As countries across the globe battle the raging Covid-19 virus with various strategies, it has invited comparative analysis of how different countries acted and reacted to this virus and to what extent they succeeded and at what cost.
India has become the country with the second-largest number of reported infections in the world and the highest in Asia. A lot has been written about India’s predicament but at the same time evoked intrigue about its relative success in handling the virus. But when someone asks how various countries have fared against the pandemic, all one needs to do is to look at the total number of cases reported by each country.
Better than Most
Is India doing better than the rest? Let’s look at some figures. To put into context, a true measure of a country’s performance is the number of confirmed cases and deaths per million of population. As of November 30, India has 6,731 cases per 1 million population. In comparison, the US has 40,000 cases per million, UK has 23,361, France has 33,424, Brazil has 29,129 while Italy has 25,456. Most of these countries have about four to five times the number of cases per million than India.
Over the same period, India reported 98 coronavirus-related deaths per million. Every life is precious, not even a single death is acceptable, but this is just to compare how effective countries have been in saving lives from the pandemic. The death toll in Spain stood at 955 per million, followed by Italy with 888, the UK (846), the US (813), Brazil (805) and France (780). Almost all these countries have about eight to nine times more deaths per million. This is despite the fact that healthcare system in many of these countries is reputed to be better than that of India.
Currently, India’s curve is showing a downward trend. From the peak of almost 97,894 daily cases in mid-September, it has been halved to 43,174 cases by the end of November. It appears that India seems to have bent the curve when we look into the recent trend of 7-day average.
How was this possible?
India was among the quickest to react at the government and institutional level. When China notified the world about the virus on January 7, 2020, India had a mission meeting on the very next day. India started screening passengers from January 17, among the first countries in the world to do so. The first case in India was detected on January 30 and aggressive containment and screening measures were instituted then and there.
On the other end of the spectrum, India was among the first to introduce Rapid Antigen Tests along with RT-PCR tests. India was criticized initially for this strategy but later the WHO itself has adopted this model.
Early in March, Prime Minister Narendra Modi announced that he would not participate in any holy festival based on scientific advice to stay away from mass gatherings. It was among the earliest examples by world leaders about observing physical distancing rules. When Modi sent this message of staying away from mass gatherings, India had fewer than 50 cases.
As early as April, India made mask wearing mandatory, while the WHO waited until June before recommending it to the world. It is clear that this early lockdown proved critical to contain exponential spread.
When the prime minister announced a complete lockdown on March 24, India had just about 500 cases of the virus. India could have waited or delayed imposing a lockdown and risked going down the European or US trajectory. But India’s growth rate of new cases had increased from 10.9 percent to 19.6 percent in just a week and doubled in the next three days. That is when Prime Minister Modi took the decision to impose a national lockdown, which till then no other country had taken a similar step.
The decision changed India’s trajectory. It helped not only contain the virus during that crucial phase, but also avoid deaths and overburdening hospital capacity at the early stage. Moreover, this was a crucial period for the government to build up infrastructure to deal with the pandemic.
The lockdown period enabled the Government to create 15,362 health facilities dedicated for Covid-19 patients, 1.54 million isolation beds, 2.7 million oxygen-supported beds and 78,000 ICU beds. It also delivered 32,400 ventilators to government hospitals across the country and distributed 37 million N95 masks and 16 million personal protective equipments to state governments.
India’s GDP growth naturally went down given the pandemic-driven disruption. However, a 7.5 percent contraction of the Q2 GDP was much smaller than the -23.9 percent reported in Q1. Between these two quarters, already a huge improvement could be seen in private consumption expenditure. Agriculture reported a growth of 3.4 percent in Q2, the same as in Q1. Manufacturing has grown by 0.6 percent in Q2 compared to a contraction of 39.3 percent in Q1.
For a better perspective, here is a comparison with other economies which shows India is in a better position:
First to Lockdown, First to Unlock
India went into lockdown early, but also unlocked the economy much earlier than other countries. The impact of this could be seen in most economic indicators seeing an uptick.
For example, Manufacturing Purchasing Managers’ Index (PMI) rose from 56.8 in September to 58.9 in October, registering the highest figure in over a decade. PMI Services index also rose to 54.1 in October, ending the seven-month sequence of contraction and signaling improved market conditions. Power consumption clocked double digit y-o-y growth of 12.1 percent in October and 4.5 percent in the first 24 days of November, reflecting a post-recovery rebound and even in growth economic activity across all spheres -- agriculture, industry and services.
Passenger vehicle sales reported a 2 percent growth in October 2020, while total domestic sales of two-wheelers increased by 16.8 percent, auguring well for consumption demand. Domestic tractor sales posted a 7 percent y-o-y growth in October, auguring well for rural demand and signaling an early indicator of the transformation arising from agricultural reforms introduced under ‘Aatmanirbhar Bharat’ package. Railway freight grew by 15.4 percent y-o-y in October and 13.6 percent in November. Cargo traffic volumes registered a 1.23 percent y-o-y growth in October.
