How the West can help India fight Covid war

Hospitals in Delhi are openly pleading for supplies of medical oxygen, a commodity so scarce that it is now being sold on the black market for almost ten times the normal cost. Makeshift crematoria are being set up around the city to cope with the surge in the number of deaths. Richer countries are asking why India, with 20 million Covid cases, is so reluctant to lock down again. It’s a good question. The answer lies in the disastrous effects of lockdown for so much of India’s population.

Closing any society has serious consequences, but the results were always going to be worse in the developing world. I have been watching the pandemic unfold in India from Stanford University, where I’m a professor of medicine. But for me, it is not just an abstract problem in a faraway country. I was born in Kolkata and still have many family members in India. Some have contracted Covid, while others have suffered from the terrible effects of lockdown.

As soon as the pandemic started, India followed the familiar litany of Covid lockdown policy: masks, a testand-trace system, school closures and border closures. India was one of the first emerging economies to announce a lockdown and adopted one of the world’s most stringent approaches.

Stay-at-home advice is easier to follow if you have a proper home. But in India’s slums, where millions live, quarantine is almost impossible -- as is the concept of “working from home” or home-schooling.

Then there are migrant labourers, ten million of whom were living in India’s cities before the pandemic. Lockdown meant many of them immediately lost their jobs, livelihoods and homes. Millions started on the long journey back to their villages on foot, not knowing whether they would ever make it home.

Lockdown meant precipitating India’s largest human displacement since Partition in 1947. The forced resettlement of massive numbers of Bengalis, including my grandparents, is within the ancestral memory of my older family members, who recall the story with horror.

One way to understand the trajectory of cases in India is to see that the lockdowns at first protected the professional Zoom class from infection, while exposing the poor. But it was never a guarantee that more affluent populations would not end up affected by the disease as well. India’s experience is consistent with the track record of lockdowns around the world. Official Indian government estimates suggest that between 37,000 and 80,000 lives were saved by lockdown. Even if this is correct, the numbers are surpassed by the death and suffering lockdowns also caused.

What could have been done differently? A better strategy of vaccination, for a start. When the jab first became available in India, I argued for focused protection of the elderly population. There is a thousand-fold difference in the risk of mortality from Covid between the young and old, so protecting elderly Indians from infection would yield substantially lower Covid mortality and hospitalisation, as well as reduce pressure on healthcare systems.

So far, vaccines have been delivered to roughly 10 per cent of India’s population -- which would have been more effective if jabs had been targeted at those most at risk. Instead, perhaps half these jabs have gone to those who had the virus and will therefore have natural immunity. Worse, nearly 60 per cent of these doses have gone to people under 60, leaving a vast number of the older population vulnerable during the recent surge in cases. Rather than focus on those most at risk of dying, India has made the vaccine available to anyone over 18, which has diverted even more doses from the poor high-risk elderly to the more affluent low-risk young.

But before we in the West shake our heads at India’s misplaced priorities, we ought to ask: is Britain not also guilty? The UK’s vaccination success has now covered the at-risk groups who constitute 99 per cent of Covid deaths. The plan is to keep vaccinating the British population right the way down to teenagers and children. Why not donate these vaccines to India instead?

If Britain and America are sitting on millions of doses of vaccine that could save the lives of India’s elderly, what should we do? Share the vaccine? Or give it to those for whom it would make little or (in the case of those who have recovered from the disease) almost no difference? It is hard to find a moral justification for not doing more to help.

India makes lots of vaccines. Yet Angela Merkel, the German Chancellor, has complained that India is not exporting enough of its supplies to Europe. Discussion should instead focus on how to save as many lives as possible -- and how it is more important to vaccinate older, high-risk Indians than young Americans and Europeans with minimal mortality risk. President Joe Biden is sending raw materials to help make AstraZeneca vaccines in India: no great hardship, as the Astra jab hasn’t yet been authorised in the United States.

I was one of the signatories of the Great Barrington Declaration, which advocated shielding those most at risk, and fewer restrictions for those at low risk. When vaccine programmes have followed this general principle and been targeted at those most in need, the results have been extraordinary. We should ask: why not apply this principle worldwide? When our own at-risk groups have been protected, might we then start to help countries still in mortal peril?

Britain and America both have proud records of helping friends in need. There can be no better example, right now, of a country needing aid than India.