India
The Statistics
India has been severely impacted by COVID-19. At the time of writing it has recorded 11,308,846 cases and 158,326 deaths with only the USA ahead of it in terms of total numbers. However with a population of nearly 1.4 billion people India has had 8,138 cases per 100,000 people, much lower than the USA and the UK with 90,004 and 62,275 cases per 100,000 of the population respectively. (1) (2)
Unfortunately, a lack of COVID-19 testing capacity across many states in India means that the true cases figures are likely to be much higher.
India has also administered an impressive 25,685,011 vaccine doses, a very similar number to the UK although again, given India’s large population, this represents a much smaller percentage of people overall. (3)
Background to COVID-19 in India
In July 2020 the blog piece Asia and COVID-19 – India (click here to read) looked at the situation as COVID-19 was sweeping across India.
Its first case of COVID-19 came on 30 January 2020 in the state of Kerala in a student who had recently returned from Wuhan. (4)
In February 2020 the Indian Council of Medical Research estimated that the capital Delhi could see as many as 1.5 million cases with up to 500,000 cases in other major cities peaking in August. (5)
Cases peaked in mid-September 2020 but figures have so far been lower than these early predictions. Delhi has had a total of 642,030 cases and Mumbai 338,643 cases at the time of writing. (6) (7)
However concerns are growing as case numbers, which had been steadily falling since September 2020, have been rising again throughout February and early March 2021 with the health ministry announcing 22,854 new cases in 24 hours on 11 March 2021, the highest single day number yet in 2021. (8)
At the beginning of the pandemic, the Indian lockdown was one of the world's strictest because of how swift and severe its restrictions were. On 24 March 2020, when the total number of confirmed cases across the country was only 550, Prime Minister Narendra Modi ordered the entire nation to remain confined within their homes with the one exception of essential workers. The announcement was given with just four hours notice and saw the closing down of the entire country including all of the transport network. This precipitated a huge humanitarian crisis in a country which relies on millions of rural migrants who found themselves stranded in cities with no work, no food and no money. With no public transport operating many attempted to get back to their villages on bikes or on foot often facing journeys of hundreds of miles. It is estimated that up to 90 million people became stranded during lockdown and some did not reach their home villages but died en route from exhaustion. The irony was that during the panic that ensued as lockdown was so swiftly enforced large swathes of people had no choice but to congregate in huge crowds as they tried to find food, water and any possible transport thus creating ideal conditions for the virus to spread. (9)
There is limited testing capacity across the country. In the state of Uttar Pradesh, India's poorest and most populated, there was only one laboratory able to test for COVID-19 for 30 million people. The state now has 33 although they are concentrated in the cities. (10) (11)
On 12 May 2020, when the infection number had risen to 71,000, the Prime Minister adopted a different approach to the pandemic telling the nation that they would have to learn to live with the virus and should go back to work. He gave a televised address saying, "Corona will remain part of our lives for a long time but we cannot allow our lives to be confined only around corona.” (10)
However, with cases rising some local lockdowns are now being re-imposed particularly in the state of Maharashtra which has seen the biggest spike in case numbers. (12)
India’s relatively low death rate compared to many other places should be viewed with caution. It has recorded 114 deaths per 100,000 of the population which contrasts sharply with the USA at 1,632 per 100,000 people, the UK at 1,837, Italy at 1,675 and France at 1,354. The Indian Health Ministry has claimed that the country has one of the lowest death rates in the world. However with a norm of up to a fifth of all deaths never registered in India and only a quarter of the registered deaths actually certified by a doctor, plus allegations of deliberate under-reporting of COVID-19 deaths, any claim to have a low death rate should be viewed with caution. (13)
India and the New Variants
India was the fifth country in the world to sequence the genome (the genetic code) of the coronavirus and is now taking steps to analyse samples so they can track changes in the virus.
Variants found to date have been those already sequenced, namely the UK, South African and Brazilian variants with the UK variant found the most.
Work is ongoing on two variants found in areas experiencing a surge in infections. In particular researchers from the Indian Institute of Science are concerned about three strains all identified in the southern city of Bangalore. It is not yet known how significant these variants will prove, but the hope is that as vaccination is rolled out India will see its case numbers start to fall - but that could be disrupted if it discovers a home-grown variant in the country. (14)
India’s Vaccination Programme
India has authorised two vaccines - Covishield (their name for the AstraZeneca vaccine which is being manufactured by Serum Institute of India) and Covaxin (manufactured by Bharat Biotech Limited, an Indian company.)
