As India recovers from a brutal second wave of the Covid pandemic, it faces a new challenge: Can it quickly vaccinate enough people to minimize the risk of a third? Over the first three days of this week, India jabbed 21 million people—a significant acceleration. Stepping up vaccinations, combined with protection gained from a large number of Covid infections, could carry the country toward herd immunity by year’s end. But this week’s surge in vaccinations may not be sustainable, and the duration of protection provided by previous exposure to the virus remains uncertain. Read: India's COVID-19 tally crosses 30 million The high stakes for India are self-evident. Covid has battered the country’s economy, diminished its international standing, and raised serious questions about its government’s competence. Officially, about 392,000 Indians had died of Covid as of Wednesday. But many experts say that figure is a gross underestimate. India’s battle against the disease also matters disproportionately to the global effort against Covid. The longer the virus continues to spread, the more variants can emerge, and a nation with one-sixth of the world’s population is a potentially huge incubator. The highly contagious Delta variant sweeping the world was first detected in India. This mutation has already led to an uptick in cases in the U.K. and is set to become the dominant strain in the U.S. This week, White House chief medical adviser Anthony Fauci said the Delta variant is the “greatest threat” to eliminating Covid in America. He expects the strain to be “quite dominant” in the U.S. within several weeks to a month. The longer India’s vaccination effort takes, the higher the odds of other variants emerging there, including some that may be immune to current vaccines. “It’s safe to say that India is the most important challenge that we know of in the world today,” says Jerome Kim, director general of the International Vaccine Institute, in a phone interview. “So far we’ve been lucky, but a vaccine-resistant mutant could undermine $18 billion worth of U.S. government investment in vaccines.” India’s troubles have also set back vaccination efforts in other poor countries. As the world’s largest manufacturer of vaccines, India had been poised to supply the World Health Organization with hundreds of millions of doses earmarked for the developing world. But since March India has diverted vaccine supplies to its domestic market. After coming under attack for an ill-judged vaccine-diplomacy effort that critics say gave priority to global grandstanding over citizens’ health, New Delhi will be loath to resume exports until India’s own population is inoculated. It’s easy to be skeptical about India’s prospects. The best India has done before this month was 84 million Covid vaccinations in April, on average 2.8 million shots a day. As of Wednesday, only 3.7% of India’s 1.4 billion people were fully vaccinated. About 17.5% had received one dose of vaccine. Read: Why India is shattering global infection records In a phone interview, Gagandeep Kang, a virologist at the Christian Medical College in Tamil Nadu, points out that historically the bulk of Indian vaccination efforts have been aimed at children or pregnant women. Reaching all adults poses a new challenge. She also worries about “huge resistance” to vaccination in rural areas rife with ill-founded rumors about the dangers the shots present. Dr. Kang estimates that India does not yet have sufficient vaccine production to consistently vaccinate even four million people a day. She doesn’t expect the country to start administering eight million to 10 million doses a day before the end of the year. It’s unlikely that international help can cover the gap. Dr. Kim expects global supplies to remain constrained for at least the next three to six months. Should people need booster shots or fresh vaccinations for variants, global demand could reach 30 billion doses over the next two years. To put this in perspective, so far about 2.79 billion doses have been administered across the world.   Nor does New Delhi’s response to the pandemic so far inspire confidence. In an email interview, T. Jacob John, an Indian virologist, says the Indian government’s response to the pandemic has been marked by a mix of “denial, [a longing for] God’s help, wishful thinking and pseudoscience.” Unlike better-prepared nations, India failed to order sufficient vaccines in advance or boost manufacturing capacity with grants. Its haphazard pacing seems to favor appearances over reality: India made all adults eligible for vaccines almost seven weeks before Britain, despite having vaccinated a much smaller proportion of the population. A hastily approved domestic vaccine appeared to privilege vaccine nationalism over scientific rigor. Nonetheless, there’s reason for cautious optimism. The scale of the pandemic in India—an estimated 637 million cases, according to the Seattle-based Institute for Health Metrics and Evaluation compared with the official estimate of 30 million—means that the country may already be relatively close to herd immunity. Indian private companies have decades of experience producing vaccines. Dr. Kim believes that top Indian companies, including Pune-based Serum Institute of India and Hyderabad-based Biological E and Bharat Biotech, have the capacity to ramp up production of high-quality vaccines. A clutch of new shots will likely become available before the end of the year. The U.S. vaccine Novavax has been licensed to Serum Institute; Biological E will manufacture Johnson & Johnson’s single-shot vaccine. There’s no question that India flubbed its management of the second wave. But with a little luck and a lot of effort, it may still dodge a repetition of this spring’s devastation.   This article was first published in WSJ

