[The uneven response to India’s catastrophic second wave, coupled with widespread vaccine hesitancy, indicates that the coronavirus is here to stay.]
By Mujib Mashal and Hari Kumar
It was a different story in the two
villages on either side of Khilwai. Testing remained limited. The local health
center in one village had been closed, its staff sent away to a larger
hospital. The coronavirus spread, and at least 30 people in each village died
with Covid-19 symptoms.
But even as the three villages in
India’s most populous state, Uttar Pradesh, diverged in their handling of the
coronavirus, they have been united in another way: a vaccine hesitancy that is
prevalent throughout India and threatens to prolong the country’s crisis.
The combination of an uneven virus response
— a reflection of huge
inequality in resources and the vagaries of local attitudes — and a
struggling vaccination campaign has left officials warning of a third wave of
infections when the second has at best only leveled off. Any sense of rapid
relief like the one now prevailing in the United States is unlikely anytime
soon.
Just 5
percent of India’s 1.4 billion people are fully vaccinated, while
about 20 percent have had a first dose. That gives the country insufficient
protection against the highly contagious Delta variant of the virus, which
first surfaced in India.
At the same time, the country
continues to report tens of thousands of new infections and close to 1,000
deaths each day, numbers that are almost certainly an undercounting. Resigned
talk of a third wave is indicative of how virus fatigue, and the catastrophic
toll of hundreds of thousands of people in the last wave, have resulted in a
new definition of acceptable loss.
“Last year, if you had told
somebody that we have over 1,000 deaths a day — and the real number might be
five times that — they would have said that is completely unacceptable,” said
Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics
and Policy, a public health research organization based in Washington and New
Delhi. “This year, people are as if ‘It’s just 1,000 deaths a day. It’s fine.
We can manage with that.’”
Dr. Laxminarayan said the vast
unvaccinated population and the persistent circulation of the virus meant there
would still be flare-ups large and small.
“It is not going anywhere; it is
going to be an endemic disease that will stay with us,” he said. “The thing is
— can we keep it at a low-level intensity, rather than high intensity, with
vaccinations and other measures?”
Vaccinating a population of more
than one billion was always going to be a daunting task.
India’s upper hand as the
world’s largest vaccine manufacturer was wasted because of
mismanagement. After the first wave, the authorities acted as if India had
defeated the virus for good, sending vaccines abroad as part of its “vaccine
diplomacy.” In a move seen as an admission of the problems, Prime Minister
Narendra Modi on Wednesday replaced his health minister as part of a sweeping
cabinet reshuffle.
Now, as the government finally
seems to have some
of the supply issues sorted out, vaccine hesitancy is so widespread
that Mr. Modi himself has stepped in to address it.
“I’ve myself been vaccinated with
both doses,” he told one villager who joined his monthly
radio call-in last week to report that people were afraid. “And my
mother is close to a hundred years of age; she too has taken both doses.”
In the countryside, the aggressive
vaccination push by a state machinery that is absent in other times of need is
seen by residents in a conspiratorial light. Urban elites question the vaccines
because of their rushed development and a lack of transparency about a
domestically developed shot.
Misinformation, particularly spread
through WhatsApp groups, has led some to believe that the vaccines have side
effects like sterility or magnetism. Opposition figures trying to score
political points against the government have amplified the concerns.
In some corners, cow dung, lemon
juice, oils and herbs have been promoted as remedies. Business-minded religious
gurus have pushed their own products as Covid cures, once even with help from
Mr. Modi’s health minister. In a video clip, Baba
Ramdev, a religious entrepreneur, mocks modern science and falsely claims
that 1,000 doctors have died after taking the vaccine.
The three villages in Uttar Pradesh
reflect the problem. A health official said that teams had set up vaccination
clinics across the villages with a daily capacity of 100 to 200 doses. But each
day, the supplies are barely touched. The official read from the ledger for one
of the villages: 10 doses one day, five the next, two the day after.
In one of the villages, Dautai, the
doctor at the local clinic, Ahmad Arsalan, went door to door with local elders
to answer questions. Ishrat Ali, the principal of the local school, said one of
his friends had read that anyone who took the vaccine would die within two
years.
“I told him, ‘OK, the doctors got
the vaccine, the police got the vaccine, everyone got the vaccine. If they all
die, what are you going to do living on your own here?’” Mr. Ali said,
recalling his convincing argument with a chuckle.
Rajveer Singh Tyagi, a village
leader in Khilwai who had helped rally testing resources to contain the spread,
said that persuading people to respond similarly to the vaccination drive had
been difficult.
“We had vaccination camps, at least
four times, but still they are not coming forward,” Mr. Tyagi said. “They say
that corona has not affected any of them, so why should they take the vaccine?”
In the absence of blanket
vaccinations, Uttar Pradesh, like the rest of India, is left to hope that any
third wave of infections is not a repeat of the second.
The state is run by a Modi protégé,
Yogi Adityanath, who is up for re-election next year. Critics accuse him of
playing down the devastation, even as hospital officials cried
out for oxygen and bodies surfaced in the Ganges River.
The crematories on one stretch of
the river near Garh Mukteshwar, which includes the three adjacent villages, had
an eightfold increase in the number of bodies from late April to early May,
reaching 160 a day.
Khilwai, the village that fared
well, was spared in part because of happenstance. The second person to die was
a relative of the village chief. Her leverage was used to pressure the district
government to set up the testing camps, one at her home and the other at a
temple.
While local elders counted more
than 30 deaths in each of the other two villages, teams sent by the district
health office to “survey” the claims would officially register Covid-19 deaths
only if there was a positive test certificate. A column listing the cause of
other deaths read: “Unknown fever. Unknown fever. Asthma. Chest infection.
Unknown fever.”
“All the elders are gone,” said Ram
Nath, a resident of one of the villages, Janupura. “But there was no testing.
How do we know it was corona?”
The health facilities across all
three villages were largely similar. In Khilwai, the government clinic amounted
to one nurse in a sweltering room that has not had electricity for nearly a
decade. In Janupura, Dr. Rajendra Prasad’s private practice was pretty much the
last hope.
Dr. Prasad said he had a degree in
traditional medicine known as Ayurveda, though local villagers doubted he had
any degree at all. As he treated patients, he was recovering from his own
Covid-19 infection, which required him to be put on a ventilator.
Now, he was on oxygen, under a fan
in his first-floor office-cum-medicine-shop. His son, a physiotherapist, was
helping to parcel out medicines.
“He’s better than all the doctors
with degrees — at least he checks from up close,” a villager, Mohit Tyagi, said
of Dr. Prasad. “The other doctors just take the fee and don’t even come close
to check.”