India was always going to have a tough time with Covid-19, given its dilapidated and under-resourced public health system. Last year, the country had just over a million doctors for its 1.3 billionstrong population, less than the minimum WHO requirement of one doctor for every 1,000 people. It had only 8,350 critical care specialists for the whole country. Basic precautions such as regularly washing hands to prevent the spread of Covid-19 would be a problem in a country where, according to UNICEF and the World Bank, 50.7 percent of the rural and 20.2 percent of the urban population have no access to a regular water supply. In April last year, according to the Indian Express, between 20,000 to 30,000 ventilators across the country did not work and rural hospitals had no protective equipment for health workers. “India is a vast country and a very densely populated one,” says Dr. Vasantrao Gujadhur, former director of health services in Mauritius. 

Faced with the outbreak of Covid-19 last year, the Indian government reacted by announcing a dramatic lockdown in March until the end of May, with just three hours’ notice. India’s lockdown hit the poor and middle-class the hardest: in September 2020, the Centre for Monitoring of the Indian Economy estimated that 21 million salaried jobs had been lost across India. Another survey found that 78 percent of start-ups and small and medium enterprises had to downsize their staff and a report to India’s health ministry estimated that the lockdown had forced between 22 million to 25 million daily wage laborers to leave the cities and flock back to their villages due to a lack of jobs, tramping across the country and spreading the infection still further. 

Dr. Deoraj Caussy, an epidemiologist who spent 13 years working in India, says that this is par for the course, “there is always lack of planning and a fire-fighting approach; from the outside it looks chaotic but even in normal times this is the way the system functions in India”. By October last year, the Nobel prize-winning economist Joseph Stiglitz, in a talk to the Federation of Indian Chambers of Commerce and Industry, was calling India a “poster child of what not to do”. Despite the economic damage, by the start of 2021, India seemed to have gotten a grip on the pandemic: daily rates of new cases were waning, and the government opened the economy once again. In March this year, the health minister declared that the country was “in the endgame” of the pandemic. 

Then a couple of more missteps from the Narendra Modi government gave way to the second wave. This month, Kumbh Mela, a festival on the banks of the Ganges that can attract as many as 3.5 million people was held. “So many people gathered there, by millions, with no social distancing, no masks, and no precautions,” says Gujadhur. Critics of the government pointed out the event as a ‘super spreader event’; according to Indian media reports, no less than 10 percent of people returning from the festival to just the city of Ahmedabad tested positive for Covid-19. 

The Indian government, already knowing about the second wave since March, reacted on the 17th day of the festival with the prime minister urging devotees to celebrate the festival spiritually and not by going to the festival. “They wanted to go to religious festivals, which are celebrated with much gusto in India; they simply brushed aside the more immediate threat of Covid-19.” In mid-March, the state government in Gujarat also organized two cricket extravaganzas in the Narendra Modi stadium in the state, packing audiences of at least 130,000 each time with no social distancing. 

Politics too had a role to play. With elections underway in the state of West Bengal, all political parties have been drawing mammoth crowds and at political rallies across the state since March. A report from India’s NDTV stated that just the ruling BJP Party had held no less than 44 rallies between March 1 and April 19 across the state, coinciding with a spike in new cases from 200 percent to 400 percent during that same period. The BJP was not alone in this. All Indian parties contesting the elections were doing the same thing. Since then, some parties such as the Congress Party announced that they were no longer going to hold rallies while the BJP on Monday said it was going to limit crowd sizes to a maximum of 500. Both these announcements came only after India’s Election Commission on April 11 threatened to ban all political rallies because they flouted health rules amid the second wave.

How our health system could suffer

There is reason for Mauritius to worry about a prolonged second wave in India. And India’s woes have already affected Mauritius. It was one of the early beneficiaries of Vaccine Maitri and looked to India for supplying its vaccines. In June, it will receive the last shipment of 100,000 doses of AstraZeneca under a deal reached in January, before India curbed vaccine exports in mid-March. 

Encouraged by the Indian High Commission, Mauritius was looking to Covaxin, placing a purchase order for a million doses. However, the Indian government limited the purchase to just 200,000 doses, forcing Mauritius to turn to Russia instead for a megadeal on Sputnik to carry out the bulk of its vaccinations and another 500,000 doses of the Chinese-made Sinovac. “With such a small percentage of Indians vaccinated so far, the main issue for Mauritius is: ‘are we going to get vaccines from India now?’ That is the big issue,” says Gujadhur. 

The problem goes beyond vaccines. On April 6, health minister Kailesh Jagutpal was asked by the leader of the opposition, Xavier-Luc Duval, whether Mauritius was looking to import Remdesivir (a drug previously used to treat Ebola). In his reply, Jagutpal maintained that Mauritius did not plan on buying Remdesivir since there was no evidence that it worked against Covid-19: “As the efficacy of Remdesivir is uncertain and it is expensive and potentially dangerous for some patients, Remdesivir is therefore not used in Mauritius.” This is just as well, as on April 11, India banned the export of Remdesivir, given the exploding demand for the drug in that country. One state, Jharkhand, has even asked New Delhi for permission to import the drug from Bangladesh. The Mauritian government is looking at another drug, Tocilizumab (according to minister Jagutpal on April 6 in Parliament). 

It is unlikely that India will be open-handed with that drug, given that some of its states – such as Chandigarh – have already reported shortages of the drug. During 2020, India saw a thriving black market in Tocilizumab. This raises the main problem that should worry Mauritius; its health system – both public and private – in many ways is joined at the hip with Indian suppliers. The bulk of its Rs 10 billion in annual medical imports is made up of generic medicines from Indian companies and India is where the public health system in Mauritius sends its patients requiring complex medical procedures. “It takes a lot of human resources, equipment, logistics and materials to supply drugs and medical equipment,” warns Gujadhur. “If the second wave in India gets worse, and as more and more of its resources are turned inward or redirected to deal with Covid-19 in India, can we expect disruptions in the supply of other medicines and equipment from there? Will they have the same capacity to supply these?”