On Monday, April 26, 2021, India recorded 352,991 new cases of Covid-19, bringing the total number of cases to over 17 million, with 5 million cases counted in April alone. India has now had the world’s highest number of new daily Covid-19 cases for the fifth consecutive day. In the past 24 hours alone, 2,182 people have died from the virus, bringing the official death toll up to over 195,000. It is likely that these dire figures are actually underestimates, because despite being over a full year into the pandemic, India still has insufficient testing and tracing capacity to properly diagnose everyone experiencing symptoms, let alone asymptomatic carriers. Surveys of mortuaries yield estimates that the true death toll could be up to five times higher than the reported 2,000 per day.

The drastic influx of cases is hitting under-resourced and under-staffed hospitals hard, especially in New Delhi. The city is facing severe oxygen shortages and requires an external supply that the central government hasn’t been able to keep up with. On Saturday, at least 20 critically ill patients died due to insufficient and delayed oxygen supply at just one Delhi hospital. Hospitals have been tweeting SOS messages in desperate bids to acquire oxygen. With hospitals over-capacity and lacking necessary resources, some people have turned to the black market to try to acquire medications with dubious effectiveness. Black market traders in India are charging up to ten times the recommended retail price for remdesivir, despite a lack of evidence that the drug lessens the risk of dying from Covid-19 or needing mechanical ventilation.

Another emerging problem has been India’s insufficient supply of Covid-19 testing supplies. Officials from four diagnostics companies said the number of daily samples coming in is between 300-650 percent higher than in February, straining healthcare infrastructure and the healthcare workers who are administering the tests. One estimate predicts that if the number of samples coming in increases by 25 to 30 percent, “probably the testing facilities will crash, in terms of turn-around time.” In cities like Kolkata, where one in every two tests is coming back positive, this delay is incredibly dangerous. Many people are simply unable to get Covid-19 tests, which is increasing individuals’ circle of transmission, thereby increasing the nationwide Covid-19 caseload.

No Vaccines for the Pharmacy of the World

Critically, the vast majority of the population has not been vaccinated, and it is unclear as to whether they will be able to receive the vaccine anytime soon. A private company, Bharat Biotech, is licensed to produce its own vaccine, Covaxin, and India has licenses to manufacture the U.S.’s Novavax and Johnson & Johnson shots, but neither are authorized for use in India itself because they have not been approved by the government. Russia’s Sputnik V vaccine is authorized for use in India, but the country hasn’t received any doses yet. Instead of agitating for patent sharing, which could greatly speed up production of a variety of vaccines, the Indian government is trying to court foreign manufacturers to license their products in India so that they can fast-track their authorization. Calculations estimate that Pfizer, Johnson & Johnson, and AstraZeneca have paid out $26 billion in dividends and stock buybacks to their shareholders in the past 12 months, which is enough money to pay to vaccinate at least 1.3 billion people, approximately the entire population of India. Public funding covered 97.1-99.0 percent of the research and development costs for the AstraZeneca vaccine, primarily from a variety of international governmental institutions. These companies have taken public funds to conduct research operations, sold the vaccines to generate huge profits, and are withholding the information required to produce the vaccines in order to protect these profits. 

India is one of the largest worldwide manufacturers of vaccines, however the government did not secure sufficient supplies of domestically-produced vaccines and slowed the approval of proven foreign vaccines for Covid-19, sharply limiting the domestic vaccine availability. To maintain an image as “the pharmacy of the world” and provide a positive global image through vaccine diplomacy, India has exported 66 million doses overseas since January. In April, as cases continued to skyrocket, two million doses were still exported. On April 24, India temporarily banned vaccine exports to other countries, and Biden agreed to partially lift the ban on exporting vaccine production materials outside of the United States, exclusively permitting the export of raw materials used in the AstraZeneca vaccine in order to ramp up production in India. The ban on export of raw materials out of the United States has had disastrous consequences for vaccine manufacturers around the globe, including the Serum Institute of India (SII), which faced a shortage of vaccine-production materials and had to attempt to find a new source. Several weeks of global criticism from the public at large to government officials finally pressured the Biden administration to revise its stance, offering “therapeutic drugs, testing kits, ventilators, and PPE” and “pursuing options” for oxygen supplies, as well as sending funds to Indian vaccine manufacturers to “produce at least 1 billion doses… by the end of 2022.” 

