A man wearing a protective face mask sitting on a special bus taking people to a quarantine facility amid concerns about the spread of Covid-19 in the Nizamuddin area of New Delhi on March 31, 2020. Photo: AFP / Sajjad Hussain

India should focus on controlling the spread of Covid-19 by imposing focused lockdowns in hotspots that threaten to negate the country’s containment successes, Dr Shiv Pillai, director of the Harvard Immunology Graduate Program at Harvard Medical School, told Asia Times in a telephone interview.

Over a longer time frame, India’s best hope of controlling the runaway spread of the deadly virus would be injecting a significant number of citizens with the vaccines currently being tested in various countries. Dr Pillai expects approvals for vaccines to come before the end of the year.

“It will be a silver bullet compared with what we have now,’’ he said from Cambridge, Massachusetts. “India is a great country to make vaccines. We have the two best vaccine-making companies in the world – Bharat Biotech and Serum Institute. They are also cost-effective.’’

India has numerous pockets of high density across its 1.38 billion population, which makes it tough to contain Covid-19. Widespread lockdown fatigue and a lack of discipline regarding wearing masks, hand hygiene and social distancing is negating the tireless efforts of health workers and administrators in several parts of the country.

“India is not Sweden, where you can tell people to stay apart. People have to go out, people have to work. Vaccination is the only answer,” said Pillai. “Fortunately, the deaths are not as dramatically high as elsewhere. Many [0f] the sick are recovering, including older people.’’

Countrywide lockdowns had a severe impact on the economy, with the June quarter reporting a 23.9% contraction in gross domestic product. More than a hundred million lost their jobs and many workers had no option but to head back to their villages, inadvertently spreading the virus across the hinterland.

India, which has 5.6 million cases, the second-highest number after the United States (7 million), has a fatality rate of around 89,000, much lower than than the US’s 204,000. Brazil and Mexico have recorded 137,000 and 73,700 fatalities from 4.56 million and 700,000 cases, respectively.

“I do think maybe there is something to the fact that Indians are exposed to many infections, or we have BCG or whatever, which may be attenuating the disease somewhat,’’ he said.  India has compulsory universal inoculation for children with the Bacille Calmette-Guerin (BCG) vaccine, mainly to protect against tuberculosis. That, according to many experts, may be giving Indians some level of immunity against the virus.

At no point in history have so many vaccines been created in such a short span of time, he said. Over time it will become clear which ones will be the most effective. Medical experts within the country say vaccination may have to begin with the most vulnerable sections of society such as frontline workers (doctors, nurses and other medical staff) and the elderly.

Fortunately, India has a large network of public health programs that reaches everywhere in the country. Many of these programs will need to be boosted with staff training in Covid-19 inoculation.

India must begin preparations now with regard to the transport and cold storage of the vaccine, and training people to administer it. If India has inoculation teams ready to go by the time vaccines roll out by the end of first quarter in 2021, the immunization of 700-800 million people will take up to the end of 2021.

Until then countries have to grapple with the virus. India still leads with almost 75,000 daily cases, about double that of the US with 36,000 and Brazil with 15,000 cases. While the total number of daily case seems to be slowing, have the graphs peaked?

Medical researchers say different parts of the world will see new peaks over the next few weeks. Europe is beginning to see a new peak, the US will see one next month, and India may see one in the winter. With people spending much more time indoors during the winter, the virus is expected to spread more easily.

“It is hard to predict. I don’t think the peak has come yet. It will peak at some point, hopefully this year and keep declining after that, but then you can expect it to rise again,” said Pillai. “There’s already a decline; maybe not in India but elsewhere in the world. In Europe there was a good decline, a clear bell-shaped curve decline. In North America, it started to decline, in the northeast it declined, but it will come back because we cannot control transmission.’’

Experts say the virus is here to stay.

“With asymptomatic people this is not a disease we will ever be able to eradicate even with vaccine,” he said. “We can contain it, control it, and reduce the numbers, so I think we will have less than the number now.”

Another containment challenge is unique to India: the main Hindu festivals taking place from mid-October until early November.

“I think God will be happy to wait for one or two years. He won’t be forgotten,’’ said Dr Pillai. “The culture of discipline should be there. I would go for the same strategy of having testing, contact tracing, isolation when needed, a lockdown of hotspots when needed.’’