Covaxin was approved for use in January 2021 whilst phase III trials were still underway sparking some controversy as it not common practice to authorise a product at this stage. However the trials are indicating an efficacy rate of 81% against COVID-19 and it is of note that Bharat Biotech makes 16 other vaccines and exports them to 123 countries.
As with the Astra Zeneca vaccine, Covaxin is stored at normal fridge temperatures (2-8’C) which affords a significant advantage over vaccines such as Pfizer’s and Moderna’s that must be stored at -70’C.
India began its vaccination programme in January 2021 and has already vaccinated more than 20 million people. Healthcare and frontline workers were prioritised followed by those over 60 plus people over 45 who are clinically vulnerable. This amounts to more than 300 million people and the hope is to have vaccinated them all by the end of July 2021.
India is also supplying the vaccine to other nations and has already shipped tens of thousands of free doses of Covid-19 vaccines to several other countries.
Bharat Biotech has four manufacturing plants capable of producing Covaxin and reports that it has already made 20 million doses of Covaxin and aims to have made 700 million doses by the end of 2021.
Covishield is being manufactured by the Serum Institute of India which is the world's largest vaccine company.
The Institute is also developing a second vaccine in partnership with the American vaccine development company Novavax. India will play a significant role in the production of vaccines. (15) (16)
Pakistan
The Statistics
Pakistan has recorded 600,198 cases and 13,430 deaths at the time of writing.
Pakistan’s first wave of infections peaked in June 2020. This was followed by a second wave that began in November 2020.
Cases were falling from mid-January 2021 but, like India, it is currently seeing a worrying uptick in its figures again. (17)
Background to COVID-19 in Pakistan
The government implemented some lockdown measures in March late 2020 but they applied only to some of the larger cities and were seen by many as symbolic. They were lifted in May 2020 when case numbers were still rising. (18)
Since then the country has been instigating “smart lockdowns” which are similar in concept to the local lockdowns used here in the UK. When an area has more than 1.5 cases per 1000 people it is placed in a mini-lockdown. Residents are given 24 to 48 hours’ notice and then are not allowed to leave their communities for two weeks. Only one person per household is allowed to go shopping and only food shops and chemists remain open. There are numerous checkpoints around the cordoned off area.
Mask wearing is mandatory across the country and indoor weddings are not allowed. Restaurants, cinemas and shrines are closed. (19)
Many are reluctant to come forward for COVID-19 testing fearing they will be stigmatised if sick or denied a proper burial should they die. Officials acknowledge that it is impossible to know the true figures for Pakistan’s outbreak. (20) (21)
Pakistan’s Vaccination Programme
Pakistan began rolling out its vaccination programme in February 2021 beginning with its frontline health care workers and moving onto all citizens aged 60 and over.
China donated doses of its Sinopharm vaccine to Pakistan which was then sent to 279 vaccination centres across the country. Pakistan is also due to receive 14.6 million doses of the AstraZeneca vaccine through the COVAX initiative this month. Pakistan should receive 45 million doses in total through the scheme. It has also approved two other vaccines - Sputnik-V from Russia and Cansino Bio another from China. It hopes to reach 70% of its population over the next year. (22)
Concerns are growing that vaccine hesitancy is a threat to the vaccination programme. Conspiracy theories are circulating against COVID-19 vaccines in Pakistan and as are claims that COVID-19 is a hoax. (23)
Unfortunately some of the theories are propagated by well-known political figures in Pakistan which adds credence to their claims in the eyes of many. One political commentator claimed the virus was an attack on Islamic nations by the west with the aim of enslaving them. An ex-foreign minister is claiming that Israel, the US and UK have conspired to manufacture the virus in order to achieve world domination. (24) (25)
Punjab’s health minister announced that the public took their vaccine “at their own risk.” (26)
The government has launched campaigns on television and other media outlets to try and quell fears over the vaccine but it will be an uphill struggle. Only half of Pakistan’s healthcare workers have accepted the vaccine. In the province of Sindh vaccine uptake amongst healthcare workers was so low that Sindh’s health minister ordered them to have the vaccine or face disciplinary action. Similar orders have now been given at the main government hospitals. This does not bode well for vaccinating the population. (19)