Notably, this agreement does not include anything about sharing hoarded vaccines. The U.S. has stockpiled tens of millions of doses of the AstraZeneca vaccine, administration of which is still unauthorized by the FDA. Outside of a few million shots sent to Canada and Mexico, most of these AstraZeneca doses are sitting in U.S. warehouses collecting dust despite their potential to save millions of lives in countries that are currently being brutally hit by the pandemic. Biden is continuing Trump’s “America First” policy, alleging that he wants to ensure that all Americans are vaccinated before exporting unused doses, while the real priority is to guard U.S. producers’ worldwide profits. 

Imperialist stinginess isn’t limited to the United States, either; the UK is sending 600 pieces of medical equipment to India after a direct request from Modi but alleges that it cannot send any vaccine doses because it does not currently have a surplus. In stark contrast, Mexico waived an upcoming shipment of Covid-19 vaccines from India as an expression of solidarity, despite that only 9.5 percent of its population has gotten at least one vaccine dose, compared to 51 percent of the UK population. According to the UN World Health Organization, 87 percent of the world’s vaccine supply has been administered to wealthy or upper middle-income countries, compared to only 0.2 percent of the supply reaching lower income countries, demonstrating the massive consequences of vaccine apartheid. 

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As of May 1, India will expand vaccine availability to everyone over the age of 18; however, the country has yet to acquire enough doses to distribute. Vaccines are currently only free for healthcare and other frontline workers. When eligibility was expanded to senior citizens and people above 45 years of age on March 1, private hospitals were allowed to charge ₹250 per dose, costing up to ₹500 for full vaccination or around $7, which is more than the average Indian’s daily wage income and enough to feed a family of four for a day. After May 1, makers of authorized vaccines will be able to directly sell 50 percent of their product to state governments and private hospitals, resulting in competition over vaccine prices. State governments would then be tasked with deciding whether residents could get their vaccines for free, despite the federal government having already earmarked ₹350 billion for their vaccination budget. Instead of negotiating lower vaccine prices as a country purchasing doses for all billion plus of its residents, the Indian government failed to intervene in price negotiation, allowing vaccine manufacturers to dictate prices per dose for state governments and private hospitals. Covaxin is currently being sold to the central government for between ₹150 and ₹200 a dose, but will later be sold to states for ₹600 a dose and to private hospitals for ₹1,200 a dose. Private hospitals will then be allowed to charge vaccine recipients even more money to account for administration costs. The combination of letting states decide whether they will cover vaccination costs for residents ages 18-45 and charging more per dose will make it significantly more difficult for the working class and poor to afford vaccination, despite these groups being the most at-risk of contracting Covid-19. This disparity will lead to thousands of unnecessary deaths, all for the sake of capitalist profits.

Uneven Lockdowns

The recent explosion in caseload can also be attributed to the BJP’s abysmal management of the crisis. In late January/early February, cases were at record lows, and the government essentially declared that the pandemic was over. Modi held large rallies to attempt to win over the state of West Bengal in upcoming elections. At one such rally on April 17, Modi said that he was happy to see such a huge crowd in attendance, even as India was already counting 250,000 new daily cases and a surge was clearly on the horizon. Though of course BJP officials are unlikely to actually face any charges, judges at the Madras High Court have said that “irresponsible” officials of the Election Commission of India should face possible murder charges for allowing election rallies to continue. The Hindu nationalist BJP also not only permitted but also promoted Kumbh Mela festivities, a Hindu religious festival held in the city of Haridwar, where millions gathered. No Covid-19 security checks were conducted at any of the airports or in Haridwar, many attendees were unmasked, and social distancing practices were not observed during the prayers. While it’s unknown exactly how many people contracted coronavirus at the Kumbh Mela, it’s extremely likely to have been a superspreader event, and Haridwar’s chief medical officer said more than 1,600 cases had been confirmed among attendees between April 10-14. 

The political hypocrisy of the BJP becomes even more stark when compared to how the party has painted religious minorities throughout the pandemic. Muslims were labeled jihadis and super spreaders at the beginning of the coronavirus pandemic in March 2020 when over 3,000 of them, including foreign nationals who had visas and permission from India’s government to attend the Tablighi Jamaat, congregated at the Markaz in Delhi’s Nizamuddin. At that time, the seven-day rolling average of coronavirus cases in the country was less than 200 per day, compared to the 250,000 new daily cases occurring at the time of the Kumbh Mela. Sikh farmers attending the Red Fort Protests on January 26 to protest farming bills that threatened their livelihoods were immediately branded as “Khalistani terrorists.” In addition to hosting political events and sanctioning Hindu religious events that both have the potential to be (and likely have already been) catalysts of the exponentially increasing caseload, Modi has taken advantage of the pandemic to crack down on religious minority groups in India who have already experienced a great deal of oppression. 

