India's crisis eases but fears remain as complacency creeps in

NEW DELHI • India's coronavirus crisis, which was killing thousands of people a day just seven months ago, has eased after the nation's leaders revamped their policies and ramped up the vaccination drive.

Now, as the country celebrates the delivery of its one-billionth vaccine dose, a feat that until recently seemed improbable, health experts are sounding a new warning: the turnaround is losing steam.

Vaccinations are slowing down. As the temperature dips amid India's most important festival season, people are crowding markets and hosting unmasked friends and family indoors. And the government is telling vaccination campaign volunteers that they are no longer needed.

"Now is not the time to let our guard down," said Mr Namanjaya Khobragade, a coordinator for a health non-profit in the eastern state of Jharkhand.

"Many people have taken just the first vaccine. We cannot leave them like this. We need to increase the intensity."

India's progress represents a significant step towards ending the crisis globally and stands as an important political win for Prime Minister Narendra Modi, whose government came under heavy criticism for failing to prepare for a devastating second wave that struck earlier this year.

After the virus killed tens of thousands of people, India's government threw money at boosting vaccine production, stopped vaccine exports and tossed out cumbersome rules that had made it hard for state governments to get doses and for people to sign up for shots.

By official figures, daily infections have plunged to about 12,000 per day, from about 42,000 four months ago. Deaths, too, have fallen by half, to about 400 per day.

Experts consider India's statistics on infections and deaths to be a gross undercount. Still, normal life has returned in many parts of the country. Shopping malls are crowded, roads are full of traffic, and children who have been out of school since March last year finally returned to classrooms this month.

But with only one-quarter of its vast population fully vaccinated, India remains deeply vulnerable. The possibility that a dangerous variant will emerge remains a concern.

The central government appears to acknowledge that India has lost a step. Shortly after returning from the United Nations climate conference in Scotland, Mr Modi led a meeting focused on parts of the country where fewer than half the residents are fully vaccinated.

"Now we are preparing to take the vaccination campaign to each household," he said, adding that officials would take a "knock on every door" approach towards "every household lacking the security net of a double dose of vaccine".

Complacency contributed to the devastation of the second wave. In January, with India reporting case numbers comparable to this autumn's, Mr Modi declared victory over the coronavirus. The government, encouraged by a flawed mathematical model that showed the pandemic had all but ended in India, prioritised vaccines for healthcare workers and older people with conditions that made them more likely to die from Covid-19.

For everybody else, the government moved more slowly. The Serum Institute of India, the world's largest vaccine-maker, set aside 100 million doses of the AstraZeneca-Oxford University vaccine for its home country in January. That month, Mr Modi's government bought just 11 million doses. It exported more than five times that number.

"There was an unfortunate sense of overconfidence that the pandemic had ended with India," said Dr K. Srinath Reddy, president of the Public Health Foundation of India.

Then the second wave hit. At its peak in May, India was reporting more than 400,000 new cases each day. Demand for vaccines skyrocketed. To cope, Mr Modi's government introduced a vaccine pricing system intended to direct doses to those with the greatest need. Instead, cities fought over limited supplies and corporations stockpiled.

By June, five months into the national vaccination campaign, just over 3 per cent of the population had been inoculated.

As criticism from opposition parties grew, Mr Modi centralised the procurement and distribution of vaccines. India's inoculation programme hit its stride, making use of the systems and know-how that had made vaccine campaigns against polio and other diseases such a success.

He shelled out billions of dollars from India's budget for an advance payment deal that allowed the Serum Institute to ramp up production to 220 million doses per month. It struck a similar deal with another Indian vaccine-maker, Bharat Biotech.

With supplies shored up, Mr Modi's government enlisted an army of volunteers, including paramilitary forces, teachers and religious leaders, to help get shots into arms.

The Serum Institute now says the government has cumulatively bought 1 billion doses. More than three out of four adults have received at least one shot. Mr Modi's government is now so confident that it will fully vaccinate all adults, some 900 million people, by the end of the year that it has lifted its eight-month ban on vaccine exports.

At a meeting of the world's largest economies in Rome last month, Mr Modi said India would be able to supply 5 billion doses towards the global vaccination effort next year.

That may be good news for the world, but at home, health experts warn that the government needs to stay vigilant. Health workers are struggling to persuade millions of people to return for their second dose.

NYTIMES