffering the most.
It is even more unfortunate to see the loss of countless lives at this specific moment, when in a few months, copious supply of vaccines may be available. India has vaccinated only 1.5% of its population fully, we have a long way to go. We cannot be fatalistic and surrender to destiny and let people die, we have to work together as a nation and as a world, as a powerful and solidified human force against this insidious virus. The fundamental principle of public health and medicine is to save human lives, regardless of skin color, cast, creed, socio-economic status, religion, political ideology or country of origin. As clichéd as it may sound, we are indeed, all in this together. Colossal mistakes have been made to get us to this precarious juncture, insular focus on self-reliance is just not enough anymore.