Lockdowns, especially in areas of India that do not have sufficient testing or hospital capacity, are the only way to truly stop the spread of coronavirus. There is no nationwide lockdown guidance, so instead individual states are attempting to make their own decisions based on local caseloads. Karnataka just went into a two week lockdown, and the capital city of New Delhi went into lockdown for about a week, but there are many states with widespread transmission that have not instituted any lockdown measures. Modi is hesitant to institute a countrywide lockdown, saying that it would just be too painful for India’s poor. However, members of the working class and oppressed are already dying in the streets at the hands of a woefully unprepared government that has sacrificed working people at the altar at almost every turn. This being said, a lockdown of any length of time is not sufficient in and of itself if it isn’t geared towards actually defeating the virus, and if mass testing, vaccination, and economic assistance to the working poor are not also part of the plan. Without economic benefits, workers will brave anything to continue to work so that they are able to afford basic necessities, which will inevitably prolong the length of a lockdown, causing financial hardship while not actually addressing the root causes of transmission.

Inconsistent and insufficient lockdowns are also driving the spread of new, potentially more deadly variants. The new variant, B.1.617, which has a double mutation, is thought to be fueling India’s deadlier new wave of cases. In some districts in the state of Maharashtra, where Mumbai, one of the current centers of the second wave is located, the prevalence of this variant was more than 60 percent of all sequenced samples. This new variant is spreading faster than pre-existing variants. Based on previous research on one of its mutations, the new variant may increase viral transmission by around 20 percent and reduce antibody efficacy by more than 50 percent, and it is yet unknown as to whether vaccines will be effective against it. This variant has already been found in ten countries around the world, and without a strict shutdown replete with financial aid to the working class so that they can stay home, it is unlikely that India will be able to sufficiently contain its spread. 

The mismanagement of the coronavirus response by Modi and the BJP at every turn, from failure to secure vaccine and oxygen supplies, to refusing to institute lockdowns, to encouraging super-spreader events, is all characteristic of a capitalist pandemic response that will prioritize profits and electoral votes over people’s lives. The reopening of global supply chains, particularly with the economic recovery and growth in the United States and Europe, now creates pressure on the global south to “return to normal” — one that will further force countries to open for business as usual while still battling the pandemic to deadly effects, like we see in India.

The situation in India is a stark example of the failures of capitalism to address this crisis. The only way to defeat the virus is to redirect all productive forces of society to meet this need. Against a system that puts profits over people’s lives, we need one that is under the control of the working and toiling masses. While the Modi government continues their superspreader events, healthcare and other essential workers are battling this current surge every day and are the ones who save peoples’ lives. To increase healthcare budgets, including hiring healthcare workers to administer vaccines and properly staff hospitals, wealth taxes should be instituted. Putting the country’s national healthcare infrastructure and nationalizing all healthcare and essential industries under worker control, redirecting military funds to an emergency public health response, and democratizing the distribution of vaccines, goods, healthcare assistance, and other public health resources are all critical to de-escalating the crisis now instead of waiting for healthcare capacity to spontaneously combust under the strain.

Pandemics are, as the name implies, global. Countries in the global south like India, especially ones that are primary producers of vaccines, should not have to wait until 2022 to actually use the products they’re already making locally. Patent abolition, sharing of formulas and technical know-how, and immediate public control of all pharmaceutical companies and laboratories are imperative to expanding vaccine access to all as quickly as possible. The sooner that vaccine access and uptake is universal, the fewer vaccine-resistant variants will emerge, which would actually sunset the Covid-19 crisis instead of prolonging it. 

However, we will not be able to make these changes by calling Biden and his representatives or petitioning the WHO. We cannot expect imperialist powers to bridge the gap in access to life-saving medical supplies for countries like India or for capitalist parties like the BJP to institute measures that are essential for saving human lives but hurt the economy. The only way to implement these kinds of measures is to develop the common struggle of the working class and oppressed sectors at an international level. Indian workers have already demonstrated their militancy, through a general strike, farmers’ protests, and anti-government protests throughout 2020 and 2021. As socialists, it is imperative that we support their resistance and fight alongside them for patent abolition, equitable vaccine production and distribution, and access to healthcare resources.