The world’s fastest pace of spreading infections and the highest daily increase in coronavirus cases are pushing India further into a deepening and deadly health care crisis. India is massive — it’s the world’s second-most populous country with nearly 1.4 billion people — and its size presents extraordinary challenges to fighting COVID-19. Some 2.7 million vaccine doses are given daily, but that’s still less than 10% of its people who’ve gotten their first shot. Overall, India has confirmed 15.9 million cases of infection, the second highest after the United States, and 184,657 deaths. Also Read: India records world's highest single-day spike in Covid cases The latest surge has driven India’s fragile health systems to the breaking point : Understaffed hospitals are overflowing with patients. Medical oxygen is in short supply. Intensive care units are full. Nearly all ventilators are in use, and the dead are piling up at crematoriums and graveyards. HOW DID WE GET HERE? Authorities were lulled into believing the worst was behind them when cases started to recede in September. Cases dipped for 30 consecutive weeks before starting to rise in mid-February, and experts say the country failed to seize the opportunity to augment healthcare infrastructure and aggressively vaccinate. “We were so close to success,” said Bhramar Mukherjee, a biostatistician at the University of Michigan who has been tracking India’s pandemic. Despite warnings and advice that precautions were needed, authorities were unprepared for the magnitude of the surge, said K Srinath Reddy, president of the Public Health Foundation of India. Critics have pointed to the government deciding to not pause Hindu religious festivals or elections, and experts say that these may have exacerbated the surge. “Authorities across India, without exception, put public health priorities on the back burner,” Reddy said. Consequently, India’s 7-day rolling average of confirmed daily new cases has risen over the past two weeks from 6.75 new cases per 100,000 people on April 6 to 18.04 new cases per 100,000 people on April 20, possibly driven by new variants of the virus, including one that was first detected in India, experts say. Also Read: Indian capital gasps for oxygen India’s top health official Rajesh Bhushan would not speculate Wednesday why authorities could have been better prepared, saying: “Today is not the time to go into why did we miss, or did we miss, did we prepare?” WHY IS INDIA’S HEALTH SYSTEM COLLAPSING? India only spends a fraction of its gross domestic product on its health system, lower than most major economies. As the virus took hold last year, India imposed a harsh, nationwide lockdown for months to prevent hospitals from being overwhelmed. This brought terrible hardship to millions, but also bought time to implement measures to plug critical gaps, like hiring additional health care workers on short-term contracts, establishing field hospitals and installing hospital beds in banquet halls. But authorities didn’t take a long-term view of the pandemic, said Dr. Vineeta Bal, who studies immune systems at the Indian Institute of Science Education and Research in Pune city. Suggestions for permanent improvements like adding capacity to existing hospitals or hiring more epidemiologists to help track the virus were widely ignored, she said. Now authorities are scrambling to resuscitate many emergency measures that had been ended once the numbers fell. A year ago, India was able to avoid the shortages of medical oxygen tthat plagued Latin Americ and Africa after it converted industrial oxygen manufacturing systems into a medical-grade network. But many facilities went back to supplying oxygen to industries and now several Indian states face such shortages that the Health Ministry has urged hospitals to implement rationing. The government in October began building new plants to produce medical oxygen, but now, some six months later, it remains unclear whether any have come on line, with the Health Ministry saying they were being “closely reviewed for early completion.” Tanks of oxygen are being shuttled across the country to hotspots to keep up with the demand, and several state governments have alleged that many have been intercepted by other states en route to be used to meet local needs. WHAT COMES NEXT? India is faced with the massive challenge of trying to prevent its health care system from further collapse until enough people can be vaccinated to significantly reduce the flow of patients. The good news is that India is a major vaccine producer, but even after halting large exports of vaccines in March to divert them to domestic use, there are still questions of whether manufactures can produce enough fast enough. “Vaccination is one way to slow down the spread — but this really depends on the speed and availability of the shots,” said Reddy of the Public Health Foundation. Already several states have said they have shortages in vaccines — although the federal government denies it. India said last week it would allow the use of all COVID-19 shots that have been greenlit by the World Health Organization or regulators in the United States, Europe, Britain or Japan. On Monday, it said it would soon expand its vaccination program from people aged 45 to include all adults, some 900 million people — well more than the entire population of the entire European Union and United States combined. Meanwhile, Reddy said some states have had to implement new lockdowns but long-term, it was up to individuals as well to do their part. “As a society, it’s crucial that we maintain public health measures like masking, physical distancing and avoiding crowds,” he said.  

