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The catastrophic rise of Covid-19 cases in India, and the horrors that are unfolding after the Indian government prematurely declared victory on combatting the first wave, is leaving a long death trail in its wake. The current 7-day average for deaths related to coronavirus in the country stand at 1600 and fresh cases (7-day rolling) are touching 265,000. Meanwhile, the peak is nowhere in sight and thousands of people are waiting outside the crumbling resource-scarce hospitals to get emergency healthcare. Social media is flooded with requests for oxygen and medicines; both of which are in critically short supply.

For those here in Pakistan who did not believe the virus existed at all or believed they somehow had higher immunity owing to a great variety of reasons unsupported by any empirical evidence; the Indian case should be a morose forewarning. The bells have been tolled- and Pakistan could be next. The 7-day average in the country has reached 5,500 cases which is only 1,000 cases shy of the June-peak.

The Pakistani government has rightfully gone back to the drawing board, mulling over how to stop the spread. But with the virus outbreak happening over a year ago, SOP fatigue has certainly set in—people are lax with wearing masks and washing hands; while physical distancing is almost never followed in public places which are hustling and bustling as if life was normal. It will be much more difficult for the Pakistani government to ensure compliance of SOPs and enforce lockdowns this time.

The government also has to ensure that the economic impact of restricting mobility is minimal. During the first wave, the Pakistan Bureau of Statistics (PBS) found through a survey that daily wagers and those working in the informal sector were more disproportionately hurt by the lockdowns (compared to formal and/or more affluent workers) with as many as 27 million people facing either a loss of job or a marked slash in income.

At the same time, the vaccination drive which is abysmally lagging must be synchronous with preventive restrictions. The Indian government started to vaccinate its population in Jan-21, but so far, has failed to meet targets. More than a 100 million people have received the first dose; of which 17 million have been fully vaccinated with the required two doses. The country has now announced it is opening up the vaccine program to every adult but that is not going to be easy (or even possible) as there are a billion people in need of the jab and there simply is not as much supply.

The Indian government intended to vaccinate 250 million people (500 million doses) by July but the second wave has caused a major shift in strategy as cases skyrocketed out of control. The pressure to supply domestically has already caused Indian manufacturers to reduce exports—the manufacturers have so far exported about 64 million doses abroad, 18 million of which are under the GAVI initiative. Now, the Serum Institute of India (SII) which is manufacturing Oxford’s AstraZeneca under the name Covidshield will likely not meet its vaccine supply promises to GAVI as India struggles itself out of the trenches.

The SII currently produces 50-60 million doses per month, ready to expand to 100 million doses by May with government grant funding. Bharat Biotic that produces the other vaccine called Covaxin can produce 6 million doses which will expand to 15 million by next month. But even together, the country cannot meet the 250 million people target very soon—specially considering the US has imposed export bans on vaccine raw materials and the Indian government’s insistence to only approve and allow Indian-make vaccines for immunization.

This overconfidence in domestic production did not work quite as effectively. In its third phase of the vaccine drive, the India government has allowed the import of vaccines including Pfizer, Moderna and J&J and has massively halted exports of the domestic vaccines, all the while praying for a miracle.

Pakistan has barely scratched the surface, as far as vaccines are concerned. The country was too late to wake up to the challenge at hand. Two imported vaccines have now been approved with a price cap in place (and hence inaccessible to a large number of population which cannot pay the price). Supply shortages are also a grim reality, both for the government and the private sector. The country was supposed to receive some doses of AstraZeneca under the COVAX program but with GAVI under pressure due to India’s worsening outbreak and an increase in demand world-over, promised vaccines will have to be rationed out and may not fulfill all of its commitments. Pakistan happens to be one of them.

While vaccine procurement is a massive problem, paying for it is equally so. Some funds have been allocated from the budget which will help buy 6 million doses by May. There is a World Bank and Asian Development Bank loan ($335 million cumulatively) potentially on the table which the Pakistani government can secure. But the three Chinese-origin vaccines: Sinovac, Sinopharm and CanSino, that are available to Pakistan are not eligible for this funding. If this issue is sorted out, and COVAX commitments also come through, Pakistan may be able to buy inoculation for 25 percent of its adult population by the end of year.

But until the time that these agreements are honored, Pakistan needs a solid plan in place to protect the population from contracting the fast-mutating virus. The country’s managers, on the other hand, need to stop burying their head in the sand. What’s happening in India is a rude awakening as to how that could drown the country.

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