EXPLANATOR: Why India is breaking world records of contagion

India is huge – it is the second most populous country in the world with almost 1.4 billion people – and its size poses extraordinary challenges in the fight against COVID-19.

About 2.7 million doses of vaccine are given daily, but that is still less than 10% of people who shoot for the first time. In all, India confirmed 15.9 million cases of infection, the second largest after the United States, and 184,657 deaths.

The latest wave has led India’s fragile healthcare system to a fracture: Hospitals with a shortage of staff are crowded with patients. There is not enough medical oxygen. Intensive care units are full. Almost all fans are in use, and the dead are piled up in crematoria and cemeteries.


Authorities were put to sleep believing that the worst was left behind when the cases began to recede in September.

Cases were falling for 30 consecutive weeks before they began to rise in mid-February, and experts say the country did not take the opportunity to expand health infrastructure and aggressively vaccinate.

“We were so close to success,” said Bhramar Mukherjee, a biostatist from the University of Michigan who is monitoring the Indian pandemic.

Despite warnings and advice that precautions were needed, authorities were not prepared for the magnitude of the surge, said K Srinath Reddy, president of the Indian Public Health Foundation.

Critics have pointed to a government that has decided not to stop Hindu religious festivals or elections, and experts say they may have exacerbated the wave.

“Authorities across India, without exception, are putting public health priorities second,” Reddy said.

Consequently, India’s seven-day current average of confirmed daily new cases has risen in 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, likely triggered by new virus variants, including the one first discovered in India, experts say.

India’s top health worker Rajesh Bhushan on Wednesday will not speculate as to why the authorities could have been better prepared, saying, “Today is not the time to get into why we missed or missed, did we prepare?”


India spends only a fraction of its gross domestic product on its health care system, lower than most major economies.

As the virus took hold last year, India imposed a sharp blockade across the country for months to prevent hospitals from being flooded. This brought terrible difficulties to millions, but also bought time to implement measures to close critical gaps, such as hiring additional health workers under short-term contracts, establishing Polish hospitals, and setting up hospital beds in banquet halls.

But authorities did not look at the pandemic in the long run, said Dr. Vineeta Ball, who studies the immune system at the Indian Institute of Education and Research in the city of Pune.

Suggestions for permanent improvements such as adding capacity to existing hospitals or hiring more epidemiologists to help monitor the virus have been widely ignored, she said. Authorities are now trying to resuscitate many emergency measures that ended after the number dropped.

A year ago, India managed to avoid the shortage of medical oxygen that plagued Latin America and Africa after it turned industrial oxygen production systems into a medical network.

But many facilities have returned to supplying the industries with oxygen and now several Indian states are facing such shortages that the Ministry of Health has called on hospitals to introduce rationalization.

The government began construction of new medical oxygen plants in October, but now, some six months later, it remains unclear whether some have emerged, and the health ministry said they were “being carefully inspected for early completion.”

Oxygen reservoirs are being shifted across the country to hotspots to keep pace with demand, and several state governments claim that other states have intercepted it along the way to be used to meet local needs.


India faces a major challenge of trying to prevent further collapse of its healthcare system until enough people can be vaccinated to significantly reduce the flow of patients.

The good news is that India is a major producer of vaccines, but even after it stopped large exports of vaccines in March to divert them to domestic use, there are still questions about whether manufacturers can produce them fast enough.

“Vaccination is one way to slow the spread, but it really depends on the speed and availability of samples,” said Reddy of the Public Health Foundation.

Several states have already said they lack vaccines – although the federal government denies it.

India said last week that it would allow the use of all COVID-19 footage that has been given green light 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 with 45-year-olds, including all adults, to about 900 million people – more than the total population of the entire European Union and the United States combined.

Reddy, meanwhile, said some states had to implement new blockades, but it is also up to individuals in the long run to do their part.

“As a society, it is crucial that we maintain public health measures such as masking, physical distancing and avoiding crowds,” he said.


The Associated Press’s Department of Health and Science receives support from the Howard Hughes Medical Institute’s Department of Scientific Education. The AP is solely responsible for all content.