  India on Thursday recorded the world's highest single-day spike in Covid-19 cases, with over three lakh fresh infections in the past 24 hours.   According to the Indian Health Ministry, as many as 3,15,660 cases and 2,091 deaths were registered in the country in 24 hours as of April 21 midnight.   To date, no country in the world has reported such a high number of active Covid cases in a single day. Prior to India, only the US logged a little over 3 lakh cases in a single day, on January 2, 2021.   With the new infections and deaths, India's total caseload has now reached 1,59,24,914 while the fatalities from the infection have mounted to 1,84,662.   Maharashtra in western India is the country's worst-hit state, with 67,468 fresh infections in a single day -- thus accounting for nearly 22% of the new cases. Also Read: India continues to record over 200,000 new COVID-19 cases   Maharashtra, where a strict lockdown has been enforced to contain the spread of Covid, is followed by Uttar Pradesh in northern India, with 33,214 new cases, and Delhi with 24,638 fresh infections.   The country is, in fact, witnessing a ferocious second wave of Covid and has been reporting over 2 lakh new cases daily since April 15.   On Wednesday, the High Court in Delhi lashed out at the federal government for for the shortage of oxygen at hospitals in the national capital. "We don't care... beg, borrow, steal or requisition new plants if you want," the court told the government. Also Read:India sees new record of 184,372 COVID-19 cases in 24 hrs   The court also took cognizance of the deaths of as many as 24 Covid-19 patients due to disruption in oxygen supply at a government hospital in Maharashtra.   Those who lost their lives at Zakir Hussain Municipal Hospital in the state's Nashik district were on life support.    In fact, oxygen supply to the Covid ward at the hospital ran out following leakage of the life-supporting gas from a tanker that was brought to replenish the cylinders at the medical facility.   UNB had earlier reported about the oxygen crisis in India, particularly in the national capital.          

India recorded a single day spike of 103,558 COVID-19 cases on Monday, the highest so far, thus taking the total tally to 12,589,067. With 478 deaths since Sunday morning, the death toll stood at 165,101. There are still 741,830 active cases in the country, while 11,682,136 people have been discharged so far from hospitals after medical treatment. Also Read: India records highest spike of daily COVID-19 cases this year There was an increase of 50,233 active cases during the past 24 hours, out of which maximum cases were reported from the southwestern state of Maharashtra. The number of daily active cases has been on the rise over the past few days, as another wave of COVID-19 looms large in India. In January the number of daily cases in the country went down to below-10,000. As many as 9,102 new cases were reported on Jan. 25-26, which was the lowest in the previous 237 days. Prior to that the lowest number of daily new cases were 9,304 registered on June 4, 2020. Also Read: India's COVID-19 tally rises to 11,599,130 with nearly 44,000 new cases . India launched a nationwide vaccination drive on Jan. 16. So far 79,105,163 people have been vaccinated across the country. Meanwhile, the federal government has ramped up COVID-19 testing facilities across the country, as over nearly 249 million tests have been conducted so far. As many as 249,019,657 tests have been conducted till Sunday, out of which 893,749 tests were conducted on Sunday alone, said the latest data issued by the Indian Council of Medical Research (ICMR) on Monday. The national capital Delhi, which has been one of the most COVID-19 affected places in the country, witnessed as many as 4,033 new cases and 21 deaths through Sunday. As many as 11,081 people have died in the city due to COVID-19, confirmed the Delhi health department. Two types of vaccines are being administered to the people in India.