While India was fighting the pandemic, the government was mindful of the need to initiate social and poverty alleviation programs. Through the Pradhan Mantri Garib Kalyan Package (PMGKP), the government announced free food grains and cash payment to women, poor senior citizens and farmers. Around 420 million poor people received financial assistance of $15 billion, which is a mindboggling number. Similarly, another $10 billion were transferred to farmers, vendors, constructor workers etc through schemes like the PM-KISAN Jan Dhan and Garib Kalyan Anna Yojana.
Oxford University Index
Despite these favorable figures, India detractors prefer to look sheer numbers in isolation and continue to question the effectiveness of government response. So let’s look at the findings of an independent entity, the Oxford University Covid-19 Government Response Stringency Index, which shows how proactively and decisively a country’s government has acted against the spread of the pandemic.
According to its rating, here is how different countries achieved their highest score on their index:
• On March 21, when the US first achieved its highest score (72.69), it had 16.24 daily confirmed Covid cases per million. On March 26, UK (75.93) already had 21.39 daily confirmed COVID cases per million, 2.74 daily deaths per million and 10.22 total Covid deaths per million.
• Similarly, on April 12, Italy (93.52) already had 77.64 daily confirmed Covid cases per million, 10 daily deaths per million and 322 total Covid deaths per million.
• In contrast to all these examples, when India first achieved its highest score (100%) on the Stringency Index on March 25, it had only 0.04 daily confirmed Covid cases per million, 0 daily deaths per million and less than 0.01 total Covid deaths per million.
It is quite clear that proactive and quick decisions taken by the Indian leadership was critical and instrumental in avoiding a major health disaster in the country.
Despite all kinds of national Covid strategies, it is crystal clear that only a vaccine could change the course of the global pandemic. Recent developments in the possible manufacture of the much anticipated and needed vaccine have raised hopes of world governments for restoration of some kind of ‘normalcy’ as the world knew it before.
As the world’s largest supplier of drugs and producer of 60 percent of the world’s vaccines, India is at the centre of global efforts to produce a Covid vaccine.
India is at various stages of talks with at least half-a-dozen companies to manufacture and procure vaccines for a population of 1.3 billion people. India is pinning its hopes on five vaccines currently in advanced stages of development — four of them in Phase II/III studies and one in Phase I.
The Serum Institute of India (SII), the world’s largest vaccine manufacturer by volume, and the Indian Council of Medical Research (ICMR), the apex body in India for biomedical research recently completed enrolment of phase 3 clinical trials for COVISHIELD vaccine developed by AstraZeneca and Oxford University.
At present, SII and ICMR are conducting phase 2 or 3 clinical trials of COVISHIELD at 15 different centers across the country. It has completed the enrolment of all 1,600 participants on Oct. 31. COVISHIELD has been developed at the SII Pune laboratory with a master seed from Oxford University/Astra Zeneca. COVISHIELD is by far the most advanced vaccine in human testing in India. Based on the Phase 2 and 3 trial results, SII with the help of ICMR will pursue early availability of this product for India.
ICMR and SII have further collaborated for clinical development of COVOVAX – a vaccine developed by US pharmaceutical company Novavax.
At the trial 3 stage, Bharat Biotech Vaccine, in collaboration with ICMR, is testing the first indigenous vaccine of India, COVAXIN, on volunteers selected from Peoples’ Medical University in the state of Madhya Pradesh.
Biological E. Limited (BE), a Hyderabad-based vaccine company (in partnership with US-based Dynavax Technologies Corporation and Baylor College of Medicine) has initiated phase 2 clinical trial of its Covid-19 subunit vaccine candidate in India.
India also has a deal with Russia’s Gamaleya Research Institute for the production of Sputnik-V vaccine in India. Similarly Novavax and the Serum Institute of India entered into an agreement in September to produce up to 2 billion doses a year. Novavax is currently under human trials in the UK.
The Indian government has acted with alacrity to ensure that the National Expert Group on Vaccine Administration for Covid-19, in consultation with states and all relevant stakeholders, accelerated the efforts towards vaccination of priority groups in the first phase. A digital platform for vaccine administration and distribution has been prepared, and test runs are underway in partnership with state and district-level stakeholders.
The prime minister is personally reviewing the progress of Covid vaccines and has leant heavily on scientific advice and evidence. India has already declared that it is its duty, as the world’s largest pharmaceutical and vaccine producer, to assist other countries, including its neighbors, in the collective fight against the virus.
Raghu Gururaj is the Consul General of India to Sumatra who currently lives in Medan. He can be contacted through firstname.lastname@example.org.
The views expressed in this article are those of the author and do not necessarily reflect the views of the Jakarta Globe.