How the US can help the COVID crisis in India

There is a wretched inequality playing out in the world. As the U.S. and other high-income countries have dramatically reduced the burden of COVID-19, the daily number of confirmed cases and deaths globally is now greater than ever before. This increase is being driven by an alarming wave of cases currently ravaging India. While official sources cite more than 360,000 cases and 3,000 deaths per day, many experts believe these numbers could be substantially underestimated.

This is an urgent humanitarian crisis with global implications. While humanitarian assistance is a moral obligation, supporting India in this time of need is also in the best interest of the U.S. and the world. As cases increase and the virus replicates, there is an increased chance that an even more transmissible variant could emerge and threaten the hard-won progress we have attained in the U.S. through vaccination.

We are encouraged by the Biden administration’s initial pledge of support, as it follows several elements in our proposed nine-point plan to address India’s crisis.

One, work with World Health Organization (WHO) member nations and Indian health authorities on the immediate transfer of surplus vaccines now stockpiled in the U.S. and other countries, as well as personal protective equipment (PPE) and medical supplies.

The U.S. needs to release their AstraZeneca/Oxford vaccine supply as soon as it is cleared by the Food and Drug Administration (FDA) and rapidly offer the 50 million additional doses as soon as they are manufactured. The U.S. has already started arranging for supplies of oxygen, rapid testing kits, ventilators and PPE, and has pledged to help India increase the supplies of oxygen that its hospitals have at hand. The first shipments landed in India last week, with more coming throughout this week.

Two, address the global supply chain shortage of filters and other active pharmaceutical ingredients needed to allow India to rapidly scale up domestic vaccine production.

The Biden administration announced in late April that it had identified the raw materials, especially the filters, needed to produce India’s Covishield. Additional financing and solutions should be identified and encouraged to ensure expansion of the production of raw materials needed globally for vaccine manufacturing in India. The country is critical in supplying low-cost vaccines not only for its own population but also for much of the world.

Three, supply India with rapid antigen testing kits that allow people with COVID-19 symptoms to test at home and provide medical therapies to prevent illness progression and optimize care. 

India’s testing capacity currently relies on PCR processing, which is labor intensive, requiring specialized equipment and a prolonged turn-around time for results. The Biden administration has promised to send high quality antigen test kits for point of care and home testing, and this should be an urgent priority. Medicines used to manage COVID-19 are in short supply, including antivirals such as remdisivir, anti-inflammatories and palliative care therapies. While the first shipment of remdisivir arrived in India on Sunday night, the Biden administration should also facilitate expansion of access to novel effective monoclonal antibody therapies, which can help reduce disease progression.

Four, support a waiver for intellectual property rules for COVID-19 vaccines proposed by India and South Africa, which would bolster vaccine production and speed up the response in countries like India.

More than 170 former heads of state and Nobel laureates have backed this waiver. The U.S. and a few other countries are still blocking progress.

Five, support humanitarian aid, which would rapidly expand the number of field hospitals and rapid testing centers to help identify sick people and give them the care they need, including isolation. 

While it is encouraging to see that the USAID and Centers for Disease Control and Prevention (CDC) Global Fund’s $75 million grant will be made available, more is needed. The U.S. can ramp up USAID’s disaster assistance to India, including through its Disaster Assistance Response Team. Non-governmental organizations (NGOs) and the private sector need to step up. The U.S. can also help India provide food, salary support and care services to economically vulnerable households so there is incentive to stay home, similar to the U.S. COVID-19 relief bill. 

Six, bolster local case reporting and disease surveillance capacity so that the magnitude of the crisis can be accurately understood and so that resources are directed appropriately. 

The immediate focus should be identifying all cases and deaths to ensure the most reliable estimates at local and national levels, which can help allocate resources. There are many well trained Indian Epidemic Intelligence Officers and Indian epidemiologists and the U.S. CDC can be invited to further support their efforts.

Seven, scale up genetic sequencing that helps detect COVID-19 variants and vaccine response.

The U.S. can provide financial and technical support to scale up genetic sequencing to identify new variants as they emerge and determine their impact on transmission, treatment and vaccine response.

Eight, encourage and fund partnerships between U.S and Indian experts in government, private sector and civil society to address key issues of communication, trust and behaviors fueling the epidemic.

Local health authorities could benefit from a communications tool kit to inform people about COVID-19 symptoms and testing, when to seek medical care and vaccines, personal protective measures including masking and isolation, and debunking misinformation about COVID-19. These communications should be prepared with Indian audiences in mind and tailored to regional audiences.

Nine, harness the influence, entrepreneurial spirit and wealth of the Indian diaspora in the U.S. to support ongoing response activities and longer-term development initiatives. 

Indian Americans can be found at the highest levels of academics, industry and politics. Many have family and friends — as well as employees — who have been heavily affected by the ongoing crisis. They are highly motivated to be part of a constructive response and have already implemented some of the policy changes and assistance. 

India is the world’s largest democracy and a major trade partner of the U.S.; a strong and prosperous India benefits both countries. The U.S. is uniquely positioned to protect health and save lives. We must act now and bring to bear all of the U.S.’ resources

Amita Gupta, MD, MHS, is a professor of Medicine and Public Health and co-chair of the Faculty Steering Committee of the Johns Hopkins India Institute. David Peters, MD, DrPH, Edgar Berman chair in International Health and co-chair of the Faculty Steering Committee of the Johns Hopkins India Institute. Brian Wahl, PhD, MPH, is an assistant scientist at the Department of International Health at the Johns Hopkins Bloomberg School of Public Health.